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Release: May 17, 2001

NOTE TO EDITORS: Medical students are scheduled to use the patient simulator on Monday and Tuesday between 3:30 and 5 p.m. If media are interested in using this time for photo opportunities, please contact Phillip Schmid, M.D., at 356-2633 or Jennifer Brown at 335-9917.

UI patient simulator an important tool for training medical students and residents

IOWA CITY, Iowa -- In an academic medical center like the University of Iowa College of Medicine, medical students learn a great deal from the patients they see. One patient in particular at the UI has provided valuable learning experiences for dozens of medical students and numerous anesthesia residents and physicians.

Obviously, this is no ordinary patient. In fact he is the UI's state-of-the-art patient simulator, a life-like mannequin complete with pulses, breath sounds, blood pressure and reactive pupils. In the 18 months since his arrival at the UI he has undergone hundreds of anesthesia procedures performed by UI students and residents.

"The patient simulator is an excellent tool for introducing medical students to anesthesia," said Phillip G. Schmid, III, M.D., UI associate in anesthesia and director of the UI Patient Simulator Program. "Although some students may see anesthesia procedures during their surgical rotation, it is very different compared to being in the position of the anesthesiologist. There is a lot to understand."

Since the arrival of the patient mannequin, the UI's simulator center has continued to develop. New technology and equipment have been acquired, and the simulator technology is now housed in a custom-built room. The simulator center also includes additional rooms devoted to computer support. These improvements have resulted in an extraordinary, interactive teaching environment for UI medical students and anesthesia residents.

"The whole wing is a giant anesthesia informatics center," Schmid said. "Our aim is to develop the simulator center at the UI to become one of the premier centers among Midwest anesthesia residency programs. We have gone a long way toward doing that."

The goal of the simulator center is to recreate operating room conditions as accurately and realistically as possible. In addition to the patient simulator, there is a fully operational anesthesia machine, which delivers oxygen and anesthesia gases to the "patient" and advanced monitors to track the virtual patient's vital signs. The student or resident using the simulator actually administers drugs to the mannequin as they would in reality. The simulator system registers the dosage and drug type, and the patient simulator reacts as a human patient would.

The patient simulator's highly sophisticated software allows the instructor to set up numerous scenarios, which mimic real-time operations. A scenario is composed of a patient-profile, the age, sex and health of the virtual patient and the type of operation being simulated, and anywhere from one to five adverse events such as an asthma attack or excessive blood loss. The patient-profile dictates the patient simulator's responses to various procedures and medications. The events can either be triggered manually by the instructor, set on a timer, or result from the actions of the student or resident.

"The whole thing is scripted just like a movie or a play," Schmid said. "If the student takes appropriate action, then the patient stabilizes and does well. If not, then the situation gets worse and the patient does not do well. Fortunately, all that means is that the student will have to start over."

The simulator center contains three cameras, which capture all aspects of the training sessions. The output from the anesthesia machine monitor is also recorded. All four outputs can be viewed in a four-panel display. This is an especially useful teaching tool because it allows the students and the instructor to go back over the simulation and learn from mistakes.

"The simulator really enhances our ability to teach because there are some things that you miss in the course of a crisis event that you can pick up on the tape," Schmid said.

The newest piece of equipment in the simulator center, a $30,000 bronchoscopy simulator, will be used to train anesthetists to deal with obstructed or anatomically unusual airways. This device displays computer generated images of the inside of a virtual patient's breathing passages, from the nose and mouth down into the lungs, as the physician threads a bronchoscope down through the patient simulator's airways.

When patients receive an anesthetic, they lose ability to breathe on their own. Consequently the anesthetist must put in a breathing tube. However, in some patients, this procedure can be extremely complicated.

"Tumors, obesity, trauma or some congenital abnormalities in kids can make the airway difficult to negotiate," Schmid said. "For safety purposes, we do not anesthetize those patients until we investigate their airway and make sure that we can maintain the airway. The bronchoscopy simulator will become a major part of our airway management training module."

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