Anyone with a video game console at home can simulate  a variety of occupations: airplane pilot, race car driver, baseball player, Old West zombie hunter. As technology improves, the experience that can be created for these tasks grows ever more accurate and immersive, causing some experts to wonder whether simulation can be used for actual education as well as vicarious thrills. In the aeronautics field, this is old news - pilots have been trained on flight simulators for decades, gaining experience on high-risk, low-frequency tasks such as landing a damaged plane on a river. But in medicine, the use of simulation has only started picking up speed in the last decade, employing a mix of high-tech and low-tech to prepare doctors and nurses for both the usual and unusual.

In their Department of Medicine Grand Rounds presentation last week, Ernest Wang and Morris Kharasch from our partners at NorthShore University HealthSystem described the current state of simulation in medicine on the eve of their state-of-the-art simulation center’s grand opening. But while the idea might sound modern, it’s actually been around for more than 40 years, as Wang illustrated using a clip from the 1972 film Future Shock, narrated by Orson Welles.

Welles’ portentous warnings were a bit premature, it turned out. Never mind the leap from medical simulation dummy to humanoid robot, a generation would pass from when the first dummies were engineered in the late 1960’s before the broader field would accept simulators as a valid training tool for doctors.

“It looked pretty much what our current high-fidelity simulators look like, but didn’t have traction,” said Wang, a clinical associate professor at NorthShore. “There’s a Chinese saying: ‘When the student is ready the teacher will appear,’ and clearly they were too far ahead of their time and the conditions weren’t right.”

However, since 2000 the use of simulation in medicine has gathered momentum. A wide range of technologies are currently used for teaching sessions, from complex simulation environments that fully recreate the experience of being in an operating room to computer programs and table-top gadgets that rehearse medical decision-making and the performance of specific tasks. Medical simulation has grown to the point where a new specialty - the simulationist - may need to be created, Wang said.

“This would be a practitioner of simulation, who takes a recipe of clinically important cases, lessons learned from other industries, computer-driven full body simulators, realistic task trainers, and a dash of theater, to create a memorable learning experience that can be transferred directly to patient care,” Wang said. “In the end, that’s what this is about: education and patient care.”

Winning acceptance for medical simulation involves proving its success and determining its most effective uses. At the NorthShore center, educators have focused on designing simulation courses around “high-liability, low-frequency” events, said Kharasch, clinical director of the Center for Simulation Technology & Academic Research. The students in these courses might be residents encountering these situations for the first time, or older doctors who need a refresher on tasks they haven’t performed in many years before serving as an attending on the wards or in the emergency room.

“We’ve learned that as the years go on after you come out of residency, you are less able to do things that you once did as residents,” Kharasch said. “We spend a lot of time training on simple tasks that can be life-saving.”

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More Honors for Shubin

In 1863, in the midst of the Civil War, Abraham Lincoln signed an order creating the National Academy of Sciences, an organization bringing together the country’s most esteemed scientists to “investigate, examine, experiment, and report upon any subject of science or art.” From the original 50 members, the group has blossomed to 2,100 today, with roughly 200 of those Nobel Laureates. Any club with a 10 percent Nobel ratio is pretty exclusive, so being elected to the Academy’s lifetime membership is a thrilling honor for a scientist.

This week, evolutionary biologist Neil Shubin was the latest UChicago scientist given the honor of NAS membership, part of this year’s class of 72 new members and 18 “foreign associates.” Shubin becomes the 40th current member of the NAS located at the University of Chicago, and joins Medical Center faculty such as Janet Rowley, Martin Weigert, Donald Steiner, Bernard Roizman, Robert Haselkorn, and David Jablonski, who was elected last year (Fermilab director and professor of physics Pier Oddone was also elected in this year’s class). Election is no simple matter - each new member must pass a 10-step process [pdf] and be voted in to the academy by their potential peers.

Shubin is most famous for the discovery of the pivotal fossil named Tiktaalik roseae, a transitional species between ancient fish and the first limbed creatures to walk the land. But Shubin’s research is more than just fossil-hunting, as he studies the genetic programs that control development of limbs in the embryos of species such as sharks and salamanders. On the blog, we recently featured a paper by Shubin and former graduate student Andrew Gillis, where the embryos of strange creatures called holocephalons revealed some of the earliest steps in limb evolution.

In all likelihood, Shubin’s election was helped by his scientific communication skills as well. From his book about the discovery of Tiktaalik and the story of human evolution, Your Inner Fish: A Journey Through the 3.5-Billion-Year History of the Human Body, to his appearances as a correspondent on WTTW, to his anatomy teaching duties at Pritzker Medical School, Shubin has proven himself eager to educate the public at large about science. Appropriately enough, a second honor announced for Shubin this week was the Distinguished Service Award for Enhancing Education through Biological Research from the National Association of Biology Teachers. Once again, he finds himself in good company, as previous recipients include James Watson, Stephen Jay Gould, and Richard Dawkins.

“I am deeply honored to receive the NABT Distinguished Service Award. In an age where the ideas and tools of biology are increasingly playing a role in our lives, it is a deep honor to be recognized by those who are at the front lines of educating the next generation,” Shubin said.

The Science of Killing Bin Laden

A news story as big as the killing of Osama Bin Laden spares no beats, and there were plenty of science stories written this week in the aftermath of Sunday night’s surprise news. The most direct scientific angle was in the identification of the terrorist leader’s body, a step U.S. officials wanted to prove beyond a doubt before going public with the news. Like many of the events surrounding the raid, many of the details remain classified. But that hasn’t stopped science writers from writing explainers on how biometrics and DNA matching likely would have been used to make sure the Navy SEALS really had killed Bin Laden. President Obama himself confirmed that DNA testing was used to confirm they had the right body, but one fascinating mystery is where the DNA used to make the comparison was gathered. Nature blog The Great Beyond describes the candidates - from Bin Laden’s half-brothers and half-sister to one of his purported 26 children - and talks a bit about the recent history of using DNA identification techniques in criminal matters, including one crook busted by DNA he left on a slice of pizza.

Elsewhere…

The creation of new drugs, and the death of old drugs - Medical Center researchers commented on both sides of the pharmaceutical life cycle in newspaper stories this week. In the New York Times blog Fixes, reporter David Bornstein looks at the “valley of death” in developing new drugs for less-than-common diseases, and focused on the Myelin Repair Foundation and researchers such as Brian Popko (who we have featured twice). Then yesterday, the Chicago Tribune’s Bruce Japsen wrote about the upcoming patent expirations on the popular drugs Plavix, Lipitor, and Actos, and talks to our Caleb Alexander about the implications for health care.

How do you make a new species in the lab? It’s easier if you find a lizard species that is entirely female and can reproduce by cloning. Ed Yong at Not Exactly Rocket Science describes genome mash-ups, asexual reproduction, and the trickiness of species-naming in this great post.

A retired nurse and research coordinator at the Medical Center talks with Dawn Turner Trice about her experiences working with a small rural clinic in Ghana.

Photo by Gerald Waddell

At ScienceLife HQ, we often hear the loud roar of the hospital helicopter as it takes off on urgent duty. In this article that originally appeared in the Medical Center publications Newsfront and Forefront, Cheryl L. Reed writes about what motivates and amazes the nurses who fly those missions. You can watch a video version of the story here.

From a distance it sounds like thunder and then like a rogue train plowing through the neighborhood. But closer in, the rumbling in the sky is unmistakable, a helicopter, its blades splicing the air. Within sight, the maroon helicopter becomes a point of pride and curiosity: What crisis are University of Chicago Medical Center nurses and emergency residents responding to? Is it a car crash or a woman in premature labor? Are they transporting organs for transplant surgery or ferrying a complex patient whose symptoms can’t be unraveled by doctors elsewhere?

When the helicopter lands and the noise dies down, the crew from University of Chicago Aeromedical Network (UCAN) emerge in their flight suits looking much like characters from the movie Top Gun.

“I usually get stopped at least once a week in a hospital by someone who asks me how I got my job,” said Kelley Holdren, BSN, CFRN, who has been a UCAN flight nurse for seven years.

The Medical Center’s UCAN program was the first and remains the only hospital-based flight response in the Chicago area. Though air ambulances are common in Chicago, most are operated by private companies. UCAN started at the Medical Center in 1983. At the time, it was the 53rd flight program in the country and the only dedicated flight program in the Chicago area. Now, there are over 700 medical helicopters across the country.

UCAN runs 24 hours, seven days a week and has nine nurses, several of whom are part-time, and a crew of emergency medicine residents. At least one flight nurse and one resident are on every transport. Second- and third-year residents spend two years doing shifts in the flight program. The pilots are usually retired military. Ira Blumen, MD, is UCAN’s program and medical director and Karen Arndt, RN, BSN, CFRN, CMTE, is its chief flight nurse and administrative director.

“UCAN is a great program and a leader in the industry nationwide,” said Pat Petersen, executive director of the Air Medical Physicians Association (AMPA). “Ira Blumen was an original board member of AMPA and was the editor of a textbook about medical transport. He and Karen Arndt have done amazing things for the industry; their contributions to the safety reviews have been invaluable.”

Kelley Holdren on board the helicopter. (Photo by Cheryl L. Reed)

For Holdren, her job as a flight nurse is the culmination of a dream that began in sixth grade while sitting in her orthodontist’s office. Among the magazines scattered in the waiting room was one that featured a story about the UCAN program. Instantly, it hit her: “That’s what I want to do.”

On her honeymoon in Maui, she convinced her husband, who gets motion sickness, to take a helicopter ride to see if she could really handle being in the air. “It had become such a big part of my drive to become a flight nurse and, yet, I’d never even ridden in a helicopter,” she said.

When Holdren graduated from nursing school in 1997, she held out for a position at the Medical Center because her ultimate goal was to become a flight nurse. She started out in the Medical Intensive Care Unit and then moved to the Pediatric Intensive Care Unit (PICU). “It was all just a holding pattern until I could start flying,” she said.

Along the way, Holdren was coached by Arndt who encouraged the young nurse to expand her experience in the PICU and in cardiac care. “It’s pretty rare that someone leaves,” Arndt said, “but when they do there are always lots of people trying to get in.”

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