I remember the first time I was exposed to simulation. I was an intern in my emergency medicine residency. I was so intimidated by sitting in a room of peers that were my senior and residency directors. I was called on with a few others to
walk into the simulation lab and care for a 1 year old simulated baby who was
having difficulty breathing. Everyone's nightmare... a sick kid.
Although the situation was not real, my fear of not exactly knowing what to do was…. It was VERY real. I felt my heart pounding in my chest, beads of sweat on my forehead. “I can’t let this kid die” I said to myself. After talking to the "mother," a tech playing the role, I found out that the child had eaten a cookie that contained peanuts. At first I thought he was choking, but when his oxygen saturation started to fall, and I saw the mannequin's lips becoming cyanotic, I knew I had to intubate the child to protect his airway.
With my heart pounding, I stepped to the head of the bed. Laryngoscope in one hand, and endotracheal tube in the other, I stood at the head of the bed. “I got this!” I thought. But when I opened the child’s mouth, I could only see a diffusely swollen tongue, and was unable to intubate the child. I panicked… The kid was going down the tubes. “Call anesthesia!” I yelled out, hoping that a consulting service could help me. "Anesthesia is not available" I heard over the overhead. My heart stopped. I watched as my senior resident asked for a large bore needle and quickly shoved it in the child's neck. After being prompted by the nurse, we ordered jet ventilation for the child, and admitted him to the pediatric ICU. I learned later during the debriefing session, that this procedure was called a needle cricothyrotomy. And I never forgot it...
4 years later as a senior resident, I stepped into the simulation lab during one of our monthly meetings. Again, I was faced with a scenario of a child in what I later learned was anaphylactic shock. This time, after peeking into the child's mouth and noting the swelling, I quickly grabbed a needle angiocath and placed it into the child's neck. Then I asked for the nurse to set up jet ventilation and call the PICU.
I had never seen an actual case of pediatric anaphylaxis during my residency training, but it really dawned on me how, despite this, I remembered exactly what to do. Was it my skills? My knowledge? Or was there something else that happened that day as an intern that helped me to recall exactly what to do to save this kid?
At that moment I realized the power in learning through simulation. Not only does it provide a hands-on approach to learning, but the associated emotional component that leads to learning retention and accuracy of performing procedures.1 I fell in love with using simulation as a learning tool, and decided to do a fellowship in simulation after I graduated from residency.
Now I get to create, design and run simulated sessions for medical students and residents. As stated in the photo above, I work at the UC Irvine School of Medicine Simulation Lab, the only simulation fellowship for emergency medicine in all of Southern California!
If you're not convinced by my story, take a look for yourself at the graph below depicting the rates of retention from different learning techniques:
Although the situation was not real, my fear of not exactly knowing what to do was…. It was VERY real. I felt my heart pounding in my chest, beads of sweat on my forehead. “I can’t let this kid die” I said to myself. After talking to the "mother," a tech playing the role, I found out that the child had eaten a cookie that contained peanuts. At first I thought he was choking, but when his oxygen saturation started to fall, and I saw the mannequin's lips becoming cyanotic, I knew I had to intubate the child to protect his airway.
With my heart pounding, I stepped to the head of the bed. Laryngoscope in one hand, and endotracheal tube in the other, I stood at the head of the bed. “I got this!” I thought. But when I opened the child’s mouth, I could only see a diffusely swollen tongue, and was unable to intubate the child. I panicked… The kid was going down the tubes. “Call anesthesia!” I yelled out, hoping that a consulting service could help me. "Anesthesia is not available" I heard over the overhead. My heart stopped. I watched as my senior resident asked for a large bore needle and quickly shoved it in the child's neck. After being prompted by the nurse, we ordered jet ventilation for the child, and admitted him to the pediatric ICU. I learned later during the debriefing session, that this procedure was called a needle cricothyrotomy. And I never forgot it...
4 years later as a senior resident, I stepped into the simulation lab during one of our monthly meetings. Again, I was faced with a scenario of a child in what I later learned was anaphylactic shock. This time, after peeking into the child's mouth and noting the swelling, I quickly grabbed a needle angiocath and placed it into the child's neck. Then I asked for the nurse to set up jet ventilation and call the PICU.
I had never seen an actual case of pediatric anaphylaxis during my residency training, but it really dawned on me how, despite this, I remembered exactly what to do. Was it my skills? My knowledge? Or was there something else that happened that day as an intern that helped me to recall exactly what to do to save this kid?
At that moment I realized the power in learning through simulation. Not only does it provide a hands-on approach to learning, but the associated emotional component that leads to learning retention and accuracy of performing procedures.1 I fell in love with using simulation as a learning tool, and decided to do a fellowship in simulation after I graduated from residency.
Now I get to create, design and run simulated sessions for medical students and residents. As stated in the photo above, I work at the UC Irvine School of Medicine Simulation Lab, the only simulation fellowship for emergency medicine in all of Southern California!
If you're not convinced by my story, take a look for yourself at the graph below depicting the rates of retention from different learning techniques:
1. Okuda Y, Bryson EO, DeMaria S, Jacobson L, Quinones J, Shen B, Levine A. (2009). The utility of simulation in medical education: what is the evidence? Mt Sinai Journal of Medicine. 76(4):330-43.
2. Image retrieved on May 25, 2015 from http://www.simulationpoweredlearning.com/retention-graph.html
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