Headquarters U S Air Force Integrity Service Excellence

Headquarters U. S. Air Force Integrity - Service - Excellence Air Force Medical Modeling & Simulation Program: “Building the AFMS Cloud” Colonel Deb Burgess, MD, FACP Chief, Medical Modernization Division Headquarters, Air Education & Training Command 20 July 2010 1

Overview n Mission/Vision n Program Overview n Training Limitations n Future Technology n The AFMS Cloud Huffman Prairie – AF Island on Second Life Integrity - Service - Excellence

Air Force Medical Modeling and Simulation Program Mission Integrate Modeling and Simulation Technology into all AF Medical Education, Training and Sustainment Platforms Vision Build a Distributed Simulation Network, Create Simulation Centers of Excellence, and Exploit Technological Innovation Battlefield Trauma, Critical Care Air Transport, In Garrison Care, Patient Safety, Humanitarian Missions, CBRN, Disaster, Homeland Defense and Pandemic Response Integrity - Service - Excellence

Air Force Medical Modeling & Simulation Target Areas n Combat Casualty Care n Critical Care Air Transport/Aeromedical Evacuation n Proficiency & Sustainment Training n Graduate Medical Education n Nurse and Allied Health Education n Patient Safety & Team Training n Pandemic Response n Natural Disaster & Homeland Security Response Integrity - Service - Excellence

Medical Modeling &Simulation: Playing Catch-Up n 1960’s—Resusci Anne n 1994—Peter M. Winter Institute for Simulation Education and Research (WISER), UPMC n 1995—International Meeting for Simulation in Healthcare n 1999—National Capitol Area Medical Simulation Center Established (USUHS) n 2004—Society for Simulation in Healthcare Integrity - Service - Excellence

Medical Modeling & Simulation: Training Platforms Computer-Based Training (CBT) Standardized Patients Human Patient Simulators Task Trainers Laparoscopy Anastomosis Bronchoscopy Integrity - Service - Excellence Central Line

Medical Modeling & Simulation: Training Platforms Serious Gaming for Operational Medicine Squad-Based Multi-player Avatars & Virtual Words Immersive Virtual Environments Single or Multi-player “Holodeck” Integrity - Service - Excellence

“On-The-Job-Training” Not An Option Integrity - Service - Excellence 8

Current Program Central Program Office (AETC/SG) n Provide CONOPS, strategic plan and oversight, Simulation training & execution consistent across AFMS n Standardize and validate current & future simulation req’s n Ensure total asset visibility n Equipment packages c/w requirements and training platform n Staff contract support n Consultant for equipment purchases/bulk negotiating agent n Staff assistance and technical support n Program for sustainment through corporate process n Integrity - Service - Excellence

Distributed Simulation Training Network: Tier I Sites BEGINNING VALIDATION STUDIES OF THE SIM EXPERIENCE n Wilford Hall * n Keesler * n Travis * n C-STARS Saint Louis n C-STARS Baltimore n C-STARS Cincinnati n USAFSAM - EMEDS * n Lakenheath, UK n National Capitol Area Simulation Center (USUHS) n Defense Medical Readiness Training Institute (DMRTI) LAKENHEATH USAFE * Simulation Operator Course – Community College of the Air Force Certification/Special Experience Identifier Integrity - Service - Excellence

Distributed Simulation Training Network Central Program Office Tier 1 Students Tier 2 Knowledge Sharing Tier 2 Standardized Curriculum and Scenarios Tier 2 Students Tier 1 to Tier 2 & 3 sites Tier 3 Dynamic Network for Knowledge Sharing Integrity - Service - Excellence

Current Program: Distributed Simulation Network n 33 Medical Simulation Scenarios loaded on the Knowledge Exchange (KX) n Relational Database for cross referencing; Inventory ID n CME/CEU/EMT credit now available for time spent in the simulation lab n Must use standardized scenarios on the Kx n Simulation training incorporated into medical RSVP Integrity - Service - Excellence 12

Web-Based Simulation E&T Tool Defense Connect Online & Web Based Tool Simulation Supervision Image Sharing 13 Procedure Supervision Multi-User Collaboration Integrity - Service - Excellence

Challenges of Conventional Training n Lack realistic simulation--surgical & invasive procedures n Fail to exhibit dynamic physiological sequela of trauma management and critical care n Students cannot appreciate or anticipate complex pt care n Simulation curriculum is not standardized n Variable quality and execution n Training is not reproducible internally or within the AFMS n Dependant upon availability of skilled instructors, simulation operators, program directors and SMEs Integrity - Service - Excellence 14

Challenges of Conventional Training n Low throughput – extensive set-up & breakdown time n High student-instructor ratios limit: n # of decision-making training sessions n Individual instruction opportunities n Objective performance metrics not established, tracked or archived n Feedback variable, format not standardized: verbal vs taped AAR n Lost workload and cost if TDY to simulation center Integrity - Service - Excellence 15

Future Technology Technological advancement is accelerating at an exponential pace. Future education and training platforms must be as innovative as the young Airman we wish to recruit. We need to be on the cutting edge Integrity - Service - Excellence 16

The Future is Upon Us Integrity - Service - Excellence

Virtual Reality and Avatars n Leverages gaming technology n High throughput n Available 24/7 n Standardized, Performance Metrics Tracked, AAR n Visit remote locations before deployment n Equipment familiarization Integrity - Service - Excellence 18

Avatars and Virtual Worlds: Educational Uses n Artificial Intelligence n Triage/Trauma/Disaster Response n Virtual Patients/Humans n Scenario and Simulated Illness Practice n Team Training and Group Exercises n Interview Skills, Cultural Training n Anonymous Supervision n Empathy Training/Doctor-Patient Interaction n Virtual Classroom Integrity - Service - Excellence 19

Future Technology Blended Learning – Live, Virtual, Constructive, Gaming n Didactics n n n Open courseware Electronic books, journals Available 24/7 Portable device Learning Management System n n n Enterprise-wide solution Track and archive metrics from all learning sources Historical documentation Integrity - Service - Excellence

Future Technology n Virtual Medical Campus, Medical Gaming, LMS In Garrison and Deployed Environments n Air Force Theater Hospital (Balad & Bagram), C-17 walkthrough n Hospital or Aircraft Tour, Equipment Familiarization n Patient Management Scenarios n Virtual Iraq & Virtual Afghanistan Integrity - Service - Excellence

Future Technology: Serious Gaming “Operational” Rehearsals – Virtual Surgery n Scenarios: Trauma, Critical Care, Burns, CPGs from JTTR n Solo or Multi Player n SCORM compliant, performance metrics tracked, archived, AAR n Display dynamic physiological responses trauma & tx n Train for “worst case scenario” and catastrophic complications n Map to task trainer or simulator (mannequin) n Must work on standard desktop computer n Integrity - Service - Excellence

Future Technology: Knowledge Management Infrastructure is Knowledge Centric NOT Network Centric n Enterprise Learning Management System n n n Tailored learning – Learner Centric n n Type of learning environment Rate of information delivery Knowledge pushed & pulled on demand Information access 24/7 n n n Overarching Framework Data tracking (performance metrics) Enables archiving/historical documentation Persistent environment Public, NIPR, SIPR, portable device Identify/incorporate new technology n n Based on requirements Live Virtual Constructive Gaming (LVCG) Mix Integrity - Service - Excellence

Future Technology: Knowledge Management Mobile Learning n Ensure access to Knowledge Base information (reach back) n Enable quick, informal learning “on the go” n Access whenever and wherever needed – airport, AOR n Enable communication and collaboration n Deliver learning content through videos, simulations and text messaging n Matches learner needs Integrity - Service - Excellence 24 24

AFMS Cloud Architecture AIR FORCE MEDICAL SERVICE Evolutionary Phased Development HAPTICS 6 3 MEDICAL SYSTEM CBT/EBOOKS MANAGEMENT LEARNING 1 AFMS WEB PORTAL 5 Performance Metrics MEDICAL SIMULATION VIRTUAL ENVIRONMENT LIVE TISSUE MEDICAL 2 SIMULATION TRAINING 4 GAMING MEDICAL MODELING & SIMULATION Integrity - Service - Excellence 25

Way Ahead n Air Force Strategic Plan for Future Technology R&D n Joint Do. D Cloud n Partner with Professional Societies, Academia n Systematic Approach to New Technology Integration n Investment Strategy to Resource & Sustain n Close Integration of Training & Operations n Rapidly Integrate Lessons Learned Integrity - Service - Excellence 26

AFMS Medical Modeling and Simulation Vision Theme: CENTER DEVELOPMENT Phase: 1. Simulation Centers Doctrine Organization Training Materiel Personnel Facilities 3. Educate/Train Med War Games 2. AFMS Distributed Simulation Network Joint integration for training/war games Service Primary Location/Med Facility Consolidation Standardized Service Materiel Solutions Integration of training sites Standardized Joint Integration Updates Standardized Joint Materiel Leadership JOINT INTEGRATION SERVICE SYNERGY Standardized Service Synch Updates Materiel Solutions Innovation Solutions Materiel Solutions Joint Service Tier 1 Sites Tier 2 & Tier 3 Sites Distributed Human Patient Simulation Network Joint Simulation Centers: NCR/SAMMC Where we are now Integrity - Service - Excellence

Questions? Col Deb Burgess, MD, FACP Office: (210) 652 -9720 Deborah. burgess@us. af. mil Integrity - Service - Excellence 28