The Surgical Skills Simulation and Education Center is a cornerstone of the training program for the Keck School of Medicine of USC Department of Surgery. Students hone their technique on everything from suturing to open-heart surgery. Simulation Specialist and Lab Manager Mike Minneti has kept the Center at the top of the field in part by building new simulation devices from scratch. He recently spoke with HSC News about his work and experience.
Simulations Specialist may be one of the best job titles on Earth. What first brought you to the Surgical Skills Lab?
Cold weather, my wife Lara, our friend Cindy, and the intermittent windshield wiper.
Robert Kearns invented the intermittent windshield wiper by combining existing parts in a new and non-obvious way. I kind of see that as what I do. There are few genuinely new things left to create in the world, fewer that I have a shot of developing. But modifications that change original purpose? Plenty.
I spent 15 years in pediatric critical care and extra-corporeal membrane oxygenation (ECMO) at the University of Minnesota. ECMO is a procedure that uses a machine to pump and oxygenate blood outside the body. The last five of those years were spent as the ECMO manager for the department. My first conference as a manager was a perfusion meeting in San Diego where I saw a presentation on ECMO simulation and my world changed. I saw their model and all of its flaws, but the seed was planted. At the time our method of education for potentially catastrophic events was the manager sabotaging the circuit in front of us then watching as we went about the steps of fixing the problem.
Within a week of returning, I developed a pediatric critical care and ECMO simulation lab in a storage room in the old hospital. My first simulation was with the simulator on a cardboard box covered with a baby blanket on a round table. Nervous as heck, I read the scripted hand-off to the first skeptical learners. All disbelief was put aside when the scenario started and the vital signs deteriorated as the air began coming from the patient. They went immediately into problem-solving mode — thank goodness. It got even better when we sat down afterward with proper assessment tools and addressed the good and the bad on the video playback.
By the third month in my role, I began ECMO and critical care simulation, a monthly newsletter, online content and meaningful case reviews. That year I applied for and our department was recognized as an ECMO Center of Excellence. This was with $400 from the department, $100 for the manikin that I modified to fit our needs, and $300 for an infant warmer to keep the patient comfortable in.
But, it was cold in Minnesota.
Our good friend Cindy had found a change for the better in a program out here in Los Angeles, so Lara and I decided to see if the same could be true for us. I met Dr. (Craig) Baker and was taken immediately by his passion for simulation. It was one of those “stuff slows down” type of moments for me. He walked me over to the Surgical Skills Simulation and Education Center to meet Dr. (Maura) Sullivan and Angela Martinez — stuff slowed down again. I knew I could fit in and add value to the team.
I was hired by the respiratory department as their educator and was to share my time in the Center. It took three months for licensing, so I was happily unemployed for the first time since the age of 12. I lasted a month before talking Angela into letting me come to the lab.
A little work, and I converted another old storage room into an ECMO and critical care simulation lab. This time I only had concrete walls and floor to work with, so I bought a home improvement book and a nail gun. I hung furring strips and drywall, and read how to tape, mud and sand.
I needed a wall to separate myself from the learners, so I built a patrician wall with a mirrored window; the floor was covered with carpet (bad choice). This time it cost a bit more. $1,000 for a manikin that was again modified to fit our needs and $1,500 for the supplies to convert the “dungeon” into the simulation suite. Within six months, Dr. Baker was able to bring me on full time in the Center. When he saw the ECMO simulator, he said, “We should put a heart in there.” So we did.
Why did you start rigging up your own equipment?
I began fabrication when I needed something that didn’t exist the way I wanted it to. If I can make a mental representation of what is needed, I can usually come up with the solution. I fail a lot, but I’ve developed a few tricks that help.
Which is the piece of equipment that you’ve made that you’re most proud of?
The ECMO simulator started it all for me, so I have to give it its fair place on top. Once I work all of the kinks out of the beating heart model, I’ll have a different answer.
What sparks the creation of a new piece of equipment? Is it an instructor telling you they wish they had something? Is it you watching students practice? That’s my answer! I work with incredibly smart and driven people. It pays to listen and watch them work. There should always be a “what’s next.” Also, modify the modification.
What do you do when you’re not in the lab?
I began my first classes at the USC Rossier School of Education toward a master of education degree this fall, on my way to a doctorate of education if all goes well. After work and studying, I have just enough time to spend late evenings with Lara and the best dog in the world, Zoe.
Is there a question you wish I had asked you?
I would have liked to write about my mentors Dr. Sullivan and Dr. Baker and the Skills Lab team more. You never work a day in your life if you love what you do. Without their support and the incredible leadership of the Department of Surgery I wouldn’t be answering your questions.
— Lex Davis