“We ramp up the emotional content of the simulations even at the junior level,” said Dr. Levine.

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The confrontational surgeon, the harried nurse and the headstrong resident are not part of most formal simulation scenarios. Yet one or all of them participate in mission-critical simulations at the Icahn School of Medicine at Mount Sinai Simulations HELPS (Human Emulation, Education and Evaluation Lab for Patient Safety) Center in New York City. Dr. Adam Levine, director of the HELPS center, says the beauty of these improvised characters is they can enter the scenario at the most inopportune moment to unnerve the participants, distract with a question or disrupt with a potentially fatal error.

“We ramp up the emotional content of the simulations even at the junior level,” said Dr. Levine. “There is no sense being in that simulation if it’s not going to be high-stakes and have a lot of impact.”

An early adopter of simulation, the Department of Anesthesiology purchased the first commercial METI Human Patient Simulator (HPS) in 1994. Levine led initial simulations for anesthesia residents while helping to beta test the HPS. Today, he and a core team of anesthesiologists use the HPS for high stakes simulation events for professional retraining, re-certification and remediation as well as resident training and undergraduate education.

A proponent of high-stakes simulation for both education and assessment, Levine admits that the HELPS center model is unique.

“I know we are doing things very, very differently,” Dr. Levine said. “We're proud of the way we have created our program. We don’t use technicians or ancillary teachers. We use MDs to educate all of our students. We’ve been very prolific with only three or four core faculty and a team of dynamic anesthesiology resident educators.”

The center’s two simulation rooms frequently are booked solid, delivering thousands of simulation experiences a year and generating a self-sustaining revenue stream for the program. In addition to offering regular American Society of Anesthesiologists (ASA)-endorsed Maintenance of Certification in Anesthesia (MOCA) courses, the center conducts competency assessment for medical licensing bodies and retrains anesthesiologists who have been on clinical hiatus.

The center has become a distinguished site for teamwork evaluation, clinical skills instruction, and professional remediation following poor outcomes.

“It’s much more challenging to evaluate and document judgment, professionalism and interpersonal skills,” Dr. Levine said. “But one can readily see these skills deteriorate in a simulated environment when the scenario takes a challenging and stressful turn.”

Levine would like to see medical associations create simulation-based standards for professional assessment, reentry or retraining.

“It’s talked about but not available,” Dr. Levine said. “People are aware simulation exists, and licensing and credentialing bodies have heightened awareness of patient safety and the desire to make medicine safer. I would like to see them promote high-stakes education and assessment instead of teaching with checklists and tasks.”