Simulated Trauma: Real Medical Education
Using Dry Runs to Prepare Medical Students, Residents
UVa Trauma Center Director Jeff S. Young, M.D., associate professor of surgery and emergency medicine, believes giving medical students and new physicians practice evaluating and treating patients will serve them - and their patients - well in the coming years.
So Young founded "War Games" to teach students and residents how to handle trauma, emergency and urgent-care cases they might see in a hospital environment. War Games is a paper simulation that doesn't use actual patients, but the evaluation and treatment required in a real-time setting mirror what real patients will need. Participants move through three difficulty levels as their skills improve, and all of their responses are recorded and go into a study. As a result, medical students and residents see this exercise for what it is: an excellent learning experience.
Young's research confirms his belief. "After going through three sessions, our residents and medical students perform at a similar level to that of expert physicians who have done this for years," he says.
Consider a simulated case given to third-year medical student Alexander Hawkins: a comatose, 18-year-old motorcycle accident victim with a head injury and unknown internal injuries.
Hawkins checks the patient's airway, breathing and circulation. Then he orders multiple lab tests. However, the patient's blood pressure is falling. Hawkins immediately orders intravenous fluids. But the patient's blood pressure is still falling. "Now what do you want to do?" Young asks.
Hawkins orders two more units of intravenous fluids, pauses, and says he also wants to put in a chest tube. As his patient's pressure stabilizes, Hawkins wants to call surgery and tell them he has a patient who needs to come up immediately. As Hawkins walks Young through the phone call, Young checks off what Hawkins does and doesn't do.
"That was very good," Young tells him. "I would have started in with blood after the first two units (of intravenous fluid), but that was good. Just one thing - you never really checked the head injury, but the bleeding was the main issue."
Hawkins says War Games gives him and his fellow medical students the confidence they need to face the challenges of a real-life trauma call. "No matter what's going on, you can fall back on the steps (taught in War Games), and that gives you confidence that you're doing what needs to be done," he says.