A patient comes into the Emergency Room complaining of chest pains. You check his vitals, ask some questions, and, in mid-reply, the patient loses consciousness and the monitors attached to his body start beeping like crazy. What do you do?

Some 4th-year medical students from the Roy J. and Lucille A. Carver College of Medicine recently had the opportunity to practice their responses to just such a scenario in the Department of Anesthesia’s Simulation Center. Most of this group plan to specialize in internal medicine or surgery, and they haven’t had many chances to learn about and practice the ABCs of a cardiopulmonary arrest: airway, breathing, and circulation.

“Simulations give trainees the opportunity to experience adverse events that they’ll have to respond to at some point, but in a low-risk environment,” says Clark Obr, MD, director of the Simulation Center. “Then, when they see the real thing in the OR, they’re not dealing with it for the first time. The Simulation Center is a safe place to make mistakes.” 

These days, simulation in healthcare is common, and even growing in use. But when the Department launched its simulation program in 1999, University of Iowa Hospitals & Clinics was one of only 20 academic medical centers in the country equipped with a then-state-of-the-art electronic patient simulator.

“Pilots had been using simulators for a long time, and in the 1990s, a bunch of doctors thought, ‘Wouldn’t it be great if we could have residents practice before they work on actual patients?’” says Johann Cutkomp, who managed the Simulation Center from 2006 to 2018 and still helps out most weeks. “There was some reluctance at first, but then residents said, ‘Wow, I really learned something today,’ and people started taking it more seriously.”

The first manikin, a MedSim model, could simulate a number of realistic physiological responses: It breathed, blinked, had a pulse, made heart and lung sounds, and responded to various simulated drug administrations. Dale Morgan, MD, an alumnus of both Carver and the Department of Anesthesia, came out of retirement to help set up the manikin and teach airway management to medical students and residents.

In 2006, the Department traded in its MedSim manikin for one manufactured by METI. By that time, Paul Leonard, MD, had taken over as director of the Simulation Center, and residents were doing regular simulations during their non-OR rotations. The Simulation Center also added an infant manikin, which the staff called “Baby.”

“The original idea was that we would name the baby after Jeanne Jaggard, who had donated (with her husband, Hal Jaffe) the money for the new manikins. Jeanne had been a pediatric anesthesiologist and was an alumna of the Department,” Leonard says. “But we didn’t want to call the baby Jeanne. We liked Jeanne, and we didn’t always like Baby.”

The infant manikin was only the third model built, which may have contributed to its temperamental moods, Leonard says.

Today, the Simulation Center boasts high-fidelity Laerdal adult and infant manikins and exposes anesthesia residents to an average of 30 simulated scenarios over their three years of clinical experience.

“The education we provide through simulation is 10 times greater than the typical anesthesia program, and it’s always very highly rated by our residents,” Obr says.

The center’s activities have broadened, too. Stephanie White, who became the center’s operations manager in 2018, has been asked to set up simulations for the Ambulatory Surgery Center, the Day of Surgery Admission unit, the Post Anesthesia Care Unit, Stead Family Children’s Hospital, and the hospital’s Team-based Simulation Design & Debriefing team. In addition, the center offered sessions at the hospital’s annual Girls Go STEM event in 2018 and a new Kids Go STEM event in 2019 and hosted a local 4H group for a half-day simulation session over the summer.

In fact, during the 2018-2019 academic year, the Simulation Center conducted more than 1,050 simulation activities. More than half of these were “core” simulations for medical students, interns, residents, fellows, nurses, and student registered nurse anesthetists. The Simulation Center also was heavily involved in training providers hospital-wide for the institution’s new deep sedation privilege policy.

“It’s really gratifying to see so many people recognizing the value of simulation in such a broad spectrum of situations,” White says. “My favorite thing is when the residents encounter a real-life situation and then bring it to us to create a simulation so they can teach it to their peers.”

 The value of simulation is priceless, residents say.

“Simulations are integral in preventing bad outcomes when rare and dangerous situations occur with patients,” says CA-2 Philip Schulte, DO. “Going through a simulation of a situation you may only see once in your career could be the difference between saving a life and losing it.”

Healthcare Simulation Week is Sept. 16-20, 2019, sponsored by the Society for Simulation in Healthcare.