Hands-on training can be critical for residents to prepare them to face a real life-or-death situation. Young doctors at Children’s Hospital of Alabama are receiving the practice they will need through a state-of-the-art Pediatric Simulation Center. The center has evolved from a mock code program that was developed by Dr. Nancy Tofil, assistant professor of pediatrics in critical care at Children’s Hospital, when she was a fellow there several years ago. “We had one dummy that we took around the hospital during these mock codes, and we videotaped each code to see what we could improve upon,” Tofil said. “Studies showed that these codes helped the hospital but were of little benefit to the individual residents.” Last year, donations from the Bruno Foundation and a matching gift from Protective Life and the Department of Pediatrics at the University of Alabama at Birmingham as well as Children’s Hospital gave Tofil the opportunity to purchase two additional mannequins and to develop space for medical simulations. “We now have four converted patient rooms and real-time video so we can watch the code while it’s happening or watch it later and debrief,” Tofil said. “It also enables us to do teamwork and multi-discipline training. We already had an infant simulator, so we purchased a child and teenager. Those three simulators represent the range of patients we see at Children’s Hospital.” These virtual teaching opportunities help residents and other healthcare personnel learn treatment protocols and master basic and procedural skills before treating a real patient. The simulators are hi-fidelity, and each one is directly connected to a laptop computer so Tofil can digitally control bodily functions to mimic symptoms of illness or injury. They breathe, talk, cry and coo, depending on the situation they are programmed for. The heartbeats and pulse rates of the “patients” are computer generated, and they have monitors for blood pressure. Trainees can place a breathing tube as well as IVs and needles in the simulators. “The simulators allow us to do everything from interviewing a family that speaks Spanish to running a full code,” said Tofil. In addition to the mock codes for the entire hospital, Tofil also conducts a weekly mock code just for residents in the pediatric intensive care unit. She also has developed a mobile simulator that she can take to patient floors for training exercises. New interns have recently been trained, and each received 15 hours of simulator training on topics such as CPR and spinal taps — spinal taps being the most commonly performed pediatric procedure, Tofil said. “We also have a course on how to intubate and how to do cardiac treatments, as well as a course on proper handoffs of patient care issues,” she added. Tofil says that more than 650 people have participated in the Simulation Center training since January, including emergency medicine and critical care fellows, doctoral-level pharmacy students, anesthesia and pediatric residents, as well as hospital nurses and respiratory therapists. She says that test scores from recent trainings are higher than in the past. “The simulator allows difficult knowledge to sink in,” Tofil stressed. “It really helps with patient care, and the residents are more comfortable with codes and different procedures after going through this simulator training. They are more comfortable when they have to grab a needle and perform a procedure on a real patient.” Comments from course participants validate the effectiveness of the training: • “I felt the addition of the videos, simulation labs and case study examples were excellent. It kept my attention, and I felt I could retain and use the information in the real world more comfortably.” • “I have done simulations for the past four years as a medical student at another school. None of my previous experiences came close to the quality of these simulations. Great program. I really feel better prepared to start my residency because of the simulation lab.” • “I think that the simulation labs were great hands-on experience and would be great for all medical professionals to participate in in all categories of pediatric advanced life support.” Tofil says that the simulation training also helps in assigning roles and teaching participants how to communicate effectively during a crisis. “It also helps the teachers to correct residents when they see them actually doing a procedure,” she said. “It’s been fun to go from nothing a year ago to doing 30 to 40 simulations this year. It’s a lot of work, but the feedback shows us that it’s worth it.” August 2008