Gaining Medical Skills Through Simulation

Article and photos by Becky Steenburg, Administrative Assistant for the Department of Tracks and Special Programs

The Rural and Wilderness Medicine Track, joined by the new Urban Underserved Track, participated in a series of simulated critical care patient scenarios. In teams of five, the student physicians worked together to analyze and evaluate cases. They were then expected to treat the simulated patients using a reasonable differential diagnosis and plan. Finally, they had to complete a brief case presentation in a SOAP format, which was delivered formally with two attending physicians present.

Each team participated in two of the four different scenarios, which were presented with the assistance of simulation operators: Tina Underwood, MA Ed, CHSE, Director of the Standardized Patient Program; Patrizia Grob, OMS II; Danielle Kauppinen, OMS II; and David Ross, DO, FACEP, Director of the Rural and Wilderness Medicine Track (who has worked with high fidelity electronic patient simulators in a variety of training settings for over 15 years). The simulation operators control the simulators, mimicking things a patient might say and do. They also provide data that would be gathered from performing tests or procedures performed in a real situation; however, the students have to specifically ask for the test, procedure, or data. On more than one occasion, Dr. Ross was heard to say, “The nurse is confused by your orders.”

Scenario #1: A 75-year-old male with subjective fevers, fatigue, malaise, bilateral flank pain, and nausea presents by private vehicle to the emergency room of the small rural hospital in which the student physicians are working.

Scenario #2: A 45-year-old female recently diagnosed with metastatic colorectal cancer. Currently being treated with chemotherapy, she began having mid-sternal chest pain and shortness of breath, especially with exertion earlier that morning.

Scenario #3: A 30-year-old, obese female woman in the obstetrics unit four hours post-delivery of a large-for-gestational-age baby at 39 weeks, following labor of 12 hours. She had significant postpartum bleeding and now is in shock.

Scenario #4: A 6-week old infant brought into the clinic with a complaint of fever for four hours. The patient is not acting normally and has a diffuse purpuric rash.

The goal of this event was to give students an opportunity to work in a simulated setting with realistic cases where they could practice teamwork and differential diagnosis skills while under pressure. It also allowed students to summarize and verbally present the patient to attending physicians in the “hospital” using the SOAP format.

This event was the first of its kind for Jean Bouquet, MD, Co-Director of the Urban and Underserved Track, who is just starting his second year as a medical educator. “It’s amazing how time contracts when [you are] faced with bells and alarms going off all around you and your patient is actively dying (even if it’s a plastic patient)!” he said. “The students really seemed to enjoy this simulation and all of the patients will live again to die another day.”

Also participating and observing were Jenifer Fisher, Co-Director for the Urban Underserved Track; Kelsey Phillips, Coordinator of the Office of Simulation in Medicine and Surgery (SIMS); and Becky Steenburg, Administrative Assistant for the Department of Tracks and Special Programs.