Review of Groupman (2005)

Scott Lanum

SSP 205

Spring 2005

Review of Groupman

Just what should people look for in educational tools of the future? That question, which will plague people for decades to come, has come to a point in our current day and age with the popularization of various educated tools created, essentially, from video games. Video games, however, aren’t the only way of simulating play in order to achieve an educational end. Students for ages have been doing it inside classrooms under the guise of a social simulation, a model of social theory with certain key elements abstracted from complex reality (Tamminga 1977, Brewbaker 1972). This notion of social simulation pertains a great deal to the article written by Jerome Groopman entitled “A Model Patient” as he seems to be making his judgments about the idea of a doctor simulator from exactly this definition. A former doctor himself, Groopman has extensive experience when it comes to training doctors. He realizes the time, effort, and expense that go into each individual participating in doctoral training. Yet, one must wonder if this experience is to his benefit or his hindrance.

The view has often been taken that these training dummies used by doctor candidates, discussed in the article, need to be developed by the people who use them. It would appear that every iteration of the dummies are created with a doctor (or group of doctors) as the primary and those simply related to the ins and outs of building the dummy as a secondary. In the example given by Groopman, Dr David Gaba and Abe DeAnda Jr created the first version of the surgery training dummy. This first version needed to draw from the extensive medical knowledge of Gaba, his previous training as an engineer, and the expertise of Mr. DeAnda, a graduate student with an undergraduate background in engineering. Presumably, they drew from each others talents, one bringing in the techniques of the new in order to bolster the shortcomings of the old. The dummy they created served their purpose and helped pave the way for simulated learning in the medical realm for years to come. The article goes on to question the effectiveness of this simulated training in a real environment. While this line of questioning is important, it doesn’t get at the real matter of the subject. How is it possible to teach the skills needed in order to save lives without the necessary threat of loosing lives? A question that is often posed in the realm of education and simulation is that of detachment. Even if the most realistic environment in the world is created, with the rules for manipulating that environment being as close to, if not exactly like those of our current society, you will always be missing that sense of the person actually being there. Any urgency that the situation might at one time carry is no longer held. The subject in question may perform exceptionally in the simulated environment, yet have major issues when it comes to performing the exact same task in the real world.

In the world of aviation training (often compared to in the article due to its close relationship with using simulators as a form of training) the detachment issue is mildly resolved by teaching in a manner that makes every aspect of flight routine. Take off, landing, and every possible weather scenario in the sky are presented to the training pilot as one in which the specifications of what to do are not life threatening. They are taught to remove themselves from these situations and thus everything is fine. There is, however, a problem that arises in emergency situations. It is difficult to teach the ability to remove oneself from a truly life-threatening situation in a classroom setting. All that can be done is hope that the pilots rely on their training and perform as expected. As a result, the majority of the time they act in the real world they behave exactly as they would behave in the simulated world. The case is completely different in the medical world, where the opportunity to remove the urgency from a situation is completely lacking.

The profession of a doctor is always urgent. If a doctor fails to perform a step, even in a routine procedure, it can mean the worst for the patient. Doctors train extensively in order to, in a sense, numb their senses to the pain, suffering, and overall heartache of those who they treat. The makers of the simulated surgery training devices rely on this training of doctors being numbed to their patients in the simulated world, as it allows the doctors to act calmly, yet efficiently, in the real world as a result. . Is it enough? Can you simply rely on training in one realm to carry over into another realm? I propose no. Ingrained into the simulation needs to be a way to remind them that the simulation is just that, a simulated environment used as a teaching tool. It will still be necessary to use the apprenticeship technique of teaching medicine in order to convey the sense of real world urgency to training students. Nothing highlights this urgency more than the author’s experience with the Computer-Enhanced Laparoscopic Training System (CELTS), one of the training devices. His experience from the real world and the ability of failure to ingrain itself in ones memory to prevent possible occurrences, is what allowed him to solve the problem presented to him. Should students gain the simulated experience, what is going to ingrain it into their memory as something important? It would just become another routine exercise. Then again, this is precisely the strategy that works with pilots in training. However, as stated earlier, there is a danger in having everything become routine. When presented with a unique situation and the routine characteristics of the situation begin to peal away the students will need to rely on experience to get though through. If that experience was solely though simulation then what will keep the students grounded during these times of crisis?

Simulation has a way of generalizing situations and experiences so as to benefit the entirety of those engaged in the simulation. In this generalization of the medical experiences, is anything being lost? Also, if one were to use simulation as a means of training for other professions, what could they gain/lose form the interaction? While the medical profession seems to have a slant toward using simulation, what about being a business executive? Or possibly a taxi driver or a soldier? While the answers to these questions are far from clear, what is understandable is that simulation, in regards to training, is a tool. It should not be used as a comprehensive educational requirement. While the article doesn’t propose this, I’d like to ask what happens if schools end up requiring that students do 10 times more simulated operations than real ones? What about when that number is bumped to 20 or 50? There is the possibility that the real experiences will end up having a diminished value on the overall educational effectiveness of the program as a whole. There is also the possibility that those real experiences will come to define the potential doctor. Simulation has an equal potential to make the abilities of individuals in any profession go up or down. That’s why it’s such a promising field, no doors are closed.