Life or Death Challenges Governed by Reset Button
By Jeannine Manning Hutson
Stan had a bad week. First, he suffered injuries from an automobile accident, and then he was shot by a friend and then again by his wife. The story changed each time the reset button was hit and Stan experienced a new medical challenge for the medical students, residents and new nurses working on him.
Stan is short for “Standardized Man” and is the computerized mannequin in the Department of Emergency Medicine’s Medical Simulation and Patient Safety Laboratory. He can assume one of 12 different patient profiles or an individualized patient profile, with a few keystrokes.
The computer-driven full-sized mannequin can open its eyes, has vital signs, varying breath rates and sounds, heart tones, pulses and even has a voice transmitted via a speaker under his neck.
“We’re trying to create a life-like experience in this lab,” said Dr. Walter C. “Skip” Robey, clinical associate professor in the Department of Emergency Medicine at the Brody School of Medicine. “Medical students and residents are able to learn and practice skills in this no risk, hands-on environment before proceeding to the bedside to provide care.”
The Medical Simulation and Patient Safety Laboratory is directed by Robey and is in the academic offices of the Department of Emergency Medicine. Stan isn’t the only simulation modality used for skills training. Robey and his colleagues use a variety of partial-task trainers (such as a torso model) and mannequins when teaching complex medical procedures to medical students and emergency medicine residents.
|Emergency medicine professor Dr. Skip Robey works with Stan, a mannequin used in medical simluation exercises.
Robey and Dr. Charles Brown, professor of emergency medicine and vice chair for education for emergency medicine, recently put Stan through his paces for a group of new emergency department nurses at Pitt County Memorial Hospital and an emergency medicine resident physician.
After Stan was stabilized, Donna Zekonis, educational nurse specialist at PCMH, walked through with the group what went well and what “they were slow to make happen.”
She said the patient simulation lab is a good tool for health care providers to learn to work together in limited space. “It’s true to life. We need to have the nurses in here with the residents working side by side,” Zekonis said.
Robey and his fellow faculty members provide several simulation sessions each month to groups of three or four residents, or physicians in training, plus additional training for medical students and PCMH personnel.
Brown added: “It gives them a chance to get close to a gunshot wound victim. In a real-life gunshot patient, the medical student isn’t going to be that close, and the new nurse might be overwhelmed because of the demands and the constant needs of multiple people in the trauma bay.”
And if Stan dies, then the resident has to speak to his family, usually portrayed by another faculty member.
Robey said they strive to make it as real as possible.
“We strive to get the team members to suspend disbelief and immerse themselves in the moment by making the mannequins and scenarios as realistic as possible,” he said.
He added that having Stan be able to communicate with the residents adds to the realism and their ability to treat him as a real patient.
“Our residents start with self-directed study materials to learn the basics then proceed to a variety of skill labs and workshops that include partial-task trainers, mannequins and cadavers,” Robey said. “The next step is the full-sized high-tech mannequin that allows for the learner to put it all together, in the context of a simulated patient and a team.
“We have models, such as adult airways or pediatric mannequins, that they use to practice psycho-motor skills. Once they have mastered the skill, such as a lumbar puncture, then they may proceed to the bedside to perform the procedure under direct faculty supervision.”
Robey said he and his colleagues focus on educating the medical students and resident physicians in a non- threatening educational environment, not ridiculing those who make a mistake.
“We are decreasing the risk to actual patients. Mistakes can be made in the lab. Errors can be discussed in a non- threatening way,” Robey said.
“The days of see one, do one, teach one philosophy are gone,” said Brown. “Now it’s a system like the airlines have. You don’t fly an airplane until you’ve trained on the simulator.”
One reason that simulators are valuable is because in July 2003, residents were limited to 80-hour work week of patient care.
While Robey and Brown understand and support the need to regulate work hours, it also limits the number of unusual medical cases a resident might see in a given week, such as an allergic reaction to a medication, which Stan can easily have.
Physicians are evaluated on six core competencies during their residency training and are expected to have mastered those competencies by residency graduation, according to the Accreditation Council for Graduate Medical Education. Those core competencies are in patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism and systems-based practice.
“Using the computerized mannequin and the different modalities, you can cover the six core competencies and assess the residents on each one,” Robey said.
One hurdle is time. A faculty member must be present to operate the computer and evaluate the simulated patient encounter.
“The issue is providing the environment where they can practice these type of things on demand,” Robey said.
Stan cost approximately $40,000 and was paid for by a grant from the Pitt Memorial Hospital Foundation. The Eastern Area Health Education Center also provided approximately $10,000 for the video recording devices and other equipment.
Videotaping the patient encounters with Stan allows Robey and other faculty members to show the students what went well and what needs to be improved or done differently the next time.
For second-year emergency medicine resident John Whitman, who worked with the new PCMH nurses during a recent training session, Stan is close to what he sees in the emergency department on any given day or night.
“It’s not exactly the real thing, but it’s close,” he said.
Then it was time to reset Stan. He had been shot again.