Simulated Encounters---Dummies, Software, etc.

[Strength&Speed]

I am amazed this sort of technology/curriculum hasn't come sooner, but later is better than never. All med students/interns should have practice handling crisis situations (codes, hypotension, dyspnea, high heart rates, placing central lines, etc) on dummies or practice situations BEFORE they actually have to handle them for real. This could avert lots of mistakes that are learned on the job in residency.

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[Winged Scapula]

Hmmm...some places do. We have one of those "simulated patients" with all the bells and whistles, but in reality its mostly used for practice intubation, managing codes and arrythmias, etc. There are lots of programs, CDs, etc. to help as well.

But there is no replacing real patients and you can't simulate the element of suprise and anxiety that can make the best prepared resident react in less than his/her best manner.

 

[logos]

Our school always brags about how much their simulated patient for codes cost them...something like 400k. It is a pretty cool gizmo, but I dont think it gets a ton of use. Hopefully we (2nd years) will get to use it during our ACLS training this spring....but who knows, its probabably tough to get 200 people the chance to use it.

 

[dpmd]

We used the SimMan in the Army to practice our combat medical skills on (similar to practicing codes, but also including less severe scenarios). One place I did it at even had simulated mortar sounds, flashing lights, and a simulated field environment to make it more realistic. However, I don't think it was really that great a training tool. I suppose it is better than nothing, but you end up learning how to treat the simulator, not a real patient. You have to listen in specific areas for breath sounds, lines are ridiculously easy to start, there is only so much a simulation can portray. Also, even with the most realistic setting they tried to give us we never really felt the same adrenaline rush and pressure as you do with a real life patient. Maybe that had to do with the fact that it was difficult to fail, and no real consequences if you did.

They did start using a computer based system that gave you scenarios which you had to respond to. I did some of the MD level scenarios, and those seemed pretty good. Again, no real pressure but it did grade you on whether you did the proper things in the proper order within a certain amount of time. Something like that might make remembering the correct steps a little easier, and more second nature.

 

[Winged Scapula]

However, I don't think it was really that great a training tool. I suppose it is better than nothing, but you end up learning how to treat the simulator, not a real patient. ... Also, even with the most realistic setting they tried to give us we never really felt the same adrenaline rush and pressure as you do with a real life patient. Maybe that had to do with the fact that it was difficult to fail, and no real consequences if you did.

That was my experience as well. I used our SimMan for Trauma simulations and while it did make you think, I was only anxious that I would embarrass myself with my decision in front of others, rather than being anxious about the patient's outcome (which is the primary adrenaline rush IRL).

 

[Strength&Speed]

Nothing beats real world experience. Nobody will doubt that. But at what cost. I think with improvements and proper motivation (i.e. making it more realistic, incorporating some risk/reward, and stressing the residents a bit) you can avert some mistakes that are going to happen later on. Better to make a mistake on a simulated patient, than learn it later on a real human.