One night last year, third-year internal medicine resident Nicholas Honda, M.D., was leading a group of interns on rounds at Riverside Methodist Hospital when trouble struck. A patient at the 800-staffed-bed Columbus, Ohio, hospital suddenly developed an irregular heart rhythm. The group sprang into action, putting in a breathing tube, introducing meds through a central line, and shocking the patient with a defibrillator to end the bad rhythm.
Because the physicians were well-prepared, the patient survived. The group had worked on a virtually identical case earlier that night with one key difference: Their earlier “patient” was a computerized mannequin, one that at first glance might be mistaken for a real human being.
Honda’s group had practiced the “code blue” scenario on one of seven patient simulators in use at Riverside’s Center for Medical Education and Innovation. The technology-heavy medical education center replicates the hospital environment from the scrub sinks to the patient monitors. The simulators—four adult, one pediatric, one infant and one designed for cardiology—are amazingly lifelike. “They react just as a human would,” says Pam Boyers, the center’s executive director and chief academic officer. “They breathe in air, exhale carbon dioxide, blink, have pupils that contract, and respond to drugs. If you do not do a procedure correctly, their physiology will change, their heart will speed up, and they may lose consciousness.”
Honda has practiced on seven life-threatening code blue scenarios with the simulators, which are preprogrammed with various conditions and operated by technicians who observe and can manipulate the proceedings. A tech talks into a microphone, but his voice sounds as if it were coming from the simulator’s mouth. Each simulator is connected to monitors that respond to drugs and other stimuli. The simulators can even mimic a vocal chord that spasms when a breathing tube is inserted down the throat, Honda says.
To administer a drug, Honda passes the proposed dose under a barcode reader, and the computer calculates its effect. During a training session, all the actions are recorded, so in retrospect, an intern can see what effect his or her actions had on the patient. “It gives you more confidence in what you’re doing,” Honda says. “You can read about what to do in a book, but until you see it, it is hard to conceptualize.”
Manufactured by Medical Education Technologies Inc., the simulators cost up to $250,000 apiece, says Boyers. The simulators can be programmed to duplicate thousands of different clinical scenarios. In addition to residents and interns, staff physicians use the simulators; for example, cardiologists may practice stent placement or develop their skills in airway management, Boyers says. “To practice a stent placement, they go into a vein through the simulator’s groin and can see it all happening on the fluoroscopy screen,” she says. “It is a tactile experience. You can make the patient have all kinds of challenges.” —Gary Baldwin