Simulation Station

Where medical trainees can practice surgery and other procedures again and again — while doing no harm to patients

Hands-on training at the operating table is invaluable, but it presents distinct limitations. Medical students and residents are restricted to the cases that present themselves. Learning through trial-and-error is not an option when a patient’s safety is on the line. And minimal opportunity exists for the repetitive practice needed to master surgical and clinical procedures.

That’s why the University of Michigan Medical School has created the Clinical Simulation Center. Established last year, the Simulation Center brings together high-tech teaching tools and innovative curricula to deliver realistic, intensive and risk-free training.

Pamela Andreatta in the Clinical Simulation Center, where Jim Cooke, M.D. (Residency 2000), and third-year resident Catherine Bettcher, M.D., are working with an infant mannequin. Photo: Martin Vloet

For example, the center is home to a full-size mannequin, known as a human patient simulator, equipped with software and sophisticated electrical, mechanical, hydraulic and pneumatic devices which realistically replicate human physiology. He (or she — the patient simulator has interchangeable genitalia) speaks, blinks his eyes, and has a heartbeat. His pupils dilate and constrict to light, his chest rises and falls with each breath, and his pulse can be felt in his neck, wrists, thighs and feet.

Instructors program the patient simulator to present specific symptoms and create medical scenarios for students to respond to. The mannequin can be intubated, ventilated, anesthetized, catheterized and medicated intravenously — and he will mirror human responses to the treatments. His heartbeat can be set to mimic arrhythmia. If he goes into cardiac arrest, students can perform CPR or use a defibrillator. If his lung collapses, they use a needle to reinflate it. A tube can be inserted into his chest to remove gas trapped in the lungs or fluid around the heart.

“We can create any medical scenario we want. Students respond to the scenario, and the simulator responds to the students’ actions,” says Pamela Andreatta, an assistant professor in the Department of Medical Education and director of the Clinical Simulation Center. “You can’t get that in real life.”

The Simulation Center also has a full-sized female mannequin which simulates childbirth. Called Noelle, this patient simulator replicates a variety of medical situations, since instructors can alter fetal head descent, cervical dilation, placenta location, the speed of delivery, and fetal heart sounds and heart rate.

The center also is equipped with infant and pediatric patient simulators, mock operating/ trauma rooms, and procedural simulators which allow doctors-in-training to practice laparoscopic surgery, hysteroscopy, endoscopy and other clinical procedures. Audio-video equipment records simulations from a variety of angles for review and debriefing.

The goal of patient simulation is to provide medical students and residents the opportunity to practice critical procedures earlier in their training and more often before performing them on patients, Andreatta says. This helps ensure that the necessary motor skills and cognitive processes become ingrained, which enables trainees to focus on more substantive issues when they treat patients — thereby improving both the quality of care and the learning experience. “We want to provide our students, our faculty and our staff with access to procedures so they can hone their skills to perfection and have complete confidence,” she says.

Clinical simulation is quickly being integrated into the U-M Medical School curriculum across disciplines, Andreatta says, and faculty are conducting research to evaluate the validity and effectiveness of this instructional approach.

—DW

The Clinical Simulation Center is located in the Towsley Center at the U-M Medical School. For more information, call (734) 936-8305 or visit www.med.umich.edu/umcsc.