Sunday, July 19, 2009
Patients are fake, but lessons are all too real
By ERIK MAZA
Orlando Sentinel
ORLANDO, Fla. — Louis Johnson was admitted into Seminole Community College’s nursing school with chest pain.
He is 62, shows normal vital signs and costs $35,000.
He is a robot. And it’s the nursing students’ job to diagnose him properly. Johnson is one of the many roles the 14 patient simulators at the school play for training nurses. An increasing number of health-care professionals are being taught this way, and because of its potential to reduce medical errors, this emerging technology is considered the next wave of health-care education.
The goal is for students to make their mistakes on the robots and not on patients in the real world, said Cheryl Cicotti, director of nursing.
Imagine Florence Nightingale on the set of “Blade Runner,” and you’ll have an idea of what it’s like for the nursing students to deal with these replicants.
“It’s so funny because I was with other students who’d never dealt with several patients at the same time before, and one girl was freaking out because it felt so real,” said Patricia Saint Louis, a recent nursing grad. “It may sound silly, but it really prepares you.”
The simulators don’t look lifelike at all. They’re plastic, wear bad wigs and are about as coherent as Britney Spears at the MTV Video Music Awards.
But their reactions and, more important, students’ interactions with them, are real.
The robots can make different lung noises, so students can distinguish a “wheeze” from a “crackle.”
They can produce bowel noises, have varying degrees of pulse and even have functioning mechanical bladders with actual liquid inside.
In a typical scenario at SCC, Saint Louis might be asked to look after four robots with different conditions that start showing critical symptoms simultaneously.
The Johnson robot might be having a heart attack, while another is simulating respiratory problems.
Saint Louis, who is preparing to be licensed as a registered nurse, has to decide which patient to attend to first, how to direct the underlings working beside her and how to deal with a situation that practically and emotionally mirrors a real hospital experience.
Those who have worked with patient simulators compare them to the training pilots go through.
Until very recently, it was nearly impossible to re-create in an academic setting some of the critical situations health-care students would face in the real world. Students had to practice on real people for the very first time under strict supervision or observe experienced practitioners.
Simulation allows students “hands-on” experience sooner.
“We’ve long known in education that experiential learning is superior for adults,” said Dan Raemer of the Center for Medical Simulation, which serves Harvard Medical School teaching hospitals. “Most adults learn best when they’re experiencing something, rather than observing or being lectured.”
The robots started becoming popular in health care in the 1990s as a way to reduce medical errors among health-care graduates.
Raemer estimates there are 3,000 to 5,000 high-end simulators — such as the ones at SCC — in the world. And the technology keeps improving.
“We’re really at the beginning of this revolution in health-care education,” Raemer said. “In 10 years, we’ll look at the current simulators and think of them in the same way we think of Apple II computers with 2K memory. In 20 years, they’ll be hard to tell from real people.”
Raemer said the impact of simulators goes beyond safety — it could help ameliorate shortages in health-care jobs as well.
By 2020, the national shortage of nurses could increase to 1 million, according to the Department of Health and Human Services, in part because there will be more older Americans needing services, and fewer nurses to supply them.
Nurses from the baby boom generation, like their patients, are retiring.
Even though more people than ever want to go into recession-proof jobs such as nursing, nursing schools have had to turn applicants away for lack of space, faculty and hospital training programs.
SCC received 300 nursing applications for 100 slots last August.
Cicotti said that at a small school such as SCC, the focus is on maximizing the limited resources and training students as efficiently as possible.
“It’s a way to educate students in a safe environment and maintain patient safety,” Cicotti said. “It’s not a replacement for working with live patients; it works in conjunction.”
Saint Louis started doing simple simulations in her first semester at SCC and later progressed to more sophisticated ones.
“In the real world, you have to deal with several patients at once, you have to deal with the angry family members. You have to be able use your resources,” she said.
“[The simulation] prepares you even before you go into the hospital because it is as overwhelming.”