Medical center makes training advances: ‘When the mission is patients first, you don’t try first on patients’

WASHINGTON — It’s a new approach to medical training: A special high-tech center where doctors from around the region can learn new skills or improve their technique without touching an actual patient.

Clinical simulation is sweeping the country. In the D.C. area, the MedStar Simulation Training and Education Lab (SITEL) has become a go-to spot for doctors and nurses seeking special training in areas from trauma care to gynecology.

Dr. Terry Fairbanks, an emergency room physician, heads MedStar SITEL, staffed by a team of technical innovators and medical educators.

“Our mantra here is, when the mission is patients first, you don’t try first on patients,” he says.

Thirty-five resident fellows from hospitals across the area took part in a recent SITEL boot camp that focused on high-risk procedures.

The boot camp included a session using a computerized mannequin that “played” the role of a heart attack patient. Boot camp participants worked as a team to coordinate and follow through as their “patient” exhibited severe symptoms.

Dr. Burton Lee, a pulmonary specialist, helped develop the critical care course. He says it allows trainees “to develop their competency on a mannequin or a machine so that all the errors, hopefully, will happen here rather than on a real live patient.”

Lee says that simulation can help doctors hone their skills in a fairly relaxed atmosphere, so that when they are in the pressure cooker of an emergency room or trauma center, their moves are automatic.

“When you are under stress and people are watching you and the patient is literally dying in front of you, it has to be second nature; it has to be well- rehearsed.”

In addition to managing a heart attack case, trainees at the boot camp also used virtual reality to practice inserting a scope with a tiny fiber-optic camera to look inside someone’s lungs. The procedure, called a bronchoscopy, is delicate and involves maneuvering the scope around the vocal cords and air waves.

While trainees slowly move the scope in air, a computer screen shows them exactly where it would be in a real patient’s body.

Most of the simulations use high-tech equipment, but at times the lab staff has to think outside the box. When the faculty asked for a way to simulate removing fluid from the lungs with a long syringe, the staff turned creative.

They put their computer training aside and went to a nearby grocery store, where they bought some ribs at the butcher counter. The ribs were put inside a plastic replica of a human torso with a small plastic bag beside them holding fluid, so trainees could practice extracting that fluid through the rib cage.

Fairbanks says the facility is among the best of its kind in the country, saying that the critical care boot camp brings in the best and brightest young physicians from many hospitals.

“This is huge for patient safety,” he says. And while most of the trainees are residents, fellows and students, Fairbanks predicts that sometime soon all physicians will take part in simulation training on a regular basis.

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