Stan, a fairly healthy 42-year-old, has a problem. He’s just been thrown from the pickup truck his coked-up friend was driving, is drenched with an unknown liquid and dusted with powder chemicals, has a head injury, and blood is spurting from his right leg. Lucky for Stan, he’s fake. But for the medical students surrounding him who must deal with his quickly deteriorating state, the situation is very real.
Stan is a human patient simulator, one of a series of computer-driven, full-sized mannequins that UVA’s School of Medicine employs in simulation workshops. These sessions allow students to practice a range of procedures, from administering IVs and performing tracheotomies to doing CPR and injecting medication. Stan is a highly sophisticated model outfitted with a number of human traits and tendencies, such as a pulse, pupils that dilate and a chest that rises and falls with breath, all of which can be altered to showcase certain life-threatening scenarios. The most advanced simulator, a $200,000 model sold by the METI Corp., can even respond to medication through a barcode system that alerts students when a bad reaction occurs.
“It’s about as close as you could get to a real situation,” Todd Larson, a third-year medical student, says of the daylong workshop. It begins with lectures on the history of simulation. The students then practice various procedures on synthetic body parts and finally put it all together in an emergency room scenario. Among the details that ensure verisimilitude are piped-in emergency room noise—babies crying, random beeps, stretchers rolling—an EKG machine that hangs above the patient depicting his fluctuating stats, and a havoc-wreaking actor (in the role of “belligerent friend of the patient”) who disrupts the proceedings by attempting to pull out a tube, prompting one of the students to call security.
The constructed fracas adds pressure to an already stressful situation. The students crowd around the model, watching him with furrowed brows and the kind of facial twitches that indicate deep concentration. Someone unrolls a blanket with an array of tools across the patient’s chest. They’ve stopped the bleeding in Stan’s leg, but now he’s not breathing. Someone suggests that they perform a tracheotomy. Another student starts performing CPR. The EKG machine depicts a heart pattern that doesn’t look life-sustaining.
“One of the things about trauma is that things can go south real fast,” says UVA anesthesiology professor Keith Littlewood, who is watching the students’ performance through a control room’s one-way mirror. He is surrounded by equipment that allows him to manipulate Stan’s vital signs depending on how the students are doing. He can cause Stan to flatline or hyperventilate. He can even be the voice of Stan, using an intercom system in the model’s throat. “Don’t stick that thing in me!” Stan/Littlewood cries out when the students begin the tracheotomy, thereby lobbing a whole new problem at the students: the issue of patient consent.
The episode is taped and, later, in the debriefing room, the students will watch themselves and dissect the experience, discussing what could have been done differently. In one session, communication is stressed as one aspect that could have been better. “You have a lot of work to do in terms of getting in there and getting information,” says Littlewood. “What medicine does the patient take? What’s he allergic to? Has he ever been to the hospital before?”
The workshops, a local example of a widening trend of simulation in medical education, give students a chance to solidify their learning in a way that’s not possible sitting behind a desk. “The cognitive aspects of patient care are improved,” says Marcus Martin, chairman of UVA’s Department of Emergency Medicine. “They have to think through the process of why the vital signs are abnormal and how to manage them through medical procedures.”
Every third-year medical student is required to take the workshop. And they rate it as an invaluable experience. Just as flight simulation helps pilots learn how to handle an airplane, it seems obvious that emergency room simulations would improve the performance of future doctors. “I think we should do it more often,” says third-year student Sixtine Valdelievre. “You learn a lot about yourself, what kind of person you are in a team, how you react to stress.”
“There aren’t many opportunities to do things on the fly, but addressing things in real time, taking them as they come,” adds Larson, “you can’t learn that from a book.”