Hershey, Pa. -- Imagine you are a patient in a hospital in the 1890s. You have had trouble with upper abdominal pain and your doctor said he has to remove your gall bladder. You are moved from the ward into the operating room where several young men are standing around the room, attentively watching the surgeon prepare his equipment. They are the residents, or doctors in training. Another resident, obviously more advanced than the others, is assisting the surgeon with preparations. As they begin putting you to sleep, you hear the doctor giving instructions to the assistant regarding where to make the incision and what to look for. The doctor is going to talk the resident through the operation. If the resident (and you) is lucky, he already has observed several operations and probably has assisted with some of them. Now it is his turn to be "in the driver's seat" for the first time, with you on the other end of those instruments.
It has always been the catch-22 of medical education: In order for medical students in training to capably perform medical and surgical procedures they must practice and gain experience. That means someone has to be their first patient.
Through a presentation Friday (March 23), Penn State's Board of Trustees received a glimpse into the next revolution in health-care education, which is unfolding at Penn State Milton S. Hershey Medical Center and the College of Medicine.
In simulation training, the first patient isn't a human being -- it's a computerized manikin with replicated vital signs and health-care indicators. It reacts in much the same way a living person would react to treatment and testing. The big difference is that if something goes wrong, those teaching and practicing a medical procedure can hit the proverbial reset button without real consequences for the patient.
"The benefits of simulation training are tremendous," said Elizabeth Sinz, director of the Simulation Development and Cognitive Science Lab at Penn State's College of Medicine, and associate professor of anesthesiology. "There are three primary benefits to simulation training. It is safe, not only for the patients but for students. It is efficient for those who are learning and for the overall educational system, and it is very effective because of the degree of realism our simulators provide."
The Simulation Development and Cognitive Science Laboratory or "Sim Lab" at the College of Medicine is a 2,000-square-foot facility, which houses two teaching spaces and a research/development area. The teaching areas are designed to be adaptable to varied teaching needs and styles. The laboratory features two adult and one child METI Human Patient Simulators situated in realistic operating-room settings, two portable full-body manikins and virtual-reality-based stations. Virtual-reality simulators from Verifi Technologies for laparoscopic (minimally invasive) surgery and from Immersion for endoscopy are used along with surgical instruments and disposables and a full laparoscopic equipment cart for open and minimally invasive procedures. The lab contains several anesthesia machines, intensive care unit ventilators, and a variety of monitoring equipment and defibrillators.
Adjacent to the lab is a 1,200-square-foot full conference room and library containing equipment for presentations. This facility often is used in conjunction with the lab to give presentations, then allow the skills described in the lecture to be practiced on the models. It also can be used as a debriefing area. When used in conjunction with the lab's video setup, large group teaching also can take place here.
The Sim Lab is used formally for clinical skills training -- not just for medical students, nursing students and residents, but also for continuing education for current health-care professionals. It also is used for teaching operation and troubleshooting of currently used monitors and equipment, in-services on new equipment, instruction on diseases and their treatments. Practice and training currently is being conducted by Emergency Medicine for pre-hospital personnel, including paramedics and EMTs. Anesthesiology uses the lab for professional recertification. Crisis Resource Management (teaching group dynamics and teamwork during a crisis) is regularly offered to many departments. Informally, the lab is used to review unusual events or disease states, learn more about a procedure, add new techniques, and to hone already established skills.
In addition to the many teaching opportunities in the lab, there is a co-mission of educational development. Members of the lab's core staff are generating and modifying new educational programs. The lab originated the First Three Days in Anesthesiology and the First Three Days in Surgery, a novel approach to resident orientation. These First Three Days programs have been successfully transferred to institutions around the world. Other examples of new curricula include Emergency Medicine and Internal Medicine incorporating simulation training into the first couple of months of their residency programs. Several nursing areas have improved their curricula by adding orientation programs, rare-event training, and skill assessment sessions.
"Instead of the old adage 'see one, do one, teach one,' medical education now has the option of 'see one, practice safely, do one, teach one,'" said Sinz. "After learning from lectures and observation, residents can practice on a realistic -- but not real -- patient. When they are ready to perform the task for the first time on a real patient, they are merely fine-tuning their technique."
For more information on the Simulation Development and Cognitive Science Lab go to http://www.hmc.psu.edu/simulation/ online.