Human patient simulation: a teaching strategy

AORN Journal,  Oct, 2004  by Suzanne C. Beyea,  Linda J. Kobokovich

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Human patient simulation is a novel teaching method that allows nurses and other clinicians to refine and apply their skills in realistic health care situations and participate in learning experiences tailored to their educational needs. Simulated patient care scenarios relevant to an actual patient population within a specific clinical environment help clinicians learn skills, gain experience, and develop competencies in a planned and prescribed manner. Learning is achieved without fear of harming a real patient.

Airline pilots have used simulation technology as a training tool for decades. Using specifically designed simulators, pilots practice taking off and landing, as well as managing a variety of emergency events. Health care applications of simulation have been used predominantly for medical student and physician training and research purposes. Educators in nursing education programs and hospitals have begun to use human patient simulation in an effort to develop, maintain, and evaluate competencies. Other clinicians and researchers have used human patient simulation as a strategy for interdisciplinary training and learning more about approaches to patient safety.

THE SIMULATOR

A human patient simulator is a highly sophisticated, technologically advanced mannequin in adult, child, or infant size. These mannequins fully integrate with computer software that supports the development of preplanned scenarios that mimic a wide variety of clinical situations. Most human patient simulators produce lung, heart, and bowel sounds; have anatomically correct pulses; and respond to medical and pharmacological interventions with expected physiological responses. Human patient simulators can be programmed to speak and, thus, interact with clinicians much like an actual patient.

Simulators come equipped with a number of different features that support a variety of learning experiences. For example, one simulator model allows the insertion of a chest tube or application of a trauma or wound care kit. Such features support educators' abilities to create learning situations that address a variety of specific clinical problems or needs.

Simulation technology has been shown to be an effective educational tool that is well accepted by students and results in significant improvements in core clinical areas, such as cardiovascular bedside skills. (1) In addition to hands-on skill, the use of human simulators promotes the application of critical thinking skills. Other benefits include the ability to

* experience preprogrammed rare events;

* repeat procedures and experiences;

* learn by making errors that do not harm an actual patient;

* observe different outcomes of a situation that stem from the actions chosen; and

* practice teamwork, debriefing, and team interactions.

SIMULATION AND PATIENT SAFETY

Human patient simulation provides an opportunity to reduce medical errors and their severity while improving patient care. This can be done by tailoring clinical learning experiences more directly to the patient population in a particular setting and providing opportunities to train for high-risk, low-volume events. Experiences and patient care scenarios relevant to the actual patient population create opportunities for clinicians to gain the skills to handle emergencies and unexpected events in a planned and prescribed way. In the perioperative setting, for example, clinicians could train for a malignant hyperthermia crisis. This would allow team members to examine processes and procedures that are effective and identify those that result in treatment delays or create conditions for error.

Human patient simulation also can provide clinicians with an opportunity to care for a simulated patient with acute clinical problems, such as airway obstruction or cardiac arrest, hemorrhage, shock, or various other common emergent situations. Using simulators, health care team members can work through each clinical situation by assessing the presenting symptoms, providing appropriate interventions, and managing the simulator's response to the various treatments. Additionally, well-developed scenarios that incorporate simulators require clinicians to solve problems, work as a team, and communicate effectively with their colleagues and other providers.

Role play provides an opportunity to improve communication and, thus, enhance patient safety. Skills learned from case-based scenarios and human patient simulation help members of the health care team make transitions to actual patient care and clinical environments. By integrating concepts related to patient safety, such as human factors engineering, crew resource management, and situational awareness, participants concurrently learn approaches and concepts related to patient safety and develop clinical skills that reduce the potential for errors.

Patient safety and avoidable medical errors are a concern in any institution. The Institute of Medicine report To Err is Human: Building a Safer Health System recommends simulation training as one strategy to prevent errors in the clinical setting. (2) Education and training with human patient simulation allows clinicians to examine causes, circumstances, conditions, and other factors connected with adverse events without causing harm to an actual patient. Clinicians can practice tasks and processes in lifelike circumstances, and when a simulated crisis occurs, they can use the feedback received to learn to respond more effectively.