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He's No Dummy
Photos by Brad Nelson, Text by Susan Sample

Need a 28-year-old male, weighing about 175 pounds, to act the part of an unresponsive patient with shallow, slow respiration after being thrown from a snowmobile? Stan's your man.

How about a 58-year-old who's recently had surgery for bowel obstruction and can complain convincingly of pressure in his chest and shortness of breath? Try Stan, of course.

He's not your typical Hollywood actor starving for roles; he's just very adaptable-and adept at simulating human patients. But make no mistake: Stan's no dummy.

"You get nervous, if he's crashing," said Matthew Cyphers, M.D., a third-year internal medicine resident at University Hospital, after defibrillating Stan. "He's pretty realistic. He gives you good feedback. You didn't have that before with the dummies."

Not with the "Annies," two heads resting on shelves at the medical school's Center for Human Patient Simulation, or "Harvey," an anemic torso with doll-like blue eyes that never close and a cheap brown wig. Stan, a computer-driven mannequin, is the newest generation of human patient simulators. Not only do his eyes open and close, but his pupils dilate in response to anesthesia, his chest rises and falls with each breath-and he talks.

"What's going on?" he asked Emily Moss, a fourth-year medical student just finishing her test on conscious sedation during an anesthesiology rotation.

"Just take some deep breaths for me, Stan."

He coughed. "What happened to me?"

"You fell asleep," replied Moss. "But you're doing great. I'm going to switch you over to another mask now. It's just oxygen._"

Later, out of Stan's earshot, Moss explained: "By your fourth year of medical school, you've done a lot of role-playing. But you don't have all this great equipment," she said, pointing to the MASH-like surgery unit with real anesthesiology machines and a vital signs monitor that beeps and shows Stan's heart rate, ECG, blood pressure and blood oxygen saturation. "Here, you really have to be watching. No one prompts you that his blood pressure is dropping."

Purchased by the medical school's Department of Anesthesiology five years ago for $178,000, Stan has had several upgrades, most recently new eyes. "He's becoming more and more useful," said Dwayne R. Westenskow, Ph.D., professor of anesthesiology and founding director of the simulation center. Kenward B. Johnson, M.D., directs the center now. Despite the allure of virtual reality as a teaching aid for medical students, Westenskow is adamant about Stan's value. "This is way better. Everything sounds just right and feels right. It's pretty easy to forget he's not real."

Hundreds of University Hospital staff, from nurses to physicians to technicians in critical care areas, revolve through the simulation center every two years to re-certify for Advanced Cardiac Life Support (ACLS). Before the written test, each team is given one of five scenarios centered on Stan. For instance, they might be told: "Here is a 16-year-old, 60-kilogram male who was brought into the emergency department by friends after being struck by a car while riding his bike. He is obtunded and unresponsive. Blood pressure is 180/100. Heart rate: 114. Respiration: 28, shallow. No obvious external injuries, except for a large frontal-parietal scalp contusion and a 5-cm laceration. A CT scan has been ordered. What are you going to do?"

As the physicians and nurses narrate their actions, Noah Syroid, M.S., research biomedical and computer engineer for the anesthesiology department, sits nearby at a computer and operates the mannequin, much like the Wizard of Oz-except that the humans' questions are answered directly.

"You said you wouldn't want to give two meds. What's the reason for that?" Jana Proctor, R.N., an emergency room nurse, asks Earl Fulcher, the ACLS instructor leading the team through the exercise.

Dental and medical students use Stan to practice conscious sedation. Respiratory therapists learn how to set up patients on ventilators, while flight nurses use him to practice emergency intubation. Anesthesiology residents are among the most frequent users. For the past two years, they've participated in a training and research project designed to improve patient care by better understanding cognitive processes.

The residents wear an eye-tracking device with two cameras: one records the surrounding scene, while the other calculates where an individual focuses his eyes by measuring the reflection of his pupils. A computer worn in a small backpack integrates the data, enabling researchers to determine how the information anesthesiologists glean from new drug displays or the vital signs monitor affects their treatment of patients.

"It's improving their performance drastically. Doctors are not using as many drugs," noted Frank A. Drews, Ph.D., research specialist in the anesthesiology department and adjunct assistant professor of cognitive psychology.

The drug displays provide information that, previously, the anesthesiologist had to infer from patients' vital signs. "When people have to cognitively integrate information in their heads, it takes time. Seconds matter in medicine. They can be a matter of life and death," said Drews. "We want clinically significant deviations to jump out, so the doctor can act."

Westenskow, who has pioneered instrumentation design for anesthesiology monitoring and delivery, is the principal investigator on the five-year, $2.2 million grant from the National Institutes of Health funding the project. Five departments across the U campus are involved in the collaboration: bioengineering, psychology, computer science, architecture and anesthesiology.

As for Stan's contribution, Westenskow and Drews say he's integral. Not only does the human patient simulator eliminate the need for animal models, but Stan and his simulated OR enable the researchers to quantify their results in statistically significant terms. By training anesthesiology residents, the project already is contributing to improved patient care.

As David Odell, M.D., a third-year resident, noted, "I'd rather experience things happening here first than in the operating room."

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