“Are we worried about shock?”
Sabrina’s question hung in the air as her fellow students shared a look of simultaneous recognition that, yes, indeed they should be worried about shock. From behind the glass in the observation room, an instructor looking on cracked a knowing half-smile, satisfied that the group found the path that will lead them to act with the proper urgency and escalation of care for their simulated infant.
On the examining table, the eerily accurate cries emanating from the high-fidelity mannequin begin to subside as the students initiate their treatment and breathe a collective sigh of relief.
It’s situations like this that make the kidSTAR lab at Lurie Children’s Hospital such a vital learning experience for Feinberg medical students during their pediatric rotation. The 850-square-foot simulation center provides a flexible learning environment to practice key clinical skills like teamwork and effective communication to its 3rd year med students, all of whom are required to complete six weeks of pediatric training regardless of their future specialty.
Led by instructors Jennifer Trainor, M.D., and Robyn Bockrath, M.D., the lab provides students the opportunity to independently manage a patient from start to finish, which is not possible in a real clinical environment at this point in their training. For the students, it’s an opportunity to experience an acute situation in a team setting without the psychological stress of dealing with real pediatric patients and their anxious parents.
During the simulation experience, students enter as a group and work to efficiently gather the patient’s history from the parent and bed-side nurse while at the same time examining the patient, then making and executing a plan for treatment. Hospital volunteers act as parents while one of the instructors acts as the nurse. They are there to fill in the gaps where the simulation mannequins cannot give information to help facilitate progress.
Lab sessions incorporate two distinct cases. Today, the first case is a baby who is having trouble breathing. The second, more involved case is a baby who is lethargic from hypovolemic shock due to vomiting and diarrhea. The students need to consider what could be going on, agree on a diagnosis, and proceed to treat the patient. Doctors Trainor and Bockrath are looking for the students to vocalize that the issue is shock based on the baby’s vital signs and physical exam.
In both cases, the students correctly diagnosed the issue and came up with a plan for treatment as a group, but the point of the simulation is not necessarily to get it right. The instructors are expecting the team to vocalize what they think is going on regardless of whether it is right or wrong. It’s not so much about the correct diagnosis, Trainor says, but about talking out loud and “sharing your mental model.” That process allows members of the group to chime in with other thoughts, whether in agreement or not, and eliminate or confirm individual concerns like the one Sabrina voiced during the second case.
The simulations also help the students acclimate to being in the role of doctors, not just medical students. The students’ jovial attitude in the debrief room swiftly becomes serious when they begin a simulation. Even in the short time between cases, it was evident that the students had learned enough about their individual strengths and weaknesses that they could quickly divide and conquer without ego when it came time for the second simulation.
One of the critical aspects to the overall success of a simulation lab like kidSTAR is the accurate setting of a scene. The lab utilizes high-fidelity mannequins which can be controlled remotely and provide vitals to the in-room monitors. In the control room, the simulation tech and second instructor manage and record the students’ actions to ensure a practical experience at a high level. In addition to teambuilding and determining an accurate diagnosis, the lab can give students a sense of whether they are comfortable in a fast-paced environment where they need to make rapid decisions and act quickly. Through their experience, students gain an immediate understanding of consequences and how to correct issues in real time. It’s also a pure learning opportunity as the lab itself is ungraded and has no weight on their official med school evaluations.
Over the course of their pediatric training, the situations presented in the kidSTAR simulations each build off the preceding session to “teach to the knowledge gap” as Dr. Trainor says, a technique that was reinforced during her Searle Fellowship. Rather than lecturing her students, she learned to watch them in action and address directly each individual’s weaknesses to improve their overall skill in patient care. The Searle Fellowship allowed her to focus more deeply on curricular design, get feedback on her teaching, and network with other educators across Northwestern facing similar issues with designing content for millennial learners. It emphasized the importance of getting feedback from learners after every simulation so that Drs. Trainor and Bockrath and can be aware of what worked and what may need to be tweaked for the future.
“The simulation lab really opens up the ability to practice emergent situations. As medical students, we get plenty of practice in the normal day to day functions of a medical professional. However, there aren't too many opportunities to "practice" medical emergencies. With the simulation lab, we have the ability to practice these skills and really develop the confidence to take charge when these situations actually arise in real life,” says student Brian Chou about his experience in kidSTAR.
Each lab session ends with a lively discussion about process and a deep-dive into treatment options for each of the diagnoses. By enabling students’ realistic hands-on experiences early in their studies, Feinberg is making the simulation labs an important factor in the development of excellent doctors and physician’s assistants.