This year, Noelle will give birth at least 36 times. Sometimes it’s a smooth progression; other times the birth takes longer and may present complications.
A high-tech bedside computer monitors her blood pressure and heart rate; another keeps track of the fetal heartbeat. A team of students delivers appropriate care until, at last, a new baby enters the world, complete with umbilical cord and placenta.
Noelle is a birth-simulating mannequin who helps nursing and medical students get firsthand experience of different childbirth scenarios to better prepare them for safely supporting a real, live mother and her baby through labor, delivery and postpartum.
She is one of a family of 20 health education mannequins — seven adults, four birthing moms, and nine infants and children — who are clothed in hospital gowns, staring ahead silently, as they await their next assignment at the University of Texas Medical Branch Interprofessional Simulation Center.
“We’ve learned a lot from the aviation industry: it’s better to crash in simulation than in the real world,” Rachel Kilgore, the center’s director, said.
Medical simulation offers students an opportunity to learn and to make mistakes without hurting anyone, Kilgore said.
‘It looks authentic’
As director of the simulation lab, Kilgore produces learning scenarios and also gets to do special assignments that are both unusual and creative.
“I had to figure out how to create a rash on a child simulator that would look like bacterial meningitis,” she said.
Sometimes, the mannequins need fluids, which can be placed in specialized cavities for certain scenarios, such as a hemorrhage after birth.
Kilgore has manufactured vomit from oatmeal and realistic post-delivery blood from crushed cherries.
“It looks authentic, like it’s clotting,” she said.
It’s in the simulation lab that future medical personnel learn clinical, behavioral and cognitive skills through firsthand experience.
“A few weeks ago, we had a simulation with a patient who went into cardiac arrest and we did a full code, exactly as if he were a living patient,” said Lindsay Murray, a fourth year nursing student who plans to practice emergency medicine.
“It gave me the opportunity to respond to a medical emergency in a safe environment without so much anxiety. Having practice helps you get more comfortable so you are ready for actual emergencies.”
They’re not dummies
Murray concedes that caring for a mannequin that blinks and moves and talks is initially strange. But once students get used to it, they treat them like regular patients, she said.
During all scenarios, student interactions are recorded so they can learn what they did and discuss how they might improve from watching a video.
As director, Kilgore sets high standards for how students care for simulated patients, she said.
“They must be treated respectfully, appropriately draped, and students must never talk about the mannequin’s health conditions outside of the conference session,” she said.
No photographs are allowed and no one refers to the simulators as dummies.
The computerized human look-alikes are not as realistic or responsive as the robots in science fiction TV drama “Westworld” — at least not yet.
As the science of simulation evolves and mannequins become more lifelike, they increase in value as a teaching tool.
One sick mannequin
Ken Carson, the university’s newest high-fidelity model, most closely resembles a functioning human. He is programmed to demonstrate dozens of medical symptoms and conditions, but he also has a softer side. Next to his bedside is a framed photograph of his girlfriend, Barbie.
Carson is able to converse with students; his chest rises and falls as he breaths, his pulse varies, he sweats and his pupils dilate. He has a lexicon of coughs, heartbeats and realistic seizures. Fluids come from his mouth and nose; and he is anatomically correct.
He is one sick mannequin.
Carson is used for advanced and complex medical scenarios. Earlier generations of simulators, now middle-aged, fill an open hospital ward and are used to practice basic skills like inserting nasogastric tubes or urinary catheters.
Housed on the second floor of Rebecca Sealy Hospital, the 15,000 square foot simulation laboratory will more than double its size in the new university learning center, which is expected to open in the summer of 2019. In the new dedicated space, students from all the disciplines will learn as an interprofessional team.
“The future of health care is difficult to predict but critical thinking will always be necessary in delivering quality care, and simulation is a good way to develop this skill,” Kilgore said.
The next generation
With all its many possibilities, simulation science still has hurdles to overcome.
Culturally diverse mannequins are not part of the teaching pool yet, but are being developed, she said.
The next generation mannequin is expected to be more human-looking with soft, possibly warm skin.
The medical branch was an early adopter of high-fidelity simulation, beginning in the year 2000 when the products first became available.
Simulation is expensive — Ken Carson cost $71,000 — in addition to his laptop and bedside monitor but Kilgore said it pays off in superb training.
“Our nursing students have high pass rates on the national licensure examination, and this year they had the highest rate of any school in the University of Texas system,” Kilgore said. “I believe simulation makes a difference.”
Because of the expense, educators work to keep the simulation laboratory active, productive and open to all students.
Avoiding medical errors because of simulation experience is more than a matter of cost savings — it may save a life, Kilgore said.