Viewed through a window, three students participate in a medical simulation with a standardized patient portraying a woman in laborNurse-midwifery students and obstetrics and gynecology residents took part in a birth simulation, with a standardized patient portraying a woman in labor, at a University simulation center directed by CEHD alumna Jane Miller.

Making it real

Simulations are evolving as a transformative tool in higher education

In what looks like a hospital room, a midwife and an obstetrician-gynecologist consult with a new mom about the best ways to feed her baby. In the room next door, a patient experiencing labor fatigue has just been transferred from a freestanding birth center to a hospital. Down the hall, a woman at risk for shoulder dystocia—when a baby’s shoulder obstructs the birth canal—is helped safely through labor.

All of these situations can be stressful for patients as well as health care professionals. At the University’s simulation centers, it’s a typical afternoon.

In 2017, more than 500 simulations that served 13,000 learners were conducted at the University’s Interprofessional Education and Resource Center (IERC) and Academic Health Center (AHC) Simulation Center, the largest of several U simulation centers serving educational needs.

Jane Miller, standing, leads a debriefing session with students after a simulation.
After a simulation, students reflect on their experience and learn from other students as part of the debrief led by simulation centers director Jane Miller, top photo.

“Simulation is a powerful tool,” says Jane Lindsay Miller, PhD ’98, founding director of the two centers. “It’s a great way to expose learners to some really difficult problems before they actually have to experience them in the field.”

Simulations range from introductory skills, like establishing patient rapport, to immersive, complex scenarios that require a whole team of people. Some involve mannequins or models of body parts. Many simulations focus on strengthening interpersonal and teamwork abilities.

While medical simulation as a formalized practice is relatively new, simulations in some form have long been used to train health care professionals. Improvements in technology, organization, and data collection have helped the field develop in more recent years.

Miller is currently at work on plans for a new simulation facility to open about two years from now. It will continue and expand the work of the IERC and AHC Simulation Centers and the Medical School’s SimPortal.

“Our aspirations for the future are going to be following what we already do best—using the best of simulation science to improve teamwork and patient outcomes—but also using new emerging technologies,” Miller says.

Those new technologies include 3-D printing, which allows learners to practice procedures on a specific printed body part while interacting with a real person.

Better tools for professional learning

Miller came to Minnesota with a background in medical anthropology and global health. She didn’t foresee simulations as a focus in her work. But early in her career in maternal and child health, in countries struggling to respond to infectious diseases including HIV, Miller encountered many medical training programs that lacked a full understanding of how people learn.

A Fulbright scholar from CEHD encouraged her to consider coming to Minnesota, with its comprehensive research university, international programs, and medical school. Miller came, completing a PhD in higher education evaluation and assessment in CEHD.

“My training, both in anthropology and education, has been incredibly valuable,” Miller says. “I use those resources more than I ever thought I would.”

After three years working in faculty development for the Minnesota State Colleges and Universities system, Miller was recruited back to the U to establish the IERC in 2003. The AHC Simulation Center followed in 2009.

Failing safely

Learning through simulations can teach future health care professionals to give thoughtful care to all patients, regardless of gender, age, race, or culture. But achieving that goal requires a highly skilled staff and a strong cohort of standardized patients.

“We’ve developed a team of professionals who are able to address a variety of needs, both as educators and as clinical content experts,” Miller says. Seven full-time staff members work to create realistic clinical scenarios designed to challenge learners wherever they are in their career development.

Photo series showing various students participating in birth and labor simulations
Simulations allow students to test their skills and collaborate on interprofessional teams in a range of situations they will face in practice.

In addition, the centers rely on a special group of what are called “standardized patients” to portray patients, family members, and sometimes health care providers to teach and assess learners’ skills. That takes more than being a good actor.

Consistency, technical ability, and the desire to educate others are critical to the job. To Miller, the centers’ 180 standardized patients are one of their biggest assets.

A simulation is a safe place to explore mistakes and misconceptions. By working with standardized patients from a variety of backgrounds, learners have experiences that reflect the patients they’ll eventually serve.

“One of the things we often talk about in simulation is failing safely,” Miller says. “Students can fail safely in a structured environment, get feedback, and then incorporate that into their practice. That’s what we see over and over again as being one of the most powerful aspects of our work.”

For example, Miller worked with the School of Nursing and Medical School to develop simulations for nurse-midwives and obstetricians, who are increasingly collaborating to provide quality care to women and their families that will improve outcomes and lower costs.

Simulations for social work

The School of Social Work developed a partnership with the simulation centers over the past few years to offer simulations for master of social work (MSW) students. Scenarios involve patients with complex physical and mental health issues, such as abuse or addiction—situations in which social workers and nurse practitioners have to work together to find the best treatment for the patient in question.

“In treating so many diseases, not just one discipline is going to have the answer,” says Miller. “It’s going to be a whole team of people. We’re trying to expand the medical knowledge of social workers, and expand the social assessment skills of nurses, so that they can understand better how to work together.”

Read more about social work and simulations in “Healthy practice” from the fall 2015 issue of Connect.

A bridge to practice

Midwifery student Fartun Mohamed says simulations have helped her bridge classroom learning into critical practical skills.

“I’m a visual learner,” says Mohamed. “Taking the textbook and bringing it into real life makes a huge impact in my learning.”

Melissa Avery, professor of nursing and director of the U’s graduate midwifery program, which regularly conducts simulations through the IERC, considers simulation essential for her students. She has watched the field advance dramatically since, as a nursing student, she and her classmates practiced injections using a syringe and an orange.

An important part of the simulation experience is receiving feedback in a debriefing.

“Just as much, if not more, of the students’ learning comes from that one process,” says Avery. For example, students have an opportunity to reflect on how they interacted with the standardized patients. Appropriate use of language understandable to consumers and listening fully to their story are important discussion points. Learning through simulation means students can practice these as well as more technical skills and correct missteps before they enter the workforce.

“We feel better about the knowledge and understanding that our students have as they graduate and go out into the community,” says Avery.

Communicating to save lives

As much as 70 percent of medical error comes from faulty communication. As a health care professional, says Miller, effective communication is just as important as other more technical skills—critical to patient safety.

Whether it’s improved communication or specific technical skills, studies show that training through simulation reduces medical error once professionals enter the field. Fewer hospital-acquired infections and lower rates of re-hospitalization have been tied to simulation learning.

“It really comes down to prevention. It saves lives.”  —Jane Miller

Effective communication not only with patients but also with health care staff in other disciplines is essential. Simulations can prepare students for real-life circumstances where collaboration with professionals from different fields is crucial to a patient’s well-being. In the programs Miller directs, the commitment to interprofessional practice stands out.

Simulation centers are a space for positive change in both skills and perspectives.

“This is the reason I really love what I do—It’s the transformative power of simulation,” says Miller. “The way simulation helps students and providers do better continues to inspire and motivate me.”

Learn more about the simulation centers.

Learn more about graduate programs in higher education and evaluation studies in the Department of Organizational Leadership, Policy, and Development.

Story by Ellen Fee | Photos by Jenn Cheesebrow | Spring/Summer 2018