Everyone makes mistakes. Most people can resolve them by acknowledging their error, learning their lesson and moving on.
But for physicians and physicians-in-training, a mistake could mean the permanent injury or even death of a patient and could potentially end that health care provider’s career.
Medical training often lacks a forum that allows students to make mistakes. That’s where the Interprofessional Simulation Center, housed at the Health Education Center at UTMB, comes in.
UTMB is a pioneer in simulation methodology, with a focus on enhancing simulation-based education in which the use of standardized patients and manikins plays a central role. Standardized patients are individuals trained to portray the personal history, physical symptoms, emotional characteristics and everyday concerns of a health care patient so students can practice and be tested on their clinical skills.
“We have 715 residents and fellows in graduate medical education on this campus,” Associate Dean for Graduate Medical Education Dr. Thomas Blackwell said. “When our students perform on a live patient after all the practice they’ve had with standardized patients and manikins, they need to be sure, and they need to be right.”
The footprint of UTMB medical students is immense, said Dr. Katie Branch, vice president of Interprofessional Education and the Health Education Center. Their reach can be felt across the nation as they go out and practice medicine, demonstrating confidence and competence in their skills.
“We have human, standardized patients from the community who function as ‘mock’ patients, and our students do physical and cognitive exams on them,” Branch said. “The standardized patient has been trained to portray a person with a history of an illness, and the student who is performing the interaction is evaluated by both the patient and faculty, who are watching.”
Standardized patients go through a screening process, depending on the objective of the case for the learner, and available cases are circulated among those who are interested.
“They get training ahead of time about the disease and its process, and they are taught to follow a script,” she said. “A rubric is followed to ensure students are hitting their milestones. That’s where the evaluation process comes in, with feedback about how well the students communicated, including whether they made eye contact and introduced themselves.”
The interaction becomes part of the overall evaluation, with faculty watching what transpires.
“We have many quality assurance standards in place, and we’re standardized across the board with scoring, to ensure fairness,” Branch said.
Branch added that the majority of what health care professionals do is rooted in communicating effectively with patients.
“It doesn’t matter how much knowledge you have, if you can’t put that patient at ease and show that you value them, they will not fully disclose why they’re there,” she said. “It’s not just skill attainment but therapeutic communication. We record all our events, and faculty can watch in real time to see how well their students are doing.”
Learners also have access to videos of their interactions with their standardized patients.
“We have the mindset of training students in a safe environment, allowing them to make their mistakes and learn from them with the goal of providing the best possible patient care outcomes,” she said. “This is why we do what we do in this building.”
Blackwell said UTMB has a long history of using standardized patients and published some of the very first articles referencing them.
“The Health Education Center and Dr. Branch are the penultimate re-creation of what we started long ago, on Saturdays with just 30 rooms,” he said. “Now we have this building, and Dr. Branch is in charge of it, and we are continuing our history of being leaders in this area.”
Learning collaboration
Providing future physicians with the training they require to work collaboratively with other health care providers to assure patient safety means reinforcing the need for teamwork and breaking out of information silos.
The HEC is utilized by the School of Medicine, the School of Nursing, the Graduate School of Biomedical Sciences, the Department of Physician Assistant Studies, the School of Public Population and Health and the School of Health Professions.
“The Interprofessional Simulation Center is unique to UTMB,” Branch said. “In other universities, they have separate facilities for residents and med students. And then the others, like nursing students, occupational therapists, physical therapists, etc., will go somewhere else. Here, we have this centralized resource, which is a wonderful opportunity for this kind of collaboration and interaction.”
Branch stressed that the focus is not just on skill attainment.
“We have to learn to work as a team to be effective, and we have to think about ways to strengthen that,” she said. “Other institutions operate in silos; at UTMB, our learners are working together and learning in the academic environment prior to going out and working in teams.”
Blackwell said they were setting the framework for students to work as an interprofessional team from the beginning instead of expecting them to do it after they have gone out into practice.
“And they’re doing it in a state-of-the-art facility,” he said. “Having gone through these simulations takes care of much of the rest. We teach both ends—procedural interactions via the manikins, communication via the standardized patients—and the outcome is a competent, empathetic physician.”
Branch said that through the Office of Interprofessional Education and Practice, also housed in the HEC, undergraduate and graduate students receive an interprofessional core curriculum.
“We also provide supplemental interprofessional opportunities for the entire UTMB professional community,” she said.
“All the core curriculum and supplemental interprofessional activities are designed to meet at least one or more of the Interprofessional Education Collaborative core competencies and provide an opportunity for health care students and professionals to learn from, with and about each other’s professional roles and responsibilities,” she explained. “The Office of Life Support Education and Training offers training in all areas of basic life support, including advanced cardiac, pediatric, and advanced stroke life support.”
In July, Branch said, 255 new physicians will begin their new GME training at UTMB.
“There is such a large number of students going through, and even more when you add the nursing students and the others,” she said. “We have 8,000 events per year for learning within the HEC—training sessions of all kinds. The numbers speak volumes and it’s reflective of the amount of training we provide our learners so they can go out and practice with confidence, competence and skill.”