Pilots train on airplane simulators before they ever fly real people from one city to another. Now Yale-New Haven’s doctors are getting in on the simulation act, too.
Pilots learn in the safety of the simulator how to react to an emergency, so that if an engine flames out or the hydraulic lines freeze, the pilot will know what to do — and what not to do.
When it comes to physicians, however, they learn on living, breathing people. Medical school students usually learn anatomy by dissecting a cadaver, which cannot complain about ill treatment.
Doctors are now catching up to pilots, tank crews and nuclear power plant operators, by using realistic simulations of patients.
Yale-New Haven Hospital recently acquired computerized, life-sized patients who can sweat, make two kinds of retching sounds, bleed from the ears, and simulate most kinds of abnormal breathing and heart sounds.
The SimMan doppelganger is made by the Laerdal company based in Sweden. Two copies have been installed in Yale-New Haven’s simulation center as a central part of the hospital’s Simulation at Yale New Haven: Advancing Patient Safety and Education (SYN:APSE) program.
Eventually, SYN:APSE will have eight Sim men and women. The center already has SimBaby.
The $60,000-SimMan comes with software that provides the plastic and metal robot with a circulatory system, which is operated remotely by Dr. Stephanie N. Sudikoff (at left in photo), medical director of the SYN:APSE Simulation Center, and Jason Zigmont (at right), manager and educator at the center.
SimMan’s operators can also speak through his mouth, enabling the life-sized replica to complain, question, nag, and generally make life difficult for trainees.
Sudikoff and Zigmont can display his heart rate, oxygen saturation, respiration rate, blood pressure, and other information that appears on real patient monitors.
SimMan and SimBaby can die. Some scenarios end in death no matter what the staff does, Zigmont said.
For example, one simulation involved a baby with sudden infant death syndrome. SimBaby flatlined and the human participants need a few moments to steel themselves before the “mother” and “father” entered the room. The staff then had to tell the parents that their baby was dead.
Even though the baby was an inert virtual person, the staff felt considerable stress.
“A lecture doesn’t have the same impact as a simulation,” Zigmont said.
Simulations also reveal the confusion and conflicts that often arise in emergency cases, and offer attending physicians, residents and nurses a sense of how to communicate more effectively.
After one recent session with SimMan, the ranking physician, nurses and other health care specialists discussed how a “lowly” member of the team can make a suggestion to the all-powerful doctor.
The “patient,” in this case, came to the hospital with heat stress. Then a nurse accidentally injected him with a paralytic agent. Participants had to figure out what happened, how to save the patient, and how to explain to his distraught parents how simple dehydration had turned into a life and death struggle.
The lead doctor had administered simulated albuterol, a drug that improves air flow by relaxing the bronchial muscles. After the exercise, nurses questioned the choice.
They also commented on what seemed like disorganization. Doctors and nurses were performing their jobs without providing any explanation.
Zigmont said the problem is similar to how a co-pilot relays important, overlooked data to a pilot. Cockpit simulations led to a “crew resource management” model that reconciles different approaches to leadership, and is now used by all major airlines.
Almost all trainees find themselves working on SimMan as though he were a real patient, Sudikoff said. The patient room used to be equipped with a live telephone, which was rerouted to the control room after one trainee dialed a hospital number to summon help.
Sudikoff said she allows parents into treatment rooms, unless they physically start to interfere with her work. So during simulations, anxious “parents” are sent into the room to question the doctors and seek reassurance.
Having parents looking over your shoulder as you check airway, breathing and circulation, can be disquieting.
Interactions with SimMan can be videotaped so that participants can later evaluate what they did and how they handled the emergency. This helps the participants become acclimated to an increasingly multi-disciplinary approach to care, Zigmont said.
Simulators like SimMan are becoming common at hospitals, Sudikoff and Zigmont said. Medical schools are using them earlier in their curriculums, he said.
“In a few years there will be ‘sims’ all over the hospital,” Zigmont predicted.