Gary Meller MD, MBA

MedSim USA, Inc

Medical education for thousands of years was based on the experience of an apprentice learning from a master. The newest generation of computer technology has stimulated the development of a broad set of new technology applications for learning. In the place of videotapes, recorded lectures, or animated textbooks, the latest generation of computerized education incorporates the technology of virtual reality and the realistic simulation of complex human functions. These developments will lead to the incorporation of simulator based education in the curriculum of medical schools and allied health professions. This technology provides a level of realism and interactivity long absent from education. In effect, we will be returning to a virtual apprenticeship.

In order for these changes to be adopted by the educational system, we must focus, not only on product development and technology, but also on the creation of the market for simulation in education. Simulation technology has been already widely adopted in these fields:

0. Pilot training
1. Aircraft navigation
2. Marine operations
3. Power generation
4. Industrial process control
5. International telecommunications.
6. Battlefield training

Education simulators are available or under development in the areas of:

0. Human anatomy and physiology
1. Pharmacology and pharmacodynamics
2. Anesthesiology
3. Diagnostic, interventional and therapeutic radiology
4. Cardiology, electrocardiography, and echocardiography
5. Laparoscopic surgery
6. Nursing procedures, physical therapy and physical diagnosis

Additional applications are under development for arthroscopic surgery, laser ophthalmologic surgery, and vascular procedures. New applications appear each month. The field is growing rapidly as the underlying technology advances, and the need for advanced clinical education becomes more important.

This article will explore the development of the market for medical simulators. Educating the market and the customer is a critical activity for any new technology. Helping those customers to adopt and use the technology, and purchase the products, is essential for success.

We are currently in a situation analogous to the fourteenth century when the publication of books became possible with the advent of resettable type. Textbooks prior to Gutenberg’s innovation had to be printed on carved type, or copied by hand. Access to these texts was limited, and most education was done either by lecture or by apprenticeship. Today, we have a situation which promises to reverse our dependance on textbooks, and allow the student to experience firsthand many of the essential elements of medical education. The dissemination of simulator based education will take time. The machine alone is not sufficient for the adoption of this technology, it must be accompanied by a carefully prepared curriculum in order for educators to want to invest their time and money.

Economic and social factors are driving the change to new forms of education. Experienced clinical professors are both costly and scarce. Good teachers are harder to create than good practitioners. The teacher must not only understand and practice a skill or body of knowledge, but they must be able to communicate these skills to students of different aptitude and ability. This talent is rare. We all remember the exceptional teachers we have had. The indirect costs of putting students into clinical settings are high. There is a significant opportunity cost having students in a hospital or clinic. As the health care system struggles with the need for higher productivity, medical education is an early loser.

Medical and allied health training is always occupational as well as cognitive. There is a skill component which must be transmitted along with a knowledge component. The need to train and teach simultaneously makes this education among the most expensive for society.

The adoption of new technology is slow in education, usually constrained by budgets and the needs of teachers. The first users are generally experienced and sophisticated leaders in their field. These individuals are eager to evaluate new ideas. This phase can last several years. Changes are made in one program at a time. Adoption spreads from one department to the next, encouraged by the enthusiasm of students, and by results on examinations. The technology is picked up by additional schools. As word of mouth spreads, additional programs will follow the leaders and begin to incorporate simulation programs into their curriculum.

Who are the influential groups and individuals sponsoring adoption of simulators? Several key target segments can be identified. Teachers who can readily understand the usefulness of the simulator are the primary target audience. This includes both educators and program directors. Students can create demand for easier methods of learning. These individuals should be contacted early in the development process so that their ideas and requirements can be built into the simulator and it’s curriculum. Let the market help define the product. We have discussed the process of market analysis and product design in an earlier article in this series. (See Focus on Product Development in the Fall/Winter issue of Medical Simulation and Training). This feedback also creates word of mouth advertising, and helps to generate a base of support for future customers. It is helpful to identify individuals who are interested and adept in computer technology in order to create a “positive buzz.” Programs with specific needs and requirements may be able to perceive the need for innovation. These groups may already be adept at implementing change.

During the development process, it is important to inform, educate, demonstrate and communicate to potential customers. A common mistake made is to assume that everyone in the market has already heard about a simulator before it is developed. This is never true. The development team may be saturated with industry information, while potential users have heard nothing about the product. Showing the product during development stages can be risky if the product has problems, but it can generate great enthusiasm about potential future applications. This will lead to early identification of leading users. The market dynamics of a new product introduction suggest that satisfied early users are the most influential in leading to rapid growth in sales. You can cultivate this kind of market acceptance. Begin advertising the product before it is ready for delivery. Use product development and market research as extensions of the advertising effort.

It is helpful to place the product in programs with high visibility in the user community. These “name” institutions are home to “luminaries” and have a reputation for innovation or excellence. It is useful to support these programs with special projects, research grants, support staff, etc. The process of curriculum development can also be an important adjunct to market communications.

Any form of professional recognition or official sanction can assist the adoption of a simulator product. State and local governments have created programs to encourage the adoption of new technology in education. Grants may be available to

support the purchase of equipment, or for special projects. Companies should help the schools to develop sources of funds from private groups and foundations, public funds, and clinical care organizations in the community.

The company should carry out an ongoing market surveillance program to see how other simulators are being used and to identify potential new customers. In the classroom of the future, multiple simulators will be used. The company may be able to create cooperative marketing agreements with other developers to sell simulators jointly.

The adoption of simulator based education will be driven by economic factors. The cost of reproducinideal clinical experience for students is much greater than the cost of creating the same experience using a simulator. In the clinical environment, the time spent by the educator, patient and the student is expensive. Using the simulator, the student can conduct the same clinical examination, without a patient, and often without a professor present. The educator can select and program which clinical situations the student will encounter, and in what order. This offers advantages over the random and unplanned scheduling of the clinic.

While the initial capital outlay for a simulator may be high, the per student cost of training, and the flexibility of the program, will more than justify the cost. Initially, teachers are concerned about the effectiveness of this type of training. Studies have documented the validity of the learning methodology, and the standardization which it allows. Future products and curriculum will broaden the impact of simulator based education.

Companies involved in the development of simulators can enhance the adoption of this technology by working with organizations which regulate, credential, and accredit the professions which are affected. As these organizations learn about simulators they will adopt educational and evaluation programs which are based on the simulator. This encourages the user community to adopt them more rapidly. Having an accreditation organization accept the simulator for continuing medical education and examinations is a great step forward towards acceptance, and future sales.

Companies in the field of medical simulation must address many issues. While product development concerns seem most important, marketing should not be ignored. Helping future customers to understand and accept the use of simulators in medical education will help ensure the success of the company. Modify the market environment so that the simulator will be eagerly anticipated and well received. Understand that simulated education is the next stage in the evolution from apprenticeship to virtual direct training.