I have seen the future of medical school training, and it is extremely cool. And extremely expensive.
We went to the Palo Alto VA Hospital’s patient simulator today, and met our patients: two almost-creepily real medical mannequins (one cost $180,000, the other, about a quarter of that). As our professor said, “they can do just about everything but live.” The experience was to give us exposure to how to manage an acutely ill patient, and it was one of the coolest experiences in medical school. The mannequins have pulses (femoral, radial, and carotid), heart beats, breath sounds, and bowel sounds. They breathe in and out (and their chests rise), they can get IVs, chest tubes, cardioversion shocking with paddles, central lines, foley catheters, and just about anything else you can think of. They even have oxygen sensors in their noses: if you give them O2, their saturation increases. And their pupils dilate and constrict. They even talk. (Well, okay, they talk through a speaker in their mouths, and the voice is from the control room person running the simulation, but it’s still a little eerie.)
We had several different scenarios, the first with the preceptor to just get acquainted to the simulator system: how to give IVs, how to call the code team (you actually dial a number on a real phone, and it links back to the control room), how to get monitors started (ask for them outloud and they magically appear on the monitor screen), and how to ask God things. Unfortunately, the mannequins don’t sweat or react fully just yet, so you sometimes have to say things like, “God, does Mr. Ford have full intact sensation in his face?” (To which God replies from a speaker in the ceiling, “Yes he does.”) The control room can also change any parameters they want on the mannequin in real-time: if you give the patient epinephrine, his heart rate will go up along with his blood pressure. If you shock a patient, they can put the patient back in normal sinus rhythm.
We split into two groups, and I got to watch the first group from a monitoring room next door. We all flipped out when our classmates kept missing some key information, and the patient eventually crashed for quite awhile (luckily God performed a miracle). But we knew it was much easier to watch than to actually perform. When it was our turn, I was a little eager but nervous.
We had a couple ideas initially from the patient’s history and basic presentation, so we started testing hypotheses. The patient kept getting worse, and his oxygen levels kept dropping, so we started to bag him (put a mask on him and force oxygen into his lungs), and then we decided we needed to intubate. As intubating has become my latest procedure of enjoyment (intubating is feeding a tube into a person’s airway while pushing down on their tongue to get the airway and vocal cords into view), I grabbed the laryngoscope and prepared to try it. This was the coolest part: the patient was technically still conscious, so the preceptor told us he was fighting us, and it was making it hard to intubate him. It truly was: when I first tried to stick the scope in his mouth, it seemed 100 times harder than it had ever been on any of the other mannequins-his tongue was totally in the way. We decided to sedate the patient, and magically, when I opened his mouth again, the tongue was down and out of the way. I wish my classmates could have seen it; it was the coolest surprise to me.
A really great experience, and further pushed me toward Emergency Medicine (or maybe anesthesia?); apparently there was an anesthesia resident watching us who commented that I’d make a good colleague.
These simulators are only going to get better, cheaper, and smarter, and I can totally see them entering the medical school curricula in the next 10 years (Stanford’s new med school building will have a simulator room all of its own, and has recently named a new Associate Dean for Medical Simulation) – the same Dr. Gaba who runs the VA simulator. The simulators mean less experimenting on patients, and more practice before the real thing, which will hopefully lead to better outcomes and fewer medical mistakes, especially for newbies like myself.