Lifelike mannequins, advanced technology and seasoned staff provide a range of simulations to make everyone from new nurses to surgical residents more confident and better trained.
Mr. Clooney isn’t responsive. He’s recovering from emergency surgery after a motor vehicle collision. His breathing is slow – just six breaths per minute. When the nurse enters his room, she knows right away something isn’t right. She calls her colleagues for help, and a group of four nurses enters the room. They look a little nervous. Understandably: It’s their first day on the job.
What better place to work out the jitters than here: Nursing Orientation Day at Sunnybrook Canadian Simulation Centre. Mr. Clooney is a very real-looking, computer-operated mannequin, also known as a simulated patient. He has a pulse. He breathes, talks, moans and groans.
That is, when Susan DeSousa, Simulation Centre Co-ordinator, speaks into a microphone from the simulation control room. She also controls Mr. Clooney’s vital signs, and determines how he reacts to the interventions.
“The simulation isn’t meant to replace the participation in the operating room. It is meant to enhance it,” says Dr. Shady Ashamalla, who trains staff in laparascopic surgery in Sunnybrook’s Simulation Centre.
Photgraph By: Tim Fraser
“These scenarios always have a focus on teamwork and communication,” DeSousa says. “There are other learning objectives. In Mr. Clooney’s case it’s about demonstrating respiratory and airway management, but there is always an element of communication involved.”
New nursing hires at Sunnybrook are required to attend the simulation session as part of their corporate nursing orientation. In 2012, more than 250 nurses attended the simulation education day. It ensures that new staff understand hospital protocols, and practise essential elements of teamwork and communication with their colleagues.
Mr. Clooney’s nursing staff safely administer the appropriate dose of a drug called Narcan, after they determine through various phone calls to the on-call physician and the rapid response team (also DeSousa in the control room) that he’s having a reaction to the morphine he’s been given for the pain. Narcan is the antidote. The patient’s condition improves, the scenario ends, and the team regroups in the debriefing room.
DeSousa talks through the scenario with the participants, who admit it was challenging and hard to communicate with others, as well as the observers who’ve been watching the situation unfold via a video link-up. They go over each step, with DeSousa offering tips and reminders about how to make a situation like Mr. Clooney’s run a little smoother: introduce yourself when you enter a room if you don’t know your colleagues; delegate tasks by name or pointing. By the time the team is ready for its next scenario, it’s clear they’ve taken DeSousa’s advice to heart.
PRACTISE AND REPEAT
Established in 1995, the Sunnybrook Canadian Simulation Centre was the first of its kind in the country. Through hands-on experiential learning, the centre provides multi-disciplinary, advanced health-care education to all levels of learners, from medical students to long-time physicians. Simulation mannequins and other advanced technologies allow trainees to experience very true-to-life scenarios in a controlled environment, with the ultimate goal of enhancing patient safety. In 2012, 1,415 people attended education sessions in the simulation centre.
This year, it celebrated the opening of its new surgical skills suite, an expanded 800-square-foot skills centre where basic and complex surgical skills will be taught to trainees of all levels. Evidence suggests simulation is particularly useful in teaching reproducible situations or technical skills that are used often in surgery.
Dr. Shady Ashamalla, a surgical oncologist, leads the laparoscopic surgery program. He says that while the observed apprenticeship model he trained under is effective, there is room for improvement.
“When I was training, the attending surgeon showed the trainee how to do it and then increasingly allowed the trainee to try different tasks,” he explains, adding there was classroom work and lectures. “Gradually, you do more and more, and soon you are doing the whole surgery, and soon after you are teaching it.” Now, in addition to the observed apprenticeship, there’s simulation.
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