The very real future of health care education

OHSU Extra, Spring 2013

Before they fly solo, commercial airline pilots log hundreds of hours in flight simulators training for any eventuality. And yet until the 1990s, the same could not be said of an emergency room team. Today things are different, thanks to simulation training designed to provide low-risk practice for high-stakes situations. OHSU's world-class simulation faculty – and philanthropic community – will play a key role in taking simulation to a new level.

As our nation’s health care system evolves, so does health care instruction. Simulation training is emerging as the key to developing the technical skills and interdisciplinary teamwork required of today’s health care professionals. OHSU students from every discipline are honing their ability to work together, led by national experts in simulation training and research. With a new 20,000 square foot simulation facility under construction, OHSU has made a significant investment in the future of simulation. The university’s ambitious plans include raising at least $2.5 million in philanthropic support.

“See one. Do one. Teach one. That was the old model,” said Jeanne-Marie Guise, M.D., M.P.H., co-director of OHSU’s simulation programs and a national expert in evaluating simulation training. “We’ve come a long way since then.”

Today OHSU’s schools of medicine, nursing and dentistry have developed simulation programs that reach far beyond what a commercial pilot could ever dream of. From realistic emergency drills that teach teams how to resuscitate struggling newborns (at left) to sophisticated software that can mimic endoscopic surgery, simulation education at OHSU ranges from high drama to high tech.

OHSU’s simulation leaders believe that excelling in communication and teamwork is as important as mastering technical skills. This holds especially true in the hospital emergency department, where teams must work with speed, coordination and accuracy.

“Health care is increasingly a team sport. It’s important to establish strong relationships before you head into a crisis,” said Robert Cloutier, M.D., program director for OHSU’s Emergency Medicine Simulation program.

Low-stakes practice for high-risk situations

Jessica Bailey, M.D., pediatric chief resident at OHSU Hospital believes simulation training helped her become a better communicator and team leader. “Once a month they stage mock codes in the emergency department. We learned to make the essential decisions quickly – like pulling together the right team and starting treatment. All the while, you are listening to what your team is telling you about how the patient is responding, and readjusting. A real emergency would have been terrifying the first time had I not gone through so many drills.”

“Simulation shows you how your brain reacts to stress,” said Mary Anna Gordon, D.N.P., R.N., assistant professor, OHSU School of Nursing, and an expert in interprofessional simulation. “Students tell me they’ve lost their ability to speak clearly or do simple math during a mock code. It’s good to know in advance what your vulnerabilities are – and have a plan to compensate.”

When every second counts, clear communication is key. For example, when a doctor leading an emergency team shouts, “Someone get me some epinephrine,” it typically results in no one fetching the life-saving drug or several people going off task to get it. “That’s why we teach best practices in communication and teamwork, such as directed and closed-loop communication,” said Guise. Residents learn to ask a specific nurse for a specific dose of epinephrine. And nurses learn to respond back confirming that they have administered the requested dose.

This mock-up is the real deal

Despite the fact that simulation trainings often involve advance preparation and plastic mannequins, the drills feel authentic. “We go through real scenarios in real time with real resources. It’s the same pressure, the same adrenaline rush as a real crisis,” said Bailey.

“Today’s medical residents work fewer hours than they did 20 years ago – which is a good thing – but they also have fewer opportunities to make independent medical decisions. Simulation provides a safe opportunity to practice those low-frequency but high-stakes scenarios. Everyone benefits – health care professionals, the health care system and especially patients,” said Cloutier.