EMS Simulation Training: It’s time for a leap forward.

What do augmented reality medical simulation training and the horseless carriage have in common?   

Answer: Both are beholden to the diffusion of innovation. 


History is filled with examples of technologies that take decades to become widely adopted. The transition from horse pulled carriages to the automobile was fraught with controversy, fear of change and countless innovations. Some early adopters of the horseless carriage had their lives threatened and the first motor vehicles were described as ‘demonic’ and ‘monstrous’ machines by many.  Ultimately, at the turn of the twentieth century, phasing out horse driven transportation prevented the loss of over 20,000 lives related to illnesses from animal dung just in New York City. From the modern perspective, it’s hard to imagine what all the fuss was about, but such is the march of progress.  Adoption of innovation just takes time and relies on countless variables that converge in creating powerful advances. 

In a parallel example, the time for harvesting the benefits of augmented reality (AR) has arrived after decades of development in research labs.  The confluence of affordable hardware and powerful software has made the possibilities as limitless as the human imagination.  The application uses are poised to dramatically advance training at the frontline of emergency medical services and beyond.  But are you ready?  

The advantages of medical simulation training are well documented including standardized learning environments that aide in the development of teamwork skills and critical thinking in “safe spaces”.  The old ethic of “see one, do one, teach one” just does not seem so ethical anymore.  On the job learning is still required, but risking patient safety to acquire the fundamentals is not acceptable.   

Huge investments have been made into building medical simulation facilities (sim labs) at most institutions of graduate education because perceived benefits outweigh the costs.  Those training others to save lives need great learning tools to prepare learners for real world encounters. The challenges thus far have been multifactorial.  Three of the most commonly cited challenges have been to implementing a program in simulation training are affordability, portability and realism.  Most existing sim labs cost millions of dollars to build and the state of the art mannequins just lack the realism required to trigger suspension of disbelief in learners. MedCognition was started by clinician educators and computer scientists who set out to overcome the obstacles of affordability, portability and realism in medical simulation training.  Our mission is to make high definition medical simulation accessible to all in health care.  No longer relegated only to fixed sim labs with high costs of overhead and logistic complexities high definition medical simulation can be finally brought to every classroom and even to the front lines on community practice. 

Imagine performing simulation training of a paramedic student in the back of an actual rig with a technology that transforms a low fidelity mannequin torso into a high-fidelity simulation experience. Imagine having access to such a technology at a fraction of the cost of current high-fidelity mannequins. How invaluable would such a tool be in training those who will go onto save lives?  It’s time for a leap forward. Click here. 







What's in a name?

Over my career, I've been a clinician, trained hundreds of medics to deploy to war, prepared physicians for emergency practice and analyzed cases that didn't go as hoped. Through all these activities, I've come to realize that medical knowledge and skill are only part of the equation.  To be a truly accomplished, confident and competent provider, we must be able to analyze how, what and why we think the way we do. We must be able to understand why we make the decision we do, when those decisions are prone to error, why those errors occurred and lastly what cognitive factors influence our decision making. We must think about thinking.

 Metacognition: thinking about thinking

Metacognition: thinking about thinking

Medical practice isn't just the regurgitation knowledge and doing procedures. The critical component is having the understanding, judgement and cognitive skill to apply the knowledge and motor skills in the appropriate context.  Metacognition is the knowledge and awareness of one's own thought processes. The more aware a medical provider is of their thought processes, their limitations and strengths, the more effective that medical provider can be.

When we started our company, we sought to provide a tool that allowed medical educators of all types and professions to really help their trainees understand their own thinking.  Hence the name: MedCognition -- thinking about medical thinking.

 MedCognition: Thinking about  medical  thinking

MedCognition: Thinking about medical thinking

PerSim, our initial product offering, is specifically designed to challenge medical decision making. By designing a system that can be deployed nearly anywhere with highly realistic depiction of disease symptoms (we have different shades of cyanosis to depict worsening or improvement in a respiratory distress patient). This realism also allows the instructor to get out of the clinical feedback loop. With other systems, the instructor has to say, "Your patient is getting more diaphoretic"  while with PerSim, the student can see the beads of sweat developing on the chest. Now, the student can see, analyze and make a decision -- without any input necessary from the instructor. This more closely mimics real-world practice and gives the trainee and instructor an opportunity to talk about the why and how of medical decision making rather than focusing on the simulator itself and the student-instructor information loop. It gets the instructor out of the simulation and frees them to better teach and train.

CEO, Medcognition



Why we use Mixed Reality

A little while ago, I wrote a post discussing the different approaches to computer generated simulation (VR, AR and MR). Each approach has its advantages, but we think that for medical simulation, Mixed Reality (MR) is the way of the future.

Our focus at MedCognition is to bring affordable, portable and realistic simulation to our users. Our implementation of Microsoft's HoloLens Mixed Reality technology allows to us rapidly deploy high-quality simulation in nearly any environment in just a few minutes. PerSim™ can be used in an ambulance, roadside, in a classroom -- nearly any environment medical professionals practice. Weighing in at approximately 20 pounds, mixed reality technology allows us to deliver one of the most portable patient simulators available today.

However, where mixed reality really shines is in realism. We have put in considerable effort into making sure our animations provide highly realistic depiction of patients with various medical conditions.  However, ensuring the environment is realistic is another, important part of the puzzle.  The more realistic the simulation, the easier it is for the student to "suspend disbelief." This suspension of disbelief actually helps with learning.  If the learner spends less cognitive effort dealing with a less-than-realistic simulation, they are able to place more effort into the actual learning objectives.

 Ever seen pictures of those airline simulators -- you know the ones the airlines use to train their pilots?  Those multi-million dollar simulators look, behave and move like the real thing. In fact, the Air Force's $339-million F-22 Raptor fighter does not have a two seat version. A pilot's first flight is a solo, but only after many hours at the controls of a high-fidelity simulator. However, that sort of approach isn't feasible for medicine.  The cost is too high (imagine a $1 million ambulance simulator!), and it isn't portable.  Plus, every ambulance service has subtle differences in how they configure their rigs.

That's where portable mixed reality comes in. With the PerSim™ you have high-quality simulation in your ambulance where you can learn the limitations of how it's configured. Is the monitor out of reach while doing compressions?  Does it take two hands to open the drawer and grab some tape?  You can't answer those questions in a virtual simulator or in a simulation center. 

Mixed reality has allowed us to bring you a simulator that is affordable, portable and realistic. That realism isn't just a collection of awesome animations, but also in where you can use it -- nearly any operational environment. This combination allows for nearly limitless training scenarios, enhancing the training opportunities and allowing pre-hospital professionals to train more realistically and prepare to provide the best possible medical care.



AR, VR, Mixed Reality -- What's the diff?

Maybe you're confused. I certainly have been and I work in this industry. There are a bunch of different acronyms floating around to describe how computers can be used to create images to represent a simulated reality.  So what do they all mean and why is it important?  

"VR" or virtual reality is just what it sounds like: a reality that is completely virtual.  in this application, the computer creates the entire environment: the walls, floors, ceiling, objects, people... everything that the viewer experiences. Typically the user will don virtual reality goggles that block all vision and display the virtual environment on small computer screens placed right in front of the eyes.  Various sensors track the user's position and head movements so that the virtual environment responds accurately. The key here is that everything the user sees is virtual.  Recently I demoed a VR system that dropped me in the middle of an emergency department, while I was standing in the exhibit hall.  

"AR" or augmented reality is "computer assisted reality". What I mean by that is the user sees the actual world, either directly with their own eyes or though a video feed on the goggles they are wearing.  The computer then provides information, data and other display information or graphics that augment the reality, but are not part of it.  For instance, a worker in a warehouse might see a highlight around a box they are supposed to pull for delivery.

So, what is "mixed reality"?  This is similar to AR.  Again, the user sees the actual environment they are standing in, but while AR projects information and graphics that are not supposed to be part of the environment, mixed reality projects objects that are supposed to be part of the environment, but are not. PerSim™ is a perfect example of mixed reality.  For instance, a user wearing our system can be sitting in the back of the ambulance they work in on every shift, but we can place a simulated patient with severe respiratory distress on the stretcher.  

Each of these approaches has its benefits. The next entry in our blog will explore why we chose to use mixed reality for patient simulation.


Texas EMS Conference 2017

We had the great fortune of attending the Texas EMS conference in Fort Worth, TX on November 19 and 20. This was our first conference with our primary customers:  pre-hospital professionals. And what a conference.  First, Fort Worth is a beautiful city and a great location.  Good weather, great restaurants and a city-wide party celebrating the holidays (Parade of Lights).

We had the great fortune of meeting many of the dedicated, skilled pre-hospital professionals from Texas and surrounding regions. We even met one gentleman from Trinidad! Over 100 of you visited our booth in the 13 or so hours we were open -- many thanks for the enthusiastic response.

For those of you not at the conference, I'd like to announce that we are beginning to accept pre-orders for the PerSim Medical Patient Simulator for expected delivery in Spring 2018. Interested in a price list or quote? Please send us an email.

While we're working hard to bring you PerSim, we're also making preparations to make it even better with a vastly expanded animation library and patient types.  Stay tuned for more details.

Lastly, if you were at the Texas EMS Expo and wanted to join our mailing list, but haven't yet gotten an email from us, please sign up for drop us a line through our Contact Us page.  Some of you didn't have emails associated with your registration.

Thanks for your ongoing support!


Getting closer

Well, our trip to Washington DC and the American College of Emergency Physician's Scientific Assembly was a success!  We met tons of great people and learned a lot. 

We were very fortunate to meet people from a variety of disciplines -- EMS, rural emergency departments, military, academic training programs -- who gave us some great thoughts on the PerSim.

We've largely completed the refinement of our sofware and are now focusing on getting the distribution mechanics down. Our goal is to automatically push updates to our customers and ensure that the software you are using is the most up-to-date possible. We're still recruiting beta customers, so if you're interested, drop us an email (link at the bottom of the page)

Lastly, we're heading to the Texas EMS Conference November 19th & 20th (Sunday and Monday) in Fort Worth.  Drop by our booth (#1032) and try out PerSim for yourself. 

Thank you all for your ongoing support. As always, if you have questions, comments or suggestions, don't hesitate to drop us a line!



We're getting on a jet plane...

Well, this is it.

We're heading to Washington DC this weekend to attend the American College of Emergency Physicians (ACEP) Scientific Assembly. This is the largest meeting dedicated to emergency medicine on the planet.

And we're going to demonstrate PerSim to the public for the very first time. 

Queue butterflies.

Several months ago, we were invited to participate in the conference's IncubatED program where startups, such as MedCognition, are able to show their ideas and products to over 10,000 conference attendees.  IncubatED is an activity inside the InnovatED area of the exhibit hall where companies gather to show their latest and greatest innovations aimed at helping us all take better care of our patients. Check it out at https://www.acep.org/innovatED/

Not only will be be showing off PerSim in booth 2807-i15 (booth 15 inside the InnovatED area) but we're also competing in a pitch contest on October 31st at noon in the InnovatED theater. Please come by to root us on and cast those all important votes to help us win!

As always, thank you for your ongoing support.  Give us a shout with any questions, ideas or thoughts.  We'd love to hear from you!


We've been busy

Well, it's been an eventful few months.  We're working very hard to bring the PerSim™ to you in the coming weeks. Not only does that include writing code and getting the hardware working, we also have to develop business agreements, figure out how to package the system so that not only does arrive on your door safely, but you can also move it to different training events with the peace of mind that your simulator will be safe and sound.  So, lots of little details to go, but the list is getting shorter!

I want to give you a peek behind the curtain and show you what we're working on.  So, here's a quick tour:

Welcome to our site

Welcome to our site!  You are one of the very first people to hear about our exciting new solution for pre-hospital provider training: the PerSim™.  We are working very hard to bring this product to market as soon as possible.

In the coming months, we'll be posting updates and videos showing our simulator.  By late summer, we'll launch a beta program. Keep an eye out for an opportunity to get your hands on the PerSim™ early and help us make it a great product.

In the mean time, please subscribe to our feed and subscribe to our email list.  Thanks for dropping by!