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USF's Center for Advanced Medical Learning and Simulation growing slowly

By Jodie Tillman

Times Staff Writer

TAMPA — It has been called a game changer, a first-of-its-kind, a Disney World for doctors. It conducted 700 tours in its first year alone.

By any name, the University of South Florida's Center for Advanced Medical Learning and Simulation, known as CAMLS, is a place that dazzles. In its sleek, $38 million downtown home, the 2-year-old education and research center offers gee-whiz features like a virtual operating room that simulates the sights and sounds of a battlefield and a 3-D printer that creates customized knee implants.

But starting next fiscal year, CAMLS is supposed to do more than make heads turn. The goal is to make money. And its ability to do so could depend on whether the medical industry changes fast enough for CAMLS to play a prominent — and profitable role in improving patient safety.

An ambitious legacy of former medical school dean Stephen Klasko, CAMLS trains medical professionals through high-tech simulated scenarios that don't put patients at risk. Neonatal nurses, for instance, may work on a small dummy that convulses like a real baby in stress. While such training gets high praise, it's mandatory only in limited cases.

CAMLS pulls in enough revenue to cover its bills, but it is expected to run a $2 million deficit this year due to the depreciating value of its state-of-the-art equipment. It is slowly attracting more paying customers, though the pace must quicken if CAMLS — which has competitors as close as the Orlando area — is to meet its goals.

University leaders say CAMLS faces a challenge familiar to any startup company: how to make money when you offer a product that is slightly ahead of its time.

Chief executive officer Debbie Sutherland said leaders knew CAMLS would have to be flexible — and prepared to accept some early lean years.

So from the start, CAMLS officials have been talking with other countries about franchising its model abroad, a potential money-maker. Leaders are also tapping into markets away from the core mission: A Japanese film company, for instance, recently shot a commercial at the facility.

"We'll always be looking for new opportunities," Sutherland said. "We'll always be evolving."

• • •

At 90,000 square feet, CAMLS is thought to be the largest facility of its kind. It's not just a training center but also a place for research and product design. Its research division holds 45 contracts with device makers.

CAMLS is one of about a half dozen "Waldorf Astoria"-level training and research facilities in the nation, said Dr. Roger Smith, chief technology officer for Florida Hospital's $35 million Nicholson Center in Celebration, which he also puts in that high-end tier.

"They're all very nice and were built at roughly the same time," he said.

Many medical schools have their own simulation centers, though they may be relatively small. So do some hospitals. The world-famous Cleveland Clinic, for instance, has three specialty simulation centers that are scattered across its large campus, said Susan Vetrone, global director for marketing for Simbionix, a device maker that collaborates with CAMLS and others.

Sutherland said CAMLS is distinguished by the variety it offers under one roof. While the Nicholson Center may also offer robotic surgical training, she said, CAMLS offers a fuller range of courses, such as specialized training for paramedics and pharmacy students.

• • •

Under its business plan, CAMLS is supposed to be self-supporting by the end of the 2014-15 fiscal year. Its finances are difficult to suss out through public records since federal tax documents lump CAMLS's figures in with several other university-affiliated programs.

Sutherland put the total budget at $8 million — a budget that she said CAMLS is covering mostly through training and course fees, contracts with device makers and facility fees.

By the end of the 2013-14 fiscal year, 18,000 "learners" — from USF nursing students to mid-career surgeons to device company sales representatives — will take a course or train on devices at CAMLS. That's up from 14,000 in the first year, but less than the 30,000 projected for 2015.

More than a quarter of its revenue comes from public money, due to CAMLS's academic affiliation.

The center receives $1.2 million a year in building maintenance funds from the state since it educates USF medical students, according to Sutherland. CAMLS also has an ongoing contract with USF Health — she put it at $600,000 to $800,000 a year — to teach its medical residents.

While CAMLS, which has about 50 employees, covers its bills and debt, its books show a $2 million non-cash deficit, according to Sutherland. That's due to the depreciation costs of expensive surgical equipment, much of it donated by medical device companies. Companies must show such declining values of their property on their balance sheets.

In its first year, she said, CAMLS ran a $4 million deficit for the same reason. She said she believes the center will be in the black by next year as depreciation costs level off.

• • •

The use of mannequins and actors are not new to medical education. But the development of high-tech training — virtual reality and high-fidelity simulated scenarios — is a relatively young field, following in the footsteps of the aeronautical industry. It tracks the growing complexity of surgical robotics and treatment procedures.

Training without putting real patients at risk may seem like a no-brainer. But simulation is an evolving and expensive concept without a large body of scientific evidence behind it, said Paul Phrampus, immediate past president of the Society for Simulation in Healthcare.

And changing a medical culture that has long emphasized apprenticeship — called the "see one, do one, teach one" approach — doesn't come quickly.

"This is a growth industry," Phrampus said. "But how it grows is going to be a little more curious."

Local hospitals send limited numbers of employees to CAMLS for training. BayCare Health System, for instance, the Tampa Bay area's largest hospital chain, sends its family medicine doctors to CAMLS for patient safety courses, according to spokeswoman Beth Hardy.

With the federal Medicare program's growing emphasis on reducing hospital readmission rates, CAMLS officials have been trying to sell more extensive patient safety packages to Florida hospitals. So far, it hasn't materialized.

Money is one issue. When a surgeon is training residents in the traditional way — by showing them the ropes with actual patients — the hospital gets paid for the procedure. Not so for training at CAMLS.

"When they come over here to learn, who pays?" Sutherland said. "This is an expensive model, much more expensive than 'see one, do one, teach one.' "

• • •

Many experts say the tide is turning in favor of the high-tech simulation centers. But how quickly?

Dr. Barry Issenberg runs one of the state's oldest simulation centers, Gordon Center for Research in Medical Education at the University of Miami's Miller School for Medicine. He noted that some specialty disciplines, such as anesthesiology, require simulation training as part of physician recertification.

"They're all talking about it," he said. "It's just a matter of time."

About a decade ago, he said, the state of Florida began mandating doctors' licensing requirements include patient safety courses. Simulation training could become part of that.

"It's going to become a requirement. It's a matter of when," he said. "These centers are presuming that at some point it becomes a requirement."

Dr. David Smith, CAMLS's chief medical officer, agrees that the medical industry is creating a more accountable system, which will require doctors to demonstrate skills, not just sit through a weekend ethics course. CAMLS will be part of that, he said.

"I think what we're doing is transitioning from, 'The building is really neat,' to 'How do we best improve the proficiency by which doctors do procedures?' " he recently told the Times editorial board.

He did not, however, venture to say when that might happen.

Jodie Tillman can be reached at or (813) 226-3374.

USF's Center for Advanced Medical Learning and Simulation growing slowly 01/12/14 [Last modified: Sunday, January 12, 2014 12:36am]
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