Medical Simulator Training 

Systems for:

Maternal-Fetal Health

Surgery

Mark W. Scerbo, Ph.D.

Old Dominion University
Prevalence of Medical Errors

• In 1999, Institute of Medicine estimates medical errors 

may be responsible for 98,000 deaths a year in U.S. 

hospitals.

• In 2008, HealthGrades pulls actual Medicare records 

and confirms that medical errors contribute to as many 

as 80,000 deaths annually.

• The incidence of medical harm is estimated to be 

40,000 per day.

• Medical errors add $3 billiion/yr to healthcare costs.

• If medical errors were a disease, it would be one of the 

top ten contributors to death in the U.S.
Medical Errors: A Leading Cause of Death

Cause of Death Annual Fatalities

Heart Disease 1 (2006) 631,636

Medical Errors 2 (2008) 79,445

Diabetes 1 (2006) 72,449

Alzheimer’s 1 (2006) 72,432

Highway Fatalities 3 (2007) 41,059

Homicide 1 (2006) 18,573

Occupational Fatalities 4 (2007) 5,488

Wars in Iraq/Afghanistan 5 (2010) 5,420

Commercial Airline Fatalities 6 (2007) 0

1 www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_14.pdf, 2 http://www.healthgrades.com/press-releases/,

3 www-fars.nhtsa.dot.gov/Main/index.aspx. 4 www.bls.gov/iif/oshcfoi1.htm#2007

5 www.defenselink.mil/news/casualty.pdf on Apr. 9, 2010, 6 www.ntsb.gov/Pressrel/2008/080416.html
Some Virginia Statistics

• In HealthGrades (2010), of 42 VA hospitals reviewed, 

only 3 made it into the top 15% for patient safety, 

representing only 1.26% of all top performing 

hospitals in U.S. 

• of the safety events studied, VA ranks among the 

poorest performers, in the bottom 10 states.

• Thomson Reuters 2010 Top 100 Hospitals in (only 1 

in VA)

• VA ranks 9th in serious disciplinary actions taken by 

State Medical Licensing Boards (Public Citizen, 

2010)
Anesthesiology, Emergency Medicine, Nursing

Current Medical Simulators 

Systems

SimMan (Laerdal, Inc.)
Laparoscopic Surgery

LapSim

(Immersion Medical, Inc.) LapTrainer

(Simulab, Inc.)

Current Medical Simulators 

Systems
Commercial Simulators Across 

Medical Specialties

General surgery (laparoscopy) (8)

Emergency medicine (6)

Anesthesiology (4)

Radiology (3)

Obstetrics and gynecology (3)

Psychiatry/Psychology (2) 

Orthopedic surgery (1)

Colon and rectal surgery (1)

Urology (1)

Cardiothoracic surgery 

Physical medicine/Rehabilitation 

Plastic surgery 

Preventive medicine 

Ophthalmology

Medical genetics 

Neurology 

Neurosurgery 

Nuclear medicine 

Otolaryngology 

Pathology 

Allergy and immunology

Dermatology 
Simulation training 

systems that fill in gaps 

in medical curriculum
Maternal-Fetal Heart Rate Simulator

A training system for identifying potentially ominous 

signs in maternal-fetal heart rate tracings.
Technology Applications

 Accelerations, decelerations

 Defined by a bell curve shape

 Parameterization morphs curve into desired 

appearance

 Analysis of actual tracings to determine typical 

profile and frequency

 Short-term variability can be changed

 Heart rate baseline can be changed at any time

 Authoring interface for building custom 

scenarios

Technology Applications

 Play a custom scenario

 Play an actual patient record

 Real time and accelerated

 Play four concurrent custom scenarios
Sample MFHR Images

0-sec Delay

Marked Variability, S/N = .35

4-sec Delay

Moderate Variability, S/N = 1.0
Commercial Applications

• Can be used to train and assess medical 

students, residents, nurses, and other 

Labor & Delivery personnel

• Can be used in educational settings or 

clinical environments
Collaboration Opportunities

• Old Dominion University and Eastern 

Virginia Medical School welcome 

opportunities for collaboration and 

licensing arrangements

April 21, 2008

Sources of Error in the OR

PHYSICAL DEVICES

ERGONOMICS: displays, controls, workplace layout

INDIVIDUAL PERFORMANCE: cognitive and motor skills,

information processing

TEAM and GROUP BEHAVIOR: communication, task

responsibilities, coordination

ORGANIZATIONAL BEHAVIOR: safety culture, reporting 

practices, work scheduling, economics

LEGAL and REGULATORY RULES: legal liability,

work practice constraints

SOCIETAL and CULTURAL PRESSURES: politics, media scrutiny
April 21, 2008

Sources of Error in the OR

PHYSICAL DEVICES

ERGONOMICS: displays, controls, workplace layout

INDIVIDUAL PERFORMANCE: cognitive and motor skills,

information processing

TEAM and GROUP BEHAVIOR: communication, task

responsibilities, coordination

ORGANIZATIONAL BEHAVIOR: safety culture, reporting 

practices, work scheduling, economics

LEGAL and REGULATORY RULES: legal liability,

work practice constraints

SOCIETAL and CULTURAL PRESSURES: politics, media scrutiny

Current medical

simulators limited

to these areas
The Virtual Operating Room

• A fully immersive virtual 

environment 

representing a 

standard OR

• Incorporates real and 

virtual team members, 

equipment, and 

medical simulators
The Virtual Operating Room

• Surgical procedure - Laparoscopic 

cholecystectomy (gall bladder removal) 

performed on LapTrainer (Simulab, Inc.).

• OR environment modeled on a genuine 

OR 
Computer-Based Agents

 Architecture supports computer-based 

agents that substitute for team members

 Scripted agents follow procedures 

approved by subject matter experts

 Sequencing provided by hierarchical state machine

 Voice recognition triggers transitions

 State drives animations and specifies interactions 

with other agents
Simulation Infrastructure
Commercial Applications

The Virtual Operating Room

• Exercises the problem-solving, decision-making, 

and team skills of trainees in a contextually 

appropriate environment

• Can be used to train surgical teams, individually 

or in units 

• Provides training across specialties: surgeons, 

nurses, technicians

• Can be used to address all sources of error in the 

OR without putting patients at risk
• Provides tighter control over the training 

environment and manipulation

• Provides greater consistency in training 

experiences because the environment and 

scenarios are computer-based

• Can be deployed in a fully immersive or 

smaller scale environments

Commercial Applications

The Virtual Operating Room
Collaboration Opportunities

• Old Dominion University and Eastern 

Virginia Medical School welcome 

opportunities for collaboration in

– Physiological modeling

– Serious gaming

– Speech recognition and natural language 

interfaces

– Artificial intelligence and intent inferencing
Contact Information

• For further information contact:

Mark W. Scerbo, Ph.D.

Department of Psychology

Old Dominion University

Norfolk, VA 23529

mscerbo@odu.edu

(757) 683-4217