Mr. Clayton is a 45-year- old male with a breathing problem. Given that limited information, 16 medical, nursing, pharmacy and respiratory therapy students spring into action in the inaugural SimWars, a simulation training exercise at the University of Alabama at Birmingham (UAB). Mr. Clayton is in no real danger — he is actually a mannequin, voiced by a UAB doctor, while a nurse plays his distraught wife.
The students, divided into two teams, are charged with managing his case, coping with his wife, diagnosing his condition and applying the appropriate treatment. An audience, made up of physicians and students, votes on which team best handled the case.
“We create teams of multi-disciplinary students and then create a clinical challenging case,” said simulation director Nancy Tofil, M.D., associate professor of pediatrics.
SimWars is part of a week-long workshop called RIME – Research and Innovation in Medical Education – held on the UAB campus in August 2012. The idea is to let students from different disciplines work together in a training exercise just as they will work together when they finish school and embark on a career in health care. Students from UAB’s schools of Medicine, Nursing and Health Professions, along with McWhorter School of Pharmacy at Samford University, took part.
“That’s how it’s going to be in real life,” said Tofil, who is co-medical director of the Children’s of Alabama pediatric simulation center. “A lot of medical education is moving toward working together as teams early on in training, so that graduates are not waiting until they have their professional degree to interact between nurse and respiratory therapist, nurse and physician, or physician and pharmacist.”
The scenario has Mr. Clayton arriving at a hospital with difficulty breathing, after he underwent a routine gastrointestinal procedure that morning. The student teams are furnished with vital signs that continually update. They can ask for x-rays and laboratory reports. They can call the gastroenterologist who did the morning procedure for a consult. All the while, Mr. Clayton responds to everything they do or do not do.
“As they begin to figure it out and the case unfolds, the mannequin gets better or worse depending on their intervention,” said Tofil.
“SimWars is an excellent learning tool because it really puts you in the moment,” said Jessica Scott, a fourth-year medical student and leader of one SimWars team. “This gives us an opportunity to truly be in charge of the situation, rather than to just be observers.”
The first strategy both teams used to cope with Mr. Clayton’s breathing issues was to order supplemental oxygen. When that did not relieve his symptoms, they had to dig deeper for a solution. On one team, respiratory therapist Danielle Foster recalled learning about a similar situation in class. She suggested that her group call for a particular lab test, which led to a diagnosis of met-hemoglobin anemia, a potential side effect of the anesthesia from the morning procedure.
“In SimWars, it’s all on us, and we have to figure it out,” said Foster. “We were a team, and everybody had an active role.”
The solution to Mr. Clayton’s woes was administration of a medication called methylene blue. Both teams reached that conclusion in about the same amount of time, even though they followed different paths to the solution.
“Unlike a multiple-choice test they take in school, this was a clinical scenario while they were standing on their feet, taking care of a patient with a team like they will for the rest of their life in clinical medicine,” said Tofil. “The key to most patient care is teamwork, and as that care gets more complex, teamwork becomes more and more important.”
Tofil said students enjoy simulation learning.
“I think they walk away with a faster heart rate, which is very different from how they leave a classroom,” she said. “They’ll go home and replay the case in their heads, whereas they probably will not replay the slides they saw at a lecture earlier that day.”