The Model Patient
Stan's not what you'd call good looking, nor is he articulate, and his wardrobe can be downright shabby. But he's seen and had it all — voluntarily — from minor cuts and bruises to strokes to lung cancer to Ebola. He takes it all lying down, and he never complains. In his own modest way, he's one of the best teachers medical students have ever had, even though he's a bit of a dummy.
Actually, strike that last word.
Stan is not a dummy, but a "human patient simulator" at The University of Texas Health Science Center at Houston, and he's controlled by computers. He's made of hard and soft rubberized plastic on the outside, while his inside consists of various tubes, hoses, wires, motors, speakers and computer boards and chips, as well as a plastic bladder and other organs. Students encounter him on a hospital bed or gurney, possibly hooked up to a real anesthesia machine, defibrillators and the like. He breathes and has a heartbeat (both can be normal or abnormal, depending on how he's programmed). Pass your hand over his blue eyes and his pupils dilate and contract as the light around them changes; hold his wrist to take his pulse, or inflate a cuff wrapped around his upper arm to take his blood pressure. His vitals appear on a monitor as digital readouts and beeps. Give him the wrong medicine and he can immediately react for the worse, depending on the programming and the person running the computer.
Stan, a contraction of "standard man," was actually the name given the first simulators, which appeared in the mid-90s. Today's simulators are much more complex, and can be anything from newborns to adults of either gender; the most sophisticated run up to $300,000 for the whole package, including computers and software. The UT Health Science Center - Houston actually now has several simulators in addition to Stan; the medical school uses them to teach and train residents and medical students, and also in certain outreach programs. The public health department also uses them. According to medical director Dr. Eric F. Reichman, the simulator allows students to learn much more thoroughly than in the past, when they trained mainly on cadavers and live hospital patients.
"First off, the simulator allows all students to learn many things. A student in a hospital might encounter a heart attack and he'd learn from that, while another student in another facility might get someone injured in an explosion and he'd learn from that. But the first student may never see an explosion injury, and the second might not see a heart attack. They'd both have to learn about those from reading a book," he points out. "But we can simulate both those things with this technology and both students can learn to deal hands-on with both conditions. This simulator training sticks better in their memory than just reading about it."
"Plus, they get to do things with the simulator we'd never let them attempt in the hospital," he continues. "For example, they can make a mistake and administer the wrong medicine and with the computer we can alter the simulator's symptoms instantly so they can see and understand what they did wrong and how to make it better. If they started to give a live patient the wrong medicine in a hospital, we'd have to stop them and say, 'You can't do that because if you did such and such would happen and the patient would get worse, or could even die.'" The simulator, programmed to act like nearly any patient a doctor might encounter, puts students into complicated scenarios — from the emergency room to the intensive care unit to the surgery ward — in which judgment, knowledge, communication and teamwork are all essential; as the simulator reacts realistically to whatever the students do, it forces them to think on their feet, and that's how they learn to work effectively under pressure. That's tough to teach in a conventional classroom setting, and helps explain why increasingly sophisticated simulators will become commonplace at medical schools.
"Right now some schools have them and some don't," Reichman says, "but in the next few years everyone will have them. That's definitely where things are going."