Artificial Intelligence

No patients were harmed in the making of this physician

By Darla Brown

Tucked away in a University of Texas Health Science Center storeroom, they've been crammed into boxes. Over 500 lbs. of feet, hands, lungs, heads, arms, and torsos – the skin rubbery and cold to the touch, a glazed look in the eyes.

Not to worry – these are not smuggled body parts, or a grisly horror waiting to be uncovered. These are 25 boxes of programmable training simulators awaiting the opening of The University of Texas Medical School at Houston's Surgical and Clinical Skills Center (SCSC), where they will undertake an extraordinary teaching assignment.

The SCSC is being constructed in an 11,400 square-foot space in the Medical School basement that has been empty since Tropical Storm Allison hit in 2001. Scheduled to open in June 2006, it will be the largest and most versatile training facility in existence, merging the technical aspect of medicine learned through practicing surgical procedures with the clinical side of treatment gained through personal physician-patient interaction.

The unique center will be home to a cutting- edge training facility featuring mannequins, two operating rooms, a microsurgical skills lab, a virtual reality personal computer lab, and nine surgical skills stations. The space also will house the Medical School's standardized patient program – where actors portray patients to test student competencies – complete with 14 patient examination rooms. The entire SCSC will house a state-ofthe- art digital audio visual system.

Ready to Serve

Once unboxed and plugged into monitors and computers, these exceptional mannequins will be ready for the students and physicians they will serve at the SCSC– equipped with a heartbeat, pulse, blood pressure, and spontaneous respiration.

These high-fidelity mannequins will be joined with low-fidelity mannequins, which are used primarily for teaching students how to insert IVs, catheters, and to perform intubations. There also will be several other hightech human patient simulators on board.

"These high-fidelity simulators feature physiological functions, such as pupils that dilate and arteries that pulse. They are programmable to simulate medical emergencies like cardiac arrest," explains SCSC Director Eric Reichman, Ph.D., M.D. "These simulators will be programmed so that when the medical student or resident administers an injection, a barcode reader on the simulator reads a barcode on the syringe. This allows the mannequin to react to the different medications and concentrations."

Through the use of both the low-fidelity and high-fidelity mannequins, medical students, residents, and practicing physicians will be able to experience "controlled emergencies" as well as practice new techniques time and time again without the fear of harming a real patient.

"Here, we can use mistakes as a learning situation," Dr. Reichman says. "We can never let a student make a mistake in the hospital, but we can let them give the wrong medication here and control the physiology. They will learn what they did and solve it, practicing resuscitation and teamwork."

In the two operating rooms (complete with scrub sinks and anesthetic gasses), the mannequins also will train students, nurses, physicians, and teams of health-care providers in a variety of emergency settings, such as an anthrax attack or a weapons of mass destruction event.

The programmable mannequins are adaptable to a variety of settings and feature replaceable skin and blood packets.

"The Trauma Man mannequin allows for realistic training of surgical procedures. This simulator allows us to teach and train for procedures such as a cut down (a dissection to insert an intravenous line) and inserting chest tubes. We can introduce learners to rarely performed, yet critical, as well as routine procedures," Dr. Reichman explains. Simulators provide not only an enhanced learning experience but a fiscally responsible approach to medical training.

"Cadavers are very expensive and a hard to obtain resource. Training on a simulator will cost very little compared to a cadaver," Dr. Reichman says. "And, they are pretty realistic without the problems of a cadaver – the smell, the occupational exposure to embalming chemicals that preserve the cadaver, and the unrealistic feel of an embalmed cadaver. Plus, the simulators don't need to be fully replaced after use, just some disposable parts. This allows the use of a simulator repeatedly."

Information technology staff of the SCSC, under faculty physician guidance, will program the cases into the simulators. Key faculty in each department will be trained to run the simulators for teaching purposes.

"It will be easier to incorporate the simulators into the clinical rotations, but we foresee this facility being used throughout the Medical School student's career here," Dr. Reichman says.