Spring 2010
Training together: Simulation center opens in Las Vegas

synapse: University of Nevada, Reno School of Medicine

Ashley Feis, Ryan Hafen and Jennifer Freeman in the simulation center

Third-year medical students Ashley Feis and Ryan Hafen work together on a simulated laparoscopic surgery procedure, as general surgery resident Jennifer Freeman, M.D., practices basic suturing techniques. Photo by Edgar Antonio Nunez

A tangible step toward the integration of interdisciplinary health sciences learning in Nevada was unveiled in early December with the grand opening of the Clinical Simulation Center of Las Vegas.

Story by Anne McMillin, APR

The facility, on the Shadow Lane campus, serves as the premier training facility in southern Nevada for the next generation of University of Nevada School of Medicine physicians and surgeons, as well as nurses from University of Nevada, Las Vegas and Nevada State College.

"This facility is a credit to the institutions involved and the tireless efforts of their leaders' work, determination and commitment to make this dream come true," said Maurizio Trevisan, M.D., executive vice chancellor and chief executive officer of the Nevada System of Higher Education’s health sciences system, at the Dec. 2 grand opening.

"The integration and coordination of learning in the health sciences will better serve the citizens of Nevada and is proof of the health sciences concept," Trevisan said. "It is one of the best clinical skills labs in the country."

The health sciences system provides academic leadership and guidance to link and integrate the health professional schools including nursing, medicine, dental and public health, all of which are part of Nevada's eight higher education institutions. The system includes 150 health sciences programs and nearly 18,000 students attending a state college or university.

The 31,000-square-foot center offers the latest in health care training with five high-fidelity simulation rooms, two clinical skills labs, a surgical simulation suite, 12 standardized patient rooms, a hospital ward, four multi-purpose classrooms and administrative spaces. The facility is fully integrated by a computerized audio and video system.

The simulation rooms are equipped with specialized mannequins representing adult and pediatric patients that allow students to take vital signs and make assessments while practicing their communication skills, team management, task performance and decision making. Faculty can monitor performance via one-way mirrors and can dynamically alter patient physiology, dialogue and behavior. Scenarios are streamed in real time to debriefing rooms and can be digitally recorded for playback and discussion.

The 1,150 square-foot surgical skills lab, utilized by School of Medicine students and general surgery residents, features a wide range of training modules from surgical knot-tying to procedures such as a cholecystectomy.

"The simulation center is a wonderful opportunity to take training of residents and students to the next level. They will be better prepared to provide safe and effective care to patients following learning experiences in the various areas of the center," said Miriam Bar-on, M.D., associate dean for graduate medical education at the School of Medicine and the school's representative to the center's management administration team.

For the grand opening, nursing and medical students, along with residents, demonstrated the center's capabilities for the public and media.

In the maternity ward, fourth-year medical student Daphne Scott "delivered" a baby for a "pregnant" mannequin patient as first-semester UNLV nursing students Lindsey Barron and Heather Rabben helped the patient with breathing and pushing. Short of an actual delivery, this is as real as it gets.

"This is my first time working with a medical student and my first delivery," Rabben said. "We have been in the labs working on the fundamentals which include catheterizing, wound care, tube feedings and injections."

By practicing on mannequins and working with each other, nursing and medical students learn communication and patient care skills in a simulated environment before moving into real-life situations in a clinical setting.

According to Paul Stumpf, M.D., chair of the school's obstetrics and gynecology department who oversaw the simulated delivery, patient safety is greatly improved because the quality of care increases as health care professionals learn to work together to reduce hierarchy and become more efficient.

In another room, third-year medical students Ashley Feis and Ryan Hafen set about trying their hand at suturing and surgical stapling on rubber "skin." Both had just finished their 12-week surgical rotation and were in the center for the first time to practice what they had observed in their rotation.

"It is less nerve-wracking to practice on simulators," said Feis as she weaved surgical thread through cut "skin."

Collaborating with nursing

Carolyn Yucha, Ph.D., dean of the UNLV nursing school, said her students have been using the center daily since it opened for academic instruction last fall.

"Educating physicians and nurses together is critical," she said. "This training is being created together with scenarios relating to patient cardiac arrest."

Yucha said if the nursing and medical schools had not worked together over the last three years, a state-of-the-art facility would not have been created.

Now we have more space, more open labs and more flexibility, she added.

Shirlee Synder, Ed.D., Nevada State College interim dean of nursing, said her school’s curriculum has been developed concurrently with the center's design taking into account the new skills labs it now offers her students.

"We are still getting our feet wet as our first students used the facility last fall," she said. While the nursing schools teach some initial skills within their own institutional walls, Snyder said they start training students together at the center.

"We meet to learn how to drive desirous outcomes and achieve those outcomes on an interdisciplinary basis," Snider said.

She added that the collaboration of the organizations to create the center is unique in her experience.

"This is an outstanding opportunity for Las Vegas in nursing and medical education as we use this facility to stay competent using reality-based simulations," she said.

Surgical skills lab

In the surgical skills lab area of the center, surgical residents use high fidelity software and video monitors to practice laparoscopic procedures in what looks like a video game, but considering the seriousness of the training, is anything but child's play.

At one station, surgical resident Jennifer Freeman, M.D., tries her suturing technique on the laparoscopic monitor, which is set up for a gall bladder removal program.

Shawn Tsuda, M.D., chief of minimally invasive and bariatric surgery and director of the surgical skills and simulation laboratory, demonstrates a colonoscopy as the video screen moves through a "patient's" colon. As he moves along, he points out polyps and other significant finds.

"The old teaching model of 'see-do-teach' has transitioned to this new model of 'practice makes perfect.' We can do the practice with these virtual simulation systems and offer procedure-based training," he said.

The laparoscopic simulator tests and challenges the surgeon's dexterity and hand-eye coordination, which are vital to the modern practice of surgery.

Other skills taught include delivering bad news to patients, obtaining informed consent, placing wound care surgical drains, inserting chest tubes and practicing patient interaction.

Back at the monitor with the gall bladder removal program, surgical resident Michael Russo, M.D., carefully holds aside the gall bladder on the video screen as he prepares to clip the "neck" before cutting the organ out.

"The surgical skills lab offers me the unique advantage of being able to hone my surgical skills," Russo said.

"This benefits both the resident and patient alike by ensuring that, once in the actual operating room, the resident performs the tasks at hand with a high level of skill." He added that without the surgical skills lab facility, he would not have an equivalent opportunity to practice his skills.

"The lab gives me the opportunity to make mistakes with no risk, giving me the ability to learn from my errors without endangering patients' well-being. Without this simulated environment, the less-than-optimal 'see one, do one, teach one' traditional dictum would be the only way to learn and practice," Russo said.

Deborah Kuhls, M.D., associate professor of surgery and assistant dean of medical education, is in charge of developing surgery skills lab curriculum for medical students.

The Clinical Simulation Center employs a director, two simulation technicians, a lab assistant and an administrative assistant whose salaries are paid by the three institutions, which also have designated representatives to a management group charged with overseeing the entire operation.

The University of Nevada School of Medicine funds the salary for the surgical skills lab technician. Future plans include hiring a standardized patient coordinator.

The facility was built with nearly $16 million in state funding and support from Nevada's congressional delegation, including U.S. Senator Harry Reid, who provided almost $2 million in federal funding.