Retrospective: Red No. 40

Above: Robert Moore, Director of Patient Simulation, Ross University School of Medicine - Bahamas campus demonstrates use of a patient simulator. (From Derek Caroll, BahamaIslandsInfo.com)

IN MY DAY,
WE CALLED HIM STAN.

2008. I remember during fourth semester in Dominica, I was ready to draw blood for a blood test on the patient. My proctor was watching me as I went for the median cubital vein for the draw, and I only pulled out air. He said, try again, and as this was my first shot at drawing blood, I mistakenly pushed the syringe in the wrong direction, pushing the air into the patient.

STOP! WHAT DID YOU DO!?
He shouted.

Back then, I didn't know. He told me I almost triggered an air embolus in a patient. Fortunately, I never harmed the patient. After a second try, I hit the median cubital vein, and I drew blood properly using the syringe method. Okay, I fibbed, it wasn't blood... more like a watery substance colored with loads of Red #40 food coloring.

----

If you didn't catch it by now, I was working on a full-blown human simulator.

I'll admit that it wasn't exactly like working on a real patient: the simulator couldn't give feedback (only through what our proctor interpreting as the patient), techniques that require fine hand skills (e.g. placement of IVs or drawing blood) could only be coarsely worked upon, and we always had a second chance if one of us did something wrong. In the case of the failed blood draw on my part, I was glad I did: an air embolus might have killed the patient.

However, it was different in years past. From a recent New York Times article by Pauline W. Chen, much of her clinical experiences on patients was done directly to real patients with that risk, and teams reviewed their cases on videotape. Now, patient simulators can be used for full clinical situations, putting away that risk that lies with working with patients needing critical care. It seems to be the answer to the ethical dilemma of if its acceptable to use patients as "airplanes or machines" (according to Dr. David M. Gaba from Stanford University School of Medicine) to test on.

With the simulators at Ross University in Dominica, we were able to work in teams of eight directly on a simulator with a professor as a proctor. And if a group of eight of us, for the first time, had issues with figuring what to do in such a critical situation, imagine us doing the same with a real patient. We'd definitely scare them, and not to mention put them at harm. The simulator room gave us a "safe zone" where we could try our best to develop a team dynamic so we could work efficiently towards the patient. Seconds count with the simulator, but fortunately running out of them doesn't mean life or death (in real terms, anyway).

The one thing I found initially annoying though was how easily the program running the patient could be manipulated. Sometimes our proctor would go right to the controlling computer and click a button, and all of a sudden the patient would be undergoing a deadly arrhythmia. However, I responded exactly as I would have with a real patients, with greater alertness toward the situation, and our team made the appropriate actions. This flexibility enhanced the realism and educational benefit of a simulator session, and in the end, I actually appreciated the switcheroo.

I really hope that simulator technology improves for the next generation of doctors, as I found it very valuable in my medical education. Thanks for the memories, Stan.

Sources: BahamaIslandsInfo.com & The New York Times