Tech Sessions: Simulation Center uses technology to educate medical students

by Jonathan Sessions

May 29,2009

May 12 marked the one-year anniversary of a little-known department of the University of Missouri’s School of Medicine: The Russell D. and Mary B. Shelden Clinical Simulation Center. The simulation center is an amazing new facility and resource for medical and nursing students, but remains unknown to most of the general public.

University of Missouri medical students and a nursing faculty member discuss the importance of safety and communication in preparation for a simulation exercise.

Tucked away on the sixth floor of the new Clinical Support and Education Building (between the medical school, hospital and the Maryland Avenue Garage), it is not a spot most hospital visitors find by accident. I was lucky enough to see it as a part of a larger Columbia health-care tour and was blown away by the concept and technology.

The simulation center provides the medical student equivalent of student teaching. As a part of their curriculum, first-year medical and nursing students in their first eight-week block use the center to simulate experiences such as taking a patient’s history as a primary care physician and working in a busy emergency room. In the second block, the students do their first simulated physical exam.

What makes the Clinical Simulation Center impressive is its use of technology. Often technology is used because it can be, not because it helps educate. That’s not the case here. Here, the technology is the patient. While some of the simulations use actors or older medical students, many of the simulations use state-of-the-art mannequins. Originally developed for military in-the-field medical training, these mannequins allow medical students to interact and make mistakes without endangering a human life.

Though a wireless connection, the instructor can control the reactions of the mannequin “patient.” From pupil dilation and blink rate after an injection, to respiratory sounds and basic auditory responses when a patient enters the ER with a problem, the mannequin provides the students with human-like responses. This machine can provide the students with a real enough simulation without having to have a human patient.

With four adults, two infants, a 5-year-old, a 1-year-old, two birthing mannequins (one at Columbia Regional Hospital) and single-function body parts, the simulation center can provide a complete simulation experience for medical students.

In addition to mannequins the facility’s other key feature is an integrated video-monitoring system, allowing students to review their performances. The building is wired with 40 IP cameras (Web cameras), all integrated into Web-based software that is simultaneously recording the action. The facility consists of four large simulation rooms and eight standardized exam rooms. In each of the exam rooms, where beginning students take their first patient history, there are two cameras. In some of the larger rooms, where ER and OR simulations happen, there can be up to eight or more if using mobile cameras.

The cameras do more than offer new reality TV possibilities. The Web-based software allows students and professors to review simulations and see the stats of the “patient” while annotating for future study. Although the footage is currently only available at the center for security reasons, students, teachers and doctors will have access to their specific simulations through secure login from anywhere they have Internet access.

The Clinical Simulation Center offers students a new way to practice routines. This and other simulation centers eliminate the old “see one, do one, teach one” method of the medical profession. The students can now see one and practice many, review the video of their performance and practice some more. And it can all happen before they “do one” on an actual patient.

As I left the simulation center, operations manager Chris Sandars was on his way to replace a lung bag on one of the mannequins because it had worn out. As a person occasionally needing health care, I was pleased to think about medical students having the opportunity to develop their skills and routines on a device with replaceable organs.