Cath Lab Digest

Continuing education can be a blast! While we healthcare professionals often look forward to a weekend “away” or even a week if we can squeeze it in for a continuing education conference or symposium, the excitement usually revolves around the exhibit hall, a vendor educational demonstration or a side trip. However, the future of educational programming is upon us and we may find the educational experience to be more like a visit to Disney World®, taking in a 3-D Hollywood movie or playing on a Wii™.

Step into a virtual hospital or simulation lab on a health sciences campus or log into a serious medical game and you may think that you are aboard the Starship Enterprise. Medical and other healthcare professions students are being educated on the basics of patient care as well as advanced clinical procedures using computer-enhanced mannequins (CEMs) or human patient simulators (HPSs) (figure 1) and 2-and 3-D medical games with electronic patients in virtual environments (figure 2). These technologies are being used to simulate the patient and the patient care environment. With advanced or high-fidelity CEMs, students can listen to vital signs, administer drugs and watch a typical human physiological response play out, perform chest compressions and receive feedback about their technique, draw blood from an arm vein or collect urine via a catheter. Additionally, certain high-fidelity CEMs have wound simulation packages. In some CEMs, these wound simulation or moulage kits can be used to create realistic wounds that can even be connected to the mannequin hydraulic system to produce bleeding. Through computer-aided controls, blood pressure can be controlled and set to produce a venous “ooze” in the wound, an arterial “squirt” or the pulse can be removed in a limb to simulate arterial insufficiency.

Different categories of CEMs exist.1,2 They include low, medium and high fidelity CEMs or HPSs. Each has their merit and can be used for different teaching objectives. Costs are also a consideration as high-fidelity simulators cost significant more than their low and medium-fidelity counterparts. A table comparing features and costs is provided below.

Like CEMs, serious healthcare games allow students to actively experiment with clinical skill performance and decision making without the inherent risk to real patients. The learning process has been termed “successful” failures by many in the simulation field. As a result of the interactive capabilities of these applications, health science centers across the country are rushing to integrate serious gaming into their training paradigms. Serious medical games exist for performing dental implantation surgery, preparing a surgical instrument tray, studying the immune response and for preparing students to manage hospitalized patients. Another example of a serious health game is one being developed by Winston-Salem State University. Physical therapy students will be able to practice patient care skills with electronic patients individually and together (Figure 2).

To fully take advantage of the capabilities of these simulation technologies, applied learning centers such as virtual hospitals are being created. For example, CEMs are being housed in simulation labs that mimic healthcare settings such as an ICU, birthing room or a surgical suite. Depending on the level of financial investment, some centers have created virtual hospitals that contain a number of simulation suites along with control rooms for video recording role playing activities and debriefing rooms for student self-assessment and peer-evaluation. Additionally, full scale patient care scenarios are played out in these environments using teams of students and health care professionals. This interactive learning experience allows group performance to be assessed along with individual performances. As a result, team dynamics can be evaluated along with clinical competence in the delivery of health care services. Because of the potential benefit of these virtual hospitals in providing hands-on skill training for learning new procedures and trouble shooting patient safety issues, healthcare centers are establishing simulation suites or partnering with health science centers and others to build virtual hospital training facilities. A search for the term “virtual hospital” on Google will locate a plethora of these facilities.
However, CEMs and medical games are only two examples of simulation. According to Dr. David Gaba, “Father of Medical Simulation”, there are five categories of medical simulation.1,2

These categories include:
(1) Role playing
(2) Standardized patients
(3) Simple (part) task trainers
(4)Computer-enhanced mannequins (CEMs)
(5) Electronic patients (see Table 1).

Simulation has a role in educating both students and practicing clinicians. Some of the earliest use of simulation can be traced back to teaching medical students about wounds and dermatological conditions.3 The literature indicates that wound simulation has been a part of medical education since at least the Middle Ages when beeswax was used to prepare models of wounds and skin lesions. Wax models of these skin conditions were used to preserve the detail of interesting medical cases in the form of castings and sculpture. Interestingly, wax models representing a wide variety of common and unusual skin lesions were used in dermatology education until the 1940’s when they were displaced by photographic slides.