Patient safety initiatives are increasingly directed at improving both the individual and collective skills of teams of health care professionals. The Institute of Medicine estimates that poor communication among health care professionals is a major source of those errors. In an effort to increase patient safety, several centers around the country are using simulators to train physicians to more effectively care for patients.

The Clinical Simulation Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis is one of several grant recipients involved in a federal initiative — funded by the federal Agency for Healthcare Research and Quality (AHRQ) of the Department of Health and Human Services — that hopes to improve patient safety by designing more effective training and assessment strategies using simulation. This simulation-based research is used to establish practice and competence standards for physician skills that are directly applicable to patient care.

David Murray, MD, the Carol B. and Jerome T. Loeb Professor of Medicine, and his colleagues have been using simulators to help assess and improve physician competence for more than a decade. This new project continues that training to include the more complex skill sets in specialty practice, but it also investigates how communication can break down between members of medical care teams during simulated acute-care events.

In a typical test of communication, one or two members of the team working in the simulation center are scripted. They know what’s wrong with the mock patient and are coached to react in predetermined ways. Unscripted team members then are assessed, both for their competence in diagnosing and treating simulated problems and for their ability to communicate with the scripted members of the medical team. The goal of the research is to gain insight into the common causes of communication failures, and ultimately to bring significant changes to the practice of medicine that will improve patient safety.

Other research areas

Murray and other faculty members in the School of Medicine’s simulation programs have published a number of scientific articles on topics such as setting standards for mannequin-based acute-care scenarios and whether an inventory of simulated intra-operative scenarios provides a reliable measure of anesthesia residents' and anesthesiologists’ skill.

Research projects currently underway include:

  • A Web-based program for ultrasound training (supported by the Anesthesia Patient Safety Foundation): The use of ultrasound to guide central line insertion has been shown to improve patient safety, yet relatively few training programs teach health care professionals how to use it for this purpose. The goal of this proposal is to develop a web-based training program that can be used to train professionals across the United States and to validate its effectiveness.
  • A simulation-based pilot curriculum for team training in obstetrics (funded by the Barnes-Jewish Hospital Foundation): In this study, a group of experts from multiple disciplines is designing a simulation-based training program for obstetric emergencies. The project goal is to develop an obstetric simulation-based team training program that serves as a prototype for designing training for other health care professional teams.