Plastic Makes Perfect
By Shamona Harnett / WINNIPEG FREE PRESS
Winnipeg, Manitoba
December 14, 2009
Realistic robotic mannequins give medical students a chance to do some stressful doctoring in state-of-the-art simulation facility
One day, Noelle gives birth to a healthy baby.
On another, her labour does not go as smoothly. Her blood pressure shoots up while her about-to-be born baby's heart rate suddenly plummets.
Sometimes Noelle bleeds profusely.
Today, she rests -- eyes closed -- on a bed in the basement of the University of Manitoba's Bannatyne Avenue campus.
Although Noelle is made of plastic and silicone, her face and body are life-like. Pull back her Velcro stomach and you can see the baby she carries.
Power her up and her blue eyes open, she breathes and she speaks. The tube of red liquid -- fake blood -- hidden inside her can gush out to replicate hemorrhaging. All the while a motor inside her system enables a life size newborn to eventually emerge from her silicone cervix.
"It will push the baby down and it will mimic all the same turns that the baby does on the way down. Because babies don't just pop out," says Dr. Rob Brown. "There's a normal process. And there's an abnormal process. And you program which one you want to have happen."
Noelle is part of the U of M's Clinical Learning and Simulation Facility, a $4.6-million, 11,000-square-foot lab designed to prepare medical students for what might happen in the emergency rooms and hospital wards where they will work.
Brown, an anesthesiology professor who heads the simulation lab, recalls being frightened as a fledgling resident while working in a clinical setting for the first time.
"Even doing the simple things like physical exams was pretty scary. Just listening to someone's heart for the first time... everything feels awkward. You feel like an idiot. It's kind of intimidating," says Brown, who hopes medical simulation will make patient-resident contact less daunting for both parties.
"It's really tough from the student's point of view and I can't imagine it's much better from the patient's."
Launched about a year-and-a-half ago, it's one of the most state-of-the-art medical simulation facilities in Canada, according to the U of M. Funding for the facility came from the Winnipeg Regional Health Authority, the provincial government and the U of M faculty of medicine -- which each contributed $1 million. An additional $1.6 came from private donations.
The five robotic mannequins housed in this hospital-like setting are available for medical students to conduct everything from colonoscopies to tracheotomies.
The facility is a definite upgrade for the faculty of medicine -- which previously had only one robotic mannequin for student use.
For the last two decades, medical students have practised pelvic and rectal exams as well as doctor-to-patient communication on volunteers who posed as patients -- some of them trained actors. Students still work with these volunteers in the new simulation facility.
In it, they can learn how to deal with operating-room emergencies. One of the robots, known as SimMan, can go into cardiac arrest and anaphylaxis. He can even flatline.
Brown says many students will never come across certain emergency situations during their residencies except in the simulation lab. The emergencies created here, he says, are often as touch-and-go as in a real-life hospital.
"It's about trying to learn how to run this like it's really happening. How to put the breathing tube in at the right time, get it in the right hole and have the dummy not die," says Brown.
How it works is that mannequins such as Noelle and SimMan each live in one of a handful of rooms which can be made to look like an operating room, intensive-care unit or emergency room -- depending on the placement of apparatus.
Each room is outfitted with at least two inconspicuous video cameras, equipment such as heart rate monitors -- plus a one-way window.
Today, Brown is on the other side of the one-way window, where, like the Wizard of Oz, he demonstrates how he controls SimMan. With a touch of a computer mouse, the plastic robot lying on a gurney can breathe laboriously -- while his chest movements and heart rate monitor match his breathing patterns.
Brown turns on a microphone at his station and says, "Oh man. I think I'm dying." His voice comes out of SimMan's built-in speakers. There are no students with SimMan to hear his moans. But if so, they would move quickly.
"These things get really intense," says Brown, who grades students on how they perform in the emergency situations. Later, he reviews their taped performances with them--invaluable, he says, in sharpening a student's technical abilities, communication skills and aptitude to think critically under pressure.
"Students just suck this stuff up. They love it."
Ainsley Espenell, a fifth-year U of M medical resident, admits she found her first emergency experience with a robotic dummy "strange and humorous."
Once she mentally suspended reality, all she could think about was caring for her plastic patient.
"Once you start getting into it and things are happening and things are changing, it feels very realistic because you are stressed," says Espenell, who specializes in anesthesia. "You're listening to things. Things are changing with the monitors. You're getting a lot of feedback from the other people who are in the room -- so it definitely does feel very realistic.
"The good thing is that it is a SimMan--so if something bad happens or you don't perform as well as you want nothing bad is going to come of it."
Brown says although the verdict is still out, he's confident that U of M's high-tech robots are creating better doctors.
He says the university is currently conducting studies to find out.
"The very least we expect out of simulation is that when you get there and you hit the ward the very first time you'll be safer," says Brown.