Miami-Dade County

With bleeding and wheezing mannequins, high-stress simulations give UM medical students real-world experience

Several University of Miami medical students crowd around the patient’s bed, trying to pinpoint why he is having trouble breathing.

As the students talk over each other as they delegate tasks, the stress level in the room rises. A loud beeping noise lets them know something has gone wrong with patient Murray Greenberg.

“His heart rate is dropping. His O2 is dropping,” student nurse Sara Spears says loudly.

“I’m getting worse!” Greenberg wheezes from the bed.

As Greenberg’s condition continues to deteriorate rapidly, the students realize they need more help, and try to call for a senior doctor.

Suddenly, a loud voice comes over a microphone and the students relax.

The simulation has ended on the $45,000, high-tech mannequin named Murray Greenberg.

The students were participating in Patient Safety Week, a program in its eighth year at the University of Miami/Jackson Memorial Hospital. The program continued through the week at the Center for Patient Safety, the Gordon Center for Research in Medical Education and the School of Nursing and Health Studies. Along with the interactive activities, the program incorporated art and music to help train students.

As students worked frantically, doctors stood in a darkened control room and watched them through a large window.

The medical and nursing students spend a week reacting to real-world, high-stress scenarios. Some of the doctor-patient interactions involve mannequins that can cry, talk and bleed fake blood, while others use actors and actresses. Students also listen to lectures and watch videos about patient safety.

Last week, more than 200 students, divided into 29 teams, underwent training.

A big aspect of the program is bridging the gap between future nurses and doctors and teaching them to communicate with each other.

“It makes more sense to have a team approach,” exercise organizer Jill Sanko said. One of the program’s main goals is to teach situational awareness.

After the exercise, Dr. David Birnbach, director of the UM-JMH Center for Patient Safety, debriefed the group. He spoke firmly but didn’t ridicule any of the students — a technique he has perfected over the years.

“It’s important to put yourself in their place,” he said. “You can’t be judgmental, and you can’t embarrass them.”

When the simulation began, Birnbach gave the students basic information about the patient and rushed out of the hospital room. He didn’t leave a direct contact number, and students were too timid to ask for one. When things headed south, they had no way to reach him.

“I parachuted you into a minefield,” he told the students.

The students nodded as Sanko and Birnbach gave tips on how to react in a high-risk situation. They discussed the patient’s comfort level, previous health history and allergies.

“Just having that information can make it so much easier to communicate and work as a team,” Sanko said. She said she thinks doctors and nurses can learn from the way the military and aviation industry operate.

Both Sanko and Birnbach said students who participate in realistic patient scenarios leave with a better understanding of how important communication is. By the end of the week, Birnbach said, students noted improved teamwork skills and communication.

Third-year medical student Sumit Mehta said he didn’t know what to expect, but he was surprised by how realistic the exercise was.

“When we’ve interacted with the simulators before, they’ve never responded to us,” he said, laughing.

Spears, who served as the team leader, agreed. While she felt a little prepared beforehand, she saw the exercise go downhill pretty quickly.

“It really is a humbling moment,” she said.