The warning message sounded real and urgent. “Code Blue in Critical Care! First Responder Team Alert!" The team arrived within minutes, expecting to find a desperately ill patient in need of reviving. Instead they found SimMan, the centerpiece of Bellevue Hospital's surgical skills laboratory.
The computerized mannequin that can simulate nearly anything a human patient can do - breathe, talk, generate breath, heart and lung sounds, was again on duty testing the emergency response proficiency of medical students who practice life-saving clinical, technical and decision-making skills without risk to patients or healthcare providers.
During this surprise "Code Blue" drill, the response team appeared hesitant and a bit intimidated by the smart dummy. But they quickly became absorbed in the task of saving him. The life-like doll allows the team to check for blood pressure or insert an IV. He can also be programmed by computer to have breathing problems, restricted airway or become difficult to intubate. Surgeons also use SimMan to train for surgical emergencies, trauma and laproscopic surgery. They can also practice endoscopies and colonoscopies. In emergency preparedness drills, he can be transported from the field to the ER to simulate a disaster such as chemical poisoning.
"Simulation technology is a vital teaching tool and the introduction of SimMan opens up a new world that is limitless in training possibilities," said Norma Keller, MD, Director of Cardiology at Bellevue Hospital.
During simulated codes, attending physicians, medical students, fellows, nurses, administrators, anesthesiologists, clerks and even chaplains participate. The encounter is filmed and the staff is debriefed to determine what went well and what didn't. Last year over 500 medical students and fellows had a date with SimMan as part of Bellevue's comperehensive surgical residency training program
"The experience improves communication and team-building even among seasoned code responders," said Dr. Keller. "The team is more cohesive, more confident - particularly nurses who have become more assertive and more organized."
SimMan is not the only test patient at Bellevue. Another component of the training involves patient actors who help hone evaluation, diagnostic and treatment skills. Med students encounter different patient scenarios, including patients in wheelchairs and on monitors. Students develop effective communication skills as they take the patient's history, accurately assess their condition, conduct a physical and render a diagnosis.
"These new teaching techniques were initially resisted by some of our veteran doctors, but there's been a huge change over the four years we've had the lab," said Peggy Gluszak, RN, Coordinator of the Surgical Skills Laboratory. "Now they understand the value of simulated practice. They're teaching classes here and sending their students."
November 2008
