SAN DIEGO -- Look at Victoria long enough and she'll blink. Nearby, her buddy HAL, who lost his legs due to some unspecified accident, takes a deep breath.
Throughout Hall D at the downtown San Diego Convention Center last month, these little actions brought slightly unnerved smiles to people unaccustomed to the latest level of realism in medical simulation.
At the International Meeting on Simulation in Healthcare, visitors could browse simulated skins stratified from newborn to senior, use an ultrasound machine to guide a needle into a disembodied knee, or practice suturing with a surgical robot.
Many stopped to check out Victoria, a state-of-the-art mannequin made by Gaumard Scientific Co. that's capable of simulating birth and other gynecological issues with no wires or other tethers necessary. Over and over again she delivered, simulating complicated scenarios from breech presentation -- when the baby's feet come out first -- to obstructed labor, when a shoulder gets wedged against the mother's pelvis as the child passes through the birth canal.
Her pulse thumped. She cried out that the baby was coming. Her pupils dilated. Her abdomen contracted, depending on the stage of labor.
It was enough to get the attention of Anthony Moore and Travis Hoberecht, two emergency medical technicians who attended the show to perform demonstrations for Southwestern College, in nearby Chula Vista, and CAE Healthcare.
Moore, who recently had to deliver a baby unexpectedly at Petco Park, home of San Diego's Padres, said he knows very well the value of using a simulator. He had just performed a simulated delivery before having to use those skills in the real world.
"I was able to remember some of the little things, like creating a sterile field, the way that you wipe the child when it's born. We have references for all of that stuff, but it was nice to have it fresh in my mind," Moore said.
He and Hoberecht said the simulation products' level of realism keeps getting closer to how things look when they roll out to an actual emergency. While many visitors at the conference were impressed by the lifelike skin tones or sounds that the latest crop of simulators made, they were more struck by the sheer range of medical situations represented.
"It's not just labor. Now they can create scenarios where they can simulate something like an allergic reaction where the airway's super constricted and you have to overcome that to do an intubation. Some of them respond and react to the treatments as you're giving them," Moore said.
Hoberecht added: "Now some of them sweat. You get pupil changes, their tongues constrict, their jaws bite down ... it's getting closer and closer to the real thing."
Sometimes it was actual people, not sophisticated mannequins, who were the simulation subjects.
In one section of the convention hall's display floor, a young woman reclined as a technician passed an ultrasound wand over metal targets stuck all over her body. As the wand glided over her abdomen, the ultrasound showed twins. As it passed over her chest, the machine displayed pericardial effusion -- potentially deadly fluid buildup around her heart.
Thin and young, the model was clearly neither pregnant nor suffering from advanced heart disease. But those little targets on her skin told the ultrasound to make it look like she was, at least on the simulation screen.
The technology is being incorporated into mannequins made by Laerdal Medical that are commonly used to hone doctors' diagnosis skills, said Dr. Eric Savitsky, founder of SonoSim Inc., manufacturer of the device.
Because ultrasound machines are filled with mechanical structures, they have long been a destination beyond the reach of even the best medical simulators. But the SonoSim targets get around that problem by mapping specific body surface locations to pre-recorded ultrasound images.
This allows for more in-depth ultrasound training than has ever been possible, Savitsky said. It also can enable more sophisticated simulations where the mannequin is programmed to exhibit subtle symptoms that could lead to a broad range of other diagnoses.
"A lot of conditions that doctors have to diagnose, the symptoms are what we call protean, which means that the way symptoms present themselves are very vague and could mean several different things. Now we can have simulations where the doctor can choose to move to ultrasound in these situations, and when they do, they have an opportunity to clarify their diagnosis by looking inside the body," Savitsky said.
As he made his pitch, others in booth after booth at the convention center were doing likewise.
With so many products and with health care costs continually on the rise, experts said it is more important than ever that medical schools, hospitals and first responders invest in technologies that truly deliver a discernible benefit over less sophisticated but cheaper alternatives.
Most medical schools in the United States have made simulation a large part of their curriculum. The University of California at San Diego and the University of San Diego, for example, have invested millions of dollars in simulation centers using many of the technologies that were put through their paces at the conference.
This increased utilization has provided room for research on whether simulation improves health care outcomes, said Dr. Dimitrios Stefanidis, a bariatric surgeon from South Carolina. He was part of a research team that examined the available evidence on simulation and published a review on the topic last year.
Stefanidis said there are multiple studies that have shown clinical skills do increase among medical professionals who use simulators as part of their training. The evidence indicates that allowing repeated practice of skills in low-pressure surroundings, and having detailed debriefings with instructors afterward, builds competency more effectively than more traditional educational methods.
He said there have also been a few studies that show some patients fare better when they receive care from a simulator-trained doctor. The strongest evidence of positive outcomes, he said, involves simulating insertion of central line catheters -- typically a significant source of infection and injury for patients.
It is less clear how much incremental benefit is added by increasing the realism of simulations. Here, the evidence is thinner, and there is debate over whether making a simulated procedure feel more authentic results in better learning, Stefanidis said.
In situations where simulation is simply being used to learn the right sequence of steps for a given procedure, there may be less benefit.
"If, on the other hand, you're teaching something where precision is a lot more important, having it look real, in my opinion, is more important," Stefanidis said.
SundayMonday Business on 02/08/2016