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Embracing Medical Simulation



While the traditional mantra on many medical procedures has long been a risky: “See one, do one, teach one,” the recent expansion of available medical simulation technologies has brought a remarkable paradigm shift in both civilian and military health care thinking.

One of the best examples of the paradigm shift for veterans can be found in the Simulation Learning, Education and Research Network (SimLEARN), a national simulation training and education program that has been established for the Veterans Health Administration (VHA). Although VHA has long embraced the use of simulation for health care training and education, SimLEARN provides an integrated approach to expand and maximize those benefits for VHA staff and the veterans they serve.

“Considering that the VA is the largest health care system in the country, I’m not sure that everyone realizes the impact that simulation is having and will have as it continues to roll out. …”

According to SimLEARN National Program Manager Harry Robinson, Ph.D., the program was established in 2009 under an Executive Decision Memorandum (EDM) signed by the Department of Veterans Affairs acting under secretary for health, “Because they understood the need for simulation-based clinical training within VA, and they really wanted to put some backbone on what we were trying to accomplish.”

Established in Orlando, Florida, SimLEARN’s first responsibility under the EDM was the creation of a national program office for simulation training education and research, a successful effort that aligned program operations and management under three major VHA offices: the VHA Employee Education System (EES); VHA’s Office of Patient Care Services (PCS); and the Office of Nursing Services (ONS).

“We have three co-leaders at SimLEARN,” Robinson said. “I have the honor to work with Dr. Haru Okuda, the national medical director who reports to PCS, and Dr. Lygia Arcaro, our national director for nursing programs, who reports to ONS. I’m the national program manager and I work under EES.”

“Part of our initial charge was to look at how to best employ the use of simulation-based training,” he explained. “Second was to do it in a means that would have VHA-wide implications. And third, it called for building a national simulation center.”


U.S. Army Col. Rob Sheridan, left, and Lt. Col. Michael Yaffe, right, from the 399th Combat Support Hospital, conduct simulated surgery on Spc. John Tofth from the 388th Medical Support Company at Fort McCoy, Wisconsin, April 2, 2014. Tofth was wearing a cut suit, a human-worn surgical simulator, as part of an annual War Exercise (WAREX) involving more than 4,500 soldiers. U.S. Army photo by Spc. Robert Farrell

He described current SimLEARN status as “up and operational,” noting the “delivery of classes for training the trainers” both in Orlando and at a satellite facility in Palo Alto, California.

“We train folks here and in Palo Alto and then send them back to their facility where they deliver local-based training to the providers,” he said, adding that the SimLEARN graduates are teaching classes at 150 VA Medical Centers around the country.

The Hunter Holmes McGuire VA Medical Center, located in Richmond, Virginia, provides multiple examples of medical simulation applications at the local level.

Michael S. Czekajlo, M.D., Ph.D., is an intensivist in the center’s surgical ICU as well as medical director for its Simulation Center.

“Considering that the VA is the largest health care system in the country, I’m not sure that everyone realizes the impact that simulation is having and will have as it continues to roll out,” Czekajlo said. “In fact, one of the reasons I took over as medical director to build the sim[ulation] program here is that I see if I do anything here that works out on a pilot basis it can have national implications, because I can talk to the SimLEARN people and they can help move it along.”

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Scott Gourley is a former U.S. Army officer and the author of more than 1,500...