Healthcare simulation is about to change the world. While societies are just beginning to turn a corner on COVID-19, the devastation caused by the most recent pandemic will continue to affect us for years to come. With over 142 million cases and 3 million deaths, the estimated covid costs of $28 trillion dollars will no doubt force governments, corporations, militaries, healthcare institutions and the general public to carefully reassess their pandemic readiness. In their 2021 annual letter, Bill and Melinda Gates share several innovative strategies for overcoming future pandemics, including the creation of a specialized group of about 3,000 “Infectious Disease Responders” who will be ready at a moment’s notice to travel and contain outbreaks around the world. How will top scientists, healthcare teams, biohazard specialists, security personnel, and logistics operators plan and train for one of the world’s most important and most dangerous jobs? Through the emerging industry that is primed for a transition to mass adoption: medical simulation.
Bill and Melinda Gates Identify Simulation as Critical Step to Pandemic Readiness
The scars from the international COVID-19 disaster are so deep that there is finally a real potential that leaders will actually take infectious outbreaks seriously. With one of their foundation’s goals being to eradicate disease around the world, Bill and Melinda Gates have both the perspective and the influence necessary to help us “get ahead” of infectious diseases outbreaks. They collaboratively write:
“The unfortunate reality is that COVID-19 might not be the last pandemic. We don’t know when the next one will strike, or whether it will be a flu, a coronavirus, or some new disease we’ve never seen before. But what we do know is that we can’t afford to be caught flat-footed again. The threat of the next pandemic will always be hanging over our heads—unless the world takes steps to prevent it. Stopping the next pandemic will require spending tens of billions of dollars per year—a big investment, but remember that the COVID-19 pandemic is estimated to cost the world $28 trillion. The world needs to spend billions to save trillions (and prevent millions of deaths).
I think of this as the best and most cost-efficient insurance policy the world could buy. When it comes to preventing pandemics, scientific tools alone aren’t enough. The world also needs field-based capabilities that constantly monitor for troubling pathogens and can be spun up as soon as they’re needed. There is still a lot to be figured out in terms of specifics, including where these capabilities would be housed and how exactly they’d be structured.
If your [infection] sample turns out to be some super infectious—or entirely new—pathogen, a group of infectious disease first responders springs into action. Think of this corps as a pandemic fire squad. Just like firefighters, they’re fully trained professionals who are ready to respond to potential crises at a moment’s notice. When they aren’t actively responding to an outbreak, they keep their skills sharp by working on diseases like malaria and polio. I estimate that we need somewhere around 3,000 responders throughout the world.
To learn how to best use these first responders, the world needs to regularly run germ games—simulations that let us practice, analyze, and improve how we respond to disease outbreaks, just as war games let the military prepare for real-life warfare. Speed matters in a pandemic. The faster you act, the faster you cut off exponential growth of the virus. Places that had recent experiences with respiratory outbreaks—such as Taiwan with SARS and South Korea with MERS—responded to COVID-19 more quickly than other places because they already knew what to do. Running simulations will make sure everyone is ready to act quickly next time.“
When two of the most influential people in the world recognize the need to use simulated training as part of the solutions that will save us from the next pandemic, it is only a matter of time before legislative representatives, government bodies, corporate executives, financial investors, clinical leaders and media journalists catch on. Just as NASA’s astronauts, the U.S. Military, and every aviation pilot around the world are already educated, trained, assessed and re-certified through simulation — so too will every healthcare professional, in the very near future.
But why isn’t medical simulation already ubiquitous with infectious disease control and, to a larger extent healthcare in general? “Ego and tradition” say many medical simulation industry experts, “which prevents new technologies from changing the ways healthcare professionals, or more accurately, systems, have always done things”. (Editors Update: However, many healthcare providers have never even heard of medical simulation — an excuse which should only work once). Such naysaying is almost identical to the responses aviators had in the 1960s-1980s to black box recording technologies, Crew Resource Management (CRM) team-based communication protocols, and simulation-based training, shares world renown aviation training expert Captain Jacques Drappier. Nevertheless, the industry matured and those game-changing practices have made flying one of the safest industries in the world. Contrast that with healthcare, where the majority of educational and training programs have yet to invest a single dollar into simulation technologies or methodologies. Not yet, anyway.
How the Small Healthcare Simulation Industry is Already Having Global Impact
Gates will be thrilled to learn that his good friend Warren Buffet’s favorite medical campus at the University of Nebraska Medical Center (UNMC) in Omaha has already invested heavily into these simulation training experiences, which were instrumental in combating the coronavirus regionally and nationally. Through fortuitous timing UNMC opened the absolutely massive 192,000 square foot Davis Gobal Center in 2020 — and immediately went to work on January 28th, 2020 when the U.S. Department of Health and Human Services formally requested that UNMC provide quarantine services for 57 American citizens being evacuated from Wuhan, China. The simulation center also took in 15 passengers from the ill-fated Diamond Prince cruise ship in February of 2020, trained almost 1,250 federal-level COVID-19 responders in March and also managed to provide over 15,000 clinicians with simulated “just in time” training (such as PPE donning) last year alone — and all during the pandemic. The center represents some of the latest in medical simulation technological innovations, such as a holographic visualization theater, community, interprofessional and surgical simulation labs, and as well an entire floor dedicated to infectious disease control at the federal level through the “Global Center for Health Security” National Training, Simulation and Quarantine Center (TSQC).
Located within the Davis Global Center near UNMC and Nebraska Medicine, the TSQC is a federally funded center of excellence that leverages the infectious disease and the training expertise of UNMC and Nebraska Medicine, on emerging infectious diseases and bio preparedness. TSQC works with multiple federal partners throughout the Department of Defense, Department of Health and Human Services and National Disaster Medical System to deliver training to personnel.
Helping to lead these programs, UNMC team members Pamela J. Boyers PhD, Benjamin Stobbe MBA, RN, Christopher Kratochvil MD, and John Lowe MD emphasized to us that “training for emergency biohazard teams needs to occur regularly over time focusing on the unique needs of a deployable team. A robust training program where entire teams undergo training of increasing complexity is crucial to fielding teams capable of handling anything the next pandemic may require.” In other words, to be successful we must plan to expand the number and frequency of programs like the TSQC at UNMC so that Gates’ Infectious Disease Firefighters will be ready when the call comes. When the world’s most important medical teams train using simulation, the message to those teaching clinical practices across numerous other disciplines will be clear: simulation is the way forward.
Medical Simulation: No Longer a Question of If, But When?
Healthcare simulation is the ounce of prevention worth the pound of cure, as Northwestern University research shows “an 88% reduction in lethal infection rates” thanks to a medical simulation training program, which also resulted in a “7:1 cost savings.” National nursing simulation studies by the NCSBN have also shown that “up to 50% simulation can be effectively substituted for traditional clinical experience in all prelicensure core nursing courses.” This is especially important to consider after learning from another recent study by Leighton et al. that “no sufficient evidence was found to support traditional clinical models [which] raises serious concerns about how nurse educators assess learning in traditional clinical environments.”
Due to campus closures, clinical rotation cancellations, staff shortages, and the need to perform specialized clinical tasks that have real life-or-death consequences for both patients and providers (like donning and doffing personal protective equipment or PPE), the use of clinical simulation has skyrocketed in the past year. Many experts hypothesize that Covid19 was a catalyst event which accelerated the industry by 3-5 years.
The opportunities to improve healthcare education and training are certainly not lost on investors who see the writing on the wall, with recent investments including Andreessen Horowitz’s $60M Series C funding of Labster, Osso VR‘s $27M raise, Virti‘s $10M raise, F-Prime Capital and partners $29M investment in AppliedVR, or Health Scholars’ $17M previous Series B round. That does not even include the U.S. Army’s $22B purchase of Hololens augmented reality headsets and cloud-based training tools from Microsoft, also announced just last month.
Without alternatives, technological laggards within healthcare education and training can no longer avoid considerations of take-home clinical skills trainers, virtual patients, VR-headset training, telesimulation, 360-degree environment recording, augmented reality and other remote distance-based learning. Once these sim lab technologies are shown to be successful within a healthcare organization, the barrier against future adoptions will be yet further reduced. Clinical educators like Dr. Kellie Bryant at Columbia School of Nursing shared in her 2020 HealthySimulation.com webinar Creative Ways to Implement Virtual Simulation During a Pandemic, that their program “intends to keep many of the innovative technologies we deployed to combat COVID-19, because they are just more effective and have a better ROI efficiency than some of our previous and more traditional methods.”
While clinical simulation has been around for a few decades the high costs of advanced technologies required to provide high-fidelity experiences have only more recently become affordable for many institutions. Such tools include human patient simulators from CAE Healthcare, virtual worlds like those available from Sentinel U, audiovisual recording and debriefing systems from Education Management Solutions, simulated medication administration carts from Pocket Nurse, and virtual reality training from Oxford Medical Simulation. Additionally, increased online access to simulation resources through non-profit organizations such as SSiH, INACSL, ASPiH, Simulation Canada, SimGHOSTS, IPSS and SESAM have become even more prevalent during the pandemic. This increased adoption is matched with a growing call from leading healthcare organizations such as UPMC’s WISER, MedStar, the ISQua, and the Patient Safety Movement Foundation (lead by Massimo’s charismatic Founder/CEO Joe Kiani) to recognize and overcome the world’s estimated 3 million annual patient deaths attributed to medical error.
As the Organisation for Economic Co-operation and Development (OECD) report The Economics of Patient Safety suggested in October of 2020, “that in developed countries, the direct cost of treating patients who have been harmed [by errors] approaches 13% of health spending… which amounts to $606 Billion annually“. The opportunity to invest in better healthcare training will not only lead to better patient outcomes with more lives saved, but also in better economics — for both developing and developed countries alike.
COVID-19 Pushing Healthcare Simulation Industry From Early-Adopter to Early-Majority
As innovators and early-adopters, healthcare simulation professionals are comfortable with overcoming strong rejections to new technologies which ultimately improve outcomes and reduce costs. This meant that simulation programs were uniquely positioned to take charge when the pandemic brought chaos to contemporary institutions the likes of which had never been experienced before. Organizational leadership turned to clinical simulation programs to help them overcome restrictive training limitations, save patient lives, prepare for overflow tent patient care, simulate vaccination processes, build innovative ventilator tools, and many other needs. Industry leadership agrees that COVID-19 has accelerated the transition from early-adopter to early-majority by as much as five years — with even greater increases in adoption just around the corner with continued investments into digital training technologies.
As the world’s leaders begin to cope with the aftermath of COVID-19, the demand for improved training for clinical providers and their surrounding systems will be obvious. Building Gates’ “Pandemic Firefighter” force will take international collaboration much like the International Space Station. The world’s best and brightest will be drawn to this unique infectious disease fighting force, which in a way will become the NASA of healthcare. These brave few will be risking their own lives to save the world, but their expectation will be to receive the best training possible. As such, they will look to other high-stakes industries like the military and aviation which require precision hand-eye coordination training during emergency situations, standardized team-based communication practices, and continuous systemic failure reviews for human factors improvements. These pandemic fighters will also look to UNMC and other biohazard preparedness institutions in the United States and around the world, and quickly realize that simulation in healthcare is “the right stuff.”
With the realization that countries and healthcare systems can invest just a few billion dollars in preparedness annually to save against trillions from the next pandemic, we can easily see how it is only a matter of time before the healthcare industry completely reboots itself to be based almost entirely on simulation to educate learners, train professionals, find systemic errors, and improve outcomes.
Clinical professionals, institutional leaders, policy lawmakers, venture capital investors and most importantly, patients, will all soon take notice about the benefits of hyper-realistic training in healthcare. From their elevated perspective, Bill and Melinda Gates are suggesting there will be much more simulation in our future — and we wholeheartedly agree.
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Photo Credit: COVID-19 simulation training at iEXCEL in the Davis Global Center at UNMC, Omaha, NE
