Interview: Ivette Motola, MD, MPH, Assistant Director, Gordon Center for Simulation and Innovation in Medical Education; Director, Prehospital and Emergency Healthcare, Gordon Center

By Chuck Oldham

Veterans Affairs and Military Medicine Outlook: What is the background of the Gordon Center? When was it established? What is its mission and philosophy?

Ivette Motola, MD, MPH: The Gordon Center’s mission is to save lives through simulation technology. Our vision is to create a safe and engaging environment where innovation, simulation, and education come together to prepare learners to provide life-saving care to patients. We are a designated Center of Excellence of the University of Miami Miller School of Medicine. The Center was established almost 50 years ago for the application of advanced technology to training for health care students, physicians, physician assistants, nurses, first responders, and educators. Since then, more than 2,000 institutions worldwide have been using the educational systems developed at the Gordon Center.

What are some of the more important achievements of the Gordon Center?

We train thousands of first responders and frontline personnel annually at more than 740 agencies in the state of Florida. Through our Advanced Stroke Life Support program, we train around 10,000 health care professionals every year, on four continents and in 13 languages. More than 700 institutions in over 50 countries use Harvey, the cardiopulmonary patient simulator we first introduced in 1968.

How did the Gordon Center’s partnership with the U.S. Army begin?

The Army Trauma Training Detachment began as a partnership with the University of Miami in the wake of the attacks on Sept. 11, 2001. We knew we had to band with the brave men and women of our military to provide them with the best possible trauma care through medical simulation training of their forward surgical teams. And that’s what we did. The relationship with the University of Miami, Ryder Trauma Center, and the Gordon Center is the Army’s longest-running civilian partnership for trauma training.

How has the partnership changed over the years and what is the nature of the program or programs?

Initially, the partnership began with helping Army Forward Surgical Teams with team training and skills practice for wartime readiness. This included training to properly don and doff personal protective equipment to stay safe during attacks using weapons of mass destruction, such as nerve and biological agents.

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Over the years, the Gordon Center has helped support the Army Trauma Training Detachment and the Forward Surgical Teams in many ways, including cadre faculty development in simulation education, training space and equipment, and exploring novel ways to train their teams. We have also collaborated with them on several research projects and educational initiatives.

How do such partnerships benefit the military, and how do they benefit civilian first responders?

Our partnership has benefitted the military by helping provide forward surgical and other military health care teams with the latest, evidence-based training in battlefield and acute-care medicine. This training has been directly linked to helping save the lives of military personnel in harm’s way.

Augmented reality simulations are one of the ways the Gordon Center has applied advanced technology to training.

Some of the courses taught today for first responders, such as the Gordon Center’s Active Shooter Hostile Events and Emergency Response to Terrorism courses, evolved from Army Forward Surgical Teams training. These courses teach the same skills to civilian providers – such as tourniquet application and rescue task force – and incorporate the same training techniques, simulations, and tactics that had been used previously in the military context.

Can you describe the Gordon Center’s role in training U.S. Army Forward Surgical Teams?

The Gordon Center has served as a center for pre-deployment training of Army Forward Surgical Teams, giving military health care professionals the clinical expertise they require to help save lives.

Army Forward Surgical Teams and Special Operations military teams are trained in a multitude of challenging scenarios. During the two weeks the teams are on site, we provide the resources to intentionally replicate what they are going to experience downrange. The training focuses on both skills refinement and team training to help with readiness upon deployment. Each team member needs to be proficient in multiple skills and ready for anything.

Could you explain how the Gordon Center was chosen as an international simulation center of excellence that trains U.S. Special Operations Military Teams?

The University of Miami partners with Ryder Trauma Center, a level 1 trauma center which treats many conditions and injuries that are similar to traumatic battlefield-type injuries, such as gunshot wounds, burns, and traumatic hemorrhages. This setting allows military healthcare teams practice in the skills they will require to treat soldiers. Additionally, the Gordon Center had a well-established reputation and expertise in training using simulation and innovative technologies and educational research.

Has medical simulation grown in importance over the years? How have the technologies and their applications changed?

Yes. The use of health professions simulation training and assessment has grown exponentially over the past two decades, driven largely by the need to provide uniform learning experiences, improve patient safety, and to ensure competence of health care providers.

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The Gordon Center offers training programs in various disciplines, such as emergency medicine, disaster response, and cardiology, using blended-learning platforms that combine online interactive educational materials and hands-on skills practice. In addition, Gordon Center curricula are based on best practices, latest scientific evidence, and guidelines from professional organizations.

Innovative tools are incorporated in the immersive learning experience and include simulation scenarios, videos, interactive 3D graphic animations, extended reality, diagnostic imaging, and, in certain courses, hands-on practice with Harvey, the cardiopulmonary simulator.

Can you tell us about the recent research study conducted for the Department of Defense?

There have been numerous research studies conducted over more than a decade in partnership with the Department of Defense. For example, we help demonstrate the effectiveness of “just in time” training for certain procedural skills for military providers. The Gordon Center has also helped to develop and validate materials for the Defense Health Agency’s Deployed Medicine website.

This past year, the Gordon Center conducted a research study sponsored by the U.S. Department of Defense to evaluate whether complex procedures can be taught to trainees using telemedicine while a remote expert instructor guides them through procedures with the assistance of augmented reality. For example, a virtual overlay of the relevant anatomy is displayed to assist learners as they perform procedures on an actual, physical task trainer.

The Gordon Center has worked for years with Army Trauma Training Detachment personnel.

In another DHA study, the Gordon Center is evaluating the effectiveness of Tactical Combat Casualty Care training for all service members. In particular, we are focusing on training tourniquet application skills. We are also conducting research to validate assessment instruments used in this training.

How do you see the Gordon Center’s programs and partnerships in medical simulation and education going forward in the future?

Going forward, we envision greater use of simulations involving extended reality and artificial intelligence technologies. In addition, with the use of evolving communications platforms, new applications such as telemedicine and tele-simulation offer increasing opportunities to reach learners and providers remotely. This is particularly relevant in the military context to provide ongoing training and maintenance of skills for deployed personnel.