Learning in our simulation lab

It sounds like an awful thing for a trauma specialist to admit. But in Dr. Daniel Howes lab, the patient dies frequently, a number of times everyday.

"But that’s OK,” he says.

It’s OK because the lab the Director of the Regional Trauma Program at KGH is talking about the new simulation lab at the hospital. It’s where young doctors, nurses and respiratory therapists learn how to resuscitate a patient in cardiac arrest. 

The “patient” is a technologically enhanced computer-driven mannequin named KRIS. KRIS is short for Kingston Resuscitation Institute Simulator and he’s made out of rubber, latex and plastic but he behaves like a real patient.  KRIS blinks, breathes, he even talks.  But if you make a mistake, you can’t really kill him.

“It’s absolutely great as a teaching tool.  We want people to make mistakes in here.  We encourage mistakes,” says Dr.  Howes.

The simulation lab has been up and running for almost a year now.

“Feedback from learners has been overwhelmingly positive. They find it very exciting. Nobody falls asleep in here.  It’s active learning,” he says. “You never get the question will this be on the exam? There’s never any doubt about whether these are skills they need to know.”

Here’s how it works. The lab is fully wired with cameras and microphones. Six to eight students at a time form the cardiac response team. The entire simulation is captured on DVD for review later. Behind a one -way mirror in master control is the “Wizard of Oz” at the computer. He speaks for KRIS, controls his symptoms, and decides his fate.

The simulation lab has been compared to a flight simulator for pilots, a place to hone your skills without the risk.  First you read the textbook, and then you learn how to apply your knowledge in a safe environment. But Dr. Howes believes simulated learning is even more important in medicine. 

“Because in an airplane what pilots usually have to deal with is routine, with an occasional disaster,” he says. “In resuscitation medicine, it’s always a disaster. It’s always a crisis because someone’s life is at stake every single time.”

The lab re-creates crisis on a daily basis.  And in a crisis, teamwork is critical. Everyone has to think and act fast.  And it’s all captured on video.

“When you are in a classroom, no one around you really has any idea what you do or don’t know. But here it’s on display in front of your peers.  It is very stressful,” says Dr. Howes.

The whole experience depends on “the suspension of disbelief. How realistic is it? We are trying to create situational fidelity.”

The lab tries to duplicate the exact environment learners would face during a real crisis.  But high fidelity costs money. The more sophisticated the mannequin, the more expensive. One “patient” can cost up to half-a-million dollars.

The simulation lab is vital as a teaching tool because KGH has reduced the number of full cardiac arrests due to rapid response and early interventions.  

“People don’t get a chance to practice on real people,” he says.  “This is a teaching hospital so there are many learners. There aren’t enough crises for everyone to learn how to respond.  But here, we can produce as many crises as needed, over and over.”  

The simulation lab is so popular the challenge now is to increase the number of students who get a chance to use it.  The lab currently has three mannequins, including KRIS, and within the next six months it will be getting two more, one of them a wife for KRIS.

Practice makes perfect and the Kingston Resuscitation Institute wants people to practice. Patients coming to KGH can take comfort knowing that if they suffer a cardiac arrest, the people coming to help them know what they’re doing.