Laerdal Medical

Here’s the scenario: We’re inside a newborn nursery and a baby boy is having trouble breathing. A nurse places a flexible plastic tube into his windpipe to open the airway.

It helped, but his heart rate is still declining.

The nurse decides to insert a needle into the baby’s chest to suck out air that’s escaped from his lung.

The KERA radio story.

His heart rate picks up.

The SimNewB, created by Laerdal Medical.

The SimNewB, created by Laerdal Medical.

In this case, “he” is a six-pound manikin.

High Tech Simulation

“Healthcare providers don’t learn on patients anymore,” says Judy LeFlore. “We don’t practice procedures on new patients, [medcal students] learn about it in a simulated environment.”

LeFlore is Associate Dean of the College of Nursing at UTA. She coordinates the remote-control distance simulation project with grant support from Pediatrix Medical Group. She’s watching the nurses from a split screen in her office, controlling everything that happens in a remote site.

“I’m like Oz,” she says “I create the scenarios and then each of their interventions I respond with an appropriate patient response.”

Judy LeFlore, Associate Dean of the College of Nursing at UTA, monitoring a simulation scenario.

Lauren Silverman/KERA News

Judy LeFlore, Associate Dean of the College of Nursing at UTA, monitoring a simulation scenario.

She might make it so the baby needs CPR, or extra fluids. In this case, it’s a blocked airway and a popped lung. When she selects that on her computer, it alters the manikin baby’s heart and breathing rate appropriately. When the nurses provide oxygen, there’s also a response from the high-fidelity manikin, called the SimNewB.

“He is computerized,” LeFlore exlains, “His chest rises and falls, he has breathe sounds, a heart sound, you can do procedures on him.”

And yes, he cries.

Why Simulation?

LeFlore uses remote-distance simulation with her students at UTA, and to train nurses across Texas.

“We have a very large rural area,” LeFlore says, “and they can’t stop what they’re doing and come to Arlington or some simulation center to continue training and learn new procedures. So this is a way that we can go out there and go to rural Texas and help them learn new things.”

[More from KERA News: Rural Hospitals Struggling In Texas]

Michelle Aebersold directs the Clinical Learning Center at University of Michigan’s School of Nursing. She says simulation has become a popular teaching method at nursing schools. But until last week, there wasn’t much evidence it worked.

Nurses practice medical procedures on a high-fidelity baby manikin.

Nurses practice medical procedures on a high-fidelity baby manikin.

That’s when the National Council of State Boards of Nursing released the results from a two-year study including more than six hundred nursing students. The study found that up to 50 percent of education can be through simulation exercises instead of clinical practice.

This is important, Aebersold says, because finding a chance to get in clinical hours is challenging, and there’s no way to guarantee students experience treating a baby with rare serious conditions, like spinabifida – where the spinal cord is partially outside the body.

The Cost Of Simulation

Of course not every school of nursing can afford to outfit their simulation center with simulators that cost tens of thousands of dollars. 

But, Aebersold says, when you factor in the cost of hiring faculty, and the potential cost of having students practice on real patients, and there could be savings.

“We really need to start thinking about what is the return on investment of those simulators, how long do they last, how many simulations can we run through,” she says.

Back in UT Arlington, Judy LeFlore says the value in education is clear.

“When it’s over with, we stop and I’m able to play the video back to them and they’re able to watch themselves,” LeFlore says. “And we talk about what they did, what they could have done better, and that’s where the learning really takes place.”