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MEDICAL EDUCATION Patient Simulator Comes to Life in TMECLater this month, Harvard medical students in the HST Patient–Doctor II course will be introduced to "Stan," a computer-controlled patient simulator in the Tosteson Medical Education Center that brings a new level of realism to preclinical education.
Nancy Oriol intubates Stan, the new patient simulator in the TMEC, while James Gordon (center) and Jeffrey Cooper observe. Photo by Steve Gilbert His name is short for standard patient, but Stan the man(nequin) can be programmed to act like nearly any patient a doctor might encounter. As a stethoscope reveals, his lungs breathe—with true physiologic air exchange from pumped-in gases—and his heart beats. Pass a hand over his eyes, and his pupils dilate and contract in response to the changing light. Touch a wrist and time his pulse; inflate a cuff and gauge his blood pressure. Vital signs are fed to a patient monitor that displays them as digital readouts and beeps. Stan Takes It Lying DownJames Gordon, director of the MEC Program in Medical Simulation and HMS instructor in medicine (emergency medicine) at Massachusetts General Hospital, injects a fluid labeled as epinephrine into Stan's IV. A barcode reader identifies the "drug," a sensor measures the dose, and Stan's heart rate and blood pressure climb in response to the adrenaline."With the simulator, we now can bring to life the tutorial cases our medical students use in problem-based learning," Gordon said. The simulator is a valuable tool for learning how to perform common medical procedures. But even more important, proponents say, is the way it puts learners in complex, realistic situations where judgment, communication, and teamwork are crucial. Many HMS students have already been learning on a simulator at the Center for Medical Simulation, an educational organization founded in 1993 by the anesthesia departments at the HMS-affiliated hospitals. The students responded enthusiastically, said Nancy Oriol, HMS associate professor of anesthesia at Beth Israel Deaconess and associate dean for student affairs. "The thing they liked most was thinking on their feet," Oriol said. "At the same time that they were using their medical knowledge, they were also working through their communication with each other, their thoughts about how to manage what was going on, and the reality of the resources they had to work with. They were quite surprised by how easy it was to suspend disbelief." After a session, students are debriefed and encouraged to discuss the case and critique their own performance. In the May 2001 Academic Medicine, Gordon and co-authors report that both students and educators gave high marks to a pilot project in patient simulation. More than 80 percent of both groups said simulator-based training should be required for all medical students. Medical simulation follows the lead of cockpit simulation training used in aviation, another high-risk, high-stress job where minor errors can quickly turn disastrous. In the 1960s, attempts at medical simulation flopped due to inadequate computer power. Then in the '80s, anesthesiology researchers introduced the technology to medicine as part of an effort to improve performance and reduce errors within their specialty. Jeffrey Cooper, executive director of the Center for Medical Simulation and HMS associate professor of anesthesia at MGH, is a biomedical engineer who performed the first studies of human error in anesthesiology in the 1970s, and was an early convert to simulation technology. A World CenterAfter prototype simulators were developed at Stanford and the University of Florida, "We at the center were among the earliest adopters," Cooper said, "the first ones to buy a simulator off the assembly line." CMS has since become one of the world's preeminent simulation centers with more than 1,000 health professionals trained. A variety of specialized courses are offered for physicians (including the affiliated hospitals' residents in anesthesia, radiology, pediatrics, emergency medicine, and other specialties and, most recently, all of the anesthesia faculty of the HMS affiliated hospitals), nurses, technicians, and personnel in medical industries. The center is at 116 Huntington Avenue but will soon move to Cambridge, near MIT.The Josiah Macy Jr. Foundation in 1999 awarded funding to MIT and the Harvard–MIT Division of Health Sciences and Technology for a three-year project conducted at CMS (Martha Gray, codirector of HST, is the principal investigator; Cooper, an HST faculty member, is coprincipal investigator), to study how the simulator can best be used in medical education. The first educational project involving HMS students was organized in 1996 by Martha Gallagher, HMS instructor, and John Pawlowski, HMS assistant professor, both in anesthesia at BID, and received a best abstract award at a national medical technology meeting. Several other simulation-based modules have been used in the curriculum, including one developed by HMS associate professors of anesthesia José Venegas from MGH and Stephen Loring from BID for HST's respiratory physiology course. A collaborative project between HMS and CMS, commisioned by Daniel Federman, senior dean for alumni relations and clinical teaching, won an award from the Computerworld Honors Program as an innovative use of information technology to benefit society. This project demonstrated the value of using simulation in the preclinical curriculum, Oriol said. Stan's arrival at the TMEC gives students greater access to the technology, and Gordon envisions the simulator becoming a medical education service available to students whenever they want hands-on practice. The potential applications are vast, said Cooper, and "If it's as good as we think, it should take on a life of its own—just figuratively of course!" —Tom Reynolds |
