Roger is in the middle of a very bad day. This morning, while moving trash cans, pain gripped his heart. He took an aspirin and then rested, he tells Dr. John Clark, a second-year resident at Lankenau Medical Center. With shame in his voice, Roger confesses that he smokes. But it’s too late to do anything about that now, because Roger’s pulse begins to race and his chest pains come more quickly as he gasps for air. The machines to which he’s connected beep and buzz until finally Clark says, “He’s in a-fib.” Just like that, Roger is having a massive heart attack.
Clark runs the resuscitative procedures, directing two other doctors to administer medications and perform chest compressions. “Let’s shock him,” Clark decides.
They do that twice, and Roger’s pulse normalizes. Clark calls for medication. He’s about to issue other directives when the monitors screech. “He’s in v-tach,” says Clark. “Bag him.”
Four minutes later, Roger has a stable pulse and controlled breathing; his chest rises and falls rhythmically. Clark decides that it’s time to move the patient to the cath lab.
As it turns out, Roger isn’t going anywhere, and his life was never in Clark’s hands. It was actually in the hands of Dr. Jonathan Doroshow, associate director of the Annenberg Simulation Center at Lankenau Medical Center.
Doroshow was in the Simulation Center’s control room running the computers that manipulate Roger’s speech, heart rate, breathing—even when and at what speed he blinks his blue eyes. Through speakers in Roger’s ears, Doroshow can hear what residents say. Sensors in Roger’s torso and limbs detect how much pressure they apply during chest compressions and, via wireless technology, transmit the information to the control room. With that data, Doroshow adapts the scenario to provide Roger’s real-time responses. He records the entire exercise for evaluation by residents and their instructors. That’s especially important when Roger dies—and Roger has died a lot.
Neither man nor mannequin, Roger is a SimMan 3G, a sort of medical Terminator who can’t be destroyed by the hundreds of residents who practice procedures on him. Roger is a
direct descendant of Resusci Anne, the life-size dummy used in CPR training since the 1960s. Both are made by Laerdal Medical, an international conglomerate of companies, laboratories and factories specializing in soft plastics, microtechnology and virtual-reality systems.
Roger’s technological sibling is Noelle, a blue-eyed blonde who is chronically pregnant. A birthing simulator created by Gaumard Scientific, Noelle is caught in an obstetrical Groundhog Day, delivering the same baby again and again—and each birth is difficult.
“Shoulder dystocia, post-partum hemorrhaging, prolapsed umbilical cord, uterine rupture, breech, C-sections—all are complications that can arise in deliveries,” says Joyce Capuzzi, an RN and educator at Lankenau. “Nurses and doctors need competency and confidence in negotiating these situations.”
Capuzzi admits that they don’t get a high volume of such complications in real patients. “So the best way to learn how to deal with them is to practice on Noelle,” she says.
Although Noelle is not as high-tech as Roger, she is anatomically correct, with a pregnant belly, placenta, simulated blood and soft plastic that can be cut for an episiotomy and Caesarean section. Spring-loaded in her uterus awaiting delivery is SimBaby, a mini-medical simulator that can be programmed to breathe, have a heartbeat, turn blue around the mouth and, of course, cry.
“Patient safety is our number one priority, and that involves everything from controlling infections to soliciting proper patient histories to being calm and confident in crisis situations,” says Dr. Barry Mann, chief academic officer of Main Line Health. “There is a national movement to look at how much we can simulate to get residents up to certain skill levels before they interact with patients.”
For Mann, it’s all about patient safety. “Just like pilots conduct many simulated flights before they fly real airplanes, that’s what physicians should do,” he says.
The Annenberg Simulation Center opened in 2010 and serves as a virtual-reality training ground for Main Line Health’s residents, fellows, physicians’ assistants and nurses. The six patient simulators—Roger, Noelle, two SimBabies and two other adult males—range in cost from $50,000 to $100,000 apiece, depending on the technology. The simulation center also has computerized desktop stations for training in creating central lines, suturing, laparoscopic techniques and other work that involves hand-eye coordination.
And there are opportunities to perfect one’s skills by interacting with human patients. “First- and second-year residents are often sidelined during critical procedures,” says Dr. William Surkis, the simulation center’s program director.
But those with seniority get first crack at hands-on work, especially during emergencies. “It takes quite some time for them to advance up the chain and get to do procedures on patients,” says Surkis. “The center allows them to practice, build their confidence and continue to hone their skills.”
Meanwhile, more advanced simulation technology is in development. The newest patient simulators are operated via hand-held tablet computers that can run a wide variety of medical scenarios and create realistic human sounds.
“We’re going to look back at this in 20 years and see that this was the infancy of patient simulation,” Mann says. “The better the technology gets, the better our residents get.”