By Steve Spotswood
BETHESDA, MD—Maj. Craig Goolsby, MD, wears a lot of hats at the Uniformed Services University of the Health Sciences (USU). Along with being an associate professor there, he’s vice chair for Education in Military Emergency Medicine (MEM), Military Field Practicum 102 director, Emergency Medicine clerkship director, Bushmaster Casualty Force and Simulation Team director, director of the Val G. Hemming Simulation Center Hybrid Simulation Lab and interim director of the National Center for Disaster Medicine and Public Health.
All of these roles have one goal at their center: ensuring students emerge from the school as prepared as possible for the rigors of military medicine.
One tool that Goolsby relies heavily on in that preparation are various forms of hybrid simulation–medical simulations that use mixed modalities to create a more-robust experience for the learner. The idea is that, by using different types of simulation in conjunction with each other, they can help account for the weaknesses in individual modalities.
For example, there’s the human-worn simulator known as a Cut Suit. The suit, worn by an actor, covers the torso and includes realistic bone, organ and arterial systems that recreate the look, feel and even smell of the human body. Students can practice tourniquet application, arterial clamping, surgical chest tube thoracotomy, intra-abdominal exploration and much more.
“Students get to have the full doctoring experience,” Goolsby explained. “They have to learn patient communication. They get to deal with somebody who’s in pain and afraid, while at the same time learning the technical aspects of medicine. It’s a unique experience that blends human interactions and technical skills that’s difficult to achieve in any other learning environment.”
While the cut suit is the most dramatic of the hybrid simulation techniques, USU employs many others.
“We have simulators that have pulses and can breathe and can generate displays on a patient monitor,” Goolsby said. “We use those in our field training exercises. But we always start the cases with an actor. Students get a chance to get a history and physical and then, when the actor becomes unresponsive, they move over to the simulator. They’re still getting the benefit of interaction.”
One reason Goolsby and the leadership at USU strive to provide such a well-rounded doctoring experience in these simulations is that surgical skills are only one aspect of what they want students to learn during their time at USU.
“We spend a lot of time teaching leadership and communication,” Goolsby explained. This is why so many simulations use hired actors to play the part of patients. In some exercises they even mount videocameras on the actors’ heads to provide playback of the patient experience.
“The camera is seeing pretty close to what the actual patient would be seeing,” Goolsby said. “We film that and send it to students that night so they can critique their own performance.”
Teaching students how to communicate with their fellow medical professionals can be just as important as patient communication. The USU develops a curriculum based around the PITO model of leadership levels—personal, interpersonal, team and organizational.
In the personal level, students learn about communication, personality types, how they personally like to communicate. Then they learn interpersonal skills and how they work with a partner to care for a patient. During this level, cut suits are used extensively, Goolsby explained.
By the time students approach the end of their time in the program, they’re learning how to be a team leader. The biggest test of that ability comes during USU’s Operation Bushmaster training exercise. A simulated mass-casualty event, the exercise is taken by all fourth-year School of Medicine students.
“In this exercise, they learn how to perform medicine on patients in a very-austere environment,” Goolsby said. “In this exercise—and in all the exercises we do—we’re assessing how they’re leading these small teams. We’re looking at their leadership skills. How well they communicate with team members. How well they listen to team members. Are they getting feedback? Just in general—how effectively and cohesively are they functioning in the patient care setting.”
Goolsby always looks to improve the curriculum, “for ways to tinker with things,” especially when it comes to how hybrid simulations can be used to impact student learning. “There’s a lot of potential out there in terms of simulation technology. We have a pretty amazing virtual environment at the university, and there’s some really unique capacity with that. It’d be interesting to see how much we can make virtual environments mobile and put students in these austere settings.”
There are also lower-tech possibilities that Goolsby is looking at. “We have lots of bleeding models, but there are some types of bleeding that aren’t well replicated yet.”
For example an exsanguinating hemorrhage from a damaged blood vessel. “We want to create the warm feeling of the blood and the difficulty packing that area. We have some models that are good but not quite good enough.”
Goolsby stressed that, while he sits in a leadership position in numerous areas of USU, he—like the students he helps train—can only operate as part of a team. “We have a real focus on educating the next generation of America’s military medical officers. And there are so many people contributing to that mission.”