The Peter M. Winter Institute for Simulation, Education and Research

Submitted by: Ake Grenvik, MD, Charles Brindis, MD and John Schaefer, MD

INTRODUCTION

In the year 2000 the University of Pittsburgh, Department of Anesthesiology/CCM, Human Simulation Center in conjunction with the Schools of Medicine and Nursing and UPMC Health System agreed to combine resources to expand what was then a small simulation center within the Department of Anesthesiology into a large multifunctional facility serving medical education and patient safety missions. Nearly $1 million in external grant support from the Laerdal Foundation in conjunction with approximately $1.7 million in internal support from various participating groups were secured. A two-part plan for expansion began in the spring of 2002. In honor of the founder Dr. Peter M. Winter, the center was renamed the “Peter M. Winter Institute for Simulation Education and Research” (WISER).

II. PHASE I – ACADEMIC YEAR 2002-2003

In September 2002, WISER completed the temporary first phase of expansion to the 7th floor of Montefiore Hospital occupying approximately 6000 sq ft with minimal renovation. The existing staff of a part-time director and part-time secretary was expanded through the hiring of a full time operations coordinator, administrative coordinator, simulation specialist and a part-time systems analyst.

Highlights
• Development of an internet based simulation information management system that automatically collects all aspects of trainees performance data and quality assurance information
• Development of a new integrated WISER internet web site through which education curricula and trainee feedback information were made available
• Development in collaboration with a private industry of an innovative, affordable internet digital video system
• Development of a new simulator operating system together with Laerdal Medical that greatly simplified the operation of all simulation training and enhanced mass training capability

The cumulative effect of the proven infrastructure capabilities in 2003 put WISER in a position for practical mass training with leading edge research. WISER is the first simulation center of its kind in the world to achieve this level of accomplishment.

III. PHASE II – ACADEMIC YEAR 2003-2004

On January 12, 2004 WISER opened the new permanent facility at 230 McKee Place occupying 11,000 sq ft. WISER expanded its staff to include an administrative assistant and a senior simulation specialist as well as increasing the course director and course facilitator faculty to meet the demand for new course developments.

A. Awards, Honors and Promotions
• May 11, 2004, WISER was honored with the Sheldon Adler Award for Innovation in Education.
• May 22, 2004, the University of Pittsburgh Medical School graduating class presented the Golden Apple Award to Dr. Paul Rogers for excellence in clinical education. Dr. Rogers also received the Leonard Tow Humanism in Medicine Award from the Arnold P. Gold Foundation.
• August 1, 2004, John J. Schaefer III, MD was promoted to Associate Professor of Anesthesiology.

B. Education
WISER trained over 8,000 trainees in more than 800 courses and over 7000 simulations with immediate real time trainee feedback. In our continued effort to provide quality education at all levels in various specialties, WISER in conjunction with the school of medicine office of Continuing Medical Education developed CME accredited courses for physicians, nurses, and other healthcare professionals.

WISER opened its first satellite facility at UPMC McKeesport in April 2003 significantly expanding its training programs to include competency based assessment. The Department of Anesthesiology faculty at Magee-Women’s Hospital as well as the first year Anesthesiology and Otolaryngology residents are the first groups to have participated in this type of assessment. Preliminary results of validation scoring and standardized settings as well as retention are promising. A grant has been applied for through the Anesthesiology Patient Safety Foundation related to this work. Final results will be published in the 2004 annual report.

C. WISER Projects and Collaborations
Department of Defense
United States Army: By invitation, WISER was asked to visit and provide a needs assessment for improvement of the current 91-Whiskey medic training program at Fort Sam Houston. This assessment was submitted and WISER was then asked to provide a proposal for implementation of recommendations, all completed in the spring of 2004.

United States Air Force: WISER was approached by the medical education leaders of Wilford Hall, Texas, the Air Force’s primary training facility, to perform a needs assessment of their use of simulation in medical education and training. WISER is planning on completing this assessment in 2004-2005.

University of Hawaii and Asia Contacts
In collaboration with the Integrated Medical Information Technology System (IMITS), a telemedicine program of the U.S. Air Force, the planning began to implement a simulation center at the University of Hawaii. Through the invitation of Dr. Larry Burgess, director of the UH Simulation Center, WISER was invited to participate in the Asia – Pacific Medical Military Conference in Hanoi, Viet Nam in the spring of 2005.

SimMedical
WISER gave birth this year to our long awaited commercialization effort. In partnership with UPMC’s Health Venture Fund and the University of Pittsburgh, the SimMedical Corporation has been born. Lead by their new CEO Steven J. Schmitt, SimMedical has developed a business plan that combines the intellectual property of the Institute with $2 million of new product development. The company will launch its initial set of products at the International Meeting of Medical Simulation (IMMS) in Miami January 2005. SimMedical will offer consulting services, curriculum and a version of WISER’s Simulation Information Management Systems (SIMS). It should be noted; that the Institute and SimMedical, have taken great steps in clearly separating their respective organizational missions. The Institute will cooperate deeply with SimMedical but will continue its independence as an education and research organization. See appendix G (SimMedical)

Key milestones reached by SimMedical in 3rd quarter of 2004:
• Successful licensing of the intellectual capital from the University of Pittsburgh to UPMC
• Hiring of new Chief Executive Officer
• Approval of initial funding
• Development of business plan
• Signed distribution agreement with the Cerner Corporation
• Start of the Fort Sam Houston project
• First two beta sites identified
• Joint research agreement with Scott & White Hospital, Temple Texas
• Product development initiated: video subsystem, curriculum and SIMS

D. WISER Funding Sources
See appendices H1, H2 (WISER Funding)
Grants:
Asmund S. Laerdal Foundation for Acute Medicine Inc.
June 1, 2001 – June 30, 2006

Jewish Healthcare Foundation- Part of the UPMC Crisis Team Training Program
July 1, 2004 – June 30, 2005

Fort Sam Houston
July 1, 2003 – June 30, 2004

In addition to the Asmund S. Laerdal Foundation grant and the support from the University of Pittsburgh Schools of Medicine and Nursing, the UPMC Health Systems and the Department of Anesthesiology are the major contributors providing the resources to build WISER’s infrastructure to a state of the art facility.

UPMC also provided the capital for the Phase II expansion at the McKee Place.

E. Publications
WISER has the ability to offer standardized training in various invasive procedures, the decision making process of crisis management, and sophisticated team training. There are opportunities to acquire performance data online, provide analysis and immediate feedback to the trainees. Individual scoring is also available. Most courses utilize video-recording for accurate, direct and immediate feedback to the trainee. Without bias, the learner can see at which points the technique was considered correct or a failure. Statistical analysis of group performance is automatically available via a web-based centralized information management system, facilitating research in education.

There were more publications emanating from WISER in academic year 2003-2004 than in any preceding year. These publications include 1 peer review article, 7 published abstracts, 7 invited articles and 1 book chapter plus 1 editorial. See publications listing.

F. WISER Meeting Activities
WISER faculty participated in various conferences related to simulation education and research all over the world. See abstracts listing.

2003 Meetings

American Society of Anesthesiologists (ASA) – San Francisco, CA
October 11-15, 2003
Dr. Schaefer directed a simulation course on Difficult Airway Management at the Annual Meeting of the American Society of Anesthesiologists in October 2003. The workshops being conducted are used for validation of simulation in medical training.
University of Pittsburgh Faculty who contributed to the 2003 ASA conference for the Difficult Airway Workshops:
John Schaefer, MD, Associate Professor, ANES
David Metro, MD, Assistant Professor, ANES
Joseph Quinlan, MD, Associate Professor, ANES
Robert Krohner, MD, Associate Professor, ANES
Ryan Romeo, MD, Assistant Professor, ANES
Joseph Talarico, DO, Assistant Professor, ANES

Safar Symposium – Pittsburgh, PA
October 25, 2003
At the University of Pitt’s Second Annual Safar Symposium in October 2003, several WISER faculty members contributed with presentations during the second half of the symposium dedicated to human simulation education. All these presentations were published in the February 2004 Supplement to Critical Care Medicine (guest editors: Patrick M. Kochanek, Ake Grenvik and John Schaefer) and are listed separately under Publications in this report.

New York State Society of Anesthesiologists’ Post Graduate Assembly (PGA) – New York, NY
December 12-16, 2003
Dr. Schaefer conducted a Difficult Airway Workshop at the PGA conference.
The New York State Society of Anesthesiologists, Inc. (NYSSA) through its Committee on Continuing Medical Education and Remediation (CME&R) is a learning organization that is dedicated to enhancing the standards and practice of the specialty by sponsoring quality, up-to-date and cutting-edge Continuing Medical Education (CME) activities designed at encouraging education, research and scientific investigations, and improving quality and safety of patient care, not only within the membership but also nationwide and extending to the international community. In addition, this organization is committed to the remediation of anesthesiologists identified and referred by the New York State Department of Health Office of Professional Medical Conduct.

2004 Meetings

International Meeting on Medical Simulation (IMMS) – Albuquerque New Mexico
January 15-18, 2004
No less than six abstracts by WISER faculty/staff members were accepted for presentation at the International Meeting for Medical Simulation in Orlando, Florida, January 2004. These abstracts were all published in Anesthesia and Analgesia, Suppl. May 2004. They are listed separately in this report under Publications.

Faculty presentations
Michael DeVita, MD, Associate Professor, CCM
“Improving medical crisis TEAM performance using a computerized human patient simulator”

William McIvor, MD, Assistant Professor, ANES
“Determining the Static Lung Compliance of the Laerdal SimMan Simulator”

John Mahoney, MD, Assistant Dean, Medical Education
“Longitudinal Integration of Simulation Technology Throughout the Undergraduate Medical Curriculum”

John Schaefer, MD, Associate Professor, ANES
Dr. John Schaefer was awarded the 2nd prize for his abstract entitled “Mandatory Competency-based Difficult Airway Management Training at the University of Pittsburgh Department of Anesthesiology-Preliminary Findings”

Staff presentations
Thomas Dongilli, Operations Coordinator, WISER
“The Use of Simulation Training in a Large Multi-Hospital Health System to Increase Patient Safety”
John Lutz, IT Coordinator, WISER
“The Integration of Performance Logs with Digital Video for Review of Simulation Training Sessions”

Other Faculty attendance
Steven Orebaugh, MD, Assistant Professor, ANES
Ryan Romeo, MD, Assistant Professor, ANES
Patricia Dalby, MD, Assistant Professor, CCM

Society for Critical Care Medicine Annual Congress (SCCM) – Orlando, FL
February 20-25, 2004
The Chicago-based SCCM is the leading organization dedicated to ensuring excellence and consistency in the practice of critical care. From heart attack and stroke, to severe respiratory insufficiency, overwhelming infection, burns and gunshot wounds, the SCCM recognizes the unique needs of the critically ill patient of any age -- infant to adult -- and strives to secure the highest quality care for all patients facing life-threatening conditions. The Society of Critical Care Medicine is the only professional organization devoted exclusively to the advancement of multidisciplinary, multi-professional intensive care through excellence in patient care, education, research, and advocacy.
Dr. John Schaefer presented a lecture entitled “Integrated Simulation Learning Systems and Data Management”. Dr. Ake Grenvik was also faculty member at the SCCM congress.

American Teleconference Association (ATA) – Tampa Bay, FL
May 2-4, 2004
The ATA meeting focus is healthcare solutions through telemedicine in addition to joining the Department of Defense (DOD) and the civilian sector in a global forum to discuss and demonstrate the latest advances in Telemedicine and Advanced Medical Technologies.
Thomas Dongilli, Operations Coordinator, and John Lutz, IT Coordinator of WISER attended this meeting.

Society in Europe for Simulation Applied to Medicine Annual Congress (SESAM) - Stockholm, Sweden
June 17-19, 2004
The SESAM annual meeting is designed for health care professionals, educators, scientists, and representatives of administration and industry with a common interest in new advancements in medical simulation for the benefit of increased patient safety. Dr. Grenvik was a frequent discussant of papers presented at this 10th Annual SESAM Congress.

G. WISER Opening Ceremony
On April 29, 2004, Dr. John Williams as the current Professor and Chairman of the Anesthesiology Department welcomed more than 60 specially invited guests to the opening ceremony and provided Dr. Winter with a magnificent plaque indicating his importance for the creation of the simulation institute. Dr. John Schaefer next dedicated the Lecture Hall to Mr. Tore Laerdal, whose outstanding support of WISER through a most generous grant from the US Laerdal Foundation made it possible for WISER to move into the new facility with full equipment. Dr. Schaefer also dedicated the WISER Library to Dr. Ake Grenvik, whose devoted work at WISER has contributed significantly to the growth and funding of this institute. Finally, Dr. John Mahoney, Assistant Dean for medical students education, and Dr. Loren Roth, Vice President at UPMC, expressed their appreciation for the increasing WISER contributions to teaching of medical students, residents, fellows and faculty members at UPMC, both offering their congratulations to the new WISER.

H. WISER Tours
WISER demonstrated its facility and technology at approximately 70 visits by various local, national and international groups of academic and industry leaders, the United States military forces, and University and UPMC dignitaries. In an effort to provide quality education to new and current medical students, WISER offers training using simulation tools in the medical student curriculum. Approximately 1200 medical school and resident applicants from all over the world toured through WISER at more than 50 such events. Surveys are collected to gather data to understand what attracts today’s medical students to any particular school. Most of the surveys collected at the University of Pittsburgh School of Medicine indicate WISER as one of the most attractive educational opportunities.
See WISER Tour List.

I. WISER Committees – see appendices M (WISER Research Committee membership) N (WISER Advisory Committee membership)

Research Committee
The WISER Research Committee acted through subcommittees to deal with problems related to Institutional Review Board (IRB) issues, such as research on education when no patients are involved. Other issues discussed included use of consent forms, right of trainees to withdraw from participation in studies of simulation training for potential publication, the need for a regional conference on educational research, etc.

Advisory Committee
The WISER Advisory Committee met on June 30, 2003. Meeting minutes were attached to the previous WISER annual report of 2002/2003. During academic year 2003/2004, however, this Committee did not meet because of the reorganization and relocation of WISER to its current facility in the McKee Place.

Annual Report 2005 | Annual Report 2004 | Annual Report 2003 | Annual Report 2002