Search

Center for Interdisciplinary Clinical Simulation and Practice

PA student speaks to simulated patient

closing the chasm

  • Nursing student Jane Smith counts Dave Baker’s pulse. Her home-care patient called saying he felt nauseous after taking a new medication. Jane accesses a drug interaction database on her iPod—then speed-dials an ambulance. Dave’s meds have combined to initiate a rare but serious acute adrenal crisis.
  • Physician Assistant student Carla Robinson listens as patient Geri Bland recounts the dizzy spells that brought her to the ER. As Carla hangs the cuff on the wall, Marie’s voice wavers. Alone with her patient, is Carla witnessing the onset of a stroke?
  • Beth Carmichael mutters an explanation of the bruises on her back. But their location, and Beth’s evasive answers, fuel Physical Therapy student Paul Matinozzi’s suspicion that Beth’s account masks another beating by her sometime boyfriend.

Between the healthcare we have and the care we could have lies a chasm.

The Quality Chasm
Institute of Medicine, 2004

These scenes are both fictitious and very real. “Dave” and “Beth” are Standardized Patients, specially-trained actors. “Geri” is a lifelike computerized mannequin.

In a field where experience can make the difference between proper care and tragic error, simulation-based learning helps to weed out problems that the Institute of Medicine calls a “Quality Chasm” plaguing healthcare.

At Drexel University’s College of Nursing and Health Professions, these technologies are transforming the education of those who will safeguard Americans’ health in the coming decades.

beyond the books

A Drexel healthcare education transcends campus walls in ways not yet attempted by most healthcare schools.

  • All CNHP courses are web-enhanced through Blackboard, the College’s course delivery system. There, students find extensive clinical communications centers for every clinical course, study guides, discussion boards and numerous other resources like clinical practice tip sheets.
  • Students can access this information from any PC, Bluetooth PDA or iPod, and communicate with faculty and classmates, prepare for classes and exams, and review their Standardized Patient videos.
  • Smart-classroom technology brings a sophisticated healthcare education to audiences unfettered by time or space. One distance-learning initiative enables Drexel faculty to train Nurse Anesthetists at several remote locations in Pennsylvania, helping to alleviate a shortage of these highly specialized providers.
  • Thanks to the archiving capabilities of CNHP’s Center for Interdisciplinary Simulation and Practice (see foldout), students can now post electronic resumés complete with video clips that show, not merely tell, prospective employers how well they’ve mastered patient-care skills.

addressing reality

Radiology

Students practicing radiography with a standardized patient.

The Institute of Medicine’s bellwether report The Quality Chasm declares that "Americans can have a health care system of the quality they need, want, and deserve [...] but this level of quality cannot be achieved by further stressing current systems of care." What is needed, the IOM found, is "redesigned systems of care, including the use of information technology."

Recognizing the need to reimagine healthcare education, the report’s agenda for crossing the chasm prominently includes "environmental changes [including] preparation of the healthcare workforce [...] to acquire new skills and adopt new ways of relating to patients and each other. [We must] redesign the way health professionals are trained."

The IOM emphasizes that such changes require not only new teaching methods but more attention to changing technologies, communication skills, interdisciplinary practice and the need for lifelong learning and self-evaluation.

point of care

iPod Touch

The College of Nursing and Health Professions led the nation in integrating healthcare information technology into clinical education, requiring handheld computers into undergraduate courses when most colleges were only beginning to explore their use. All of CNHP’s clinical programs require students to use handhelds at the point of care to access the right information at the right time.

  • Evolution to the iPod Touch: to ensure that this generation of students has information and entertainment at their fingertips, the faculty decided to replace the traditional PDA with the iPod Touch handheld. Students visit the Apple “Apps” site to download required books, free applications like self health monitoring programs and a host of other applications that may be education-related or just plain fun.
  • Physician Assistant students use EValue to track clinical encounters during the clinical phase of their education. Running on on handhelds, the application tracks patient demographics including disease, ICD9 codes and procedures in a HIPAA-compliant way. The students who have their clinical practice experiences throughout the US download this information to faculty, who evaluate it on a weekly basis to ascertain the quality and breadth of the students’ clinical experiences.
  • CNHP’s technology integration team published PDA Connections: Mobile Technology for Health Care Professionals*—regarded as the standard text within the healthcare IT community.

the feel is real

Patient simulators, including newborns and a mother who gives birth, resemble a real patient and present physiologically accurate symptoms and responses. CNHP applies SimMan® technology more intensively than even most physician training programs.

  • The mannequins send realistic EKG and other signals to a monitor, issue sounds that reflect cardiac, pulmonary and digestive processes, present anatomically accurate pulses all over the body, and even weigh as much as a human—surprisingly important in preparing students to work with flesh-and-blood patients.
  • Faculty can program the mannequins for any number of scenarios so students can practice procedures, make mistakes and contend with their cyberpatient’s responses in realtime, honing the skills and earning the confidence they’ll need when real patients’ lives depend on them.
  • By simulating adverse reactions, Sim mannequins give students a baptism of fire that doesn’t burn. The instructor can initiate and control these reactions, challenging students according to their level of skill and confidence.

spearheading simulation

Controlled by faculty (at rear behind screen), SimBaby and Noelle birthing robot help students practice neonatal procedures.

Controlled by faculty (at rear behind screen), SimBaby and Noelle birthing robot help students practice neonatal procedures.

Simulation in healthcare education can be as simple as one student checking another’s pulse. Since 2001 CNHP has pursued an aggressive program to build ever more realistic simulations into the education of healthcare professionals.

Taking a cue from medical schools where standardized patients have been used since 1963, CNHP introduced SPs in nursing and began exploring other simulation technologies. The opening of the CCISP provided space, staff and resources to assume leadership in the field.

  • As of 2009, some 3200 students in all healthcare disciplines have made extensive use of SimMan robots and participated in SP encounters.
  • Drexel has continually invested in enhancements to deploy the most up-to-date technologies. For instance, sophomores began using the iPod Touch in 2009 as PDAs gave way to more powerful and flexible systems.
  • Funded by some $1.5 million in grants from HRSA, CNHP launched the Pennsylvania/District of Columbia Nursing Education Technology Collaborative (PADCNETC) last year. The project enables Drexel faculty to share simulation techniques with education technology specialists from Bloomsburg and Howard Universities and Community College of Philadelphia.

a unique investment

In leading the revolution in healthcare education, the College of Nursing and Health Professions enjoys unique qualifications.

  • A tradition of co-op experiential learning—the Drexel Model—informs the College’s programs. Students typically log 12 to 18 months as paid employees of hospitals, clinics and medical practices during their undergraduate years, in addition to their regular clinical practice rotations.
  • Drexel’s reputation attracts a career-oriented, technologically advanced student body eager to learn at the cutting edge.

    At no time in history has the growth in knowledge and technologies been so profound.

    The Quality Chasm
    Institute of Medicine, 2004

  • The College aggressively recruits faculty and administrators with proven ability to advance evidence-based teaching through the use of cutting-edge educational technologies.

From 2001 through 2009 CNHP invested some $4 million to create a one-of-a-kind nexus of healthcare simulation facilities. The results—from exceptional student performance to high demand among hiring institutions—confirm the value of the College’s investment.

Drexel's Standardized Patient Lab enables students to critique themselves.

Drexel's Standardized Patient Lab enables students to critique themselves.

results

Drexel’s investment in healthcare education technologies enlivens the curriculum, but does it enhance learning and develop a more competent workforce? The question is best answered by those directly involved.

    A major challenge in transitioning to the health care system of the 21st century ... is to redesign the way health professionals are trained.

    The Quality Chasm
    Institute of Medicine, 2004

  • “Some of the most beneficial moments in my education were when I pushed myself. The simulation experiences are those types of moments: they require you to draw on all your resources of healthcare knowledge and compassionate care, as I will need to do with every patient after I graduate.”
    —Natalie Miller ’08
  • “Seeing myself and how I interact with others was a real eye opener.”
    —Chanel Nichols ’10
  • “The instant feedback from the standardized patient and from the observers is invaluable. They’re very forthcoming with what was good and what made them uncomfortable, so I’ve been able to catch and correct myself in a real patient-care setting.”
    —Blythe Hopkins ’08
  • “Drexel nurses bring an awareness and professionalism that stands out among starting employees.”
    —Stephanie Conners, BSN, MBA, Chief Nursing Officer, Hahnemann University Hospital
  • “Drexel students are among the best and brightest.”
    —Kim Delaney, Recruitment Manager, Children’s Hospital of Philadelphia