Pilots regularly train on simulators: Why don’t doctors?

Fourteen years ago, Captain Chesley “Sully” Sullenberger heroically landed US Airways Flight 1549 in the Hudson River, saving everyone onboard. While deemed a “miracle” on the Hudson, the truth is Sully’s decision-making during such a historic landing was informed by a combination of decades of experience and countless hours of simulation training. 

Airline pilots train on a simulator every six months and undergo rigorous flight reviews every two years, which has led to the airline industry’s incredible safety record (the National Transportation Safety Board estimates the chance of dying in a plane crash to be one in 29.4 million). By contrast, the chance of an adverse event contributing to death during a hospital stay is  up to one in 333. But nearly half of these events are due to preventable medical errors.   

Medical care is a human system, which means variation among people is natural and common. Doctors are people who sometimes display bad judgment, make mistakes and have memory lapses that can lead to complications and poor clinical care. The family of comedian Joan Rivers settled a medical malpractice lawsuit that claimed doctors performed “unauthorized procedures” that may have led to her death. Similar medical errors also affect millions of other patients who lack such name recognition.  

We acknowledge that no single “magic bullet” can fix the healthcare system, but there is evidence that simulation-based training is one solution to eliminate variability in clinical skills. After all, years in practice are not a proxy for clinical skills.  

A key source of the problem, according to recent research, is traditional medical education based on dated technology and old-fashioned ideas about how doctors learn. Despite transformative advances in medical research and clinical care, America’s current medical education model supports learning through passive methods, such as the time-honored apprenticeship model pioneered by William Osler in the 1890s. Its fundamental assumption is that longitudinal, chance clinical experiences are the best way to produce good doctors.

Most physicians have scant hands-on training once they enter clinical practice. The most common way physicians maintain their subspecialty board certifications is a multiple-choice exam, which is often open book. 

Our research at Northwestern University and at other academic medical centers shows that traditional methods of clinical medical education are obsolete and need reform to better prepare doctors to serve today’s patients. Medicine needs to catch up to the training and certification procedures used by aviation and other high-risk industries in which professionals engage in frequent simulation.

In our simulation lab at Northwestern University Feinberg School of Medicine, doctors and other clinicians practice their skills in surgery, invasive procedures such as colon polyp removal (during routine colonoscopy) and central venous catheter insertion and maintenance, advanced cardiac life support, communication and several other clinical skills. Throughout this process, they receive rigorous assessment and feedback to ultimately achieve nearly flawless, mastery standards. Our work at Northwestern and research at other institutions show that clinicians trained in the simulation laboratory to mastery standards provide patients with safer care than those who were trained by more traditional methods.

Simulation is now a standard teaching tool used throughout medical schools, but to fully benefit from integrating simulation-based education into clinical practice, it will require the combined efforts of medical schools, healthcare systems and regulatory agencies. Funding medical education research must also be a top priority of federal and state grants.

Our patients expect their doctors to be competent. To meet this expectation, clinicians should be required to use simulation to demonstrate competence as part of their privileging and credentialing processes. Multiple studies demonstrate that simulation-based education produces better clinicians (individuals and teams), mitigates errors/mistakes, improves patient outcomes — and lives — and saves money. The evidence is clear and it is long past time to answer this call. 

We must dispense with 19th-century thinking and technology to train doctors for today’s high-tech medicine. The lives of our patients depend on it.

Drs. Jeffrey Barsuk and Diane Wayne are professors of medicine and medical education; Dr. McGaghie is professor of medical education and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago. Barsuk is the director of Feinberg’s simulation laboratory.  

Editor’s note: This piece was updated on Feb. 12 at 10:25 a.m. ET to correct a figure related to adverse events and hospital deaths.