By Laura Ingles
VCU School of Medicine

On the ninth and 10th floors of the McGlothlin Medical Education Center at Virginia Commonwealth University, there is no “typical day.” On any given weekday, the space may be filled with OB-GYN residents reviewing laparoscopic surgical skills, anesthesiologists running cardiac scenarios or students from the School of Medicine performing their first ultrasounds. They are some of many groups of health care providers and learners that utilize the Center for Human Simulation and Patient Safety, colloquially known as the Sim Center.  

With 20 exam rooms, an operating room and an intensive care unit, plus classrooms and conference rooms, the Sim Center provides experiential learning opportunities for students, trainees and faculty across the MCV Campus. Students practice clinical techniques on lifelike mannequins, and trained actors known as standardized patients, or SPs, simulate realistic medical scenarios ranging from a lingering cough to high-pressure trauma events. While there are no real patients in sight, for those participating in the training exercises, it feels very much like the real thing. 

“They’re doing everything from taking care of patients with very acute issues to practicing things like communication, body mechanics and teamwork,” said Catherine Grossman, M.D., clinical director of the Sim Center. “This is a unique place in that they can practice not just clinical skills, but other skills that relate to the real world.”  

Suspending disbelief 

Grossman, a pulmonologist who completed her residency and fellowship training at VCU in the early 2000s, got involved with simulation training early in her career. She described experiential learning as something that requires cycles of practice combined with regular feedback, comparing it to learning and mastering other skills, such as when she played the piano and sports growing up. Her first experiential teaching opportunities were in central line placement instruction on anatomical replicas of the neck and adult cardiac life support using a cardiac rhythm generator box and a CPR instruction mannequin.  

Now as the medical director of the Sim Center, Grossman addresses each new class of first-year medical students during orientation and introduces them to the Sim Center. She said some students may, at first, have a hard time suspending disbelief and buying into the scenarios, but the skepticism is usually short-lived.  

“The emotions will feel real,” Grossman said. “I tell them, ‘It’s not real, but I need you to pretend that it is.’”  

Stacie Rearden Hall, the standardized patient manager who started out as an actor with the Sim Center in 2011, echoed that sentiment. She noted that while students may initially feel uncomfortable, the actors’ performances are so realistic that they can’t help but be drawn in.  

“Instead of seeing a woman holding a baby doll, they see this new mom who’s exhausted, hasn’t been getting any sleep and is worried about her baby, and they forget that she’s holding a doll,” Hall said. “They just want to help the person in front of them, and that’s a real gift.”  

Long before students enter the room for a simulation, educators and Sim Center staff collaborate to come up with comprehensive, realistic and challenging scenarios that meet specific learning objectives. Grossman is quick to credit the school’s innovative faculty members with helping make the Sim Center what it is. 

“None of what we do could happen without the education leaders in the School of Medicine,” Grossman said. “The cool stuff we get to do is because they have cool ideas that fill a curricular need.” 

From the classroom to the clinic 

Kim Pedram, M.D., and Alice Wong, M.D., co-lead the Practice of Clinical Medicine, or PCM, course, a longitudinal class for all premedical M.D. students. In correlation with the basic science coursework, the curriculum covers clinical skills including professionalism, medical interviewing, physical diagnosis and clinical reasoning. Pedram and Wong work with the Sim Center to create simulations and other opportunities for students to practice, in a safe environment, the clinical skills they learned in class.

These simulated patient cases are all based on real medical issues for each specific organ system and aligned with PCM’s learning objectives. For example, when students are learning about the pulmonary system, they encounter an SP who reports having a relentless cough. Students take a medical history and perform a physical exam, while the SP answers questions per the provided script and, according to Wong, “does their best to simulate abnormal findings” during the physical exam.

As students progress through the PCM curriculum, the cases get more challenging. Once they have built confidence conducting patient interviews and interacting with family members, more advanced workshops involve scenarios such as encountering a patient with bipolar disorder having a manic episode, asking the parent of a teenager to leave the room, delivering bad news or discussing intimate partner violence.  

“We push them hard,” Wong said, adding that the SPs might cry or yell at the students, which can be unsettling the first time. “It gives them a chance to have that natural first reaction in a safe place, the SP gives them feedback, and then they have a chance to adjust before they have that encounter in real life.”

Pedram noted that having access to SPs gives students a greater sense of how individual bodies can differ from one another. Students can (and do) practice some skills on one another, she said, but performing physical exams and listening to the hearts and lungs of as many people as possible helps prepare them for the differences between patients in a real clinical setting. 

“There’s something about having a patient being able to respond to you and interact with you in this kind of learning environment,” Wong said. “And the more you practice these skills, the better you get at them.” 

This article, the first in a series on the Sim Center, was originally published on the School of Medicine’s website. The next installment in the series will highlight the School of Medicine’s partnership with the School of the Arts to recruit and train actors as standardized patients.