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Mastery through simulation at Northwestern medical school

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Technology and medicine go hand in hand. Now Northwestern University’s Feinberg School of Medicine is taking this relationship one step further.

There, students train in a real live clinical environment with real equipment. Their patients, on the other hand, are anything but.

At a community hospital, two medical residents--Charles and Eunice--care for Haley, a 19 year old who gave birth two days ago.

Hayley’s blood pressure is elevated and she complains about pain in her upper right abdomen. Her diagnosis is preeclampsia, and if she doesn’t receive proper treatment, she’ll start to experience seizures.

In the room next door, another patient is suffering from postpartum hemorrhaging.

Within a half an hour, Charles and Eunice have stabilized both the “patients.”

“Actually if you strip these particular mannequins down, they’re actually a small computer running Windows XP, at the very core of things,” says Brian Florek, a simulation specialist. He manipulates the mannequins to react like a human patient.

“So for example, if the physician decides to give a certain amount of fluids, we would tell the computer that the physician has given let’s say 1000cc bolus of a certain fluid, and we would make sure the mannequin reacts representative of the treatment given.”

Florek and fellow specialist Scott Murcko have a hand in implementing the exercises at the simulation center. According to them, this month’s simulations focus on OBGYN procedures and last month was gastroenterology. They’ve also covered neurology and toxicology.

“Every month the cases are a little bit different based on what [the students] are actively learning at the time,” Florek says.

But both Murcko and Florek agree, the “wildest” scenarios are the trauma situations, the ones that deal with multiple system failures, advanced airway placement, management of blunt trauma, chest tube insertion, management of hypovolemic shock, and massive blood loss.

For the sake of realism, the mannequins are voiced by staff members from within the control rooms, but often times creating that realism is no easy task.

The center is one of the largest buyers of fake skin outside of Hollywood, and they’ve employed engineers to help design some of the more difficult anatomical recreations.

Dr. John Vozenilek, the director of simulation technology and immersive learning, explains that recreating anatomic structures like a premature newborn’s ribcage has necessitated embedding architects and engineers into the simulation center.

“This newborn simulation is very challenging because we’re dealing with a very small space. The newborns, particularly the premature newborns, sometimes they’re only the size of a can of Coke,” says Vozenilek. “Sometimes it’s like MythBusters, sometimes it’s a little bit like the Keystone Kops, but one way or another, we wind up building body parts.”

But Dr. Vozenilek says the mannequins are only one piece of the simulated environment.

“We use real defibulators, real ventilators, real ultra sound equipment. We even stock our carts here so that if they reach into the second drawer of a cart here in the sim-lab, in the real clinical space, there’s a cart that has the second drawer stocked exactly the same, so their motions, even their motions are trainable.”

Watching and evaluating the learners from behind a two-way mirror is a whole team of medical and simulation experts.

Training in the simulation center is required of all Northwestern medical students in years one through four, and of residents from both the school and the hospital.

But it’s also available for practicing professionals, for those who want refreshers on certain procedures, or for those who want to keep up to date on the latest in medical technology, something that even experts like Dr. Vozenilek can benefit from.

“The best example is ultra sound,” says Vozenilek, “ultrasound came in, really towards the end of my residency, I’m forty years old now, and I'm getting ready to go through maintenance certification, ultrasound for me was a new technology. I know there are colleagues out there that haven’t had the same opportunity to practice with ultrasound that would really have great benefit. We have an opportunity to provide a very nonthreatening environment for that learning.”

Technology is at the center of simulation’s emergence in medical school curriculum. Dr. Vozenelik says it’s more than just a teaching tool, it’s an ethical consideration.

“We now have excellent tools to solve the problems of clinical education, tools that we didn't have before. Why would we not apply these excellent tools?”

Simulation learning has already paid dividends at Northwestern hospital. Studies indicate that simulations have helped drastically reduce infections in Medical Intensive Care Units, creating a net cost-savings of over $700,000 in just one year.


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