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Instructor: How long do you think it was from the time the baby’s heart went into the lethal rhythm until you started compressions?
Medical Student: About 10 seconds.
Instructor: Let’s watch the video and see.
Medical Student: Oh my gosh, I didn’t start compressions for 2 minutes!
Instructor: Yes. Once you noticed the change in rhythm, it only took you 10 seconds to start compressions, but because you were putting in an IV you didn’t see the rhythm change. You weren’t paying attention to the monitor.
Medical Student: Oh, that’s right… that’s why you told me the leader must delegate tasks such as placing IVs.
Fortunately, this novice mistake was made during a simulation using a high-tech mannequin. At the Johns Hopkins Simulation Center, students can repeat these types of drills until their actions become rote. Anesthesiology faculty member Dr. Elizabeth (Betsy) Hunt, The Drs. David S. and Marilyn M. Zamierowski Director of the Center, understands that everyone needs to learn. Her philosophy is that it is better to do a procedure 10 times on a mannequin before trying it on a patient. Not only will students become better doctors, but patient safety will be greatly enhanced.
The technology in use at the Simulation Center is as sophisticated as it is elegant. Students can watch the mannequin’s chest rise and fall as it “breaths,” feel the “pulse” in the wrist, and listen for heart sounds in the chest. The instructor can make problems arise and simulate emergencies. What happens if the “patient” stops breathing? The mannequin has sensors that measure how well the student assists with the ventilation, known in the lingo as “bagging” the patient. During the exercise, the instructor watches from a control room, assessing the students’ actions and controlling the reactions of the mannequin. For example, with the baby mannequin, Hunt can start and stop the pulse, change the baby’s heart rhythm, make the lips turn blue, and even make the baby cry.
The Center also has a suite of 12 outpatient exam rooms where medical students practice examining and communicating with actors called standardized patients. They learn how to take a history, perform a physical exam, deliver bad news, etc. The actors/patients then fill out written evaluations of the students.
Hunt, whose specialty is in patient resuscitation, is also interested in teamwork dynamics. It is not enough to have a group of doctors and nurses who are individually well trained. The individuals need to understand how to interact as a team. Otherwise, when the lead doctor asks for four items, 10 people might bring her one, and no one brings the other three. In the Simulation Center, clinicians can hone their skills in performing as a team.
A big goal of the Center is patient safety. Hunt says that “what is different about the Johns Hopkins Simulation Center is that we’re not just using simulation as a teaching method, but as a tool to truly advance the science of patient safety and medical education.” She is studying how simulation can be used most effectively and most efficiently and is continually focused on improving the training techniques.
The education at the Simulation Center goes well beyond instructing medical students. The facility is used by numerous departments to provide training for residents and nurses. For example, nurses practice responding to emergencies during the precious minutes before the code team arrives. Drs. Ben Lee and Eric Jackson use the Center to orient the first-year Anesthesia interns, and Drs. Lauren Berkow, Mark Rossberg, and Jeff Dodd-o, all of Anesthesiology, train multidisciplinary teams in the management of difficult airways. This type of training is extremely important for practicing high-risk but rare events.
“We’re really trying to shorten the learning curve,” says Hunt. “We want our young doctors to practice on plastic first. When they get good at it and can reliably do something well, then they can take their skills into the operating room or intensive care unit.”