High-Tech Training, Real-World Scenarios

KPSOM’s Simulation Center prepares students for patient care with hands-on experience in an authentic, supportive environment

October 07, 2022

Students perform a procedure on a high-fidelity mannequin in the KPSOM Simulation Center.

Inside a typical hospital intensive care unit, a group of medical students surrounds an unresponsive patient. The doctors-in-training check vital signs on a monitor and, recognizing that the respiratory rate is dangerously low, they immediately begin the process of resuscitation. The atmosphere is tense. Suddenly, the patient's eyes open as he begins to cough. The students exhale, relieved. 

Then, the monitor pauses, and the door opens. An instructor, who has been watching the students’ actions via live camera feed, enters and debriefs the group about what just happened.

The patient, as it turns out, is not a live human but a computerized, lifelike mannequin, and the intensive care unit is not in a real-life hospital but a high-tech classroom in Kaiser Permanente Bernard J. Tyson School of Medicine’s Simulation Center. In this highly realistic environment, students experience a variety of clinical scenarios – from routine exams to serious diagnoses to critical care events – with a combination of technological devices and specially trained actors (known as standardized patients) standing in for the real thing. The facility provides KPSOM students with authentic training in real-world doctoring experiences, enabling them to consolidate their knowledge and hone their decision-making skills. It’s a safe space that allows students to gain valuable experience that puts them ahead of the curve when it comes time to treat real patients.

“There are lots of benefits of simulation, and one certainly is psychological safety,” said Candace Pau, MD, Faculty Director of Simulation. “That's good for student confidence and it's also good for patient safety. Simulation helps our students practice all sorts of skills, from communicating with patients, to the psychomotor skills of complex procedures like a spinal tap, to the intricate teamwork necessary for critical care situations. In simulation, students have the freedom to make mistakes and then grow from them.”

The Sim Center, as it is known, is an 8,800-square-foot facility located on the first floor of the KPSOM Medical Education Building in Pasadena, California and equipped with digital technology and audio-visual equipment throughout. In the simulated exam and hospital rooms, there are cameras and video systems that allow procedures to be recorded so students can review their work under the guidance of a faculty member. When an emergent situation like the one described above takes place, an instructor in an adjacent control room monitors the situation and, when needed, provides guidance over an intercom, while a Simulation Technologist operates the mannequin and controls its respiratory system, heart rate, eye movements, and other vitals that the student doctors must respond to in the moment.

“This is all designed to provide clues, because this is what healthcare providers face in their daily work – mysteries to be solved,” said Sylvia Merino, MBA, MPH, Director of Simulation and Technology. “This equipment provides students with the clues they would see in a typical healthcare setting. This is so different from reading a case and answering multiple choice questions. The patient threw up; what color is it? A completely different part of your brain is being used. In simulation, you’re standing here, being put on the spot, and forced to put the things you’ve learned in the classroom into practice.”

Infant mannequin (L); task trainers (R).

During a recent visit, a startled observer jumped when the Sim Center’s resident baby mannequin wiggled its arms and legs as it lay in a neonatal crib nearby.

The mannequins here range from newborn to adult, including a pregnant person to simulate a live birth. They come in a variety of skin tones and have interchangeable genitalia to simulate a diverse patient population. Ranging in cost from roughly $70,000 to $150,000 apiece, the mannequins have varying features; the most complex models can breathe, wheeze, sweat, blink, and make a range of sounds to simulate internal conditions; they can even simulate a heart murmur.

They can shed tears and secrete saliva, display a temperature on the nearby monitor, and their pulse can be just as difficult to find as a real person’s. They have working major blood vessels such as the carotid, radial, and brachial arteries, and, using the techniques of moulage – the art of creating mock injuries and skin conditions for training purposes – the mannequins may exhibit hives, contusions, sores, or other conditions requiring treatment. They are instrumental in helping students learn to make clinical decisions under the pressure of fast-moving, urgent-care situations, and to practice the teamwork and communication required to do so.

For practicing skills in which a full-sized mannequin isn’t needed, students also utilize task trainers, lifelike models of specific parts of the human anatomy (arms, head, etc.) that are useful for practicing procedures such as intubation, IV placement, and more.

Another important component of working in the Sim Center is student interaction with standardized patients. These highly skilled professionals are trained to portray a specific patient case. Before seeing a student-doctor, they study a detailed scenario outlining the “symptoms” they are experiencing, their emotional state, and other criteria that will influence the nature of the exchange and put the student’s clinical knowledge and communications skills training to the test.

“As I was speaking with a patient, they produced a tear,” said KPSOM student Michael Okene. “And as I’m taking tissues and giving it to them, I’m just thinking in my mind, ‘this is absolutely wild.’ For someone to be able to produce this on command, it really speaks to the experience and how well simulated it is… This is almost authentic.”

Standardized patients also “work to foster expression of empathy – they let the student know how they made them feel,” added Carla Lupi, MD, Associate Dean for Assessment and Evaluation. This training also emphasizes advanced communication skills such as delivering difficult news and dealing with uncertainty, Lupi said.

Sylvia Merino, KPSOM Director of Simulation, in the Inpatient Simulation Suite.

The Sim Center’s Inpatient Simulation Suite has four hospital rooms and serves as the main space, where critical care scenarios are practiced. It is designed to replicate the hospital facilities at a typical Kaiser Permanente medical center; likewise, the outpatient suite with 10 clinic rooms mirrors a typical Kaiser Permanente medical office building. There is also a large procedural skills training room, plus classrooms for pre-briefing, debriefing, and training standardized patients. 

As the importance of simulation in medical education grows, the role of the Sim Center in the KPSOM curriculum will continue to evolve. The facility plays a key role in preparing students for their Longitudinal Integrated Clerkships, which begin early in their first year and pair them with a physician-preceptor in a Kaiser Permanente facility, where they follow a panel of patients over time and practice skills involved in diagnosis, treatment, and follow-up. Next year, when the Class of 2024 becomes the school’s first cohort of fourth-year students, the Sim Center will play a vital role in preparing students for their transition to residency.

Pau said the center’s technology will evolve, as well, and she predicted more use of virtual patients and digital interactions as software and other tools become more advanced. “It’s on the technological frontier to really do immersive virtual simulation,” she added.

For current students, the Simulation Center is valued as a high-tech training space enabling them both to apply classroom learnings in a real-life context, and to focus on applying the techniques of patient care in a realistic clinical space. They also credit the center’s faculty and staff with creating a supportive environment where some of the stresses of medical school can be overcome.

“They make it a place where I feel like I can come in and make mistakes and really embody the fact that I am playing a doctor and learning these skills at the same time, and it feels like a safe space to do that,” said student Kelly Shriver. “And that is a real gift of this program.”