How to train nursing students? Schools turn to fake patients


MIAMI — The University of Miami’s newest hospital has a six-bed emergency room, operating room, intensive care unit, a birthing suite and outpatient clinics.

The only thing missing is patients.

Instead, nursing students get a realistic clinical experience using computerized mannequins and staff actors.

“Practicing on real people can be a very intimidating environment, and as our patients become more savvy, they tend to hesitate when a student walks in,” said Susana Barroso-Fernandez, who oversees UM’s simulation program. “We created this environment to allow students to practice and make mistakes and never put a patient or student at risk.”

UM’s five-story, 41,000-square foot Simulation Hospital, which opened last week on its Coral Gables campus, is part of a growing trend of colleges building simulation centers to provide real-life experiences to students. Community colleges and vocational schools also use simulators for emergency medical technician, paramedic and medical assistant programs.

Broward College opened a 66,000-square foot Health Sciences Simulation Center in 2014. Florida International University, west of Miami, opened a 16,000-square foot facility in 2010. Nova Southeastern University recently opened a new simulation center on its main Davie campus. Simulation labs are standard in other South Florida nursing programs as well.

The move toward simulation has increased as nursing programs have grown faster than hospitals’ capacity to accommodation these students.

“In certain areas like pediatrics, mental health or labor and delivery, it can be very difficult to get a quality hospital placement,” said Marlaine Smith, dean of nursing at FAU, which uses simulation for about 10 percent of its student clinical work.

A 2014 study by the National Council of State Boards of Nursing found that colleges could substitute simulation for up to half of all clinical experience without any negative results. The students scored just as well on nursing license exams as those getting most of their experience in hospitals and healthcare centers. Officials at Broward College and NSU say they think simulation has helped their students achieve nearly perfect passing rates on the exams.

There are major benefits to simulation, officials said. In addition to giving students a safe environment to practice, it also gives students experience with scenarios that are rare, but still crucial for them to know how to handle. For example, students are taught how to care for a woman hemorrhaging during childbirth.

UM nursing professor Deborah Riquelme demonstrated a normal childbirth during an opening event for the facility. She served as the midwife for Lucina, an electronic mannequin who looks just like a mother about to give birth. Lucina has vinyl skin that feels lifelike and is programmed to breathe and blink her eyes. A technician sat close by using a computer screen to decide how fast to play out the scenario. Lucina could be heard saying, “I need an epidural” and “How much longer?’’

A monitor showed contractions, vital signs, fetal position and that the baby was healthy. The baby was positioned inside Lucina just like a real baby would be, with the mannequin simulating contractions.

“Let us know when you’re ready to push,” Riquelme told the patient.

The baby slowly moved down the mannequin’s birth canal. While the baby started crying, a crowd of spectators watching the simulation started cheering.

“An OB/GYN was watching and told me he was really enjoying watching it and said it was just like real life,” Riquelme said.

Several other scenarios were happening simultaneously, as a patient entered the emergency department complaining of neck pain. While this patient was being assessed, another arrived by ambulance. This trauma victim was evaluated and rushed to one of the four hospital operating rooms for surgery.

The Simulation Hospital will also be used as a training venue for people outside of UM, including hurricane training, officials said.

“You can bring companies in that want to test new products before they go to market,” Barroso-Fernandez said. “You can work with community partners like first responders, police departments and fire rescue. You can take this hospital and turn it into a mass casualty event and have the community practice disaster preparedness and response. It’s not just about nursing education.”



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