The Human Patient Simulator™

Objective: Medical students are typically excluded from the primary management of acutely ill patients, yet such experiences can be vital to integrating basic and clinical sciences and to developing essential medical skills. Not until internship do young doctors usually experience first-hand the anxiety of being responsible for very sick patients, but by this point the risk of medical error may be unnecessarily high. We wanted to allow medical students to fully experience critical patient-care scenarios in preparation for internship, but without a risk to patients or themselves. Description: At the University of Michigan, we invited a group of clinical clerks (n = 27) to participate in a pilot program using a Human Patient Simulator™ (Medical Education Technologies, Inc. ). The simulator is a computer-controlled full-scale mannequin that replicates human physiology in real time. The simulator possesses mechanical lungs with physiologic air exchange and auscultatory breath sounds, palpable pulses with a blood pressure read-out and heart tones, and extremity movements with a voice transmitter and reactive eyes. The mannequin can be intubated. All of these features are coordinated by a computerized model of physiologic simulation, so that drugs and other “therapy” can be instituted on the “patient” with resultant changes in clinical condition that can be seen, heard, felt, and truly experienced by the student. The students were individually invited into the simulation room, where a faculty instructor mentored the student through two scenarios: a trauma patient with hemorrhagic shock and a tension pneumothorax, and a cardiac patient with marginally stable ventricular tachycardia. The student was told to proceed with evaluation and treatment as if the simulator were a real patient, and to use the faculty mentor as needed. The scenario was conducted in real time. We debriefed the student immediately after each session, getting both quantitative and qualitative reactions to the experience. At the end of the clinical year, we conducted a survey to compare the knowledge base of the students who had and had not participated in the pilot program with regard to the two clinical scenarios. This pathophysiology is taught in the regular curriculum but not by using the simulator. Discussion: The students' response to the simulator experience was overwhelmingly positive, with 89% feeling that it should be a mandatory part of their education. They felt that the simulator provided important education in a stimulating way. They enjoyed working through problems under the pressure of a realistic simulation and felt that the experience had helped them to practice and build confidence in a protected environment. They requested additional sessions, and thought the exercise was a good way to integrate basic and clinical sciences and to prepare for internship. Although we have yet to put enough students through the simulator to collect statistically significant data, there was preliminary evidence from the survey to suggest better retention of key clinical knowledge among the students who worked with the simulator.