The Yale Center for Medical Simulation, which opened on Jan. 26, will provide Yale School of Medicine students and Yale-New Haven Hospital residents with the opportunity to practice surgery and emergency medicine scenarios.
Administrators and students interviewed said the center would help students translate their theoretical training into practical skills. Once a week, over a 12-week period, every third-year student at the medical school visits the center to participate in 15 to 20-minute training exercises followed by discussion and evaluation by medical faculty.
Simulation fellow Tiffany Moadel, an instructor in emergency medicine at the School of Medicine, said the center is a marked improvement from the one cramped room where students previously had to undergo simulation training. The training is an important part of a student’s education, she said, because it pushes students to make decisions according to clinical management, which does not always happen in their clerkships.
All three students interviewed echoed Moadel’s statements.
“The best way to learn is doing it hands on,” said David Zhu MED ’16.
Charles Li MED ’16 said the center was useful because students have not been put in any decision-making roles before.
During the exercises, groups of four students take turns diagnosing and operating on high-tech mannequins.
“It started an hour ago when I was watching the news,” 68-year-old “Mr. Parker” complained to four medical students gathered around his hospital bed. “It’s this terrible shooting pain down my back. I was hoping to watch Ellen DeGeneres.”
“Mr. Parker” is one of the mannequins at the YCMS.
In each simulation, one student serves as the team leader. He or she must process all incoming information and quickly make decisions. A resident doctor playing the role of the patient’s family member or a nurse is always present in the room as well.
In the control room, two School of Medicine surgeons or emergency medicine doctors monitor the students through a viewing glass and control the mannequin’s vital signs. Usually, one of the doctors acts as a consultant, assisting the students with diagnoses or interpreting various scans. The other doctor speaks as the patient and adjusts his or her heart rate, breathing and pupil size. The mannequins also have the ability to blink, seize, bleed, sweat and even foam at the mouth. Students can listen to their breath and heartbeat, insert catheters and chest tubes, and perform CPR on them if the situation calls for it.
“It’s kind of like a recipe book. There’s a lot of functionality and we pick and choose the ones we want for each case,” Moadel said.
During the simulations, students are completely in charge. They reassure the patient that they will provide them with the best care, discuss whether they are stable enough to move to another hospital, and decide to call a radiology consultant to confirm the presence of a tortuous aorta on a chest x-ray.
One of the major goals of simulation training is to improve communication between the doctor and the patient. Students often have to deliver bad news to the patient and his or her family members during these scenarios, allowing them to hone their bedside manner and conflict resolution skills.
“Sometimes, you think ‘This is medical school,’ and it’s easy to forget about the patient, a human being who is scared to be there,” professor of vascular surgery and diagnostic radiology Richard Gusberg said.
After the simulation is over, students gather in the debriefing room and review their performance with School of Medicine faculty members. They discuss how to deal with situations where they feel like they have lost control of the situation at hand, or where their orders conflict with the patient’s wishes.
According to Moadel, the YCMS is currently discussing the possibility of creating simulations for all eight clerkships, which would add medicine, neurology, psychiatry, primary care, OB/GYN and pediatrics to the current surgery and emergency medicine simulations. Additionally, two more faculty will join the existing directors and simulation fellows next year to help expand the simulation center’s services.
The Yale School of Medicine has the largest clinical simulation program for third-year students in the United States, according to the Yale School of Medicine Simulation Medicine website.