Simulating real-world health care

Simulation Center

Mark Stehle

Penn Nursing students Sara McDonough, left, and Zia Zaidi, center, learn about tracheostomy suctioning from nurse practitioner Katie Woo Castelo in the school’s simulation center.

When US Airways captain Chesley “Sully” Sullenberger III made a successful emergency landing of his plane on the Hudson River in 2009, it wasn’t because he got lucky.

In fact, Sullenberger, like other pilots before and after him, relied on a kind of finely honed muscle memory, having been prepared in flight simulators for emergencies, freak occurrences, and the unthinkable.

These days, pilots aren’t the only professionals learning how to handle the unexpected in simulated settings. Increasingly, simulation centers are integral to teaching the next generation of health care providers.

Last fall, Penn’s School of Nursing greatly expanded students’ simulation experience. The new Helene Fuld Pavilion for Innovative Learning, which was renovated over the summer and reopened in September, expands the school’s simulation space to 7,000 square feet, with rooms and berths designed to all measures of care settings, including outpatient, hospital, and home care.

“[Simulation] prepares students for patient interaction. Our goal is to help them find comfort in any setting in which they will be moving through clinical experiences and hopefully practicing,” says Angela Iorianni Cimbak, director of the school’s simulation center. “Simulation is for safety training but it’s also for low-frequency, high-impact events.”

Simulation is not designed specifically for psychomotor skill acquisition, such as learning how to properly administer an injection to a diabetic patient. Instead, Cimbak says this is a fringe benefit of simulated learning.

More importantly, simulation underscores the importance of caring for the whole patient and communicating with other nursing students, patients, and families, and gives students confidence as they prepare for real-world settings.

“I need to shake the heads of our students—reframe them. You’re giving care to the patient, so the expectation is you’re bringing with you the bedside thinking, priority setting, and decision-making, along with safe psychomotor practice,” Cimbak explains. “They go hand-in-hand. Soft skills, as we call them, and team-building skills, collaborative skills, are very important for simulation. Simulation is also about shared communication.”

The environments in which students are interacting with each other in small teams also helps to introduce them to the socialization behavior of nurses, which includes collaboration and building trusting relationships.

In the center, each berth contains a camera so students are able to watch their interactions with simulated patients. Cimbak says what they see may surprise them. They may notice—perhaps for the first time—that they had their back to the patient for most of the interaction, or focused their attention on the computer screen.

This kind of feedback proves invaluable in the learning process.

“The students see the big picture,” says Deborah Becker, practice assistant professor of nursing and assistant dean for innovations in simulation. “By participating hands-on in case studies, they are learning to be critical thinkers and have the freedom to make mistakes. Afterwards, they deconstruct their decision-making and work with a faculty member and peers to determine what they might do differently in the future.”

The renovated space includes a main room outfitted with berths that fit hospital beds, as well as several smaller rooms that mimic a variety of clinical, outpatient, or home care settings. Each berth has a headwall unit equipped with oxygen and suction instruments, as well as a computer, on which the simulated patient’s electronic health record (EHR) may be displayed. Patient simulators are interactive mannequins that range in age, gender, and race, and can be outfitted for behavioral, live action, and high-fidelity simulations. In other words, monitors beep, patients breathe, and babies cry—just as they do in real-life settings.

Every undergraduate Penn Nursing student is exposed to the simulation center, initially through a “super-sim day” held in the fall semester of freshman year. As students move through their coursework and prepare for clinical placements, they spend more time in the lab, learning hands-on patient care that ranges from bariatric surgery to complications during childbirth.

Aiding Cimbak are nearly 30 well-educated nursing professionals who work at the  simulation center between 2 and 20 hours a week. A majority are practitioners in the community, including Children’s Hospital of Philadelphia and the Hospital of the University of Pennsylvania.

The simulation center also opened its doors in December to host a three-day collaborative course for members of the Philadelphia community, including professionals from Penn Nursing, UPHS Nursing, the Children’s Hospital of Philadelphia, and Thomas Jefferson University.

In the end, it’s all about serving students’ needs, says Cimbak, to make them better equipped in the real world.

“We thought of the most critical needs in terms of the most ill patients or the most complex curriculum. We also thought of the most simple things in the design,” she says. “If we didn’t work together, this could not have been achieved. This is about teams and how we portray teams in education [which] is how our students will learn about teamwork.”

Originally published on February 21, 2013