Michael S. Gordon, MD, PhD and the University of Miami Center for Research in Medical Education

“The heights by great men reached and kept were not attained by sudden flight, But they, while their companions slept, were toiling upward in the night.”1 Beginning in January 2007 at the International Meeting on Simulation in Healthcare, a new and permanent feature will appear: The Michael S. Gordon Center for Research in Medical Education Lectureship. Endowed by private donors from the University of Miami, this lectureship will recognize invited speakers who have made outstanding contributions to healthcare simulation and patient safety in the areas of technical achievement, curriculum development, program implementation, teaching and/or outcomes assessment. The benefactors of this lectureship are long-term believers in the promise of simulation to enhance patient care and safety. On behalf of the Society’s designation of this lectureship, I would like to present a closer view of Dr. Michael Gordon and his impact on healthcare education. TRAINING Gordon received his BS, MS, and MD degrees from the University of Illinois and his PhD from the University of Minnesota. He completed his residency in Internal Medicine at the Mayo Clinic and was a postdoctoral research fellow of the National Institutes of Health (NIH) studying myocardial enzyme kinetics. He was subsequently a cardiology fellow at Georgetown University with Dr. W. Proctor Harvey. Under Dr. Harvey’s influence, he changed his career aspirations from basic research to medical education. Stimulated by his background in basic science research, Dr. Gordon emphasizes rigorous design and evaluation in all of the projects he undertakes in medical education. COLLABORATION Since coming to the University of Miami in 1966, his major interest, in addition to patient care, is the application of simulation and technology to medical education. He drew on his background and training as a basic science researcher and applied this to medical education. To carry out this mission, Dr. Gordon set out to create an NIH model for medical education to be located at the University of Miami—a central resource that draws on the talents and expertise of individuals who share his mission and expect higher standards of medical education for the betterment of patient care. This resulted in the creation of a multi-institutional, multidisciplinary collaboration initially named the “Harvey” Group (later renamed the MIAMI group), an international consortium of physicians, educators, engineers and computer program designers. For the past 35 years, this group has met quarterly to design innovation simulation tools, develop curricula content, and devise evaluation and measurement methods to perform outcomes-based research. This group ensures the validity and credibility of all programs developed and also ensures that the programs created are generalizable beyond a single institution. As a result, nearly every study carried out by this group is multicenter in design and implementation. STATE-OF-THE-ART FACILITIES An important foundation for the long-term success of these projects was the University of Miami Center for Research in Medical Education (CRME), a free-standing 14,000-square foot facility that Dr. Gordon created and funded. The CRME has comprehensive facilities for simulation and computer-design engineering and production. The Center is a unique laboratory for the application of advanced technology to medical education for medical students, physicians, physician assistants, nurses and paramedics/firefighters. For nearly 25 years, it has housed simulation-based training facilities, including a high-tech immersive learning auditorium, a self-learning computer laboratory, standardized patient training area, an actual fire rescue vehicle, an automobile for realistic extrication of trauma victims, a hazardous materials decontamination shower and a mock emergency department. HIGH-FIDELITY SIMULATION (“HARVEY”) The most long-standing example of the applied research developed by Dr. Gordon to improve training and evaluation of learners is Harvey, the Cardiopulmonary Patient Simulator. Dr. Gordon adopted an unconventional view of medical education and skills training when he first conceived of Harvey in 1966: at that time, most medical training took a “follow me” approach with live patients. The limitations were that sometimes there were no patients available with certain diseases being taught, and that patients in teaching hospitals often tire of so many people examining them for teaching purposes. So Gordon set out to create a patient specifically for training purposes. The result was Harvey, the Cardiopulmonary Patient Simulator, a full-size manikin named for Dr. W. Proctor Harvey. Initially, Gordon built three “Harveys,” each simulating a single disease. He first presented them at the American Heart Association Scientific Sessions in 1968—making Harvey the longest continuous simulation project in medicine. Over the course of the next several years, Gordon developed a single manikin that simulated multiple diseases.2–5 In 2005, Gordon and his team introduced an all-new Harvey with advanced digital technology to simulate 30 cardiac and pulmonary diseases. The new model addressed some of the challenges and limitations of the earlier generations—dramatically lighter and more portable. Throughout its history, Harvey has undergone rigorous testing and evaluation to measure its educational effectiveness. A rigidly controlled, multicenter study, supported by the NHLBI and independently evaluated by the University of Illinois, demonstrated that the bedside skills learned on Harvey transfer to real patients.6 The global acceptance of this work is reflected by the fact that the American College of Cardiology’s Task Force on Teaching recommended Harvey for day-to-day training in bedside skills.7 In addition, the British Heart Foundation placed the simulator at all of the medical schools in the United Kingdom.8 COMPUTER-BASED CURRICULAR SYSTEMS Early on, Dr. Gordon realized that having a simulator was not enough; there have always been examples of new advanced tools that collect dust soon after the initial enthusiasm begins to wane. An important component necessary to ensure the long-term success of a simulator is the curriculum package that includes appropriate outcomes, teaching strategies and assessment tools. Gordon also knew that often another limiting factor was dependence on a single “champion” responsible for the simulator, its curriculum and its integration into the wider educational programs; this individual often has competing research and patient care responsibilities that limit his/her time. He recognized the potential of computer technology to support this role for curricular resources and instructional training and led the development of the UMedic Multimedia Computer Curriculum over 25 years ago.9 UMedic provides a comprehensive cardiology curriculum with a database tracking system that analyzes learner performance.10 A multicenter study demonstrated the feasibility of using the UMedic Curriculum throughout the 4 years of medical school and also provided a curricular map to guide instructors in the implementation of the programs.11 Gordon’s team developed valid and reliable pre- and post-testing assessment instruments following a rigorous 8-step approach.12 A follow-up multicenter study demonstrated a highly significant improvement in bedside skills in students exposed to the UMedic Curriculum compared with a control group exposed to traditional instruction.13 SIMULATION-BASED CERTIFICATION In addition to a system to support curricular implementation and faculty training, Gordon strongly believed that certification utilizing a range of simulation methods was the final and most important step for universal acceptance. In that regard, Dr. Gordon and his colleagues have made significant contributions to the use of simulation for certification processes. Dr. Gordon served on the American Board of Internal Medicine Physical Examination Self-Evaluation Process Committee (PE-SEP).14 He assisted the board in developing a technically appropriate system for testing, providing digital clips of Harvey’s simulated findings for inclusion in the program. The system has been used for more than 5 years in the recertification of internists around the United States, with very positive acceptance. Recently, Dr. Gordon and the MIAMI group worked closely with the Royal College of Physicians and Surgeons of Canada to integrate simulation into their Internal Medicine Certification Examination.15 For the first time, in 2006, Harvey was used in the initial certification of cardiopulmonary bedside skills for internal medicine specialists in Canada. Currently, there are more than 170 medical centers worldwide that use Harvey and/or the UMedic system in their training and testing programs.16–19 PREHOSPITAL AND EMERGENCY HEALTHCARE TRAINING Nearly 25 years ago, Dr. Gordon recognized the need to further expand multiprofessional training programs to include emergency personnel, especially paramedic/firefighters. Since 1982, the CRME has directly trained more than 100,000 course registrants, including over 15,000 during the past year in cardiac life support, trauma, pediatrics, advanced airway and hazardous materials management. It is a designated Community Training Center for the American Heart Association. The CRME also prepares first responders to diagnose acute coronary syndromes and strokes in the field; this training uses a range of simulation methods including task trainers, full-body simulators, and standardized patients to teach and assess diagnostic and management skills.20 As a result of prehospital training, paramedics may administer thrombolytics to heart attack patients in the field and transport stroke patients more urgently, resulting in a significant decrease in death and disability. The curricula developed at the CRME are used by more than 550 medical institutions and agencies in the United States. The paramedics trained at the Center respond to the 911 calls of millions of citizens of Florida, and the curricula are disseminated to all of the 28 community colleges and vocational technical centers that train paramedics through train-the-trainer courses and on-site mentoring. SAVING LIVES THROUGH SIMULATION The programs carried out in prehospital and emergency skills are also carefully evaluated for their effectiveness and impact on patient care. The CRME was among the first to demonstrate the ability of paramedics to diagnose acute myocardial infarction on the electrocardiogram,21 and to assess the ability of paramedics to diagnose and manage stroke patients. The ER-TIMI 19 national study, that included paramedic/firefighters trained at the Center, documented the benefits of thrombolytic treatment of patients with acute myocardial infarction by paramedics in the field22 and the Southern Region of the American Heart Association for Operation Stroke adopted the MEND (Miami Emergency Neurologic Deficit) Examination, developed at the CRME.23 The Florida Department of Health designated the Center the state’s lead institution to develop, disseminate and assess simulation-based training on the Emergency Response to Terrorism (ERT) and Catastrophic Incident Response Training for paramedic/firefighters, hospital personnel and law enforcement officers. These programs are a national model for hands-on scenario-based simulated antiterrorism and disaster response training exercises.24,25 To date, the CRME has trained more than 3,000 first responders in ERT through statewide implementation via the community college system in all seven regions of the Florida Domestic Security Task Force. In addition, the CRME is currently working with the U.S. Army Trauma Training Center located at the University of Miami Jackson Memorial Hospital to train and assess the skills of Army Forward Surgical Teams during intensive 3.5-week refresher courses prior to their frontline deployment in Iraq and Afghanistan. MENTOR AND SUPPORTER OF SIMULATION-BASED MEDICAL EDUCATION One of Michael Gordon’s most significant contributions has been his mentoring of students, colleagues and fellows to further advance the field of simulation-based medical education. This is reflected in the many peer-review publications cited in the literature that are authored by those he has trained and mentored. He also supported and mentored junior colleagues who have made significant contributions to leading international initiatives in medical education. An example is the Best Evidence Medical Education (BEME) collaboration, sponsored by the Association for Medical Education in Europe and endorsed by the Association of American Medical Colleges, whose goal has been the international implementation of best evidence medical education. The CRME was designated as the lead institution for the Topic Review Group on Simulation and published the first BEME systematic review of the literature on the most effective use of high-fidelity simulation in medical education.26,27 Another initiative is the International Virtual Medical School (IVIMEDS), an international consortium of more than 25 medical institutions whose aim is to transform how students learn by providing a fully integrated online medical school curriculum.28 The CRME provides content and technical expertise in the development and implementation of several computer and simulation-based guided learning modules for the cardiovascular and neurovascular systems. To further encourage younger faculty development and involvement in simulation-based medical education, Dr. Gordon created a fellowship program 5 years ago as part of an overall Medical Educator Development Program. The fellowship emphasizes simulation-based curriculum development to train and assess the competence of healthcare providers, and has already provided a cadre of highly skilled clinician-educators in simulation-based education.29–31 WORLDWIDE RECOGNITION Gordon’s 40-year record of achievement in medical education has been recognized by the State of Florida University Board of Regents, who chose his work as an example of programs that “enrich the lives of the citizens of the state”; by the American Medical Association and American College of Cardiology, which recognized him with awards for educational excellence for “Harvey”; by the University of Illinois College of Medicine, which chose him as Alumnus of the Year; and by the W. Proctor Harvey Society at Georgetown University, which designated him as Distinguished Alumnus. Michael Gordon has always been a charismatic teacher, recognized by numerous student awards. In addition, he received the highest educational honor of the American College of Cardiology in 1996, the “Gifted Teaching Award,” in 1998; the Laennec Special Recognition Award of the American Heart Association Council on Clinical Cardiology; and was recognized for his number one ranking among all teachers in American College of Cardiology CME courses in 2000 and 2001. He also received the degree of Doctor of Laws Honoris Causa in 2003 from the University of Dundee for his distinguished contributions to academic medicine. Finally, he has been recognized by the University of Miami Miller School of Medicine through its establishment of the Michael S. Gordon, M.D., Chair in Medical Education, and its naming of the new Michael S. Gordon Center for Research in Medical Education, as a “testament to his accomplishments and an inspiration to future generations of medical educators.” ONGOING LEGACY With a career of accomplishment and achievement and with the recent completion of a state-of-the-art 34,000-square foot facility, Dr. Gordon may be expected to slow down and enjoy the success of his lifetime work. However, one of his favorite quotes is, “This is not the finish line; the future is the finish line.” He still wakes up each morning by 4:30 am, when he does his most creative thinking, and is at full speed by the time the rest of the CRME faculty and staff arrive at 7:30 am. Gordon has simply not found a substitute for determination, persistence, and hard work. There is a risk that when an idealist grows older he becomes a cynic, and when an optimist grows older he becomes a pessimist. This has certainly not been the case with Michael Gordon. He continues to exude enthusiasm and to be guided by an important lesson he learned from W. Proctor Harvey 40 years ago at Georgetown University—the give:take ratio—that he also instills in others. This principle is most exemplified in his success at raising funds for the often neglected field of education and training. To date, Michael Gordon has attracted an unprecedented $100 million of research funding in simulation-based medical education. For more than 4 decades, Michael Gordon’s efforts have influenced medical education worldwide by providing practical solutions to real problems. In all of these endeavors, Dr. Gordon fosters a system of multicenter, multidisciplinary, and multiprofessional collaboration. That is why, from its inception, Gordon felt that the Society for Simulation in Healthcare (SSH) was, in many ways, the fulfillment of his 40-year dream of enhancing medical education and patient care through simulation technology. He feels strongly that academic institutions (such as the CRME), with the resources to develop, implement and evaluate simulation systems, have an obligation to support the mission of the Society. For this reason, the CRME became a Founding Supporter of the SSH, and supporter for a keynote address and Resident Abstract Award at the 2006 International Meeting on Simulation in Healthcare. The Gordon lectureship will now serve as a long-term commitment to the Society, its mission and its members.Figure

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