June 30, 2008

UB to Build a Hospital Simulator ; Patients Will Be Actors, High-Tech Mannequins

By Melissa Repko

As part of the University at Buffalo's goal of maintaining its stronghold in the rapidly changing health sciences, the school will soon open a multimillion-dollar medical simulation center that it hopes will spur another one downtown.

The high-tech center, in 10,000 square feet of space on the third floor of Abbott Hall on the UB South Campus, will feature life-like mannequins and actors serving as patients. The simulation center's creation is expected to be under way in the next six to 12 months.

The highly flexible space will provide undergraduate students in all health care fields a chance to experience the intensity of medical emergencies and complex surgeries, without the risk of harming a patient. It will have movable walls that transform the space into an intensive care unit or emergency room, allowing it to become a virtual hospital.

Although simulation can be found at other universities and within some of UB's programs such as the nurse anesthetics program, the center will stand apart with its goal of being an interdisciplinary learning experience, said Dr. David Dunn, vice president for health services and the visionary of the project.

Dunn predicts the initial center will cost between $2 million to $3 million.

But long-term plans span farther than Abbott Hall. A second phase of the project, which would consist of building a 20,000- or 30,000- square-foot simulation facility in the downtown Buffalo Niagara Medical Campus, is part of the strategic plan.

If the second center were built, it would mostly focus on graduate and continuing education, said Yvonne Scherer, an associate professor at the School of Nursing and the chairwoman of the interdisciplinary simulation steering committee.

"Once [the UB center] is up and going and working the way we want it to and is a stellar simulation center, the plan is to move out to the community," she said.

William L. Joyce, chairman of the board at Buffalo Niagara Medical Campus, said he believes another simulation center downtown "would fit right in quite well."

"A lot of things are happening on the [medical] campus and that would be another exciting thing to have there," he said.

The James H. Cummings Foundation, a local foundation of which Joyce is executive director and secretary, has pledged $300,000 toward the first simulation project.

Ralph Behling, an alumnus of UB School of Medicine, will finance much of the larger project with his $3 million donation.

All health sciences students from nursing, social work, pharmaceuticals, medicine, dental and public health will incorporate simulation into their curriculum. Scenarios will range from diagnosing a concussion to delivering a baby and giving a terminal cancer diagnosis, all with the help of mannequins and "standardized patients" who are trained actors.

Representatives from Medical Simulation Design, a company with offices in Ithaca and in San Pedro, Calif., are serving as consultants.

Simulation combats two major problems in health care: human error and poor communication, said Jeffrey Meyers, steering committee member and EMS fellowship director.

"It's very similar to aviation," he said. "Communication can be a big pitfall and a lot of errors come from issues with communication between

the parties. One party has information that another party needs but they did not communicate effectively."

A key aspect of the learning process is reviewing videotapes that are filmed during the scenarios. A professor will go with the students into a debriefing room and discuss what he sees on the video, watching to notice if the doctor forgot to wear gloves or the nurse was unclear in her request for a certain medical tool.

"Those mistakes, when you get to see what happens after mistakes, that's what's so powerful and that's what sticks with you," said Kim Yaeger, a Medical Simulation Design principal.

In this way, simulation programs can save money and patients' lives, said Ingrid Thomas, grants and special projects manager of the Workforce Institute in San Jose, Calif.

Thomas, who also worked with Medical Simulation Design to get her program off the ground, said that simulation can combat medical errors or "near misses," a term coined for patients who almost died because of an avoidable mistake. A near miss can cost $1.2 million to investigate, she said.

"If you can put money into simulation for both the people and their patients, you're saving yourself a lot of money and a lot of bad publicity," she said.

By exposing all students to certain surgeries or diseases that they might not see in their clinical classes, they will be less likely to misdiagnose, Meyers said.

Yaegar compared simulation to getting sucked into a fictional book. "The students really go in there and believe that it's a real scenario," she said. "I've had to lay my hands on them and tell them that it's a training center."

Michelle Roehm, a first-year student in the UB nurse anesthetist program, said that she easily buys into the simulation. She admitted to feeling nervous during the scenarios and said that everything from wearing scrubs to seeing the mannequin exhale helps her feel like she's in an authentic operating room.

"It moves. It blinks. His heart sounds," she said, referring to Samson, a mannequin on which she practiced inserting a type of catheter.

Another first-year student in the nurse anesthetist program, Rebecca Go, said the experience boosts her confidence when in clinical rotations in Millard Fillmore Hospital. "The simulation helps us see our progression," she said. "It helped to see the difference between the first week and second week."

Another strength of simulation is its unpredictability for the students and professors alike, Dunn said, comparing it to the erratic rhythm of a hospital.

"When you're reading a book or listening to a lecture, that's not particularly interactive," he said. "And with simulation, each point in time may lead to a branch in a decision where you teach something different."

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Originally published by NEWS BUSINESS REPORTER.

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