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Airplane pilots have used it for years. So has the space program. Now simulation is making its way into educating tomorrow's nurses, physicians and other health care professionals - including those studying at UAMS.

In a 5,000-square-foot area on the fifth floor of the Education II building, 15 manikins in hospital beds are lined up side by side. While nursing students have named them after celebrities, such as Denzel Washington, George Clooney and Cameron Diaz, each manikin represents something more serious - a health professional's attempt to get a procedure right before practicing on a live patient.

In the last few years, this type of training has been taken to a new level at UAMS with the introduction of computerized Sim Man, Sim Baby and Noelle, a high-tech childbirth simulation manikin that can simulate scenarios from high-risk complications to normal birth.

"Simulation allows students to practice and make mistakes in a safe environment," said Patricia Dufrene, a registered nurse and director of the Nursing Learning Resource Center simulation lab.

Nursing students use the full-body manikins to practice sterile dressing change, insertion of catheters and tubes and other procedures. With Sim Man and Sim Baby, nursing students practice critical thinking and problem solving in scenarios programmed so that the manikins produce certain symptoms.

And while practice attempts to make perfect, "case analysis is a key factor," said Dufrene, who also has a Master's of Science in Nursing. "It's a place to critically analyze mistakes and plan corrective action."

Working Together

This is especially true with Noelle. She could be called one of UAMS' best kept secrets - one that Dr. Samantha McKelvey, assistant program director in the UAMS Department of Obstetrics and Gynecology, discovered while talking to

Sarah Rhoads, clinical assistant professor in the College of Nursing.

McKelvey immediately saw Noelle's potential in childbirth training for resident physicians. Such simulated training for medical doctors is becoming increasingly popular across the country. Some obstetric emergencies occur so infrequently that it may take years for young physicians to develop the experience to build their skills and feel confident in leading the team.

Simulated childbirth training, in which the obstetricians, nurses and even pediatricians work together, allows each health care professional to practice split-second decisions that could mean life or death, McKelvey said.

With Dufrene's help and College of Nursing Dean Claudia Barone's support, McKelvey and Rhoads last year held a collaborative training session dealing with shoulder dystocia, a life-threatening condition that occurs when the baby's shoulder is caught under the mother's pubic bone. To safely release the shoulder, a series of maneuvers is required that involves the cooperation of the doctor, nurse and mother. They also drew on the expertise of Ayasha Stewart, College of Nursing clinical instructor and advance practice nurse, who facilitated the project by programming Noelle's software, running the scenario and providing nursing students.

The effects of such training are "immeasurable," Dufrene said. "It was such a valuable experience to see them working together. Research has shown that a relaxed non-threatening learning environment produces better results."

"Absolutely," McKelvey said. "It lets you practice releasing a shoulder in less time, which can save a baby's life."

She said that in one study where shoulder dystocia training began in 000, there's been a four-fold reduction in neonatal injuries with this type birth.

Valuable Tools

Medical residents in UAMS' Department of Obstetrics and Gynecology also use sophisticated surgical simulation programs. "You can tie tubes, remove an ectopic pregnancy, or perform a hysteroscopy to look at the lining of the uterus," McKelvey said. "It simulates the resistance an instrument encounters when inserted so you can judge the right amount of pressure to use. It gives feedback on the amount of time a procedure takes and whether you use an instrument efficiently. And it notifies you if you have excessive blood loss or tissue damage."

Dufrene and McKelvey are quick to say that simulation cannot replace experience with human patients. And the simulation manikins aren't cheap. Noelle costs about $30,000.

But when time is critical and results of errors can be devastating, having practiced a procedure is essential, McKelvey said. The simulation models "let you practice in real time - when a complication happens fast and a response is needed now. Just like in a fire drill."

(This article was originally published in the University of Arkansas for Medical Sciences' spring 2008 issue of HouseCall magazine.)