At Ohio State, mannequins and avatars help improve safety

COLUMBUS, OHIO – "One of the simulators is leaking."

So reported an alarmed custodian at Ohio State University's Wexner Medical Center, upon finding a supine and sheet-covered mannequin dripping fluid onto the floor.

The mannequin was one of several new models, procured for Wexner's $13.1 million expansion of its patient simulation and training center, unveiled on March 1. The high-end simulators can cost as much as $250,000.

This particular model can be programmed to "sweat" in response to adverse drug events, says Carol Hasbrouck, assistant dean in OSU's College of Medicine and director of its recently expanded Clinical Skills Education and Assessment Center (CSEAC), and sure enough a blocked valve had left "water spewing out of his head."

Sweating is not all these smart dummies can do. The mannequins can be programmed to mimic different types of patients: elderly, or frail, or with low pulmonary function. They can stop breathing and close their eyes and flatline. One can monitor their breathing patterns and pulse and pupil movements. You can intubate them; you can shock them. "The only thing they don't do is stand up and walk away," says Hasbrouck.

"I've used some of these mannequins, and when you get into taking care of a critical situation, you almost forget you're not taking care of a real patient," says Steven Gabbe, MD, Wexner Medical Center's CEO.

These ersatz humans – simulating the experience of pain, "responding" to medications, able to offer mock lab results – may be expensive, but they're worth it, says Gabbe. "For all intents and purposes, you really feel like you're at the patient's bedside, taking care of them."

The bigger and better CSEAC spans 26,100 square feet, building upon an existing 8,100 square feet. The complex includes an intensive care suite, five critical care bays and interactive labs for debriefing and assessment of simulations. There's an ultrasound simulation room with five ultrasound stations and a 70-inch plasma screen.

Also in development is an immersive virtual reality room, with avatars that will respond to human interaction, says Jim Beck, senior technical applications consultant at the center. The project will emulate a physician practice, and students will learn how to interact with two-dimensional patients. "It's life-size, so when you walk in the room you really feel like you're in the doctor's office," says Beck. "It's like you're interacting with a real person to some degree."

As the technology advances, Beck hopes to see the simulations improve, he says. "The display technology is such that we can move to 3D when we want to." Moreover, CSEAC is well positioned to make use of the technological advancements to come. "We've got the infrastructure in place, the data network and hardware to support the different types of technology that are going to evolve and come out," he says. "We have the parts in place to be able to expand easily."

All this state-of-the art IT, of course, is being deployed in the service of helping Ohio State medical students increase their precision and general proficiency on an array of complicated medical procedures.

And no question, these investments pave the way toward enhanced patient safety, says Hasbrouck. By enabling students to "learn here in a really safe environment," it allows them to "try things," she says. "If they make mistakes, they learn from the mistakes, but it's not on a patient. They acquire the skills – the whole range – ahead of time, so when they're in a really critical situation they'll say, 'I did that before.'"

Gabbe, asked if he ever gets a bit jealous, and wish he had these advancements at his disposal when he was a student, says, "I sure do. I sure do. I continue to be amazed at the new technology that has become available to teach," he says.

"We never had these centers when I was in training. You always felt uncomfortable when you were asked to do a procedure that you hadn't had much experience with. And you hoped, and you did your best to make sure everything went well, but you always worried that you wouldn't do your best for the patient."

These hi-tech simulators, able to offer practice on everything from endoscopic procedures in gastroenterology to coronary artery catheterization, are available to students 24/7. "You can practice, practice, practice," says Gabbe. "We didn't have anything as sophisticated as the students have now."

Technologies such as these have "become now an expected part of medical education and will continue to be ever more important going forward," he says.

He adds, however, "the technology is great, but you've got to have the people that partner with it. You've got to have the faculty and technicians that can make these situations as real as possible – and they do become very real."