How simulation and training improve medicine

Simulating real-life situations with technology — and actors — prepares doctors for the day they treat you.

You might not think twice when a restaurant server-in-training approaches your table, a plumbing apprentice clears your bathtub drain or a new barista prepares your favorite brew.

But what if you knew you were a doctor’s first real patient? That might be a different story.

Fortunately, along with intensive classroom and in-clinic education, most new doctors have undergone extensive simulation training that involves lifelike mannequins and living actors called standardized patients.

And simulation training isn’t just for medical school students. Nursing schools like Geisinger School of Nursing use it, too. Even experienced healthcare professionals use simulation to update their skills and practice for complex surgeries.

By the time a provider walks into the room to see you, whether for a nagging cough or to remove a tricky tumor, they’ve practiced over and over for the moment they treat you — including how to communicate with you compassionately and effectively in the most difficult situations.

Gary Rozman of Clarks Summit regularly dons a gown to play the part of a patient as he trains medical students in clinical interactions.

Acting the part of patient

A typical workday for Gary Rozman from Clarks Summit involves donning a medical gown, sitting in a waiting room and getting called in for an exam. There, he acts out a whole persona, including exhibiting symptoms of illness and conditions like intoxication. His audience: medical students at Geisinger Commonwealth School of Medicine in Scranton.

It sounds like fun and games, but it’s a serious job for the “patients” and the students.

“We’re giving them a safe place to practice when a life isn’t hanging in the balance,” Mr. Rozman says. The actors take part in training sessions before presenting each condition to a medical student.

The role involves more than just acting out aching knees and abdominal pain to guide students to the proper diagnosis. Mr. Rozman, whose background in education and acting prepared him for the job, says standardized patients also help medical students learn how to pace appointments and get comfortable working closely with, and touching, patients.

“One of the things they struggle with is space,” says Mr. Rozman, who’s been a standardized patient for about three years. “Am I standing too close? Not close enough?”

A mock medical exam also offers opportunities to get past other awkward “firsts,” like the first time students apply pressure with a stethoscope or palpate an abdomen.

Gaining communication skills is a vital part of the experience, too, says Mary Lawhon Triano, director of the clinical skills and simulation center at Geisinger College of Health Sciences.

“Patients expect physicians to be competent, but they want them to be caring,” she explains. “Communication can be taught. We help them understand that the patient is at the center of everything.”

Mr. Rozman says standardized patients are asked to evaluate the future doctor’s communication during the visit. “I’ve had cases where the students have performed with 100% efficiency, but it’s not warm — not that bedside manner Geisinger is trying to instill,” he says.

Because students are so carefully evaluated by standardized patients and instructors, the experience can be intense, especially for first-year students, Mr. Rozman says.

“I’ve encountered students who’ve been visibly shaking, on the verge of tears,” he says. “They want to do so well. There’s only so much you can learn from labs. This is the first opportunity to put that knowledge into practice.”

Model patients

Even the most skilled standardized patient can’t demonstrate an irregular heartbeat or enlarged liver, Ms. Triano notes. That’s when high-tech “task trainers” — lifelike body parts and full-body mannequins — are useful.

The most sophisticated task trainers are housed in “sim bays” that look like real hospital rooms. The trainers’ heartbeats can be altered, their internal organs changed to mimic conditions and their bodies manipulated to indicate emotion.

“He breathes, sweats and cries,” Ms. Triano says of their high fidelity SimMan^® 3G advanced patient simulator. “It’s very sophisticated.”

The sim bays are connected to a large observation room, where instructors can monitor students. And because the mannequins’ verbal responses are limited, standardized patients like Mr. Rozman are sometimes stationed there to “speak” for the task trainer, using a sound system.

“This can add an emotional aspect to the experience,” Ms. Triano says, adding, “A real patient is best. It’s the highest level of simulation.”

Systemwide simulation

Medicine is always changing. And even the most experienced provider has never encountered every potential condition and case. So simulation isn’t just for medical students. It’s used throughout Geisinger — often by the most experienced providers.

To help doctors, nurses and other members of the healthcare team strengthen their skills, Geisinger offers a Clinical Skills Simulation Program, headquartered at the Geisinger Education & Medical Simulation (GEMS) center at Geisinger Medical Center in Danville.

Much like the students at Geisinger Commonwealth, the providers who use the GEMS center benefit from practicing difficult procedures and getting feedback from trainers.

Geisinger also maintains a 3D printing lab, which can generate medical models for patient education and for surgeons prepping for challenging cases, like complex tumor removals. Using CT and MRI scans, the printers create replicas of patients’ actual anatomy in incredible detail, allowing surgeons to see exactly what they’ll see in the operating room.

Post surgery, patients can take home their 3D models — a real-life reminder of a successful procedure, thanks in part to simulation.