Medical News, Education, Second Life: SimMan and Serious Games

” When five people dressed in scrubs jump up and cut off all your clothes in the exam room… that tends to get your adrenaline going and your heart rate up “.

Said Dr. P, a trauma surgeon, referring to what happens when a patient is wheeled into the Emergency Room

When the new Clinical Skills Assessment lab opened at UConn Health Center a few months ago, many staff and faculty were invited to attend the opening reception and as one of the featured speakers was addressing the group, his backdrop was a 6-foot projection screen, upon which the image of the new SimMan, a human patient simulator, was projected. SimMan was operational and “breathing”. As I listened to the speakers, my eyes were continually pulled back to the screen behind, watching SimMan‘s chest move. His respiration rate seemed high. Was he simulating pain or shock? Was he set to display symptoms of a pneumothorax? Was he having a virtual MI?

Hey, Cut - I’m a librarian but being a facilitator for problem-based learning has trained me to think along these lines too. There is so much I will never understand about human physiology (but I keep trying).

A few minutes later, during a tour of the new training facilities, a group of us got to stand up close to SimMan to look at his wired-up clinical features… simulated veins, ports to measure arterial blood gas or place a central venous line, an airway for practicing intubation.

Getting next to SimMan illustrates a point to me quite clearly: He represents why medical students train and train, and what experienced physicians, nurses and EMTs have signed on for and indeed, might come to expect daily: anticipating that emergency moment, when the trills and beeps of the equipment start wailing and the numbers are all flashing bad data.

Photo credit: Courtesy of Hartford Hospital – Copyright 2008 – All rights reserved

When the patient is crashing, the trauma team jumps into action and those years of training and hands-on clinical experience kick in while they assess: Is there a patent airway? Respiration rate. Heart rate and rythmn. Evidence of trauma or internal bleeding. Obvious fractures. Altered mental status. Pupils round and reactive to light? Response to pain or stimuli. And if those signs are ominous they may be considering their judgement about whether this patient will live or die.

Some medical decisions in trauma must be made in a short amount of time. The team knows that for some patients, no intervention will be adequate to the task. The code will be called. Family members waiting anxiously in the hall must be spoken to. Forms will be filled out. The team disperses but they’ve trained for years to earn the right to work on that line. They know there are some patients who cannot be rescuscitated.

Most of us will never bear the gravity or responsibility for assuming care of what SimMan is a stand-in for: a living human being who needs urgent medical care to preserve life and function. The emergency physician as group leader makes the call while the rest of the team pauses: Yes this is what the patient has, and so we will do This, This and then This… and the ideal outcome is: the person will live.

It is essential hands-on practice. SimMan enables those in training to work in a lower-risk environment… because (obviously) the replica is a smart computer that can perform in amazingly complicated ways but is still limited by what his software (and his human directors) tell him to do. And SimMan may be replaced some day, but he will never “die”.

At the following link is a feature recently done for National Geographic about physicians and residents from Hartford Hospital working with their new model SimMan. What a great photograph:

Photo credit: Courtesy of Hartford Hospital – Copyright 2008 – All rights reserved

Next… the idea of Serious Gaming. Here is one definition of Serious Game from Wikipedia. Here is another definition from CALT. Following are a few examples of sites which provide clinical education or training scenarios using virtual environments:

• Play2Train: Emergency Preparedness Training in a Virtual World and their blog.
  

• George Washington University Medical Center hosts the National Emergency Medical Services Project Initiative (NEMSPI) gaming project designed to train first responders to respond to mass casualty incidents, Zero Hour. Click here to watch a recorded clip of the game in real-time (Windows media viewer required).

• Medical College of Georgia has agreed with Breakaway Ltd. company to develop programs using a virtual 3-D simulator to assist students in learning dental implant techniques. Read the May 2008 announcement here: Dentistry and Virtual Gaming effort.

• Medical student and fellow blogger Berci Mesko, has written a post on Scienceroll (May 23 2008 ) about virtual pulse oximetry training within Second Life at Ann Myers Medical Center.

• John S. Miller is a nursing faculty at a community college in Washington State. He created an educational group of nursing training techniques, narrated by his avatar in Second Life. One of his clinical demonstrations (from YouTube) is shown below:

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Professor Miller also writes a blog about health-related training in Second Life and is one of a group of bloggers running Virtual Field Trips which reports on various health-related educational “field trips” in-world. His blog is where I learned about the next project.

• The Serious Games Initiative is sponsored by Woodrow Wilson International Center for Scholars and founded Games for Health to develop a community and best practices platform for the numerous games being built for health care applications. This project has brought together researchers, medical professionals and game developers to share information about the impact games and game technologies can have on health, health care and policy. An interesting post from the Games for Health Blog is here. The 2008 conference of Games for Health was held in Baltimore on May 7-9; some of the presentations can be seen on Slideshare: click here for a list. Here’s one example from that list of presentations: Pos Or Not, a game-playing demonstration project aimed at teens in high school and college, asking “Can you tell if someone is HIV positive by just looking at them?” The actual serious game Pos Or Not can be played here.

• On Ning (a social networking directory) you can join a group called Serious Games (sign-up for Ning is required first but it is free).

• Finally, Harvard Business Review published a feature article in May 2008 entitled “Leadership’s Online Labs” on the potential for training business executives using virtual/simulated environments, which you can read an excerpt from here. (Full-text available from UConn Storrs E-Journals list via proxy log-in for UCHC users).

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P.S. Here’s a real-life tale of one guy who lived.