Top Flight

Piloting jet aircraft can be a complex task, especially when things start to go wrong. Unpredictable weather, faulty hardware and human fallibility all can conspire to produce tragically fatal mishaps.

That's why airline pilots spend hundreds of hours in flight simulators, developing skills they'll need to prevent a crash in the rare likelihood of an in-flight emergency.

Providing life-saving medical care is no less complex, notes Dr. Carol Lake, chair of the anesthesiology department at UofL's School of Medicine. And now anesthesiology residents and medical students here will have access to the same type of simulation technologies pilots use to build critical emergency experience.

The school is installing two state-of-the-art human patient simulators in a newly created teaching and learning center located on the third floor of the Instructional Building.

The $170,000 simulators, purchased with a gift from medical school alumnus Dr. John Paris, are lifelike computerized mannequins that can be programmed for a variety of medical scenarios, Lake says.

UofL's simulators -- the first to be used in the Commonwealth -- represent a major advance in medical training because they allow students and practitioners to develop a substantially broader base of crisis experience.

"Just as an airline pilot learns to handle emergencies in the air by training on a flight simulator, medical students and practitioners can learn how to safely handle crises they may not see every day," Lake says.

"When they do see these situations, they'll know exactly how to respond because they've trained for them on a simulator. Ultimately, this type of training will save lives."

The simulators will be housed in spaces that replicate an operating room and an emergency room, according to Ruth Greenberg, director of academic programs at UofL's Health Sciences Center.

The setting is so realistic, Greenberg says, that students will feel palpable tension as they make their patient management decisions. Moreover, the simulators' lifelike functionality will add to that sense of realism.

For example, a technician can program a mannequin to constrict its airway, alter the rise and fall of its chest, produce various vital signs or breath sounds -- even respond to anesthesia and drugs.

These factors combine to provide the most realistic, risk-free learning experience available to students today, Greenberg says.

That absence of risk is an important factor in medical education.

"Students will have the opportunity to inject a drug in exactly the same way they would do it on a live patient and to observe the reaction in an extremely realistic way," Greenberg notes. "At the same time, if the student injects too much or too little, there is no real threat to that patient's well-being.

"So the simulator provides an excellent training experience for the student-a type of training that has only recently become available."

Another benefit is the opportunity for instant replay.

"In a simulator training session, a student will typically go through the entire scenario and see what outcome occurs," Lake says. "The simulated patient could, for example, die, or the simulated scenario could go on to other pathways of progressive difficulty because of the student's failure to do the right thing.

"Then, the instructor would take the student into a conference room and conduct a debriefing session. Because the simulator remembers everything that happens, the teacher can essentially replay the sequence of events and say, for example, 'You didn't pick up on this change until five minutes later when things had really gotten bad.'"

Lake says such reviews are "virtually impossible" with live patients.

"In real life, we can't replay everything and say, 'You should have recognized that the patient had a pneumothorax here; or you should have put a chest tube in there.' "You just can't do it."

Groundbreaking applications

UofL's approach to human patient simulators is unique in that the devices will be housed in a classroom building on the Health Sciences Center campus.

Traditionally, simulators have been located in clinical settings like hospitals and managed by anesthesia departments. Furthermore, most training centers contain just one simulator.

"We will be charting new territory by expanding the vision of how patient simulators can be used to enhance teaching and learning," Greenberg says. "Our plan is to promote their use throughout our training programs."

Lake agrees.

"While the primary use of these simulators has been in anesthesiology, we want to do more than that here," she says. "We can simulate situations in emergency medicine, critical care and pediatrics.

"There also are many other applications, including uses in the basic sciences, so that many of the traditional physiology, pharmacology and laboratory experiments can be done on the simulator."

And the school has even more ambitious plans.

Fund-raising efforts are under way to purchase four additional simulators, making UofL a regional -- if not national -- powerhouse for high-tech medical education.

UofL's facility will even be open to the medical and nursing community at large, through the Office of Continuing Health Sciences Education.

"Once our simulation center is fully operational, we'll be able to provide continuing education experiences to physicians, emergency technicians and nurses from Louisville and throughout the region," Greenberg says.

"There wouldn't be any reason we couldn't plan programs on Saturday morning or late in the afternoon for health care professionals from Indianapolis or Cincinnati or Lexington."

Such a broad-ranging impact will ultimately result in better medical care for everyone throughout Kentuckiana and the Midwest, Lake says.

"I am tremendously excited about the goals we have set for our patient simulators," she adds. "We believe this is absolutely the way to train people to be the best physicians and nurses for Kentucky and the region.

"This is a big deal. And this is the future."