Dr. Chad Epps seems pleased with the condition of the patient waiting for a heart procedure in the brand-new operating room at the University of Tennessee Health Science Center. As one might expect, the patient lying on the table can breathe, speak, express pain, respond to treatment, react to medications, and — if something goes terribly wrong — die. As one might not expect, this particular patient can be restored to life within minutes, by restarting a computer program.
Meet the Human Patient Simulator, a $220,000 lifelike mannikin that can present a variety of medical problems at the Center for Healthcare Improvement and Patient Simulation. Epps is the executive director of healthcare simulation at the center, which opened in May at 26 South Dunlap, in the heart of the UT campus in Memphis.
The “patient” in the operating room has plenty of company. Epps steps into another room and says, “This is our $60,000 high-tech baby,” showing a crib holding another simulator. In this case it’s a newborn child, with the “mother” resting nearby — so “her” sensors tell the doctors and students. Yes, the “high-fidelity” patient simulators in the OB GYN department can actually deliver a baby, complete with umbilical cord and placenta.
The Center, or CHIPS, can simulate almost any medical condition, from high blood pressure to cardiac arrest, and allow UT students to perform procedures and interact with each HPS, before they start their medical practice on human beings — who don’t reboot when things go wrong.
“The first epidural [pain blocker] I did was on a real woman in labor,” says Epps, initially trained as an anesthesiologist. “She didn’t know it was my first time, and that’s probably a good thing. But now we can learn skills here before we do it on a real patient. That’s really the whole idea for most of the facilities in this building.”
The 45,000-square-foot center has three floors. The ground floor has “low-fidelity” simulators. These don’t look human, but have ports and realistic-looking and -feeling body parts — arms, shoulders, knees. The Arthro Mentor, for example, enables students to practice arthroscopic surgery, while another device allows students to perform endoscopies and colonoscopies. It’s not as simple as slipping a tube into an opening in the machine, says Epps. “It has haptic feedback, so if I bump the side of your colon with my scope, I can feel it,” he says. The simulator doesn’t actually have replicas of organs inside, “but the monitor gives a realistic image of what it would look like, and you get a real sense of what it’s like to do this.”
The second floor holds the operating room and the more advanced simulators, along with classrooms and “debriefing” areas where instructors can review a student’s work. The third floor, the Kaplan Clinical Skills Laboratory, is a series of 24 examination rooms where students in all six UT departments — Health Sciences, Health Professions, Medicine, Nursing, Dentistry, and Pharmacy — can interact with “standardized patients.” These aren’t simulators, but actors. In this setting, the medical student meets a real human being, who is portraying a patient with a specific medical condition. This too, is more high-tech than students might encounter in the past. Not only are these visits carefully monitored, but afterwards the “patient” can use a computer to leave feedback about how well the student treated them.
The Center is the brainchild of Dr. Kennard Brown, executive vice chancellor and chief operations officer, who got the idea while attending a conference on academic medical centers like UT. “We were discussing advances in medical education,” he says, “and about simulation being the future of healthcare.”
Brown had previously worked with the local architecture firm brg3 and asked if they could put him in contact with an authority on simulation centers. “They found Dr. Michael Seropian at SimHealth Group in Oregon,” he says, “who is ‘the guy’ in that field, and he played an instrumental role in making it a reality.”
Brown explains that the $39.7 million project was entirely state-funded. “We are different from other facilities around the country because of the varied experiences offered here,” he says, “from the technological sophistication of the mannikins to the range of real-life scenarios we offer.”
Epps, hired as the director in 2016, points out that as recently as 2000, when he began practicing, simulation centers like this one didn’t exist: “Doctors learned by reading a book, watching someone else do it, and then doing it themselves.”
But the center is also about showing medical practitioners how to work as a team.
“In the past, we really didn’t communicate with each other, with people in other departments, other specialties,” says Epps. “So what we do in this building is put students together — not just from medicine but from nursing or clinical lab sciences — and they learn from each other about what everyone’s role is.”
The name on the building says it all, says Epps. “It’s the Center for Healthcare Improvement and Patient Simulation, and that really explains both the what and the why. The ‘patient simulation’ is the what, and the ‘healthcare improvement’ is the why, because everything we do here is about improving patient safety and their quality of healthcare in the community.”