MEDICINE Fake patients give lessons at UPMC

The institute hopes a new for-profit spinoff will take its technology and techniques to facilities all over the world.
PITTSBURGH (AP) -- In one room, medical students swarm to help a man whose low oxygen levels and elevated EKG indicate he's about to have a heart attack. Next door, a man lies on a hospital bed covered in pale blue surgical sheeting, blood-soaked rags on his stomach.
Down the hallway a baby struggles to breathe, its tiny stomach pulsing in and out.
It's a typical day at the University of Pittsburgh Medical Center's Winter Institute for Simulation, Education and Research, where the "patients" are actually computerized simulators -- but the practice is a matter of life and death.
In its 10th year, WISER trains thousands of medical personnel every year and is hoping a new for-profit spinoff will take its technology and techniques in patient safety to facilities all over the world.
A step further
Though hospitals and universities across the country are using simulators, WISER officials said their approach goes a step further. WISER collects data from the simulators, analyzes it and gives feedback to doctors, nurses, paramedics and other medical personnel.
"Research is every bit as important to us as training," said Thomas Dongilli, WISER's operations coordinator, one of only five full-time employees at the center. "If you don't do that then there's no value to this training center."
Founded in 1994, WISER opened with one simulator that cost about $300,000. Now, the center has 17 simulators, including a pregnant woman and baby, which cost about $30,000 each; its new offices, which opened this year, replicate the look and feel of a hospital -- from speckled linoleum flooring to a reception area that looks like a waiting room.
Earlier this year, in partnership with UPMC's Health Venture Fund and the University of Pittsburgh, WISER also helped launch UPMC SimMedical. The company has $2 million for new product development, and hopes to bring the curriculum and model of training to hospitals, medical schools and other facilities nationwide.
"This is all about patient safety," said Steven J. Schmitt, SimMedical's chief executive officer. "We are not just teaching ... we are refreshing physicians and nurses on procedures they forget about. That's just human nature."
The company and WISER will operate independently. Because WISER's model is Internet-based, however, facilities worldwide that eventually use it to set up simulation programs can share data.
"For this to ultimately go where it should go, you have to show that it's good. Therefore Pittsburgh, with other centers, can link up over the Internet and combine our standard data and do research," said John J. Schaefer III, WISER's director. Schaefer is the co-inventor of an airway management simulator that was the precursor to Laerdal Medical's SimMan, the simulators used at WISER.
WISER trained 8,000 medical personnel last year, and are on pace to double that this year, Dongilli said. The courses are completely Internet-based, so students can log in from anywhere at anytime to view results of simulations or study the curriculum.
On a recent day, several fourth-year medical students in a critical care class gathered around the hospital bed of a simulated patient named Mr. Smith. The man had just come into the "emergency room" complaining of chest pain and difficulty breathing.
One student took the lead as the doctor on duty. But as the man's vitals indicated he was having a heart attack, the student called in others to help administer CPR.
"Man, you've got to help me. My chest is really killing me," a facilitator says through a microphone from a control room just outside the simulated ER.
The patient was anesthetized, a breathing tube was placed down his throat, and the students started CPR.
"The only time they would ever get training like this would be on a real person. And if the person is that sick, they're not going to let the medical students touch him," Dongilli said.
Checking results
Afterward, students can go online to see results of how they performed during the simulation. They can even watch a video replay, as they learn not only how to perform the techniques taught in the classroom but also simpler concepts such as where it's best to stand in the emergency room to complete certain tasks.
About 170 Pittsburgh paramedics visited WISER earlier this year for an eight-hour training on clearing a patient's airways.
"It helps us make more realism of the situation," said Roy Cox, coordinator of patient care and education for Pittsburgh's Bureau of Medical Emergency Services. "We're able to put the paramedic under ... situations in a field setting without pretending."
Paramedics took an online pretest before arriving for the training. On training day they were put through four separate emergency scenarios, some of which some paramedics only see once or twice a year, Cox said.
"The problem is when we're dealing with a patient with a loss of an airway, they are in such a critical state, it's a fine line between success and not," Cox said.
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