The high-tech manikin might be made of plastic and rubber, but the husband or wife, son or daughter, mother or father, or sister or brother alongside it is a living, breathing part of the medical team in the Simulation Center at KU School of Medicine-Wichita.

Simulation experiences are being embedded in the training of each new class of medical students, reflecting an earlier emphasis on hands-on clinical experiences, teamwork and working with other medical professionals.

"So much of our time is spent in the classroom, and simulation brings it full circle so we can really apply our knowledge," said Bethany Zidek, now a second-year medical student from Onaga, Kansas. "It's a nice, broad overview of what we have learned over time."

"When you learn things in a book, you get the facts but you don't know how to apply that in an actual situation," said Norelia Ordonez-Castillo, now a second-year student who grew up in Goodland, Kansas. "It's not completely high stakes yet, but it allows you to get that experience beforehand."

Training extends beyond medical students
In addition to teaching medical students, the Simulation Center and its staff are a resource for physicians, health professionals and others in the community.

For example, the center has provided code blue simulations for internal medicine residents at Wesley Medical Center and the Robert J. Dole VA Medical Center, and is developing training for providers at Wesley, the VA and Ascension Via Christi.

Nursing students from Wichita State University and Newman University have joined KU medicine and pharmacy students in simulations that focus on health care as a team. So have students in WSU's physical therapy, physician assistant, dental hygiene, audiology, speech-language pathology and public health sciences programs.

Younger, potential health providers also benefit from the center. Each November, the Sim Center participates in the Doc for a Day event at KU School of Medicine-Wichita for high school juniors and seniors. The students take part in a code blue/CPR session and even help deliver a baby with "Victoria," the birthing simulator. These sessions are popular during a day where young people learn about being doctors and what it takes to become one.

The center also welcomes outside groups to use its facility. Fifth-graders from Wichita's Park Elementary have learned about the center's equipment, meeting "Sim Man" and training in CPR, with a chance to practice compressions on a lifelike torso.

Emphasis on team and communication
Eli Brumfield, D.O., assistant professor of internal medicine and Sim Center medical director, said the center's efforts involve two tenets: "First, we try to never expose learners to just one discipline. It always has to be interprofessional. The health care of the future requires interprofessional relationships to be fully developed. Second, we don't do sim lab experiences without patient and family representation. Including patients and their loved ones is an important skill for students to practice right from the get-go. We want them to view families as team members and assets. It's a skill no different than placing an IV or driving a car."

Wichita is unique among KU's medical campuses in its use of standardized patients - people trained to simulate patients - playing the role of family members instead of patients, bringing a live dimension to sessions alongside the lifelike manikins. Matt Lierz, currently a second-year student from St. Joseph, Missouri, recalls a session involving hypoxia, or a deficiency of oxygen reaching the tissues of the body.

"It wasn't an emergent scenario, but the determination of the severity of the hypoxia was fairly intense," Lierz said. "The standardized family added a layer of complexity and a layer of strain on your clinical practical knowledge. It made the scenario more difficult than I imagined, having to communicate with two people."

Despite the pressures, students say the center's staff is supportive but willing to push them. That's the intention, said Erin Doyle, program director.

"We're not quite Vegas, but what happens in sim stays in sim," Doyle said. "We're not going back to their instructors saying, ‘Well, Joe and Susie really had a hard time with it.' We are trying to create a safe place for them to explore. So if the student doesn't know how to put on EKG leads, we'll fumble through it together."

At the Wichita campus, the classes of first- and second-year students are divided into small groups for case-based and other learning components. At the Simulation Center, those groups are usually divided in two, with students rotating through different roles.

They'll work through scenarios, allowing student actions and decisions to guide each session, and consider how each case has multiple treatment options. Brumfield takes part in all first- and second-year sessions, which involve a good deal of debriefing where students and staff can discuss what went right and wrong, and address questions about the science behind what they've done.

"We encourage and, at times, nag them to take turns in the leader role, and become comfortable with that," Doyle said. "We give all students, even the quiet ones, an opportunity to step out and be the leader. Nothing is a trick or ‘gotcha' or a ‘you did the wrong thing and your patient's dead.'"

The center has three other staff members besides Brumfield and Doyle, who is a nurse: Mary Koehn, a nurse and education associate professor with extensive experience in curriculum development; Gary Tolle, a teaching professor and retired paramedic; and Jeanne Raitt, coordinator. The center became part of KU School of Medicine-Wichita in 2017, years after its start in about 2000 as an organization that later became the nonprofit HealthSim United.

Training grows in complexity and scope
The manikins - adult, child and infant - used in the second-floor lab of the medical school are as realistic as possible. Eyes blink, pupils dilate, chests rise and fall with breath. Via staff present in a sound booth, manikins can talk to medical students and others training at the center. They can exhibit cardiac disruptions and vital signs and deliver babies that cry.

Cases grow in complexity with additional years of medical school, and required clinical skills increase. Now, first-year med students learn, via a simulated arm including all its vessels, to place an IV, while second-years train in the delicate task of putting in a Foley catheter.

"Someone might say, ‘Oh, doctors don't place IVs,' but I think it's important for doctors to know the basics of how to put in an IV," said Ordonez-Castillo. That's particularly true in rural areas, Doyle said.

An increasing number of third-year clerkships are using the center as well. Third-years in their obstetrics rotation "each take the lead role in one regular vaginal delivery, catching one slippery baby," Doyle said. "It's pretty realistic in terms of the birthing bed. They have to gown and glove, learn what they're going to do, where they're going to stand, and what are the normal signs and what are not. The rule of the day is, don't drop the baby."

No matter who is doing the training, the goal is to build skills and confidence along with them.

"Sometimes it can be difficult to assess the importance of all the info you learn in the first two years," Brumfield said. "Docs who trained long ago say if they could go back they would know what to pay attention to. Now, students are progressing from learning what is on the test to what they need to know to take care of people."

"With my group, almost universally the things we remember best and the things that we find more interesting tend to be the things we have had difficult group discussions about or done a simulation about," Lierz said. "When you're forced to apply your knowledge, it sticks better."

This article was first published in KU School of Medicine-Wichita's Embark Magazine.