A nursing student walks into a hospital room where a woman who has just given birth is lying in bed. When the student asks how the new mother is feeling, she admits that she is dizzy, and might need to be sick. Preparing to examine her, the student pulls back the sheet and finds the mattress soaked with blood. The patient is experiencing a post-partum hemorrhage, and could bleed to death in minutes.
Instantly, the nurse scrambles into action—taking the woman’s blood pressure, affixing an oxygen mask, starting an IV. She calls for help, and her colleagues rush into the room, yelling back and forth as they assess what is happening and what needs to be done to save the patient’s life. After a few minutes of frenzied activity, the bleeding stops, the woman’s blood pressure stabilizes, and the team breathes a collective sigh of relief.
Then they put down their headsets and step away from their computer screens.
The scene is a simulation on Second Life, the 3-D virtual world in which users can create avatars and interact in realistic spaces and communities. Colleges and universities have been using the site to hold lectures and other learning activities, and now medical schools and other health-care training programs are following suit.
There’s the virtual copy of an operating room, part of Imperial College London’s virtual hospital, where students can learn their way around an O.R. before they enter the real thing. Or they can test their knowledge in the Virtual Respiratory Ward by interviewing patient avatars (usually professors or volunteers who are given scripts), ordering tests, diagnosing problems, and recommending treatment. In a program created at San Jose State University, clinical students can use the Heart Murmur Sim, which lets users listen to real cardiac sounds, training them to listen to a “patient’s” chest (an exam called a cardiac auscultation) and identify heart murmurs.
More and more training simulations are introducing complex scenarios in which students are given a lot of information and must make quick decisions. One such program is the MUVErs Medical Simulation which was launched in early 2009 by John Miller, a Tacoma, Wash., nursing instructor. It involves an avatar patient (a computer-generated character operating with a set script) who is experiencing chest pain and other symptoms. The student must interact with the patient, ask the right questions, and “use” equipment such as IV pumps, defibrillators, and medication to treat the problem.
For sims like these, students wear a heads-up display, similar to those used by pilots, which shows data like the patient’s blood pressure, heart rhythm, and medical history. Then they click on objects such as a medication dispenser or the controls of an IV pump. When an object is clicked on, it triggers another heads-up display, allowing students to select, for instance, a certain medication, the dosage, and how to administer it (by mouth, injection, etc.). Importantly, the patient avatar will react realistically—if the student gives him too much nitroglycerine, for example, the avatar’s blood pressure will sink and he’ll go into shock.
The postpartum-hemorrhage sim described above has been operating since January for nursing students at the University of Auckland in New Zealand. So far, around 20 students have used it, with overwhelmingly positive results. “After they’ve ended the scenario, the faculty sits down and talks about their decisions,” says Scott Diener, associate director of information technology at the university, who created the sim. “From a learning perspective, it’s the post-scenario debriefing that does more for the students than anything else.”