A surgeon enters the operating room, offers his hands to a nurse and watches as she helps him into his rubber gloves with a snap.
He glances at the patient on the table. A cloth covers the man's torso but for one area. Three trocars — tubes into which the doctor will slide high-tech cables — protrude from the abdomen.
The procedure is nothing new for Dr. Adrian Park, a surgeon at Anne Arundel Medical Center who has fixed thousands of abdominal walls, watching his handiwork on a video screen as he replaces herniated tissue with state-of-the-art mesh.
This time, though, the patient is a $200,000 mannequin. And that mesh is a kind he found at a craft store.
It's a simulated operation, the kind that will lie at the heart of efforts at the Simulation to Advance Innovation and Learning Center — or SAIL — a new multimillion-dollar teaching-and-research facility at the hospital.
In simulated surgery, a broad array of learners — from medical students and longtime doctors to nurses and operating-room technicians — can practice procedures familiar or new, working all the while under relatively low-stakes conditions, said Park, the center's founder and chairman.
At the learning center, "we can simulate everything from basic procedures to rare but potentially catastrophic events, even integrating them into the larger work flow of the hospital, and it will all contribute to our goal of being able to offer better patient care," said Park, known worldwide for his pioneering work in laparoscopic, or minimally invasive, surgery.
Hospital officials recently held a ribbon-cutting ceremony for SAIL, a 10,000-square-foot site made possible by a grant from Sylvia and James Earl of Annapolis. It opens for business Monday, playing host to a conference of neurosurgeons who will use virtual reality to study a new technique for removing certain brain tumors.
In a sense, there's nothing groundbreaking about the use of simulated patients in medical training. Instructors have used inert mannequins to showcase various forms of disease for centuries, and it was 45 years ago that a doctor at the University of Miami created the so-called "Harvey Mannequin," a $100,000 interactive dummy that could replicate the body's most basic cardiac functions.
Over the years, engineers devised ever more sophisticated mannequins, drawing on simulation technology in fields such as military aviation to allow faux patients to mimic everything from breathing and bleeding to eye movement and the process of giving birth.
Today's version of Harvey, for instance, replicates six different breath sounds and 30 cardiac diseases, and the amplitude and intensity of its heartbeat can be controlled.
Such advances have helped drive an explosion in the popularity of simulation technology.
"The use of simulation in medical and surgical training has increased tremendously during the past decade," according to a 2010 article in the Journal of Surgical Education. "Simulation centers are in development across the country — and the world. Boards of accreditation and professional licensure are increasingly insistent that simulation be incorporated into the preparation and assessment of care providers."
Park has long experience in the field, having founded the Maryland Advanced Simulation, Training, Research and Innovation Center, or MASTRI, at the University of Maryland Medical Center and School of Medicine in Baltimore, a facility that offers advanced training in laparoscopic surgery, among other fields, and integrates simulation-based education into the curriculum.
That's one reason Park was recruited to the 380-bed, Annapolis-based hospital in 2011.
"Adrian is considered one of the elite innovators in minimally invasive surgery, and he has been one of the leading proponents for evidence-based improvement in both the working environment for the surgeon and in outcomes for the patient," said Dr Steven Schwaitzberg, chief of surgery at Cambridge Health Alliance in Massachusetts and medical director of Interactive Surgical Systems Lab (ISSyL), a Harvard-affiliated facility that uses simulated surgical learning environments.
The American College of Surgeons has granted professional accreditation to 83 simulation centers so far, most of them in the United States. Of those, all but a few are affiliated with major university hospitals.
That's a blessing and a curse, Park said, because even though such settings are better able to acquire the funding necessary to equip "sim" centers, they tend to be more enmeshed in bureaucratic red tape.
SAIL isn't the region's only sim center, but it's the only one set in a working community hospital, a fact that appears to have inspired AAMC officials.
"The academic medical centers in this country have a critical role in education and research, but it turns out that most clinical care is actually provided outside of those settings. It's only appropriate for a simulation center of this scope to be deployed in this kind of environment," said Dr. Mitchell Schwartz, chief medical officer at AAMC.