Saving The Life Of A Dummy

Medical simulators, introduced five years ago, are rapidly finding their way into hospitals from Stanford to Sydney. They are part of a growing effort to train medical residents without risk to patients, to cut mistakes by professionals and, when errors happen, to find out why.

Everybody's first encounter with Stan D. Ardman, is the same. Whether they are doctors, nurses, medical residents, anesthesiologists or Boy Scouts, the first chance they get, they try to kill him.

From his resting place on an operating table at Penn State's College of Medicine, the $200,000 mass of plastic, metal, wire and circuit board spends his days crashing into all manner of medical trauma: heart attacks, asthma attacks, blocked airways, collapsed lungs.

Stan has blinking eyelids, pupils that dilate, an airway that opens and closes, and a pulse. He breathes and exchanges gases like human lungs. Physicians can inject drugs, drain fluid from his heart sac, intubate him, or insert chest pumps.

Part of what Stan teaches is what it takes for a patient to die. It's a lot like test pilots trying out the newest jets.

Flight simulators came about because airlines and the military figured it would be cheaper for a pilot to crash a virtual aircraft than a real one. The idea is similar in patient simulators: Better to kill a dummy than a patient.

"Just as people prepare with fire drills and disaster training, we want medical students to know what it's like before it happens," says Dr. Margaret Wojnar, a Penn State professor who uses the simulator.

Stan's name comes from his default setting "Standard Man" but he can become "Truck Driver," a beer-swilling cardiac patient who smokes four packs of cigarettes a day. There is a program for "Soldier," who has a gunshot wound. Doctors can also change his condition on the fly to keep students off-balance.

These sophisticated simulators have become all the rave despite a medical community wary at first of the technology. Even today, researchers are working to determine how, clinically, it helps teach doctors.

"What's left of the resistance is people who are threatened by it," says Chris Paulsen, executive vice president at MedSim-Eagle. "They say, 'Are they going to use it against me in a high-pressure, pass-fail test?'"

For the professionals at Penn State's College of Medicine, programs are optional. In groups of six, participants work on an emergency, focusing not on medical technique, but on group dynamics. Do the right doctors take the lead? Do the first people on the scene call in specialists soon enough?

The procedure is videotaped, and the group uses it to discuss what they could have done better.

Because the simulator has limitations, the test lacks the urgency of a true emergency. The simulator can't talk, for one thing. The other difficulties are human: These students are unfamiliar with how the dummy works, and Wojnar is still learning how she can us it to push her students.

"It's not all reality, because it's still a simulation," she says. "But it's close."