Why you should care
Hyper-realistic mannequins might make your doctor or nurse less likely to mess up.
The patient moans on the hospital bed, his chest heaving as he goes into cardiac arrest. Tense medical students take turns defibrillating and compressing his chest. They’re not getting anywhere. “Two minutes have passed,” their instructor intones. One of the students leans toward the patient, brows knit. “Mr. King, can you hear me?” he shouts. “Can you squeeze my hand?” But Mr. King just continues to moan. “The patient cannot squeeze your hand,” the instructor says. Time is up. Mr. King is gone. The students file out, heads down.
That’s when their instructor, William Stiers, powers down Mr. King — a mannequin that in due course will live again and give another batch of students at Samuel Merritt University, in Oakland, California, a shot at developing their cardiac-resuscitation skills. Turns out that dummies make good teachers, and Mr. King is among a new generation of high-fidelity mannequins that can sweat, bleed and even give birth. Over the past five years, the medical mannequin trend “has snowballed,” says Adam Levine, a professor of anesthesiology at Icahn School of Medicine at Mount Sinai, and consulting firm MarketsandMarkets says the market for “medical simulation,” worth $863.5 million in 2014, is expected to reach $2.1 billion by 2019. Among the institutions leading the way: Samuel Merritt, Harvard’s Center for Medical Simulation and Imperial College London.
Simulations allow trainees to practice handling high-stress, low-stakes scenarios before they encounter the real thing.
In some ways, of course, medicine is just following in the footsteps of other professions, like aviation, with simulations that allow students and licensed professionals alike to practice handling high-stress, low-stakes scenarios before they encounter the real thing. Simulations can also be tailored to mimic life-threatening situations that physicians might not encounter in clinical training rounds. Proponents hope this shift from the old-school “see one, do one, teach one” mantra will reduce medical errors — which, says a 2013 Journal of Patient Safety, lead to an estimated 210,000 to 440,000 patient deaths a year, making them the third-leading cause of death in the U.S. “You wouldn’t get on a plane if the pilot didn’t use a simulator,” says Levine. “Imagine you’re a patient.”
Samuel Merritt’s Health Sciences Simulation Center looks almost exactly like a hospital, with its 16 patient rooms furnished with beds, crash carts and other equipment. What gives it away are the mannequins tucked into nearly every bed. One even blinks, its chest rising and falling beneath the sheets. Stiers, a simulation specialist and a former ER doctor, leads me to a mannequin with a black wig and painted blue eyes, his carotid artery pulsating furiously. I press a stethoscope to its chest and hear crackling (fluid in the lungs, Stiers explains) and a faint rush (a heart murmur). Stiers then pulls out a chart that lists different conditions and the corresponding simulation software inputs. (He had programmed Blue Eyes to show symptoms of aortic regurgitation.)
Stiers later takes me to a control room strewn with headphones and telephones, dimly lit with the glow of monitors displaying vitals and footage of the exam room just beyond the window. He plays the role of patient, speaking into a mic with a withered, slightly Southern-accented voice for an earlier simulation. A door leads into what looks like a Hollywood prop room and is lined with plastic containers labeled with various anatomical descriptors: “obese torso,” “zombie gutz,” “genitals.” One simulation involves an actress wearing a prosthetic vagina from which an OB-GYN “delivered” a baby mannequin. Sometimes actors play distraught family members.
The students beat themselves up, but the faculty builds them up again. We want them to make mistakes.
William Stiers, Samuel Merritt University instructor
The simulations are not just for students, it turns out: Institutions are increasingly offering interdisciplinary simulations for physicians, nurses, physician assistants and other health professionals to build crucial communication skills (many medical errors stem from miscommunication, according to several studies). Many have also begun using simulations for licensing and credentialing. “Now you’re not just saying you can do it on an exam but showing you can do it in a simulation,” says James Huffman, a clinical lecturer at the University of Calgary. He also envisions increased use of hybrid simulations like surgical cut suits. Trainees perform procedures on the suit, worn by an actor who can scream and writhe in pain.
But there is a limit to how “real” the new simulators can get. Even high-fidelity mannequins can’t replicate facial expressions, skin-color changes and rashes. And although multiple studies have noted enhanced self-confidence among trainees, findings on whether the simulators reduce medical errors are murkier. Last year, a Chest study co-authored by Huffman found that unexpected mannequin “death” can hurt learning and performance. Amid these uncertainties, the price tag of a high-fidelity mannequin typically hovers around six figures.
At Samuel Merritt, one student typically undergoes the simulation while another acts as a scribe. The rest watch via streamed video footage in a conference room. Afterward, Stiers opens the debrief session by asking participants how they feel about their performance. They discuss possible diagnoses. “The students beat themselves up, but the faculty builds them up again,” Stiers says. “We want them to make mistakes.” Levine adds that messing up in a simulation makes students less likely to do the same in the clinic: “It becomes a more memorable learning experience than hearing a lecture.”
And trainees often respond with real-life urgency too. “I’m very glad it wasn’t a real patient,” laughs Tony Zahner, team leader in the cardiac arrest simulation. Suzanne Todd, an anesthesiology resident at McMaster University, recalls leading an emergency cesarean section simulation. “I was hot, and my heart was beating,” she says. “It felt really scary and real.”