By Christia Gibbons
TNAZ Regional Correspondent

First the nurse gently taps on the door before entering the patient's room. Then she speaks in hushed, calming tones, calling the patient by name and explaining why she's there and what's going to happen next.

It's a one-sided conversation, though, because some of the patients at Banner Good Samaritan Medical Center can't talk. They can, however, breathe, bleed, cough, have heart attacks, seize and give birth.

They have wounds that weep and sometimes smell bad.

That's how realistic the computerized patient mannequins are in the hospital's Simulation and Education Center, which looks like a hospital floor. They even have names and armbands.

And, if nurses and doctors in training don't call these pseudo patients by name, they don't make the mistake twice.

"We warn them once," says Carol Noe, Banner Health's regional director of simulation and training. "We kick them out the second time because we don't want that type of person." She adds, "People have a right to privacy, dignity, to know who you are and what you're doing. You tend to perform as you practice."

That's what the SimET Center, as it's called around Banner, is all about. It rejects the some 2,000 years of physician apprenticeship learning in which practice is done on real people and uses the high-tech patients and virtual reality simulators to train health-care providers.

"Our patients – we can just reboot them to live another day," Noe says. That's key. At Banner, skill and cognitive training takes place in a safe environment. It's about learning to do things repeatedly and correctly without patients getting hurt and without anyone being blamed.

Dr. Mark Smith, system director of simulation and innovation, said the center is where "practice and learning are in a consequence-free atmosphere."

Banner's 6,000 square-foot center is one of the largest in the West and the precursor to a sister center opening mid-summer at Mesa Banner (the former Mesa Lutheran Medical Center). Up to 50 nurses a day will train at the new $11 million center. Banner Baywood has its own 300 square-foot simulation lab.

"Data is showing that simulation training decreases the incidents of errors," Smith said. "Apprenticeship used to be the way, now we can get proficient on simulators." This is similar to aviation where pilots are taught in simulated environments, he points out.

Driving the use of simulation training, Smith says, is a recognition that errors are made, nurses need to have a chance to practice and that while the massive number of hours residents can work is being curtailed, they still need to train. "In a carotid stunting," for example, Smith says, "one little mistake and the person strokes."

Simulation training, Noe and Smith say, allows different scenarios to be realized. Along with skills training and assessment, simulated situations can reveal breakdowns in communication.

"It sometimes takes a bad event to realize we didn't communicate well," Noe says. She especially relishes when things go wrong because that's when the most learning can take place. "You want that ‘pit in the stomach' moment in simulation. You want that to happen," she says.

Noe tells of some fire fighters being trained in the simulation center who were working on a person/mannequin and unraveling circumstances demanded the use of a defibrillator, but the team couldn't get a rhythm.

"They were really sweating," Noe says. It turned out a certain switch on the machine hadn't been flipped. "I bet none of those people ever forget that again."

While the patient mannequins lend themselves to group training and group dynamics, the computer-generated virtual scenarios are more individual and skill oriented. A doctor, for instance, can practice a bronchoscopy – a procedure in which the doctor looks through the patient's airway with a bronchoscope. The doctor can watch the path the scope is taking and see exactly what is going on – good or bad.

In demonstrating the virtual tool, Noe's patient started coughing and she immediately knew she hadn't given the patient lidocaine to ease the pain and discomfort. She then administered the drug virtually and the patient stopped coughing. "And the computer lets you know if you've give a patient too much drug, as well," Noe says.

Smith, who started as an ob-gyn doctor and went on to get a Ph.D., says his passion is teaching. A favorite Chinese Proverb he quotes is: "I hear and I forget. I see and I remember. I do and I understand."

Denielle Headley, clinical educator for the ICU nursing, staff, said "there's nothing like" the simulation experience. "The staff gets to apply didactic knowledge to a hands-on experience (which dramatically increases learning) and if they have not learned it in a lecture format we get to teach it in a hands-on setting, which is ideal for most of our learners."

Headley will be part of the clinical education team when the new unit opens in Mesa. "If we have more SimET space we have more potential to increase patient, nursing, and physician satisfaction, because when our learners retain more of what is taught it is going to affect our patient care in a great way," she says.

Dr. Gregory Chu, a critical care physician at Good Sam, runs a central-line program at the SimET center

"My role consists of leading didactics and hands-on training of central- line placement using mannequins as well as ultrasonographic techniques when appropriate," Chu says. He also participates in a monthly code blue, or in-hospital arrest, scenario "for the purpose of allowing residents the opportunity to exercise their code leading abilities in a somewhat less consequential environment as compared to real life scenarios."

He adds, "As a tool to provide transitional experience between textbook learning and direct patient care, simulation has no current rival."

Smith says his team is making a difference not only in training, but in improving patients' care, patients' lives. "That's what's exciting," he says.