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Simulating Experience

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    Med-Nursing Simulation

    A combined team of students from the Miller School of Medicine and School of Nursing and Health Studies examines a patient actor during a simulation exercise held on June 21 at the University of Miami’s Whitten Learning Center.

    The young female patient had come into the ER complaining of severe stomach pains. Despite her discomfort, she remained relatively calm, explaining to a team of doctors and nurses that the pain occurs about once a month and that she wasn’t currently taking any medications.

    But soon the examination took a turn for the worse. As the patient lay on a gurney, she suddenly became emotionally agitated, demanding that her mother, who was present inside the examination room, make a quick exit. Her blood pressure skyrocketed—141/89, then 143/87. The group of young doctors and nurses realized they were in over their heads and called for a rapid response team as the situation worsened.

    Such is the type of medical crisis that can transpire on any given day in hospitals all over the nation. For one day last week, it occurred inside a classroom on the University of Miami campus—but only as a simulation. The exercise was part of the weeklong Interprofessional Patient-Safety Course designed to teach future nurses and physicians how to work effectively in teams to prevent mistakes and improve patient outcomes.

    “Even if each individual has tunnel vision, when you all work together you have wider vision and see the whole picture,” David J. Birnbach, senior associate dean for quality, safety, and risk and director of the University of Miami/Jackson Memorial Hospital Center for Patient Safety, said in welcoming the students to the inaugural cross-disciplinary course.

    From left, nursing students Paola Barragan and Jose Centurian and medical student and team leader Christie Thomas search for errors in the Room of Horrors.

    From left, nursing students Paola Barragan and Jose Centurian and medical student and team leader Christie Thomas search for errors in the Room of Horrors, an exercise in which students had six minutes to identify life-threatening errors.

    “There are multiple studies and research findings that show one of the major causes of medical errors is the absence of ineffective teams and a lack of communication among doctors and nurses,” Mary McKay, assistant professor of clinical nursing and safety assurance director at UM’s School of Nursing and Health Studies, said during a training-session break on the last day of the course. “This is really about having these two groups of healthcare professionals come together to learn about each other, learn from each other, and learn with each other.”

    During the course, held June 17-21 at facilities on both the Coral Gables and Miller School of Medicine campuses, 68 students in UM’s Accelerated Bachelor of Science in Nursing program and 150 third-year medical students worked as teams in a variety of learning situations, playing puzzle games that taught them leadership skills, collaborating on wiki assignments, tweeting, and attending lectures.

    But it was a series of simulations involving patient actors and lifelike robotic mannequins that perspire and register vital signs that was the most important learning experience of the course. Students encountered different challenges at the Center for Patient Safety and the Gordon Center for Research in Medical Education on the Miller School campus, as well as at the state-of-the art simulation labs of the School of Nursing and Health Studies on the Gables campus.

    They typically worked in teams of two nursing students and four medical students, with grading and judging criteria based on communication skills, delegation of tasks, and team leadership. “Each day got a little more challenging,” said McKay, noting that teams participated in debriefing sessions in which they learned what they did wrong and right.

    On the final day of the course, the two highest-rated teams competed in a “Sim Olympics,” examining the young female patient who presented with abdominal pains. The case turned out to be an ectopic pregnancy and was further complicated by the fact that the patient was a victim of domestic abuse. She showed up at the ER wearing a surgical mask in an attempt to conceal a bruised and bloody lip. “Part of the goal was to get them to ask, ‘Why is she wearing a mask?’ ” said McKay, explaining that doctors and nurses must learn situational awareness.

    “We hope this course will be the first of numerous interprofessional collaborations between physicians, nurses, and other health care professionals that will extend from the classroom setting into their clinical practices,” said McKay.

    Nursing student Sandy Alias called the one-week patient-safety course “an excellent experience.”

    “It really put into perspective for us how the actual work environment will look when we get out there into the field and how the only way to succeed is for the different disciplines to work together as a team,” she said.

    “It’s basic common sense that nurses and doctors should learn how to work together,” said medical student Ryan Dauer, “but this week’s course has really solidified that for me. Putting our skills and knowledge together is the best way to care for patients.”


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