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From Manikin to Man


A student inserts a syringe into a manikin arm beside a human arm that has an IV inserted.


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Every time Patrick Bonasso watches a patient go under anesthesia before he performs surgery, he thinks back to a manikin he used to know. As a medical student at West Virginia University, Bonasso, BS ’09, Biology, MD ’13, learned the rhythms of the human body at the University’s simulation center before he treated humans. One of the training simulations there involved a medical manikin that simulates a human patient and an anesthesia machine that mimicked how a human body can react when going under.

Blood pressure can drop under anesthesia. And if something goes wrong, you have to know how to respond. 

Bonasso, from Fairmont, W.Va., is now a surgery resident at WVU Medicine’s Ruby Memorial Hospital where he works with anesthesiologists every day. He says that anesthesia simulation gave him a baseline of what to expect. 

Students since 2009 have had that kind of experience at WVU. And the approach has only gotten more high-tech and widespread in recent years. That means that healthcare providers coming out of the University are better prepared when they meet you at the doctor’s office, hospital or emergency room. 

And as patients, we can see the benefit in that. 

“You don’t want to be the patient the first time someone starts an IV,” said Daniel Summers, director of WVU’s simulation center. 

The David and Jo Ann Shaw Center for Simulation Training and Education for Patient Safety, abbreviated to STEPS, has its origins in 2009 when WVU first established a simulation center for all of the schools within health sciences. 

Summers said that since that time, simulation has taken medical schools by storm, and now WVU is making fledgling doctors, nurses, physical therapists, pharmacists, occupational therapists and dentists better prepared and confident for their first patients. WVU medical students have gone from taking a few hours of simulation to more than 100 hours over their four years at WVU. 

Summers said the center had 10,000 student education encounters last year. In the fall, the center quadrupled in size to about 20,000 square feet, and Summers projects 15,000 education encounters due to the consolidation with the nursing skills lab and the increased need for this kind of training.

“You don’t want to be the patient the first time someone starts an IV.” DANIEL SUMMERS, DIRECTOR OF WVU’S SIMULATION CENTER

It’s hard to find healthcare programs at WVU that haven’t significantly increased their usage of simulations. In the last two years, the ultrasound program began training students to regularly take ultrasounds of volunteers willing to help train future medical professionals. The ultrasound program has become one of the best in the country, Summers said. 

“As they progress through their four years, by the time they’re done, ultrasound is just as routine to them as picking up a stethoscope and listening to lung sounds,” Summers said. 

The simulation center at WVU is different than others in that future pharmacists, nurses, dentists, doctors and others work together regularly before they go pro. And simulation training is starting earlier. Now medical students in their third week of classes are in the center taking care of manikin patients. 

Using the two clinical skills practice labs, patient care (manikin) rooms, and the 12 rooms that exactly replicate examination rooms, students  are recorded taking an ultrasound, putting in an IV line, delivering a manikin baby and resuscitating a manikin. Then the students and their professors take a look at the footage for instant feedback. They’re evaluated on how well they communicate with their manikin and human role-playing patients, what they did right, if they missed anything and how they can improve. 

“We see much greater confidence in our students, and they actually report back to us that they feel more confident in the clinical setting because of their experiences here,” Summers said. 

When the program expanded to have medical students practice IV simulations on a plastic arm and then the students inserted their first IV in a live patient at the hospital, the nurses who measured their progress, told Summers they didn’t know what the simulation center was doing differently, but it was working. 

“Because attending physicians can provide backup support, you’re not in charge in the hospital as much as you are in the simulation lab,” Bonasso said. “It really puts you in charge as a student early on, and you learn a lot from that. You’re not just going through the motions and listening to somebody telling you what to do. 

“You have to really read up on things and know what you’re going to do for your simulation patient so you don’t do the wrong thing.” 

Bonasso still visits the STEPS center as he works with fourth-year medical students using the center in a surgical anatomy course. The students are doing so many more simulations than he did as a student, but he sees the demand continuing to grow as students work to solve the real challenges facing patients. 

“The sooner you learn how to function as a doctor, the better,” Bonasso said. “The more practice you have, the easier it becomes to treat patients.”