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Dress Rehearsal
The Simulation Center will give “medical practice” a whole new meaning.

Harry Koffenberger, vice president of Corporate Security, in the department's command center. At work in the background are protective services officers Darlene Fairley (left) and Tanaya Hitt.
Johns Hopkins Medicine trustees Janie "Liza" Bailey (left) and C. Michael Armstrong, chairman, during "mini-med school" last month. Anesthesiology fellow Kristen Nelson looks on.

Michael Armstrong often gets the high-rise view of the health care that’s delivered at Hopkins. But recently, the chairman of Johns Hopkins Medicine’s board of trustees found himself firmly on the ground level, working with a small team in an attempt to resuscitate a lifeless patient.

“The patient died,” says Armstrong immediately after the rescue efforts stopped. “We never got a pulse.”

Luckily, this “patient” happened to be a computerized mannequin and the entire scene a learning exercise for Armstrong and 24 other trustees who took Hopkins’ new Simulation Center for a test-drive on March 9, one day before the facility’s dedication.

While the trustees and potential donors were only role-playing for a few hours, their experience will loosely mirror that of the medical students, residents and other health care workers who will hone their skills in the $5 million facility.

Located on the eighth floor of the Outpatient Center, the Simulation Center has launched the School of Medicine into the vanguard of medical training, offering students a bold array of realistic patient environments and scenarios.

Pediatric intensivist Elizabeth Hunt, a nationally recognized expert in CPR simulation training who is also the center’s director, says that the space within the 10,000-square-foot facility is designed to be flexible. Classrooms can be halved. Rooms can be outfitted to simulate such situations as a complicated emergency birth or a multiple trauma case.

Hunt’s convictions about simulated medical training have become a core part of her professional religion. For example, she says to consider a common hospital emergency like the code blue. “In most real codes,” says Hunt, it’s the first time someone uses the defibrillator. “That’s why we should practice on plastic first.”

Although Hopkins has used simulation to teach medical students and residents for years, it has been slower than some of its peer institutions to commit to a full-fledged center. One of the reasons the tradition-bound school viewed the practice skeptically was that it took away valuable time spent with patients.

But several factors helped simulation take on a different cast. When the 80-hour work week forced residents to spend less time at the hospital, simulation became a way for trainees to work out the bugs in their caregiving, and also to learn to diagnose and treat rare medical problems that they had fewer chances of seeing in the hospital. 

Another impetus came from accreditation bodies, which began requiring academic medical centers to measure the effectiveness of education and training—a task that is built into simulation. And as the patient safety movement has recognized the importance of effective teamwork and communications in preventing medical errors, these dress rehearsals can also help units to improve how physicians, nurses and respiratory therapists work together.

That teamwork message stuck with Armstrong, who along with his wife, Anne, will be the namesake of the School’s new education building. “Coming in, a lot of us thought that medical education was pretty individual,” says Armstrong. “But the practice of medicine has to be about teamwork, and that’s what we experienced.”

In addition to mastering the mannequins, the Sim Center’s users will also take on real humans. But the “patients” will be actors, professionally trained to mimic key complaints. Stationed throughout 12 spaces designed to look and function like exam rooms, the actor-patients carefully observe the medical students’ behaviors for professional protocols. Did they wash their hands? Did they make eye contact? Did they take a complete history?

When the student finishes the exam and exits, the actor-patients fill out a checklist that appears immediately on the team proctor’s computer screen. The interactions are all recorded on video monitors and graded by the actors, but the encounters can also be watched in real time by instructors beyond the student’s sight: Each exam room is equipped with a wall that offers one-way viewing. “Anyone who’s grading the exam can watch what’s going on in there,” says Hunt. “But we want to minimize the fishbowl effect.”

That’s a tall order for a state-of-the-art complex designed for grading performance in five dimensions—audio recordings, video, hands-on observation, paper review and computer records review. Tucked between the two banks of mock patient exam rooms, carrels of computer monitors can track the activities in their designated test rooms. At the end of the row of carrels sits a proctor’s station, where all 12 exam rooms can be viewed, if desired. The proctor can even control camera angles in each room by remote.

And then there are the six 70-inch high-definition LCD screens, standing by to play back the video of any student who performed something instructive—for good or ill.”

Ramsey Flynn and Jamie Manfuso



Johns Hopkins Medicine

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