Medical simulation centres teach doctors how to cope with a crisis

Medical simulation centres aim to teach doctors and nurses how to cope with a crisis before it occurs in the operating theatre, writes Kate Whitehead

PUBLISHED : Monday, 30 June, 2014, 10:01am
UPDATED : Monday, 30 June, 2014, 10:01am

A man lies on the operating table, a heart monitor bleeping his vital signs. There are five others in the theatre: two doctors, two nurses and an assistant. They are scrubbed up, ready for surgery, but something is wrong.

The chief surgeon leans over the patient and the nurses can smell the alcohol on his breath. Someone has to step in and say something because he's in no fit state for work. The nurses glance warily at each other; he might be drunk, but he's the senior surgeon, which means he's a god in the hospital.

The more senior nurse takes the plunge. He suggests instead of actually performing the operation, the surgeon oversees it. The doctor snaps back, he is fine to operate. Unconscious on the table, the patient's condition begins to deteriorate. The nurse tries again, trying to make his point without being rude.

The environment was just like being at work. It's the actual equipment
Kenneth leung, nursing officer at united christian hospital, kwun tong

Fortunately, this was a fictional scenario. It was played out a few weeks ago at the Hong Kong Jockey Club Innovative Learning Centre for Medicine, a new medical simulation training centre in Aberdeen. Kenneth Leung, a nursing officer at United Christian Hospital in Kwun Tong, joined a two-day training course and was scripted into the tense operating theatre simulation.

"It was a challenging scenario and all about assertive communication and how you deal with hierarchy if the surgeon does something wrong," says Leung, who has worked in Accident and Emergency for 10 years.

Medical simulation is an education technique. Put simply, it's an opportunity for medics to practise before they do the real thing and is based on aviation simulation techniques. It has become an important element of health care training over the past decade, but Hong Kong has been slow to embrace it - until now.

"We try to mimic a real working situation and train all the different professionals working together in a crisis situation. It can get very tense for those in the hot seat," says Dr Tung Wai-kit, the centre's honorary director.

Funded by the Jockey Club, the centre is the most modern and comprehensive that Hong Kong has to offer. The Hospital Authority runs eight other medical simulation centres, but they aren't as well equipped.

"I've done the simulation training at North District Hospital. They just have a mannequin and a video cam. This centre has all the facilities you may see in an emergency department," says Leung.

Occupying the seventh floor of the Hong Kong Academy of Medicine, the 6,000 square metre facility is equipped with the latest technology. These aren't plastic toys parading as hospital equipment, they are the real deal.

"The environment was just like being at work. It's the actual equipment we have in the hospital. Everything is similar to our environment, so it seemed real," says Leung.

The procedural skills room hosts three large, hi-tech machines that allow specialists such as surgeons and gynaecologists to hone their skills. Laparoscopic surgery, echocardiography and endoscopic procedures, looking at the bowels or lungs, it all happens in here.

A large room designed as a hospital ward looks authentic. A pregnant woman, her legs in stirrups, lies on a bed shrouded in a green sheet.

The mannequin is convincing and made even more realistic when she begins to scream as she goes into labour. Her heartbeat increases and if you feel her wrist you measure her pulse. All this is controlled from behind a one-way mirror by one of the centre's staff.

Each medical emergency situation is well scripted, and the doctors and nurses in the training session are given the patient's medical history.

In each case it's as much about how the medical team operates together as it is about how to treat the patient. After each exercise, there's a debriefing to take the team through what happened, how they reacted, and how they could work to improve their performance.

"There is no pass or fail. It's all about learning and what you can do to improve," says Leung, who was one of 20 medical staff in a recent training session.

Just being on the ward as the woman goes into labour is stressful. She shouts out in Cantonese and the heart monitor beside her bed flashes incessantly. It all adds up to creating a convincing environment which is at the core of good medical simulation.

"Some people will think it's just simulation and not the real thing, so part of the training is that we use the concept of suspension of disbelief: you know it's not a real person, so you need to suspend your own disbelief to try to get the most from the training," says Tung.

Medical simulation can be used to train all aspects of health care, but it's most effectively used to rehearse for crisis situation and to teach critical skills and important interpersonal skills, says Tung, who has worked in Accident and Emergency departments for 30 years managing crises that are all in day's work.

"As a doctor in the private sector, you may see a critical event once in your lifetime, and then when it actually happens you don't know what to do. So this is an opportunity to practise," says Tung.

Opened in December and funded by the Jockey Club for its first five years, the centre is run under the Academy of Medicine, which is responsible for postgraduate medical training in Hong Kong, so the colleges and their fellows can use it.

All members of the Hong Kong Simulation Alliance (the medical school, Hospital Authorities and the Private Hospital Association) can use the centre, too. This means training for private doctors and nurses, as well as those from the Hospital Authority.

So far, the centre has only held two courses, but it hopes to introduce some new courses soon and be able to support medical training for students as well as refresh and update the skills of those with many years of experience.

"We want to play a collaborative role and not duplicate what is already out there. We are planning to offer some game-based learning which will be the first of its kind for simulation in Hong Kong, and we are speaking to the College of Psychiatrists to see if we can work together to create some crisis situation scenarios for their staff," says Tung.

The simulation rooms aren't all designed to look like hospital rooms. There is Virtual Reality Room that simulates a press conference outside the hospital. The person playing the role of the doctor stands in front of the two dozen reporters as they fire questions at him. Again, it's a convincing and stressful scene: camera flashes are fired and reporters jostle to have their question heard.

Facing a barrage of questions from the media in a disaster situation, such as the outbreak of Sars, is not an everyday situation, so the training is an opportunity for doctors to see how they react to that environment, get tips on how to handle it, and rehearse.

The only drawback to medical simulation is that it's an expensive model. Training sessions usually involve about 20 staff, including three or four doctors, and, given the cost of a doctor's time, it can get pricey having them away from the hospital for a couple of days.

The future of medical simulation is in fast-tracking medical experts. You have probably heard the theory that after 10,000 hours of practice, you become an expert; Tung has his own take.

"It normally takes 10 years for a beginner to become an expert. Medical simulation tries to speed up the process of one way of doing that, which is by learning to recognise patterns. That's where medical simulation is heading," says Tung.