College of Nursing & Professional Disciplines

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Sim labs train future doctors and nurses

State-of-the-art simulation labs — some of them unique in the country — help UND health care students hone their skills

nursing student
A College of Nursing and Professional Disciplines student practices preparing a manikin arm for an IV in class. Photo by Walter Criswell/UND Today.

Health care practices are evolving, as are the tools that health care professionals use to mitigate life-threatening situations. And with that in mind, the education of health care professionals also is changing with the fast-moving times.

Those trends are clear at UND’s College of Nursing and Profession Disciplines and School of Medicine and Health Sciences, both of which are embracing innovative approaches to health care training. During the week of Sept. 18, the schools offered tours that showcased these changes for the community.

Simulations make the difference

“Simulation has just kind of exploded for us,” said Nancy Geske-Larson, the simulation manager of CNPD’s simulation labs. “Especially in rural settings, where it’s much harder for students to get immediate hands-on experiences. Simulations have offered the chance for them to get practice that they can apply in real-world settings.”

Geske-Larson, who helps to facilitate a variety of simulations at CNPD’s lab, says that the college has been integrating “sims” into much of their students’ curriculum, from their first year to their final.

Just this fall, for example, the college introduced an AI-powered program called SimConverse into first-year courses. The program allows students to practice conversing with patients and provides automatic feedback that students can learn from.

These days, simulation facilities can re-create almost anything imaginable. An infant struggling to breathe, a patient suffering from a head injury — these and countless other conditions can be simulated using standardized patients, manikins and anatomical models of the human body and its organs. Some exercises blend all these mediums to achieve the greatest realism possible.

A high-fidelity manikin of a small boy can talk, make faces and move its arms and legs. Photo by Walter Criswell/UND Today.

Geske-Larson says that CNPD has stayed up to date with research to ensure that the simulations are realistic experiences and quality educational tools.

“There has been a lot of research done by the Society for Simulation Healthcare, and they found that training students in simulations prepares students for those high-stress situations in clinical settings,” she said.

SimCoverse is just the newest addition to CNPD’s suite of simulated experiences, including birthing manikins and smaller ones whose chests rise and fall to the pattern of the infant’s breathing, thus helping students learn how to identify a problem.

The manikins range from low-fidelity models that remain static as students learn how to work with different parts of the body, to high-fidelity models that respond dynamically with voices, facial expressions, and the ability to make parts of their bodies move, controlled remotely via computer or tablet from the sim lab’s control room.

Ellen Steidl, the director of CNPD’s simulation labs, said the college’s simulations were designed to introduce students to everyday practices such as finding veins and talking to patients, and in high-stress, high-acuity situations, where mistakes won’t have severe consequences.

“In the lab, we have an intensive care simulation with a baby that’s really sick, so you’re trying to treat that while an actor who plays a concerned parent talks to you and asks you a million questions,” Steidl said. “That’s a really stressful situation that can bring out fear and anxiety, but you can learn to juggle everything with the right training.”

Steidl noted that simulations like this aren’t necessarily to see if the student can handle situations perfectly. The sim lab staff’s goal is to immerse the students in a situation so the students can find out what’s working for them and what’s not. The high-stress, low-risk atmosphere makes simulations ideal places for learning lessons that will stay with the students throughout their careers.

“I always tell students that even if they make a mistake during a simulation, like miscalculating a dosage and giving a patient twice as much medication as they should have, they’re not going to hurt a computer,” she said. “Even if it’s not real, it’s going to stick with them, and they’ll pay more attention when they’re doing it for real.”

Importantly, Steidl and Geske-Larson said they hold debrief sessions after every simulation. At these sessions, students can sit down with their instructors and peers and reflect on what they did well and their mistakes.

“The actual simulations only take 20 to 25 minutes, but the debriefing sessions can take up to an hour,” said Geske-Larson. “There is research that shows that the debrief is where a lot of the learning takes place. There’s a lot of stress and nerves when you’re handling these situations for the first time, but when you have the chance to talk it through, things start to make sense.”

The manikins have impressive features to ensure that simulations are as detailed and realistic as possible. The highest fidelity models can talk, follow students with their eyes, and have their limbs detached so technicians can replicate the appearance of bruises or lacerations.

tim shea and model
Tim Shea shows a model he made of silicone and foam. This particular model is used to teach students about “nose flaps,” a surgery performed to replace the tip of the nose. Photo by Walter Criswell/UND Today.

Tim Shea makes magic at SMHS

Tim Shea, an operations specialist for SMHS’s Simulation Center, said the customization of the manikins has allowed him to create arms, legs, torsos and heads that suit almost any scenario imaginable.

Shea, who is one of only about 40 educators in the world to hold a Certified Health Care Simulation Operations Specialist-Advanced (CHSOS-A) designation, says he’s used his experience as a paramedic to create realistic-looking models of wounds, lesions and bruises for students to practice their skills on.

While some of the things Shea makes end up on manikin bodies, he also makes small silicone models that mimic human skin’s approximate toughness and texture. These models are ideal for practicing packing and sewing deep lacerations or inserting intraosseous (entering through the bone) needles for delivering medications or retrieving samples for lab tests.

Shea said he initially began offering simulation lab “happy hours,” during which students would get extra practice in skills such as intubation and resuscitation. These happy hours became so popular that Shea started coordinating mandatory “skill bootcamps” for students preparing to enter their clinical rotations.

“This is when the students get to learn a lot of those hands-on skills,” Shea said. “You can learn from a PowerPoint about what to do for a vomiting patient whose airway is getting blocked, but until you’re confronted by that in real life and everything is happening all at once, you don’t know how you’re going to react.

“I’ve had students come up to me and tell me that they were so nervous while they were learning about these situations in the classroom,” he continued. “But when they got around to doing it at the simulation center, it took all that fear away.”

The Sim Center’s operating costs are low compared to other facilities with similar capabilities, says Shea. This is largely because Shea and other staff members make many of their own models and use donated and recycled equipment and materials. Their resourcefulness also has allowed them to make models for specialty procedures such as nose flaps and intraosseous (through the bone) injections.

Tawni Harvala
Tawni Harvala gives a tour of one of SIM-ND’s trailers. They are fully stocked with equipment including mock medications, medical devices and instructional tools. Photo by Walter Criswell/UND Today.

Advanced spaces on campus and off

Aside from manikins and models, both SMHS and CNPD have unique and adaptable spaces in their simulation labs. SHMS, for example, has an area that can function as both a standard office with one or two beds and a larger operating room in which students learn how to move and act safely.

The rooms are, in effect, fully functional. Some things, such as the nurse call buttons attached to the hospital beds, don’t need to work for the scenarios that are run, but most aspects work how they would in an actual hospital room.

Instructors and operators in the control room can adjust on the fly or talk to students through a PA system. This helps keep students on track if they make a mistake or need guidance about next steps in a simulation.

The simulation innovation extends beyond campus as well. UND also owns and jointly operates a fleet of four mobile simulation labs for the Simulation in Motion-North Dakota program. These labs are built into trailers and can be driven across the state to educate and train health care workers in rural hospitals.

The trailers feature a fully operational emergency room and control center like the ones found in the buildings on campus, as well as a simulated ambulance experience, which allows facilitators to simulate events such as ambulance crashes, complete with headgear and goggles designed to replicate the feeling of a head injury.

“We partner with Altru in Grand Forks and Sanford and Essentia in Fargo to bring these across the state, in order to train rural health care and emergency medical service professionals,” said Tawni Harvala, simulation education and mobile specialist for UND Simulation Center.

“It’s a major benefit because we’re getting current paramedics and nurses training health care workers. They’re still in it, they know what they’re doing, and they have the chance to make those connections with rural health care workers. Everyone is excited to train in these spaces.”

UND labs leading the way

UND’s sim labs have prompted educators nationwide to ask how the University has maintained such high-quality environments with low overhead, Shea said. He’s excited to see further developments in health care simulations as technologies become more advanced and accessible.

The popularization of 3D printing, for example, is helping surgeons make exact replicas of organs they’ll be operating on before surgery. The technology could be on the horizon for UND’s labs, but for now, Shea and his team are content to work with silicone molds and plastic manikins.

“I really enjoy this work,” he said. “I worked at Altru for 35 years, and my firm belief — how I’ve come to do my work — is that I’m not young anymore, and I need to train the people who will take care of me when I need it.”

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