Simulation makes huge difference to malpractice claims


Simulation of image-guided surgical procedures can dramatically reduce malpractice claims, according to Steve Dawson, Massachusetts General Hospital, Boston, USA.

Speaking at the CX Symposium in April 2009, Dawson said: “My malpractice insurer has done a 15 year analysis of malpractice claims, and those physicians who have done simulation training, and those who haven’t. Simulation has made a huge difference in the losses suffered by my insurer, and as a result we now get a bonus back on our premium if we are simulation trained.”

Though the field of medical training simulation is just fifteen years old, he said, it has already proved that it works. But he warned that there are obstacles to be overcome to make further progress towards the huge training potential.

The first of these is disruption to the traditional mode of learning in medicine. “We’ve been doing animal surgery as a surrogate for learning for human surgery for a thousand years. And the master and apprentice tradition goes all the way back to the ancient Egyptians – 4,000 years. Simulation is a way to insert a computer between the master and apprentice, and let the apprentice learn and learn on their own.”

Other obstacles are technological, as much mathematical as they are medical. A computer simulation needs to respond to the operator as does the real world – the simulation needs physics. “It’s exceedingly hard to develop this,” said Dawson.

Once this has been satisfactorily achieved, the programmers can look to replicating the properties of tissues and devices.

“Now we get to the area where device companies might be interested in using the simulator to do bench-top testing. Instead of going through iterations and iterations with devices until they find the right one, if we have a fully-vetted, physics-based, algorithm-based simulator, you’ll be able to check that your device works correctly.”

Dawson predicted that simulation will become “the standard for procedural learning”.

Dawson told delegates that his claims for the benefits of simulator training were not tainted by conflicts of interest. “The Mentice system was invented by my group. I have no conflicts of interest, however, because my hospital didn’t think that it was anything and gave away the rights for nothing!”