1. Simulators for Training: Assessment, Validation, and Acceptance Strategies The Human Patient Simulator™ Medicine Meets Virtual Reality January 25, 2003 Ron Carovano

2. This document is proprietary and shall not be used or disclosed without the consent of METI 2 Overview  Needs  History  Pacing Technologies  User Experience  Assessment, Validation, and Acceptance  Emerging Concepts and Developments  Ongoing Challenges

3. This document is proprietary and shall not be used or disclosed without the consent of METI 3 Needs  Challenges of the Apprenticeship Approach Time is fixed, learning is variable Limited access to patients in the clinical setting Focus on patient care, rather than learning  Education and Training Initial Refresher Sustainment  Operational Levels Individual clinicians Clinical teams Healthcare system  Test and Evaluation Objective performance measurement Operational test and assessment Event rehearsal

4. This document is proprietary and shall not be used or disclosed without the consent of METI 4 Brief History  1969Sim One Anesthesia Simulator, University of Southern California  1987Anesthesia Simulators Reborn, University of Florida and Stanford University  1993Simulation for Health Sciences Programs, State of Florida Department of Education  1994Commercialization of Patient Simulation, Loral Corp. and CAE Link Corp.  1997Combat Trauma Patient Simulation (CTPS) Program, US Army STRICOM  1999PediaSim™ Pediatric Patient Simulator, METI  2001CTPS Test and Evaluation, Fort Gordon, Georgia  2002Emergency Care Simulator (ECS), METI  2003Simulator-based Field Casualty Drills, Louisiana Office of Emergency Preparedness

5. This document is proprietary and shall not be used or disclosed without the consent of METI 5 Pacing Technologies  Mannequin Anatomy Clinical signs Monitored parameters  Haptics and End-effectors Technologies that bring the simulation to life Palpable pulses, breathing, pupil dilation  Models Mathematical models of physiology and pharmacology Physical models (e.g., pulmonary gas exchange)  Software Instructor operation Scenario generation After-action review  System Operational configuration Computer hardware and operating systems Communications, data acquisition and control

6. This document is proprietary and shall not be used or disclosed without the consent of METI 6 User Experience  World-Wide Simulator Installations Over 300 HPS’s Over 80 PediaSim’s Over 50 ECS’s  User Site Distribution 72 Domestic Medical Schools 74 International Medical Schools 72 Nusing and Health Sciences Schools 71 Government and Military Sites  Hundreds of academic publications  Thousands of student learning experiences

7. This document is proprietary and shall not be used or disclosed without the consent of METI 7 Assessment, Validation, and Acceptance  User Acceptance Indicative of a High Level of Face Validity for Education and Training  Schwid, H.A. (2002, December) Evaluation of Anesthesia Residents Using Mannequin- based Simulation. Anesthesiology. V 97. No 6. 1434-1444. Construct validity supported by improvement in performance from CB and CA-1 to CA-2 and CA-3 levels of training Criterion validity supported by correlation of simulator scores with faculty evaluations (P < 0.01, ABA written in-training scores (P < 0.01), and departmental mock oral board scores (P < 0.01) Reliability demonstrated by very good internal consistency (  == 0.71-0.76) and excellent inter-rater reliability (P < 0.01)  Holcomb, J.B., Dumire, R.D. (2002) Evaluation of Trauma Team Performance Using an Advanced Human Patient Simulation for Resuscitation Training. Journal of Trauma Injury, Infection, and Critical Care. 52, 1078-1086.  Partners Healthcare, Boston, Massachusetts Anesthesiologists benefited from reduced cost in malpractice insurance upon completion of anesthesia crisis resource management simulation program

8. This document is proprietary and shall not be used or disclosed without the consent of METI 8 Emerging Concepts and Developments  Operational Healthcare System Readiness Disaster Response Bioterrorism Tactical Medicine Mass Casualty Events  Test and Evaluation Tool for design and test Measures of performance and effectiveness Objective, criterion-based assessment  Credentialing and Certification Predictive Validity

9. This document is proprietary and shall not be used or disclosed without the consent of METI 9 Ongoing Challenges  Advance Simulation Beyond Training  Apply the Science of Simulation: Verification, Validation, and Accreditation  Balance Needs, Technology, and Cost

10. This document is proprietary and shall not be used or disclosed without the consent of METI 10 Ron Carovano Director of New Business Development Medical Education Technologies, Inc. 6000 Fruitville Road Sarasota, Florida 34232 U.S.A. Phone: (941) 377-5562 Fax: (941) 379-1621 E-mail: rcarovano@meti.com http://www.meti.com Contact Information

11. This document is proprietary and shall not be used or disclosed without the consent of METI 11 Virtual Hospital Chain of Patient Safety OPERATIONAL TEST & ASSESSMENT MISSION REHEARSAL Pre-Hospital Ground Ambulance Hospital Ward Emergency Department Air Ambulance Operating Room Critical Care

12. This document is proprietary and shall not be used or disclosed without the consent of METI 12 CTPS Chain of Survival OPERATIONAL TEST & ASSESSMENT MISSION REHEARSAL Point of Injury Casualty Collection Point Combat Support Hospital Battalion Aid Station Ground Ambulance Forward Surgical Team Air Ambulance