Simulation innovation at NOSM

The Northern Ontario School of Medicine (NOSM) is known for its many firsts.  NOSM is the first new medical school in Canada in over 35 years, the first medical school in Canada to be established with a social accountability mandate, and the first medical school in the world in which all medical school students undertake a community based, longitudinal, integrated clerkship.  Perhaps another lesser known first is that NOSM was also the first medical school in Canada to have “Harvey,” a cardio-respiratory mannequin.  This full-sized mock patient simulates 25 heart diseases at the touch of a button.  But already, Harvey seems “old hat” in light of more recent developments in simulation. In the short six years that the School has been open, researchers and educators in simulation-based learning have devised new programs, devices and techniques that are attracting the attention of educators across the world.Simulation in health professional education involves representing a real-world situation in enough detail to train students. It does not require the simulation to create the illusion of reality; rather, it requires that those who are involved know that it is not real, but still behave as if it were.  Simulation is used increasingly in health professional education for a number of reasons, the most important of which is that it creates educational opportunities without placing real patients at risk.

There are various types of simulation used at NOSM, including our Standardized Patient (SP) program.  SPs are community volunteers trained to provide the medical history, physical symptoms, and the behaviours and reactions of real patients.  NOSM involves SPs throughout the first two years of its M.D. program as well as for Objective Structured Clinical Examinations (OSCE) and, increasingly, in other programs, such as the Medical Council of Canada (MCC) exams.

Task trainers are models of a particular part of the human body that allow students to learn specific clinical skills such as suturing, airway management and chest tube insertion.  A third type of simulator used by the School are mannequins, ranging from basic airway life support (ALS) models to the Laerdal SimMan 3G that can exude blood, sweat and tears, as well as talk and represent a wide range of patient management scenarios. NOSM also uses onscreen simulators such as virtual patients and laparoscopic surgery trainers.


NOSM’s most extensive use of simulation training so far was in January 2010 when third-year NOSM students and Canadore College’s first-year nursing students shared a weekend of simulation-based learning sessions. Hosted at the West Parry Sound Health Centre, the student groups rotated through a series of simulation stations dealing with practical issues associated with disaster management.  Stations provided experiences with triage, shock, airway management, and managing difficult fractures, to name a few.  By using simulation, all stations allowed students to develop practical and hands-on skills in the scenarios they encountered.

Last year also saw NOSM teaming up with Sudbury Regional Hospital to host an Anesthesia Boot Camp for third-year Family Practice Anesthesia residents.  This was the longest continuous use of simulation at NOSM to date.  Running all day for five days, it provided residents with an opportunity to develop skills in recognizing and appropriately responding to situations in and around anesthesia. The boot camp also allowed learners to develop skills in dealing with stressful and difficult situations, and to acquire crisis resource management and leadership skills in a dynamic team environment. The course will be held again in the summer of 2011, but with twice the number of participants from our region and beyond. Such is the interest in this innovative program that we are already turning away some applicants from outside of Northern Ontario.

The next major simulation event will be during the medical student academic week on March 22, 2011 and after that, the Northern Lights MiniSUN conference May 13-14, 2011, both in Sudbury. The latter will bring presenters and participants together from the Northern Ontario Simulation in Healthcare Network (NOSHN), as well as experts from across North America. NOSHN is another innovative undertaking supporting collaboration between all of the universities, colleges and, increasingly, hospitals that use some form of simulation-based learning in Northern Ontario.

Virtual patient

Simulation research is also unfolding with Dr. Rachel Ellaway’s team developing the OpenLabyrinth virtual patient system that is now being used by institutions across the globe, and the Health Services Virtual Organization (HSVO) Integrated Simulation platform that allows simulation activities to be run across multiple simulators in multiple locations. NOSM medical students have been working collaboratively with their counterparts at McGill University in Montreal, the University of Ottawa, and the University College Cork in Ireland. This platform is attracting interest from institutions such as the United States Veterans Administration and CAE Systems (the world’s and Canada’s largest simulator manufacturer).

Medical education is about preparing high quality health professionals for practice. Simulation allows us to create training scenarios without having to use real patients, while retaining all of the essential elements to support the graduation of world-class physicians and health professionals. NOSM is making increasing and innovative use of simulation to address core goals of patient safety and quality care for people of Northern Ontario. The simulation team encourages all those interested to come and see what simulation is doing at NOSM!

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