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High tech ‘patient’ helps students hone skills  by Michael Baker Public Relations With the acquisition of a new training tool in early August, Medical University Hospital sharpened its focus on improving patient safety and quality of care.  Dr. Kevin Coyle reviews his first SimMan simulation with fellow resident Dr. Lori Willcox, center, and the simulation's supervisor, Dr. Jeana Havidich. The technologically advanced SimMan allows residents, attending physicians, and nurses to hone their emergency response skills on a life-sized human mannequin.  But the mannequin is no dummy. Far from the days of practicing cardio-pulmonary resuscitation (CPR) on a cold, plastic torso, SimMan embodies the highest level of simulated medical training. Linked to a computer program, it provides real-time, realistic responses to treatment during various medical scenarios. The model offers a plethora of training programs, including airway intubation, intravenous administration, CPR, catheterization, and blood pressure checks. It links with a computer program that simulates specific ailments and real-life responses to specific caregiver actions. For instance, during a sequence involving an upper-airway blockage, the medical staff must diagnose and treat the problem as quickly as possible. Just like in an emergency room, a slow diagnosis could bring about SimMan’s simulated death. An efficient response, however, brings SimMan back to stability. Although the program allows the model to function independently, responding to treatment as a normal patient would, a technician also may insert new symptoms or complications into the simulation at any time—for example, a sudden drop in blood pressure, a drastic rise in heart rate, or a rapidly progressing upper-airway obstruction.  The realistic, spontaneous training conditions medical teams to think quickly and respond appropriately in dire situations. “It tests their ability to react, and during the initial tests, our residents took the training very seriously,” said Rosemary Ellis, R.N., director of quality and patient safety.  MUH Medical Director John Heffner, M.D., also gave serious credence to the new simulation, noting that it draws attention to an important training method. “The project catalyzed the hospital’s recognition that we need more resources for simulation,” he said. “Our long-term goal is to show that simulations can have positive effects on the development and maintenance of clinical skills.” Past simulation tools haven’t provided SimMan’s thoroughness or range of simulations. Heffner said older versions of programs such as advanced cardiovascular life support (ACLS) focused on lectures and books, not clinical experiences. Even the medically- iconic mannequin, ResusciAnnie, became increasingly outdated in recent years. “The older simulations were crude compared to SimMan,” he said. “ResusciAnnie offered little in the way of tactile simulation, and house staff received fairly inconsistent feedback during training exercises.” Furthermore, tests showed that physicians who completed the ACLS training lacked the requisite skills to manage cardiac arrest in real-life circumstances as simulated by SimMan. The immediate feedback of SimMan added to the model’s popularity. Although the model came to MUSC only a few weeks ago, Ellis  received inquiries from many departments, including Meducare and Anesthesia, requesting training time with the simulator.  Hospital administration showed an interest in SimMan, noting its potential for improving patient care. “The hospital leaped at the opportunity to invest in the technology,” Heffner said. “We’re building a business case for patient safety,” Ellis added. “It just makes sense to invest in this type of training tool.” She first identified the SimMan opportunity about two years ago. In her view, the simulation training would improve the house staff’s clinical skills while promoting a team approach to emergency, resuscitative care. “We call it crew resource management,” she said, referring to the concept of how teams communicate with each other when working together in critical circumstances. The term originates within the aviation industry, an area similar to medicine in its need for tight coordination of multiple individuals’ efforts, she added. “In aviation, you have a captain, and in medicine, you have a doctor,” Ellis explained. “The same way a flight crew might hesitate to challenge the captain, even with a mountain looming, hospital staff may hesitate to correct a physician if they see a problem during a procedure or a sudden, life-threatening event.” She hopes that SimMan will remedy those reservations, shifting the perceived chain of command from vertical to horizontal. As physicians, nurses, and other medical staff practice on the model, each person should become more aware of what to look for and what needs to be done in an emergency. “We want every member of the team to feel comfortable and capable, so anyone who sees a problem will speak up right away,” Ellis said. Heffner agreed that a cooperative approach remains crucial to success in an emergency and in the push for safer patient environments. “Physicians often receive criticism for working in what’s viewed as a strict hierarchy, but we want to eliminate the General Patton approach,” he said. “We’re building an integrated team of skilled professionals, which produces better outcomes for our patients.” Equally important to teamwork, however, is the team’s preparedness. Cooperation means little if doctors and nurses don’t respond appropriately during unexpected complications in a patient’s health. “We rely on the skills of a highly coordinated team,” Heffner explained, “but it’s been said that health care is one of the few industries where the team doesn’t practice. With SimMan, our house staff applies its knowledge while gaining procedural experience, developing skills, and building team-oriented attitudes. Those three domains—the knowledge, skills, and attitudes of our staff—determine preparedness and patient safety. “We are fortunate at MUSC to have Drs. Jeana Havidich and Steve Dierdorf, from the Department of Anesthesiology, who have experience in simulation training and the willingness to lead the development of a program here,” he concluded. With a diverse array of training opportunities and an inherent ability to produce well-prepared, team-oriented medical professionals, SimMan should be the next step in safe, effective patient care at MUSC   Friday, Aug. 20, 2004 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. 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