Increased patient safety and improved medical education are major goals behind a University of Pittsburgh Medical Center (UPMC) program using human-like patient simulators that breathe, bleed, cough, and cry.
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Innovations in technology at UPMC
The Peter M. Winter Institute for Simulation, Education, and Research (WISER) is the largest medical simulation center of its kind in the world, second only to that operated by the U.S. military.
After opening two years ago, WISER has trained more than 10,000 doctors, nurses, paramedics, medical students, and other health care professionals, more than anywhere else. Every city of Pittsburgh paramedic is required to train at the WISER center.
The federal government estimates medical errors cost Americans billions of dollars each year and thousands of lives. Medical simulation that is being advanced at UPMC is widely regarded as one of the best ways to achieve a safer, better health care system nationwide.
"People's lives are being saved because of the work we are doing," according to John Schaefer, MD, director of WISER. "We're compiling data right now that I am convinced will show improved patient outcomes in the next five years."
Besides its commitment to increased patient safety and improved medical education, the center is also researching new educational uses for simulators and other advanced instructional technology. Leaders at WISER seek not only to train better doctors, but to create better training.
Pittsburgh is at the forefront of medical simulation. Dr. Schaefer helped to develop the first practical, low-cost medical simulator, called SimMan, in collaboration with Laerdal Corp. and UPMC colleagues.
SimMan looks and responds like a real person ┐ its skin can be cut by a scalpel, its veins injected by a syringe, and its heart stopped by simulated cardiac arrest. Its heart also can be started again with the proper medical intervention. At a cost of about $30,000, SimMan is a vast improvement over earlier, more expensive human simulators, whose price was in the range of $250,000. The lower cost makes simulators more affordable for medical schools.
Not only did UPMC and University of Pittsburgh researchers develop a better, less expensive humanoid medical mannequin, they also developed special software that could create different patient scenarios to challenge caregivers, thereby making SimMan a superior teaching tool. The advanced software marked the new generation of simulators, ones that not only acted like a human patient, but also provided feedback, data, and tracking to help students and teachers improve. "It replaced part of the school of hard knocks in internships of traditional medical education," says Dr. Schaefer. "Now students practice techniques before ever actually doing them on real people."
Simulators are tools, and software makes the tools easier to use. Now nurse and physician teachers don┐t have to be simulation experts to use them. The training experience becomes easier and more beneficial. The curriculum is even available on the Internet.
"It's revolutionizing the way medical students are taught," Dr. Schaefer says.
WISER is home to 19 SimMan medical simulators, 60 smaller personal computer-based simulators primarily used to teach advanced cardiac life support (CPR), a pregnant simulator that delivers a baby, and a new infant simulator still under development, called SimBaby.
The Institute also uses patient actors as well as classrooms called "theaters." The theaters transform into nearly any scene desired, from an operating room to an intensive care unit to a disaster scene on a city street.
According to Dr. Schaefer, "This is as close to reality as it gets without being real."
Every medical student at the University of Pittsburgh School of Medicine is required to take an average of 40 hours of simulation courses at WISER. Through a problem-based format, students learn how to insert an intravenous line (IV), how to manage an unstable patient, and many other aspects of medicine.
But students aren┐t the only ones using WISER. Practicing doctors and nurses continue their education and improve their competency in certain areas by taking courses. In fact, the center now trains health care professionals and students from all over the country and is sharing its findings and techniques with the medical community at large.
Competency training is a fairly new area of assessment in medicine, but one with dramatic impact. By creating new ways of training physicians and other health care professionals in difficult medical scenarios, and then analyzing the data, UPMC and the University of Pittsburgh are setting the standard for medical training nationwide.
"The end result of simulation training is better doctors and safer patients," says Dr. Schaefer. "We will know early on through objective data which clinicians are performing at a high level and which ones aren't."
Dr. Schaefer says this has already been demonstrated in the area of difficult airway management, or the proper insertion of breathing tubes. It is a problem area for doctors and paramedics across the country. And when a patient can┐t breathe, it only takes minutes before they can be seriously injured or die.
A number of techniques can solve the problem if done quickly and precisely. However, because most doctors and paramedics only occasionally see these situations during emergencies, they don┐t get a chance to perfect their techniques.
"Practice makes perfect," says Dr. Schaefer. "Unfortunately, historically throughout medicine that has meant practicing on patients. Medical education has always relied on the apprenticeship model. But now students can practice on simulators."
It made all the difference for a group of physicians tested at WISER on breathing tube competence. When they first took the test, nearly all the physicians failed; however, after completing an entire simulation course on difficult airway management, each one of them achieved proficiency and passed with flying colors.
"UPMC is one of the first health systems in the country to take such a proactive approach to patient safety," says Dr. Schaefer. "If you are going to be privileged to practice here, you must demonstrate competence in certain areas. That is a huge step ahead in patient safety, and we are becoming a model for hospital systems across the country."
UPMC is also taking pioneering research and advances beyond the walls of the hospital to save lives across the globe.
More than 130 simulators based on the SimMan design are now being used to train U.S. Army medics at Fort Sam Houston in Texas. These medics are bound for areas of strife, including the Middle East, where what they┐ve learned on simulators developed in Pittsburgh is undoubtedly helping countless soldiers. WISER now has a grant to work with these U.S. Army combat medics to enhance their skill and help them measure their outcomes.
Work is also under way to develop simulators that demonstrate symptoms of exposure to chemical agents and other weapons of mass destruction in hopes of better preparing emergency medical staff for possible terrorist attacks.