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Stanford Report, November 13, 2002

New center innovates teaching through simulation


Most people wouldn’t lump doctors in with fighter pilots, though both can benefit greatly from simulation training. Access to such advanced teaching tools has been limited for physicians and nurses, however.

The Johnson Center at Lucile Packard Children’s Hospital now houses the first dedicated pediatric and obstetric medical simulation center in the world, allowing health-care professionals to hone their skills in a simulated medical environment.

JoDee Anderson, a neonatology fellow, participates in a simulation-based training at the Center for Pediatric Education. CAPE is the first pediatric and obstetric medical simulation facility in the world. PHOTO: KRISTA CONGER

The Center for Pediatric Education, or CAPE, grew out of a collaboration with Dave Gaba, MD, professor of anesthesiology; Steve Howard, MD, associate professor of anesthesiology; and Yasser Sowb, PhD, of the Simulation Center for Crisis Management Training in Health Care at the Veteran Affairs Palo Alto Health Care System. CAPE’s proximity to the medical school and Packard will enhance pediatric- and obstetric-oriented training programs for physicians, nurses, allied health-care providers and students.

For example, trainees can now practice handling emergencies involving extracorporeal membrane oxygenation or ECMO, a life-support machine for infants. "The fact that we are right across the street means we can just roll the machine across," said center director Lou Halamek, MD, associate professor of pediatrics at the medical school. He and his colleagues plan to use the facility to offer regular, frequent training courses to health-care providers in California and beyond.

Participants will practice skills in neonatal resuscitation, preparing a critically ill newborn for transport, handling obstetrical emergencies and trouble-shooting problems with machines like ECMO. They will also work on team skills such as communication and delegating.

The simulated 20- to 30-minute scenarios designed by Halamek and his colleagues challenge participants to respond to unexpected yet realistic examples of deliveries gone disastrously wrong. As they scramble to save a "patient," Halamek watches through a one-way mirror connected to an adjacent control room laden with computers and recording equipment that capture images and sound from each of the several cameras and microphones embedded in the ceiling. He can manipulate the mannequin’s heart rate, blood pressure and other vital signs at a touch of a button to give immediate feedback in response to the team’s actions.

For the participants, the experience is both valuable and harrowing as the tension in the room escalates and they learn from their successes and mistakes.

"I was sweating," said recent participant Glenn DeSandre, MD, neonatology fellow at Packard Children’s Hospital. For him, the simulation seemed as real as treating a live patient. "Even though the odds of seeing a particular situation again might be low, at least you now have experience with it."

"It’s better to remember that simulated ‘patient’ in that horrible scenario than a real baby," said Lauren Gale, a neonatal nurse practitioner, "and it puts solutions in your mind that you may not have thought of right away before the training." The participants also value the debriefing that occurs immediately afterward, where they watch the video and discuss their performance in a supportive, non-threatening environment.

"Your view of what happened is so skewed," said JoDee Anderson, MD, neonatology fellow at Packard Children’s Hospital, "that you can be too hard on yourself. And you might not have the tools to talk to other members of your team to see what you do well and what you don’t do well."

CAPE’s facility was made possible by a gift from an anonymous donor in the community through the Lucile Packard Foundation’s Campaign for Children’s Health. In addition to neonatal resuscitation and transport, and neonatal and obstetrical team training, Halamek hopes to expand the training to include scenarios set in the pediatric intensive care and cardiovascular intensive care units.

Nurse Kim Mello and medical students Pamela Mosher and Liz Rogers are also working with Halamek to design scenarios to simulate talking with patients and parents about death and dying.

Halamek plans to make videos of the scenarios and debriefing sessions available as learning tools for those unable to attend a course at CAPE. And he hopes that the new first-of-its-kind facility will inspire others. "If we’re still the only dedicated pediatric training center in 10 years, than we will have failed," he said. "As long as the care of kids steadily improves, we’re doing our job."

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