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VA Maryland Health Care System


SimMan Helps Clinicians Stay in TipTop Form

The Simulation Learning Team prepare the mannequin Henry for the next session.

The Simulation Learning Team prepare the mannequin Henry for the next session.

Thursday, March 12, 2015

So that others may learn, and even more may live

On the gurney, a patient is air hungry. He struggles with a number of issues, but a neck injury interferes with his ability to breathe, and he needs to be intubated. STAT.

Doctors know that controlling and managing a patient's airway is the A of the ABCs of safe patient care. Doctors also know that if a patient can't breathe, nothing else they do for that patient will help. It's that simple: the balance of life and death hangs on the ability to breathe. A clinician's skill level determines patient comfort and safety while keeping a patient breathing, which, in turn, keeps a patient alive.

"Intubating patients is a procedure learned in medical school. In every day patient care, however, it's not often required, and as with any skill, practice makes perfect. It's not unusual at any medical facility for doctors to know the theory of intubating a patient while their actual practice skills are underdeveloped," says Edward Norris, chief of Anesthesiology at the Baltimore VA Medical Center and clinical professor and vice chair of the Department of Anesthesiologist at the University of Maryland School of Medicine.

"We want to ensure that all our clinicians possess high competency levels and confidence in their abilities to intubate patients in every situation, from the easiest to the most challenging," he says.

Enter Henry. A state-of-the art, high-fidelity mannequin that appears and acts eerily human, Henry now serves as the training patient in the new Simulation Learning Center at the Baltimore VA Medical Center. To maintain high standards of patient safety, clinicians must undergo ongoing professional training to sustain and sharpen their procedure skills and to keep their privileges to intubate patients.

The training team−led by staff anesthesiologist and director of Resident and Student Educational Affairs, Dr. Nigam Sheth−use Henry and a constellation of other computerized mannequins to simulate scenarios that clinicians may encounter. Behind the scenes, Sheth operates the computer that animates Henry and designs the scenarios for his fellow physicians. He often designs lessons across the continuum from less difficult to extremely challenging, depending on what the clinicians need or want to improve and at what level the clinicians are in their career. Participants in the scenarios range from new trainees to long-established clinicians, and at each level, the scenarios focus on either a skill that needs perfecting or a new aspect that benefits an experienced clinician.

"Some of the more experienced clinicians, at times, will come in feeling a bit skeptical that they can learn anything new and different, but Henry and the equipment quickly change their minds. A laryngoscope with a small camera at the tip can help physicians gain a superior and clear view of the throat which can make the intubation process a bit easier because of the clear view," Sheth says. 
Two other team members - a certified nurse anesthetist, Amanda Beccaloni, and anesthesia technician, Karen Patrick, comprise the rest of the simulation learning team, each playing assigned roles—to drive the clinician down the wrong path, to obstruct care, so that clinicians must overcome obstacles and make decisions to the best interest of the patient.
"The point is for clinicians to gain a strong knowledge base so that they will be confident to stand by what they know. Good patient care requires team work and effective teamwork can improve the quality of patient care and reduce medical errors," Sheth said.

On the gurney Henry, also known as SimMan, talks. He says he's not feeling well. He blinks, coughs, sneezes, vomits, and then codes.  The clinicians in the training must react to the medical emergency. Henry's responses are realistic, mimicking a range of how actual patients would react in similar circumstances. He could be having a heart attack, a stroke, or any number of emergency situations that would require clinicians to rapidly respond. Henry performs every bodily function that a real person does in the same situation and exhibits a wide range of symptoms requiring specific actions, such as automatic drug recognition, or lips turning blue from lack of oxygen.

"The mannequins are part of a continuum, allowing for increasingly more complex situations," said Robert A. Brown, director of Employee Education. "With the mannequins, mistakes are welcome. It's better to perfect skills with a mannequin like Henry than a real person," Brown says. "The ultimate goal of simulation learning is to continually improve the health care for Veterans by providing a safe, supportive and adaptive environment for clinicians to acquire new skills, demonstrate proficiencies, practice high-risk procedures resulting in increased competence, confidence and patient safety."

Clinicians undergoing the training agree. Dr. Preeti John, critical care surgeon and acting director of the Surgical Intensive Care Unit at the Baltimore VA Medical Center and clinical assistant professor at the University of Maryland School of Medicine, says, "Using the SimMan allows clinicians to practice and repeat procedures and treatment protocols before using them on actual patients. Leaners have the opportunity to practice on the computerized SimMan to fine tune their skills and correct any mistakes without putting any patients at risk."

On the gurney, Henry begins breathing normally, his high-fidelity chest rising and falling with each breath. Clinicians, who rapidly responded successfully to his coding, know that they ushered him through his medical emergency to a stable condition, and Henry, aka SimMan, waits quietly for the next group of clinicians and the next scenario to unfold.


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