Medical simulation technology has transformed the way doctors and other health care professionals are trained. Ever-more-sophisticated mannequins make it possible to replicate everything from a standard bedside procedure to complex surgeries and emergency medicine.
Six years ago, emergency doctors from Rhode Island Hospital and The Warren Alpert Medical School of Brown University opened the region’s first simulation center, and since then, they have trained students and staff from Lifespan and its affiliates, the Alpert Medical School, other health care providers in the community, and at national and international venues.
This month, in five articles published in the journal Academic Emergency Medicine, doctors and simulation experts from Rhode Island Hospital discussed the benefits of advanced medical simulation, looking at new portable options and offering guidance for team training.
Providence Business News spoke with the articles’ lead author, Dr. Leo Kobayashi, an emergency physician and assistant professor of medicine at Brown.
PBN: How new is simulation technology in medical training? Is it the new norm?
KOBAYASHI: Simulation technology has been around since the 1920s or ’30s, in aviation. It transitioned into medicine probably in the 1950s, and the [Department of Defense] spent quite a bit of money developing a patient simulator, but it was predictably expensive. The technology has gradually trickled down and become more affordable, [and it] has continuously improved. … The current generation of mannequins has been around about five or 10 years – and of course there are other kinds of simulation technologies. …
It’s definitely becoming more widespread, and pretty much every day we get a call asking, “How do we incorporate this into our nursing program?” or a medical student or paramedic program. There’s definitely a demand. … The old model [of learning with real patients, by watching others perform procedures and then doing them] is very dangerous and harmful to patients. … With these new technologies, you can actually practice many times before you touch a real patient. … So there’s a drive to do this, but it’s not a cheap technology. … There’s probably in the order of hundreds of simulation centers across the country, but the number of people trained at each site is probably limited because of the limitations of the resources.
PBN: Is everybody at the Alpert Medical School now trained with simulation?
KOBAYASHI: There have been changes in the curriculum. … Until about two years ago, all first- and second-year students would have to come to the simulation center and go through certain types of patient safety and medical decision-making training – the basics of patient care. And they also had ACLS, advanced cardiac life support … which was augmented with the simulation technology. … Then third- and fourth-year students would come through as part of the emergency medicine elective. … Currently, due to various issues, primarily financial, the first-year programs have been cut. But the ACLS course is transitioning into the third year, and the emergency medicine electives are still ongoing.
PBN: How sophisticated are these mannequins, and why are they particularly well suited to emergency medicine?
KOBAYASHI: If you’re trying to train a new medical resident … and they come to our center, the objective may be, for example, to learn how to treat an allergic reaction. So they’d come in … and we would introduce them to the simulated patient, the mannequin, and start the clinical encounter. That would likely entail a medical interview, a full physical exam and then initiating therapy. … And the mannequin would have breath sounds, heart sounds, a pulse, a chest wall that rises with respiration, and various other features, so you can start intravenous lines, you can apply a urinary catheter, you can apply electrical shocks and do defibrillation, you can do intubations. … The majority of the features on the mannequins are geared to acute care, and that’s why they’re useful for academic emergency medicine. They’re designed to help learners, beginners or advanced, practice how to manage someone who is critically ill, and who needs certain procedures done.
PBN: Do you have portable simulation technologies at Rhode Island Hospital?
KOBAYASHI: We’re talking about mannequin-based technology here, so we’re not talking about having to insert an IV into a plastic arm … but we’re talking about how to manage a resuscitation in a simulated patient who has a cardiac arrest in a hospital bed and assessing how the entire system responds. … So with this technology, the portable element is taking the mannequin into the actual clinical environment, rather than in the simulation environment where it’s traditionally been used. … The advantage is that you don’t have to recreate the clinical environment, and that actually reduces the disconnect, which sometimes is not insignificant … because sometimes a learner thinks, “This isn’t a real patient, this isn’t actually what I’d have to do with a real patient, this is just a mannequin that I’m required to work with for class.” … When you put the mannequin in a clinical environment, it’s much harder to say, “This is just a dummy.” … We also do have a SIM Baby mannequin … for pediatric simulations at Hasbro [Children’s Hospitals] … and we have done simulations with critical care services, the military and EMS teams. … As of August, we’ve worked with the R.I. Department of Health to qualify paramedics for licensure using mannequin technologies.
PBN: How much are you using the simulation technology to train in house, not just students and residents, but practicing clinicians?
KOBAYASHI: When we put the mannequin in a hospital bed, and we have a scenario such as a cardiac arrest … we alert one of the clinicians, a nurse or a patient tech, that we have that scenario, and then we let the entire team go to work. … That team would involve attending physicians, resident physicians and interns, nurses and nursing students, techs and tech students, respiratory therapists, pharmacy personnel, social workers, pretty much anyone who you would expect to respond to an actual cardiac arrest situation.
