The situation in the operating room is critical. As the physician trainee manages the patient through the life-or-death event, his anxiety is evident. The perspiration glistens on the trainee as his teacher watches the scenario unfold. It feels real, but it’s not.
The scenario is taking place in the UCLA Simulation Center. The
patient is a life-size, computer-controlled mannequin that interfaces with standard monitors. It has a realistic cardio-pulmonary system, palpable radial and carotid pulses, audible heart and lung sounds, and the capacity for airway instrumentation, intubation and ventilation; pharmacological response to more than 60 medications; ulnar nerve stimulation; IV insertion; and even urine output. Through controls in an adjacent room, the mannequin can be made to “talk” or simulate critical events. Once the scenario has played out, the resident is taken into a conference room for a debriefing in which his or her
performance is discussed.
“This is part of the new face of residency training—being able to rehearse both routine procedures and challenging leadership scenarios without risk to patients,” says Dr. Randolph H. Steadman, professor of anesthesiology and director of the UCLA
Simulation Center. “It’s much more interactive and performance-based than anything I got when I was in medical school or residency in the late 1970s and early 1980s.”
UCLA was among the first institutions to integrate the simulation technology, starting with first-year medical students and anesthesia residents in 1996. The use has expanded into the surgical arena, and Dr. Steadman foresees that the technology will soon be incorporated into all of the residency programs.
“When there is a cardiac arrest or other critical incident with real patients, we can’t give trainees authority,” Dr. Steadman says. “But we can take them to the simulator and let them manage the healthcare team in a re-created environment, allowing them to make mistakes and see the consequences of their decisions. That’s how the real learning occurs.”