Stanford Li Ka Shing Center uses dummies to teach

Article appeared on Nov. 2, 2010 on page C-1 of the San Francisco Chronicle
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Anesthesiology resident Dr. Vivianne Tawfik had barely been on the job at Stanford Medical Center a month before an alarm started sounding in her operating room. A ventilation machine had failed, and an anesthetized patient lay on the table in the middle of a delicate spine surgery.

Simulation engineer Kam McCowan explains how the mock ER and robot mannequins work at Stanford’s new Li Ka Shing Center.

Tawfik didn’t panic. She was in a similar situation only a week before – in a mock operating room with a mannequin patient and supervising doctors watching her on camera from the next room. When she encountered the machine failure during real surgery, she was prepared. She ventilated the patient by hand and called for a replacement machine. Crisis averted.

“It was pretty amazing how real the simulation was,” Tawfik said. “My heart rate skyrocketed, even though I knew it wasn’t real. The (mock) OR looked the same as a real OR, the surgeons prepped the same way they prep for a real surgery, and the mannequin patient reacted the same way a real patient would.”

Simulations like that faced by Tawfik are the foundation of the Li Ka Shing Center for Learning and Knowledge, a state-of-the-art medical education building opened at Stanford Medical School last month. One floor of the 5-story building is entirely dedicated to simulation learning. It features a fully equipped mock operating room, emergency room, post-op area and clinic exam rooms.

Supervising doctors can program specialized mannequin patients to breathe, cry, blink, bleed or sweat. They can have seizures, dilated pupils and blue lips. Their wrists, necks and groins have pulses, their chests have heartbeats and their lungs inflate and collapse.

Medical students can insert IVs into the mannequins’ blood vessels, intubate their airways, or cut into their replaceable skin to perform surgery.

And, yes, the mannequin patients talk. They have speakers in their heads and under their bed pillows so that doctors, who are watching med students from the digital control center, can serve as the patients’ voices, answering questions and describing symptoms.

100 simulation devices

Dr. David Gaba, associate dean for immersive and simulation-based learning at Stanford’s School of Medicine, selected all of the more than 100 simulation devices that will be used in the Li Ka Shing Center. Gaba, a pioneer of simulation learning, developed the first simulation mannequin technology in his lab at Stanford 25 years ago.

“Students rarely get the opportunity to be … the final decision makers in medical emergencies. It’s too risky when you’re working with actual patients.” Gaba said. “But they can do it in simulations. Simulations are also a good way to teach students to recognize rare medical conditions they’re not likely to see every day working with real patients.”

Mock-up training

Before Stanford got its new echocardiogram simulation mannequin, for example, students practiced giving echocardiograms to each other. But because most students had healthy hearts, they rarely had the chance to see what an abnormal EKG looked like firsthand.

Stanford’s simulation mannequins range from $30,000 to $200,000 each, but Gaba stressed his students don’t strictly rely on expensive, high-tech training.

“We’ll use whatever modality we think will do the job,” he said. “Cardiac surgeons practice on beef and pig hearts we get from the butcher shop. We insert artificial blood vessels into chicken meat so students can practice using catheters.”

The simulation center also recruits students to be patient actors so med students can practice taking patient history and giving physical exams. The mock exam rooms, like the mock operating and emergency rooms, are wired with cameras and microphones to record students’ performances or broadcast them live.

Most advanced technology

“This whole building is like a soundstage” said Chris Shay, manager of capital projects for the medical school. “We’ll record 8,000 hours of video here this year. This facility has, far and away, the most advanced medical school technology in the country today.”

According to Shay, students can download their video footage to review with professors a mere two minutes after recording it. They analyze their performances like athletes analyze game footage, and like athletes, some students put together a “greatest hits” tape to send with their applications for medical residency.

The Li Ka Shing Center was 10 years in the making and cost $90.2 million. It’s the Medical School’s first new education building since the campus relocated to Stanford from San Francisco in 1959.

Li Ka-shing, a Chinese businessman and philanthropist, was the center’s primary donor. His foundation has granted more than $1.45 billion to charitable projects worldwide, and he became especially attached to Stanford University when his son attended college there in 1982.

Dr. Philip Pizzo, dean of the School of Medicine, called the Li Ka Shing Center “a destination. It will be the defining place for the Stanford School of Medicine.”