Endowed chairs:
MUSC simulator research promises economic benefits
By Dan McCue
Staff Writer
Editor’s note: This is part of an ongoing series on the endowed chairs that have been created by the state’s research universities in hopes of fostering the biosciences throughout the Palmetto State.
To most observers, Dr. John J. Schaefer’s mannequin-based medical simulator is where the rubber meets the road for the potential of the state’s new endowed chairs to have a tangible, near-term impact on economic development.
Even Schaefer himself, the former director of the Peter M. Winter Institute for Simulation, Education and Research at the University of Pittsburgh, sees a timeline of only two to five years for taking his research from the lab to the commercial market.
Schaefer, in Charleston and on the campus of the Medical University of South Carolina since February, is overseeing the development of a statewide simulator research and education program with sites in Charleston, Columbia and the Upstate.
“In Pittsburgh, we were able to take our research and expand its application to a $3.5 billion university health system, but the problem with going further in Pennsylvania is it’s very hard to get one university to work with another, or even to get one health care system to work with another,” Schaefer said. “South Carolina is very different, and that’s why I accepted the challenge and took the risk of changing my career path and moving my family here.
“In South Carolina, the three research universities, each with its respective strengths, have a tradition of working together and working collaboratively with the business community. If we can fulfill my objectives, it’ll go a long way toward generalizing my research and expanding its application elsewhere.”
The girl in the river
To understand exactly what Schaefer is doing and why the state’s three research universities were so keen to have him accept an endowed chair, one first needs to know a little of the history of mannequin-based medical training.
Although technology has long been used to simulate specific situations in training in aviation, the military and other areas, it’s a surprisingly new development in the medical field.
The established model of medical training in the United States grew out of the Flexner Report, an evaluation of American medical schools published by the Carnegie Foundation in 1910.
It was Abraham Flexner and his colleagues, in cooperation with the American Medical Association, who established the training paradigm of four years of college, followed by four years of medical school, the last two of which should consist of an apprenticeship or residency at a teaching hospital.
However, there was a rub to this kind of training, intensive as it was: Almost every medical student tried his hand at advanced medical procedures on a live person.
The slow evolution toward simulation began in the 1950s when Dr. Peter Safar, one of Schaefer’s mentors and a pioneer in emergency medicine, developed the method of mouth-to-mouth resuscitation combined with chest compressions that we know today as cardiopulmonary resuscitation, or CPR.
To more effectively teach the procedure, Safar came up with the idea of a life-sized doll on which students could practice. He enlisted a toymaker, Asmund Laerdal, to manufacture the mannequins, something Laerdal’s company continues to do to this day.
In Schaefer’s office at MUSC is a face under glass very much like the one Laerdal and Safar used for their mannequin. “She’s always been known as ‘Resusci-Annie,’” Schaefer said.
He then quickly told the story of the anonymous young woman whose face has been immortalized by medical research.
“Her body was fished from the Seine River around the turn of the century, and she was never identified. It’s believed she’d been a suicide,” he said. “A death mask was made of her face, in hopes of establishing her identity, but to no avail.”
The beauty of the face, however, made it an objet d’art, and copies were sold in large numbers. Laerdal began incorporating it into its CPR dummies beginning in 1960.
Schaefer, whose official title as an endowed chair is associate director of statewide clinical effectiveness education, first became interested in the field of airway management and anesthesiology while still a medical student at West Virginia University, at a time when mannequins used in medical training began to get a little more sophisticated in terms of the technology with which they were augmented.
After several only partially satisfying experiences, Schaefer reworked the mannequin in his workshop, getting it to do more of what he wanted.
“The thing is, we have a lot of very good techniques for airway management, but they’re dangerous in inexperienced hands,” Schaefer said. “In fact, in traditional training, the school I came up in, you literally thought, ‘to save a life, I may have to risk it.’
“What I was working toward was developing a mannequin that could simulate the conditions of a lot of different types of patients. As a student, you then could figure out what the condition was and formulate a response to it, removing the risk of patients being exposed to all the things that can happen early in the resident’s learning curve.”
Soon he helped establish the first simulation training center using mannequin-based simulators at the University of Pittsburgh.
“There was only so far I could take my advances. I’m a doctor, not a businessman, so we sold the technology to a Texas company that was eventually bought by Laerdal,” he said.
Sophisticated simulators
Schaefer served as the director of the university training center beginning in 1997 and led a multi-partnered expansion of the facility and its program, making it the most active academic simulation center of its kind in the world.
Schaefer co-holds patents for the development of the human simulators, including the most successful mannequin-based human simulators currently on the market, and has participated in the development of hardware and software for the latest generation of human simulators of this type, including infant simulators.
“Basically this started with the mannequin everyone is familiar with. We added simulations of heart and lung activity, made it programmable to simulate different conditions and now have added a measuring system which can assess student progress with the simulator,” he said.
The next phase, a continuation of what he was doing in Pittsburgh, is measuring the impact the training is having in real-life situations at MUSC and at the teaching hospital partners of Health Sciences South Carolina.
Creating business opportunities
As a physician, Schaefer readily concedes that his bottom line is improving training to produce better nurses, better doctors and, by extension, patients who benefit from enhanced care.
However, his other bottom line, the economics of his endeavor, is never far from his mind.
“In terms of moving forward, we’re very mindful that there are significant capital costs associated with this kind of extensive, groundbreaking research,” he said. “We’re doing things like buying in bulk when we can to save on costs.”
But, Schaefer admits, there will soon come a point when he can take simulators no further.
“As I said earlier, I’m a doctor, and my business knowledge is limited; my research will continue, but it’ll take a company of some kind to really grow the application, selling it to hospital systems and offering evaluation and feedback software that can be downloaded into your remote hospital system,” he said.
Dan McCue is a staff writer for the Business Journal. E-mail him at
dmccue@charlestonbusiness.com.
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