Emily Hillman was a fifth-year medical student, still deciding which direction her career as a physician would take, when she walked into the School of Medicine’s simulation lab for the first time.

Long recognized for delivering a cutting-edge curriculum, the UMKC School of Medicine opened its Clinical Training Facility and the Youngblood Medical Skills Laboratory in the basement in 2007 with a small assortment of full-body manikin simulators and specialized models called “task trainers,” designed to teach and practice skills.

Hillman (M.D. ’08), returned to the lab repeatedly throughout her final years of medical school, and throughout her emergency medicine residency, to learn procedures in a way that wasn’t possible before the evolution of simulators.

“I found it so helpful and impactful learning to do things on a simulator rather than reading a textbook or listening to a lecture because it brought out my knowledge gaps,” said Hillman, an emergency medicine physician who now serves as director of simulation education at the School of Medicine. “I realized I thought I knew something, but actually doing it was different.”

Today, the school is looking forward to a new $120 million Healthcare Delivery and Innovation Building planned for the UMKC Health Sciences Campus. The building will provide additional classroom space and state-of-the-art educational facilities, including more simulation labs, which school leaders say will lead to better training for students and better care for the community.

Before simulation training, medical students learned by reading textbooks, examining and working with static plastic models and watching others perform procedures before they practiced on real patients. At the School of Medicine, students often prepared for exams by flooding the school’s second-floor media center, a large room filled with skeletons, an assortment of plastic model body parts and rows of monitors on which they could view videos describing everything from human anatomy to specific medical procedures.

Hillman said today’s students come in with the expectation simulation training will be an essential part of their education.
“That was not the case in the past because it was new and novel. It was an emerging thing,” Hillman said. “The available technologies today have changed and improved their realism.”

Manikins and task trainers used today mimic the human anatomy and physiology and perform with such realism that not only can they talk and move, but they can go so far as to bleed, vomit and even give birth. With life-like skin, they allow learners to practice skills in real time, such as inserting breathing tubes and using catheters to actually remove fluids.

Ashraf Gohar, M.D., an associate professor of medicine, is assistant program director of the pulmonary/critical care fellowship. He has utilized the clinical training facility for the past 10 years, teaching medical students and residents.

“Every program today, if they don’t have a skills lab, they’re developing one,” he said. “And if they do have one, they’re expanding it.”

Such is the case with the School of Medicine’s Clinical Training Facility. Today, the facility has moved out of the basement. Taking up a suite in a building across the street from the medical school, the facility has two classrooms, four examination rooms with exam tables and diagnostic tools and three patient care bays that can be set up as emergency department or intensive care bays.

Last year, the school’s second-floor media center was remodeled to house a new Experiential Learning Center, a 30-seat hybrid simulation/classroom space that serves as an extension of the simulation lab across the street.

And the growth doesn’t end there. In addition to the current simulation facilities, the Healthcare Delivery and Innovation Building is expected to provide training space that will nearly triple the Clinical Training Facility’s footprint on the Health Sciences Campus.

“For the volume of simulations we do, the size of the team and the space we operate in is small,” Hillman said. “The plus side of that is that we’ve had to do a great job of being creative with our resources and with solutions to those challenges. We do need the physical space that allows us to optimize the way these simulation events are meant to run.”

Current scheduling for faculty who want to use the Clinical Training Facility is a minimum of two weeks out, said Garren Fraser, assistant director of administration for the center.

With the increased use of the training center, Fraser and his staff now require instructors to submit a complete learning plan outlining goals and objectives for the students.

“Our goal is that you give us your teaching plan and we’ll give you the tools to teach it,” Fraser said. “We want to get as close to clinical (reality) as possible.”

An entire simulation suite in the new building will help meet that goal. A dedicated room for procedure training will also have equipment that allows for distance learning, so an instructor can connect from another campus to conduct training of procedures. A full-scale operating room will allow for different virtual simulations. A high-fidelity simulation room will be designed to meet today’s best practice standards. There will be additional office and storage space as well.

The biggest positive to come out of the new space may be the addition of 14 new exam rooms, more than triple the number of rooms currently available for the school’s standardized patient program.

Standardized patients are actors hired by the school to portray patients in a clinical exam setting or family members during virtual training sessions. They allow students to practice basic examination and communication skills. Standardized patients are also trained to help assess, and in some instances, correct simple mistakes students make while they are learning to conduct basic examinations, something Hillman said sets the UMKC standardized patient program apart from others.

As part of their training, a new class of medical students is required each year to examine four standardized patients for 30 minutes each. That requirement, which is part of the students’ mid-term exams, takes a full week to complete for an entire class of up to 130 students with the spaces currently available.

In the new Experiential Learning Center, the standardized patient program also provides students with after-hours opportunities to meet with standardized patients and spend more time practicing their basic physical exam skills.

“We need a space that delivers the best environment for our student learners and our standardized patients,” Hillman said. “Instead of a student reading a textbook after hours to prepare for an exam, they’re meeting with a standardized patient. It’s all about having a flexible learning model for students who learn in different ways. We look at how we can adapt simulation for that.”

The key to simulation training, she said, is to remember that the patient isn’t the focus.

“In simulation, the learner is the focus,” she said. “They’re free to air their mistakes or things they don’t understand because they’re not endangering a real patient.”

There are, however, times when a simulation event can become a very lifelike and stressful experience.

Ameen Awad, a sixth-year medical student, has been through several simulation events and experienced both the comfort of learning in a safe environment and the pressure of a high-stress situation.

“You can be working on the manikin, looking at the heart monitor and all of a sudden, it flat lines and you have to do something immediately,” Awad said. “You have to figure out, ‘What are we going to do? What are we going to inject them with? Are we going to start compressions?’ That is stressful, but it’s also good practice because in the real world, seconds are precious.”

Gohar brings a new group of medical students and residents to the Clinical Training Facility about every six weeks.

On a recent spring day, a class of nearly 20 medical students gathered for comprehensive skills training in thoracentesis and paracentesis, procedures in which a long catheter is inserted through the patient’s back or chest to obtain a body fluid sample. Having already watched a recorded video of the procedures, the students line up to perform the procedures on one of two task trainers.

“They come here to practice the hands-on part before they start working on the real person,” Gohar said. “This is important because they make mistakes, they learn from their mistakes. After a certain number of procedures, everyone will get more comfortable.”
As the school’s simulation program continues to grow, Hillman said, the goal is for the Clinical Training Facility to become an accredited simulation center through the Society for Simulation in Healthcare within the next five years. Accreditation proves a simulation center has established the processes, procedures and oversight that are best practice, Hillman said.

“We believe that process is going to ensure we’re following best practices,” she said. “We’ve been doing things program-wise to set the stage for that in a way that may not be apparent to the learners but is very apparent to people who ask to use our center now.”

Today’s simulation training is a high yield learning experience, Hillman said. For that reason, it’s now embedded in the school’s curriculum, which includes the school’s Physician Assistant and Anesthesiologist Assistant programs as well.

“It's an expectation now as a medical school that we provide simulated experiences,” Hillman said. “Students can encounter different problems (in simulations) that they wouldn’t in the clinic. You can’t guarantee every student is going to see every patient problem. But you can with simulation.”