Health care education "Gets Real"Fox Valley Tech animatronic patient simulation lab brings nursing and paramedic training to lifeStory by Jessica La Plante-WikgrenWhile the saying “It’s okay to make mistakes” is applicable to many professions, emergency medicine is often not one of them. For paramedics and ER nurses, being able to execute one’s job duties with confidence and competence can have life-and-death repercussions. The need to bring new hires and recent graduates up-to-speed without putting patients’ lives at risk has made training in the field of emergency medicine a long and labor-intensive process. Breaking new ground in health care education, Fox Valley Technical College has pioneered a solution to the long-standing problem of getting nursing and paramedic students hands-on, real-world experience without putting real lives in danger. The answer lies in patient simulators, computer-operated mannequins with a life-like verisimilitude that replicate the joint movements, anatomy, and physiologic functions of a real human being. Five years ago, FVTC became one of two training facilities in the state to incorporate patient simulators into its health care curriculum. Now, the college’s cast of animatronic mannequins that mimic the biological functions of real-life humans will attain a new height of realism. Thanks to a donation from Fox Cities-based ThedaCare, a new wireless patient simulator was added in December to the college’s already state-of-the-art medical training lab. The iStan adult patient simulator, manufactured by Medical Education Technologies Inc., offers the benefit of wireless portability and a level of frontline realism that runs layers deep. Record of life-like training This year, FVTC celebrated the fifth anniversary of its ground-breaking investment in health care education by taking that medical realism to the next level, renovating its learning facilities to include a five-suite simulation lab that will feature a total of nine patient simulators with the addition of iStan. The college’s family of fully automated, virtual patients includes the infant-sized “Baby Elizabeth,” and a wireless adult simulator named “Noel” who can perform such complex tasks as giving birth. Two high-fidelity units hold students’ pharmacology knowledge to real world standards. Rather than being docked an exam point on a test for making an error, students who miscalculate drug dosages get to witness the potentially devastating results of making a mistake. The simulators are capable of reproducing the effects of drug toxicity by dying in response to drug overdoses and miscalculations. In hospitals, “there are 8,000 to 9,000 medical errors that result in the death of a patient every year across the U.S.,” said Bob Sternhagen, an emergency medical services instructor at FVTC who directs the college’s patient simulator program. “We’ve seen students make medical errors and they saw the results of what happened to a patient and will never make that error again.” Because of the technology’s initial cost and the upfront learning curve of operating and maintaining the equipment, human patient simulators have not caught on uniformly at all nursing schools and medical colleges nationwide. However, patient simulators have become a staple of health care training at the nation’s most elite colleges and universities, including Harvard and Stanford. “If you went to the Web and looked at who has simulators, it reads like a list of ‘Who’s Who’ in medical education in this country and around the world,” Sternhagen said. Industry reports suggest that patient simulators may prove to be one of the most important technological advances in modern health care. “Studies are being done almost daily validating the simulation aspect of health care training,” Sternhagen said. “Critical thinking skills are dramatically increased by simulators; it has students making very logical decisions and quick decisions.” An Ohio hospital “is paying $1 million less for (liability) insurance because of the fact that they have a patient simulator lab that they are running their employees through,” Sternhagen said. Simulators allow students to see and treat a full continuum of conditions rather than simply reading about them in a textbook or medical journal. The new training technology is particularly useful for high-risk, low-volume situations that nursing students – and even experienced medical staff – don’t have the opportunity to witness everyday, said Tracey Froiland, a registered nurse and staffing development educator with Appleton Medical Center, part of the ThedaCare system. One of many providers that has partnered with FVTC to keep its employees on the cutting edge of health care education, ThedaCare uses patient simulation as a means of supplementing and diversifying learning that occurs in a clinical setting. “We use it to give students an opportunity to work on situations that they might not see during their clinical training – abnormal or once-in-a-lifetime (scenarios),” Froiland said. “We also use it to make new nurses and medical students feel comfortable.” ThedaCare’s donation of the iStan wireless simulator to FVTC was inspired by its commitment to both college education and community health. By raising the confidence and skill levels of local nursing students, ThedaCare hopes to heighten the standard of care received by all patients in the Fox Valley, Froiland said. “ThedaCare’s mission is to improve the health of the community and this is a way we can give to the technical college to help them,” Froiland said, adding that “a lot of nursing staff that we hire comes from the technical college.” An adjunct faculty member at the University of Wisconsin-Oshkosh School of Nursing, Froiland said she is eagerly anticipating the day when simulation technology comes down in price to the point where patient simulators are an affordable addition to hospital training programs and nursing school curriculums nationwide. The technology “is amazing; they can talk, they can change moods. If you forget something, something could happen to the patient,” Froiland said. “Practicing on each other or something that’s not alive is not very realistic, so you don’t always hear the different heart sounds or different lung sounds of the patient,” she said. An example of iStan’s attempt to replicate patient care in the real world is the model’s use of interchangeable “skin suits” to reflect a wide cross-section of patient types: male and female, young and old. The suits mimic the feel and turgor of real human tissue depending on which patient-type is selected. But the realism of iStan runs more than just skin deep. The simulator is built around a synthetic human skeleton, resulting in an internal anatomy that is as life-like as its external appearance. The interactive “dummy” can be programmed to simulate almost any condition medical professionals might encounter in a clinical setting. In the emergency room, that includes flail chest, a collapsed lung and any number of cardiac crises. The dummy can bleed, secrete fluids, perspire, and emit a full range of anatomical sounds students must learn to identify using their own observational skills and independent discretion. “Prior to this, we were using low fidelity technology and there really was no interaction,” said Barb Tuchscherer, chair of FVTC’s nursing department. “The student had to wait for cues from the instructors and they weren’t used to making those calls on their own. By using the simulator and higher fidelity technology, the students get comfortable with their own assessment skills (rather than) relying on instructors for that direction.” “There was one graduate who came back and said her patient started to crash and had a crisis going on,” Tuchscherer said. “She was able to determine that it was a blood clot in the patient’s lungs because she had seen that scenario in the lab. She truly believed that it contributed to that person staying alive.” Prior to graduating, every FVTC nursing student receives about 100 hours of patient simulator training. Paramedic students receive between 30 to 40 hours of hands-on training and emergency medical technicians graduate with 12 to 16 hours of experience. More than just bringing health care workers up-to-speed on a wide variety of conditions and complex procedures, patient simulators allow nursing and paramedic instructors to teach students the soft skills needed to succeed in a clinical setting. Because multiple students get to work on the same virtual patient at the same time, FVTC instructors are able to teach students the art of collaborating as a health care team. Psychological conditioning is another advantage of simulation-based learning. Mentally preparing students for real world disasters is especially important in emergency medical services, where graduates are routinely subjected to situations that can be traumatizing for both the patient and provider. “The simulators can be mocked up to simulate a number of trauma-type situations,” Sternhagen said. “If students come in unaware of what a massive bleed looks like, they might be put off or shocked badly the first time they see it for real. We can take some of that edge off.” Because of iStan’s portability, the addition of the wireless unit to FVTC’s patient simulation lab will increase the college’s capacity to provide training and consulting services to the local community. The college already serves a large clientele base of health care providers who use FVTC’s consulting services because of its expertise in simulation-based training. Wireless units expand the variety of settings and environments in which training may occur, such as ambulances and air medical transports. “Other schools have come to us and have asked about consulting services and developing (their own) labs,” Sternhagen said. “When you look at health care education at the levels of EMS and nursing, you’re getting to a point where if you don’t have simulators, you are behind the educational curve. In the next four to five years, if you don’t have a simulator lab, there might be certification issues.” In private industry, human patient simulators could help hospitals and medical providers not only reduce error rates and improve patient care but also reduce the need for long new-hire orientation periods that drain financial and staffing resources. Health care employers “in the Valley are looking to decrease the amount of orientation time that new graduates or new employees on a floor receive,” Tuchscherer said. “They are hoping that simulators will be an answer to that.” Despite the new five-suite renovation FVTC has undertaken to upgrade its training technology, the college is not content to rest on its laurels. Eager to take simulator-based training to the next level, Sternhagen said FVTC’s long-term goal is to create a learning lab that would replicate a patient’s start-to-finish journey through the emergency medical system, from calling 911 to being discharged from the hospital. “We’re working on the concept of an integrated, multidisciplinary type of training activity where we have a number of different health care professionals working on the same type of patient,” Sternhagen said. After receiving first responder treatment, “the patient would be turned over to EMT or paramedics, and (then) electronically transferred to an ER or surgical unit and discharged. Every one of those steps would be monitored and evaluated for effectiveness.” |