HERSHEY, Pa. — Everybody's first encounter with Stan D. Ardman is the same, no matter if they are doctors, nurses, medical residents, anesthesiologists or Boy Scouts.
First chance they get, they try to kill him.
Stan's a dummy--and one sophisticated dummy at that. From his resting place on an operating table at Penn State's College of Medicine, the $200,000 mass of plastic, metal, wire and circuit board spends his days crashing into all manner of medical traumas: heart attacks, asthma attacks, blocked airways, collapsed lungs.
Medical simulators like Stan, introduced five years ago, are rapidly finding their way into hospitals from Stanford to Sydney. They are part of a growing effort to train medical residents without risk to patients, to cut mistakes by professionals and, when errors happen, to find out why.
Turns out part of that training is to learn what it takes for a patient to die. It's a lot like test pilots trying out the newest jets.
"They want to see what their safety margins are," says Jody Henry, an assistant in the simulator lab whose laptop makes Stan run. "They say, 'How do I know where the bad things start if I've never seen them happen?' "
Better to Kill a Dummy
Flight simulators came about because airlines and the military figured it would be cheaper for a pilot to crash a virtual aircraft than a real one. The idea is similar in patient simulators: Better to kill a dummy than a patient.
"Just as people prepare with fire drills and disaster training, we want medical students to know what it's like before it happens," says Dr. Margaret Wojnar, a Penn State professor who uses the simulator.
The first commercial dummies actually were offshoots of flight simulation technology. They arrived in hospitals in 1994, and sales took off in 1996. Today about 150 hospitals have one. The two major manufacturers, Medical Education Technologies Inc. of Sarasota, Fla., and MedSim-Eagle Simulation Inc. of Binghamton, N.Y., say sales are strong.
Stan has blinking eyelids, pupils that dilate, an airway that opens and closes, and a pulse. He breathes and exchanges gases like human lungs. Physicians inject drugs, drain fluid from his heart sac, intubate him, insert chest pumps.
Stan's name comes from his default setting--standard man--but he can become "Truck Driver," a beer-swilling cardiac patient who smokes four packs a day. There is a program for "Soldier," who has a gunshot wound. Doctors can also change his condition on the fly to keep students off-balance.
These sophisticated simulators have become all the rave despite a medical community wary at first of the technology. Even today, researchers are working to determine how, clinically, it helps teach doctors.
"What's left of the resistance is people who are threatened by it," says Chris Paulsen, executive vice president at MedSim-Eagle. They say, 'Are they going to use it against me in a high-pressure, pass-fail test?' "
For now, most don't.
At Hershey Medical Center, home of Penn State's College of Medicine, the dummy is used by the surgical, nursing and anesthesia departments for crisis training; by the residents for trauma lessons; and by high-schoolers and Boy Scouts for health education.
For the professionals, programs are optional. In groups of six, participants work an emergency, focusing not on medical technique but on group dynamics. Do the right doctors take the lead? Do the first people on the scene call in specialists soon enough?
The procedure is videotaped, and the group uses it to discuss what they could have done better. "They can practice all the uncommon events, the crises," says W. Bosseau Murray, who runs the lab.
In the same way, medical students and residents can come into the lab and work through traumas a dozen times. The other way to learn? "On real live patients," Murray says. "On you, your wife or your children."
One recent morning, five resident doctors from Hershey Medical Center gather in the lab to prepare for one-month rotations in the intensive care unit. They are here for a refresher course on opening airways in emergencies.
First up are a handful of first- and second-year residents. Wojnar sets up a patient, a 25-year-old man with an upper airway problem. The dummy's chest moves up and down irregularly. He's blinking.
"The senior residents are tied up in a meeting. There you are in the unit by yourself," she says. "What do you do?"
Using stethoscopes, the students probe Stan's chest. They feel for a pulse and ask Wojnar questions.
Chest X-ray? "Not done."
Medical history? "Yeah, actually, somebody gave him peanuts at school today."
His breathing and heart rates fall. First they try "bagging" him, forcing air into his lungs with a pump. Nothing changes. They look down his throat and see it is blocked.
"What are you going to do? You're losing him," Wojnar warns.
They try a procedure called a tricothyroidotomy, inserting a needle into the neck and forcing oxygen into the airway. That works.
Later they will decide the patient had a swelling in the back of his throat, an allergic reaction to peanuts. The students smile, looking pleased with themselves.
"They like to challenge themselves and see if they can work through the problems," Wojnar says. "They knew they figured it out. It's a big puzzle. A lot of medicine is like that."
Because the simulator has limitations, the test lacks the urgency of a true emergency. The simulator can't talk, for one thing. The other difficulties are human: These students are unfamiliar with how the dummy works, and Wojnar is still learning how she can use it to push her students. But she's satisfied.
"It's not all reality, because it's still a simulation," she says. "But it's close."