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April 29th, 2010
04:39 PM ET

Can dummies teach doctors better medicine?

Cate Vojdik
AC360° Writer

Our patient, an adult male, was in the throes of a severe asthma attack. Standing at his head, I gripped the laryngoscope in my left hand and paused. I had watched doctors deftly insert metal devices just like this one into patients' mouths many times before - they had made it look so easy. But now I was holding the instrument that resembled a socket wrench with a flat blade - and the patient was crashing.

"Doc, I don't feel so good." Just minutes earlier, those had been his first words as we surrounded his gurney. Pressing a stethoscope to his chest, I had listened to the unmistakable wheezing sounds of an asthma attack. The monitor nearby showed his heart was beating far too fast. Someone on the team administered oxygen, but within moments his condition went from bad to worse. His blood oxygen levels were plunging, his lips had turned blue.

That's when the attending handed me the laryngoscope, calmly explaining we needed to intubate our struggling patient. Translation: insert a flexible plastic tube into his trachea so we could breathe for him; the laryngoscope would help me see where to put the tube. In medical dramas like ER and Grey’s Anatomy, this is when they yell, "Bag him!"

At this point I need to tell you that I am not a doctor in training. I am a journalist, and before this particular afternoon, the only intubations I'd seen had been on television. In theory, it sounds simple, and on television it usually looks seamless. You're supposed to use the laryngoscope (it has a light) to give you a clear view of the vocal cords and the glottis - the space between the cords. Once you can see where you're going, you thread a plastic tube through the glottis, then attach a rubber bag to the tube and press it rhythmically to force air into the patient's lungs. I soon discovered that not one of these steps is the least bit easy for a beginner.

Fortunately for everyone involved, my crashing patient was a dummy. More precisely, he was a very high-tech patient simulator. I'm not kidding when I say he talked to us or that his lips turned blue. Like the other dummies in the Simulation Technology and Immersive Learning Center at Northwestern University Feinberg School of Medicine, he can be programmed via software in myriad ways, in real time, to simulate a range of medical emergencies.

I was visiting the center with a group of fellow health care journalists during the Association for Health Care Journalists' annual conference. You can watch Joy Robertson's (KOLR-TV, Missouri) video about our encounter with the dummies here.

Dr. John Vozenilek, director of the simulation center, told us that the time-worn mantra “see one, do one, teach one” is being replaced at many medical schools with “see one, simulate many, then do some.” He says the vast majority of medical schools are now using simulation training—fully 90 percent in 2008, up from 33 percent in 2003. The concept is called teaching to mastery, which means medical students and residents repeatedly practice clinical skills on dummies and then are tested to make sure they can perform them competently. In other words, the dummies ideally take the hits along the learning curve, not actual patients.

The simulations are videotaped and students and instructors analyze them later, much like athletes and coaches use practice videos to improve performance. It’s not just technical skills that are scrutinized. Communication among team members is also evaluated. According to Vozenilek, 70 percent of medical errors occur around communication between medical team members, including nurses, residents, and senior physicians.

Students and residents also use dummies to practice inserting central lines (catheters that deliver medicines through a major vein in the neck.) Two studies published last year by Northwestern researchers reported reductions in infections and other complications in actual patients treated by simulator-trained residents. This emerging body of research is something to keep an eye on. We visited the simulation lab shortly after a new government report showed that three types of hospital-acquired infections, including central line infections, are increasing, despite a growing focus on prevention. All told, hospital-acquired infections contribute to an estimated 100,000 deaths each year, according to the Centers for Disease Control and Prevention. Many experts say these deaths are largely preventable, through improvements in hygiene, effective communication and adherence to checklists of safe practices–all skills taught at Northwestern's simulation center.

As for my crashing patient back on the gurney, the good news was that I managed, with a great deal of coaching, to get the tube into his airway. The bad news: If he'd been an actual person it's pretty certain he would have lost several teeth during the procedure. It was incredibly difficult to position the laryngoscope correctly and hold it there while maneuvering the tube into the right space.

My personal takeaway: If I ever need to be intubated by a medical resident, I fervently hope she will have practiced many times on a dummy just like the one I mangled.


Filed under: 360° Radar • Cate Vojdik • Medical News
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