PAWTUCKET â As the unresponsive five-year-old male lay motionless on a table at the Memorial Hospital, a team of doctors attached an oxygen mask and performed CPR, their eyes anxiously watching the monitors. Not liking what they were seeing, they then decided to try a defibrillator. After a few moments, the boy's eyes fluttered open and he murmured âWhat happened?â as the doctors looked at each other in relief.
While it is a scenario that plays out every day in hospitals, this one was strictly for training purposes. The doctors working on HAL were all primary care residents in the Memorial Hospital/Brown Family Medicine Residency Program. The young patient was Pediatric HAL, a state-of-the-art mannequin (or manikin as they are known in the healthcare field) designed to resemble a child. Not only does HAL look realistic, the manikin can open and shut its eyes, utter certain phrases, change skin tone from pallor to rosy, make breathing noises and has a motorized âpulse.â
On Wednesday, the Memorial Hospital/Brown Family Medicine Residency program unveiled its new Center for Clinical Skills Training in the hospital's Family Care Center. Family medicine faculty and residents demonstrated the hospital's new high-tech teaching simulators, which will be used for training in various settings, including emergency, OB/GYN and pediatric care.
Pediatric Hal is joined by three other computerized integrated manikins: Susie, an adult female simulator, Noelle, an adult pregnant female simulator that can âgive birth,â and SimNewB, a newborn simulator. The manikins can be programmed to interact with health care professionals in a variety of medical conditions. As interventions are performed, their âconditionâ will improve to reflect the treatment administered. Airway management, CPR, administering medication and IV access, as well as management of labor complications such as post-partum hemorrhage and seizures are just some of the interventions that health care providers can perform on the manikins.
Funds for the equipment were provided by a federal Health Resources and Services Administration (HRSA) grant to fund innovative primary care/family medicine residency training. At a press conference on Wednesday, Dr. Melissa Nothnagle, residency director; and Dr. Jeffrey Borkan, chairman of family medicine, spoke of how having the new simulation equipment located at the Memorial Hospital will provide much greater accessibility to this type of training for residents and will improve the hospital's overall level of care.
Dr. Gowri Anandarajah, director of family medicine residency, said, âHigh-tech simulation training equipment within the hospital and office settings is revolutionizing residency training.â She noted that such state-of-the-art equipment is typically only found in much larger hospitals, and that by having such training available to the medical, nursing and other hospital staff will help ensure that the Memorial Hospital is offering the highest quality care to patients of the Blackstone Valley.
Anandarajah, who helped write the grant proposal, said that the federal funding also paid for equipment that will improve residents' skills in clinical ultrasound, gynecological and musculoskeletal procedures. âMemorial Hospital has been serving the community for over 100 years. Why shouldn't a community hospital have this type of high-tech equipment?â she reasoned. She added that by having the equipment on site for the residents will enable them to practice this simulated training weekly rather than just once or twice a year.
Dr. Christine Nevins-Herbert, a third-year resident in family medicine, said that while practicing skills on manikins is not new in medical training, these computerized simulators allow for a more realistic experience. âWe have a chance to work on the skills that we know we will need,â she said.
Third-year residents Dr. Jodi Roque and Dr. Stephanie Chow also spoke about the value of frequent practice in emergency situations and said the simulators, offering the sounds of breathing, a pulse rate that can be monitored and changes in skin color, aid greatly in preparing them for the real thing.
Up on the hospital's maternity floor, Dr. Susanna Magee, director of maternal child health, programmed the manikin Noelle to simulate a labor situation while Dr. Manisha Kumar, a third year resident, went through the process of âdeliveringâ the baby. Magee noted that the manikin has features such as a portal that can be filled with artificial blood and then programmed to spurt out to create a shockingly realistic depiction of a post-partum hemorrhage or other complication.
Magee also noted that the room with the labor simulator is also set up just like an actual maternity room in the hospital, with a neonatal care station, featuring the SimNewB infant simulator, positioned next to the mother's bed. She explained that in this way, the training session can follow the birth and any complications that are programmed to arise and then move right into the immediate care for the baby that follows.
Magee said that the birth procedure, particularly, is a team-based effort and that the simulators allow for junior and senior residents and nurses to practice their skills in real time. âIn family medicine, we care for the entire lifespan, from sick newborns to those at the end of life,â she said. The new equipment, she said, allows for frequent practice in a wide range of healthcare scenarios.