A Flight Simulator for Doctors
Updated: Jun 10, 2021
Don't worry Joey, I have never been in a cockpit either.
There used to be an old retired flight simulator in my local shopping centre. You would pay five pounds, and enter a small cinema with nine other people which moved and shook you around as you imagined yourself in a crashing plane. Then you would continue your shopping as if nothing had happened.
My first Christmas as a doctor was a similar experience. I got three bleeps in the middle of the night, one immediately after another - Two were patients who had suddenly become unstable, and the third was a patient with chest pain. As a very junior doctor, I was not usually contacted about the suddenly unstable patients, but the nurses had been unable to get in touch with the medical registrar, and I was the next best thing.
I listened to the nurses tell me about the individual patients who had just potentially become three of the sickest people in the hospital outside of ICU. I wrote down their details, bleeped the medical registrar on call (more out of hope than expectation), and then as I was leaving the office, the medical registrar rang back. He was at an even sicker patient, and likely would not be able to help. 'Just do your best' was the theme of his advice.
Aside from the doughnut note, this fits perfectly
I don't recall what happened next. I started a medicine, or stopped one, got a few more similar calls, and acted similarly, my shift ended, I may have treated myself to a hot chocolate and an almond croissant, and then I went home.
I never heard about how those patients got on after I saw them. I wasn't called to them again. I remember what wards they were on. I think I remember what was wrong with them, but I don't know what I did for them. I wonder, whatever it was, after five years experience of working in emergency departments, would I do something different now.
A pilot undergoes 64 hours of mandatory flight simulator training before they are allowed near the cockpit of a real Airbus. When I went to see those patients, I had less than five months experience of being charged with managing patients, and no simulation training. A pilot's simulation training asks them to press the correct sequence of buttons on a flightdeck simulator when the left engine falls into the Pacific Ocean. They see the button, they press the button, they feel the plane jolt towards the water, and the next time they run the simulation, they press a different button.
Medical students spend 4-6 years in university, attending lectures and having clinical exposure in hospitals - preparing for the moment when they are called to see a sick patient, so that they know what to do. Many are finding that their knowledge of the minutiae of the Krebs Cycle, the difference between infliximab and pertuzumab, and the mnemonic for the causes of hypercalcemia (CHIMPANZEE) does not serve them and their patients when it comes to actually working as a doctor. And there is a growing annoyance among medical students and trainees about this. Some say it's like they went to pilot school and learned absolutely everything about planes, except for how to fly them.
The SIMIR platform represents that Flight Simulator for doctors, placing them in a virtual environment where they have to make decisions within clinical vignettes, see the consequences of their actions, and then have the opportunity to repeat the scenario. It offers the psychological safety of a judgment free simulation, where they can crash the planes as many times as they need before they learn how to make the correct decisions. It is within this world of clinical acumen that medical school should have its focus, rather than rewarding the student who can commit the most mnemonics to their short term memory.
Medical students that are better prepared for working as doctors will provide better patient care, and reduce the pressure on their more senior colleagues. SIMIR is heralding an end to the Dolores Umbridge theory of medical education.
Bernard Lillis is an emergency medicine doctor in Dublin, Ireland, and is the founder of SIMIR.