How dummies, drills aid medical training

(CBS News) Technology is behind any number of advances in medicine. Now it's helping to improve something essential to good medicine but often overlooked: A doctor's bedside manner. Can an imaginary stress test make all the difference? We have an appointment with David Pogue of The New York Times for our "Sunday Morning" Cover Story:


Ben Lynch, a fourth year medical student at the University of Oklahoma, entered the room, and introduced himself to "Mrs Gallagher." This young doctor has been sent to break some terrible news:

"The cancer's migrated further than we had hoped," Lynch said. "It's reached that point to where we can say that it's terminal."

The patient's response is emotional: "I know it will take my life when I'm ready, but I'm not ready. And there are -- I, I have plans!"

"I understand this is tough," Lynch said. "And it's okay to struggle with this, this news, okay?"

DeWayne Andrews, observing the interaction through a one-way mirror, reacts: "She's very good."

Fortunately, "Mrs. Gallagher" -- a.k.a. Beverly Rearden -- doesn't really have cancer. She's one of thousands of amateur actors hired by American medical schools to help future doctors improve their bedside manner.

Beverly is what medical schools call a standardized patient. Afterward, she critiques the future doctor's performance.

"He did the only kind of touch that was really important, and that was just a hand on top of mine and just letting me know they're going to be here for me," she told Pogue.

Is there any longer any suspicion among incoming doctors about the importance of bedside manner?

"It's more than just the drugs or the treatment," said Lynch. "It's the relationship that you're building with your patients."

Every med school hires standardized patients. But these days, simulated patients have gone high tech -- with mannequins that can simulate heart attacks, make urine, breathe, blink their eyes, even go into coma.

Are they robots? "Well, you could call them robots," said Andrews. "They're digitally-controlled mannequins that have all sorts of moving parts in them that simulate what humans do in a variety of medical conditions."

A "baby" dummy cries and twitches. A double-amputee "soldier" thrashes. "Eyes" dilate. A "tongue" swells up.

These high-tech dummies aren't cheap; they can cost $300,000 each. But they never complain, and show up for work every day to train young doctors how to perform spinal taps, draw blood, withdraw knee fluid, find deep arteries, and perform colonoscopies.

Pogue was shown how a colonoscopy is done -- by inserting into the mannequin's bottom, a "pain score" is displayed. "Sometimes, they'll shout," he's told.

These dummies will even help deliver babies. An OB-GYN assisting a very human expectant mother (with a very fake abdomen) responds to contractions. "When you feel the next contraction, we'll push to the count of 10, OK?"

"I need that epidural!" the mother-to-be yells. "At this point, there's no time," the doctor says. "The baby's coming. We can do this."

"God!" she yells.

"A little push . . . " In a few moments, a "baby" is born.

According to Andrews, these dummies may be soulless machines, but their job is to hone the human touch.

"The whole purpose of medical simulation, beyond just better education, is really patient safety and the quality of care," he said. "Just imagine the difference if you've practiced it on one of these models or mannequins five, six, a dozen times before you have to do it in a real situation. Your skill level is better. Your anxiety is lower."

Unfortunately, says Stephen Klasko, dean of the med school at the University of South Florida, "Too much medical education is, 'Let me have you read the book. Let me make sure you understand it,' and then when we put you in a clinical environment, to take what was in that book and do it on a patient."

The university owns the biggest simulation center in the country. Klasko says that simulations may actually reduce the cost of health care, because it can reduce lawsuits.

"We can't transform the whole health care system and reduce readmissions and create better quality and have less mistakes, without the ability -- like the airline industry taught us -- to simulate those models, not just technically but also from a teamwork perspective

As training technology advances, the simulations grow more elaborate. At the University of South Florida, Dr. Luis Llerena teaches his students to work under the stress of the battlefield.

"This is what happens in the military -- it's loud, this room can get very hot, 102 degrees hot. When I say go, you have 30 seconds. You're going to intubate in 30 seconds," he said.

He went to the control panel, adding simulated gunshots to the din.

"Nice job," Dr. Llerena said. "Next time, hold onto the chin."

And back in Oklahoma, the professors are putting future anesthesiologists through some external pressures of their own. They'll be subjected to a whole range of unexpected disasters -- including an incompetent assistant (Pogue) -- as they treat their patient, a 25-year-old "gentleman" who suffered abdominal trauma.

Behind the one-way mirror, the instructors control the "patient" 's fake blood.

Apparently Pogue wasn't very good as a surgical intern -- even with a plastic patient. But his incompetence was only the beginning of their problems. Smoke? There's smoke in the operating room!

The room goes dark.

"We just lost power! Power's out in the OR!" said the trainee. "Find a transport monitor. And an oxygen tank if you can find one. We still have a pulse? We do. Patient's color? Color's good."

While Pogue's heart was racing, the students didn't seem all that freaked out, even when the drapes caught on fire.

"Now, how often does that happen in the real world? Is that useful training?" Pogue asked Dr. Kosek.

"It happens over 100 times a year in operating rooms across the nation," Kosek replied.

As it turns out, the equipment wasn't the only thing doing an acting job. This anesthesia mannequin gave an award-winning performance, too.

"When we give them anesthetic medicine that makes them go off to sleep," said Dr. Stacie Oliver, a third year anaesthesiology resident. "His eyelids actually drop down. His pupils can constrict and dilate. His tongue can swell up, making it more difficult to put this tube into his windpipe. His lungs do rise and fall. We can hear breath sounds. He does even have a little bit of fogging in the tube sometimes."

"He actually breathes out carbon dioxide?" Pogue asked.

"Yeah, so we can see it on our monitors," said Oliver.

Robotic patient technology will certainly improve. Andrews notes that the look of the face isn't real, but in the middle of a simulation, "You get caught up in it. And you begin to forget that it isn't real, because you're trying to manifest how do I best take care of this patient?"

These hunks of plastic and circuitry are serving us all, tirelessly and expertly. They ensure that even on Day One, the young doctor at your bedside has already had years of practice.


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