Center for Interdisciplinary Clinical Simulation & Practice

Drexel's College of Nursing & Health Professions is changing the way undergraduate and graduate students learn interpersonal communication and clinical skills in their new state of the art "Center for Interdisciplinary Clinical Simulation & Practice" (CICSP) Labs. Dr. Mary Ellen Glasgow, Associate Dean for Undergraduate Programs, was initially responsible for incorporating the use of the simulated patient into the undergraduate programs at the College of Nursing and Health Professions. Simulated patients (also known as standardized patients or patient actors) are individuals carefully trained to portray common health interactions or illnesses (view image, JPG) and simulate communication or ethical dilemmas that occur in medical practice environments.

Encounters with patient actors give the health profession students opportunities to learn and practice effective communication, assessment, and intervention techniques (view image, JPG) with real people without taxing actual patients. While developing the current undergraduate nursing curriculum, she decided to challenge Drexel's undergraduate nursing students by using a graduate-level- approach to instruction, common in the nurse practitioner, physician assistant, and medical resident programs. This approach places Drexel nursing students far ahead of their peers who graduate from other nursing programs. This type of simulation learning (view image, JPG) has also been incorporated into other undergraduate programs such as Radiologic Technology and Behavioral Health Sciences.

Dr. Glasgow envisioned how the use of simulation would not only improve patient safety at the bedside, but also fill the gap in clinical instruction by allowing a faculty member to view the entire simulated "patient encounter" and provide objective feedback; an important component missing from clinical education.

Dr. Rocky Rockstraw, Director of CICSP, recalls the transformation from one-way-mirrors and video tapes to the current state of the art simulation lab (view image, JPG). Just six years ago, Dr. Rockstraw recalls that ten faculty members would stand in a darken control room for 10 hour days to view students in the simulated patient encounter, and would then wait up to two to three weeks for the arrival of videotaped experiences to review and give feedback to students. With the "high tech" (view image, JPG) equipment and software (view image, JPG) used at the CICSP lab, faculty can view students live from the lab's observation room (view image, JPG), their office, or from home. Nursing students also have same-day access to view their simulated "patient encounter" (view image, JPG).

The experience with patient actors (view image, JPG) not only portrays patients with diseases and specific verbal responses, they also portray patients in an organized and consistent manner. This enables faculty to evaluate (view image, JPG) each student's ability to perform a physical assessment, diagnosis, and other clinical skills (Prislin, Giglio, Lewis, Ahearn, & Radecki; 2000). In addition, these experiences promote patient safety by allowing students to learn skills firsthand and experience a practice clinical setting (view image, JPG) without jeopardizing the health of actual ailing patients (Wallace, 1997).

Officially opened in fall of 2006, undergraduate and graduate students began using the state-of-art facility (view image, JPG) as a key clinical assessment tool. For example, the undergraduate nursing students' patient actor encounter experience begins when the students arrive to the "check-in" room, hang their coats and store their book bags. Dr. Linda Wilson, Assistant Professor of Nursing, greets the students and briefs (view image, JPG) them of their pending clinical patient encounter. Dr. Wilson describes the encounter from beginning to end. As nursing students (view image, JPG) walk through the double doors, market with a Mario the Drexel Dragon (view image, JPG) glass etching, they leave the classroom hallway and enter a pristine clinical environment (view image, JPG) where educational and medical quotes line the wall. Next, students walk into the providers' reception room, which resembles a medical practice suite.

These students stand in-front of pre-assigned exam room doors (view image, JPG) and read their patient's (simulated) chief complaint (view image, JPG). An overhead announcement informs them to enter the patient's room. Then, lights, camera, and action-- the session begins. Students introduce themselves (view image, JPG), identify the patient, explain what the patient will experience during the encounter, and wash their hands. During the next 40 mins, each student will develop a nurse-patient relationship. He or she will perform an extensive verbal interview and physical assessment to determine the patient's chief complaint. What is unique about this experience is that all fifty student encounters on a particular day will mirror each other; thus allowing the faculty member to "control" the patient scenario and enable focused student feedback to improve clinical skills.

The simulation suite has ten examination rooms fully equipped with necessary medical equipment (view image, JPG), computers, pan/zoom/tilt cameras, and microphones to monitor and record the student sessions. Faculty members can view the encounter real-time or view the recorded digital clip (watch video) from wherever they are located and whenever it is convenient. In addition to the faculty evaluation, students work on wall-mounted workstations (view image, JPG) outside of each exam room to complete post-encounter exercises and surveys based on their experience. The digital recording equipment (view image, JPG) allows authorized staff, faculty, and students to observe their patient encounters later as a form of self-evaluation. Computers (view image, JPG) are available in every exam room for which the patient actors complete case-specific history checklists and patient satisfaction evaluations that assess the students' communication skills. Patient actors also give students immediate verbal feedback (view image, JPG) in interpersonal communication. The faculty member can view the patient/student encounter from beginning to end which is not possible in a clinical environment where faculty may only see a few minutes of the student/patient encounter because they need to supervise the other students. Drexel's CICSP Simulation Lab processes provide instant feedback on the encounter for both students and faculty members.

Drexel University College of Nursing and Health Professions (CNHP) is the first undergraduate nursing program in the country to use simulation with patient actors as a summative evaluation experience for students, as well as, a method to build student clinical confidence in early clinical courses.

The College of Nursing and Health Professions faculty has also pioneered the use of simulation learning in the undergraduate Radiologic Technology (view image, JPG) program. The simulation lab is also being used by graduate programs such as Couple and Family Therapy, Creative Arts in Therapy, Nursing, Physician Assistant, and Physical Therapy & Rehabilitation Sciences.