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 tan,
a virtual patient currently programmed to replicate a truck driver,
is in poor health. He's sixty-one years old, overweight, drinks
too much, and exercises too little. And on this particular morning
in a treatment area at Duke Medical Center, he's about to suffer
a far more serious problem. With the click of a mouse, he's given
a tension pneumothorax—a punctured lung.
Lying on an operating-room table with a blue cloth shielding his
plastic privates from view, Stan begins breathing heavily and the
left side of his chest stops moving. His heart rate climbs, the
blood pressure and oxygen level in his blood decrease, and he becomes
short of breath. Before long, Jeffrey Taekman, a Duke anesthesiologist,
steps in to do something. "That's a controversy, whether you
should let someone kill the mannequin," says Taekman. "I
don't think anyone has killed Stan yet."
Stan's a sophisticated, computerized simulator designed to mimic
a real patient in a variety of scenarios. He's a hands-on teaching
tool at Duke Medical Center, where hightech touches include a $750,000
Human Simulation and Patient Safety Center that opened in April
and a student auditorium incorporating a dazzling array of technological
advances that are perhaps the most forward- thinking on campus.
At Duke's Fuqua School of Business on a recent morning, colleagues
look up at an eight-foot-wide video screen that's part of Fuqua's
Global Conference System. With the push of a button, another time
zone comes to life as technology links Fuqua staff to counterparts
in Frankfurt. "Guten tag," they say, and their life-size
images beam from the wall and their gaze meets at eye level, as
if seated inches across the table, rather than halfway around the
globe. The audio is so realistic you hear a car horn honking from
hidden speakers—in Deutschland or in Durham?
Meanwhile, at the law school on a recent afternoon, students aren't
studying contract law from oft-dry, three-inch-thick law tomes.
Instead, via computer laptops, they're immersing themselves, in
video and audio vignettes with discussions from nearly fifty high-profile
legal scholars, practitioners, and judges as part of a groundbreaking,
DVD-ROM multimedia teaching tool conceptualized at Duke.
All around the university system, the move to "smart"
classrooms is changing the way students learn and professors teach.
Internet access, including wireless applications, other technical
features such as patient simulators, SMART Board interactive whiteboards,
sophisticated Duke-produced webcasts and DVDs, "telepresence"—all
are just a sampling of a technology arsenal being deployed in recent
years.
Duke Medical Center's training areas are full of heads and torsos,
arms and legs. In med-school lingo, the noncomputerized body parts
are known as "task trainers." But none match the sophistication
of Stan, a $170,000, computercontrolled, life-size mannequin and
control tower that exhibits symptoms and reacts to medicines and
interventions like an actual person.
The medical center bought the high-fidelity patient in February
2001 from Medical Education Technologies Inc. (METI) of Sarasota,
Florida. Housed in the Human Simulation and Patient Safety Center
in Duke South, Stan has three "parents": the medical school,
the nursing school, and the anesthesiology department. The Simulation
Center also houses a pediatric patient simulator, aptly named Baby
Stan.
The adult Stan—one of about twenty-five METI simulators
in existence—is powered by a Mac G4 hooked up to a Linux computer
controller and is run largely by pneumatics and electronics. His
output is vital signs, including body temperature, pulse, and cardiovascular
and pulmonary parameters. His pupils dilate and his vocal cords
can constrict to impede attempts at inserting breathing tubes. He
routinely suffers cardiac arrest, drug interactions, anaphylactic
shock, and more complex conditions. A fluid system allows him to
urinate and to give students the opportunity to tap chest fluids.
Stan's eerie sounds give a sci-fi feel to a room when his breathing
and heartbeat play through hidden speakers.
Taekman, who directs the center and is also assistant dean for
educational technology and an assistant professor of anesthesiology
at the medical school, says the simulator is an important technological
teaching advancement. Not only does it help promote real-life hospital
dynamics and teamwork, but it also reduces the need for students
to do laboratory work with live animals. "The simulator is
good for what-if scenarios," Taekman says. "There's a
set way of treating most disease states, so you can't look at what
happens to a patient if you try a different therapy. For example,
you can't give a patient an overdose of a medication to see what
happens. You also can teach a rare event in simulation, since we
can have it happen commonly."
The simulator reacts to "pretend" intravenous drugs,
which are administered via barcoded syringes filled with water and
scanned to determine what drug is being injected. It can model either
gender as young, old, healthy, or very ill. Switch out a few plastic
body parts, and Stan becomes Stella. Stan also can be programmed
to portray a number of cases the manufacturer has configured. Besides
"Truck Driver," there's "Mr. Outta Joint," an
orthopedic case; "Una Goodeye," an ophthalmology patient;
and "Dr. Iven Fast," a combative, inebriated male who
was just in a car accident.
In April, Stan moved into the new Simulation Center, modeled after
a similar center at the Bowman-Gray School of Medicine at Wake Forest
University in Winston-Salem. The center incorporates wireless capabilities,
videotaping equipment, and a debriefing room complete with a SMART
Board where students and faculty can share impressions following
training. Video can be fed live to nearby lecture halls. "It's
in the fiber-optic backbone of the hospital, so we can ship our
scenarios anywhere in the world via the Internet," says Human
Simulation Coordinator Gene Hobbs.
Taekman says he hopes to expand simulation to take full advantage
of the technology. "We've got a group of about twenty faculty
members who have committed to teaching over here," he says.
He plans to use humanfactors engineering, with a combination of
psychology and engineering, to study human performance in different
scenarios. These studies could look into such variables as human-
machine interface with the simulator and team interaction, considering
such issues as what would be encountered in an emergency.
The Simulation Center is one of numerous high-tech teaching areas
at Duke Medical Center. The 150-seat amphitheater classroom, where
first-year medical students have most lectures, has laptop ports,
power supplies, and built-in microphones for students; video cameras,
CD, and DVD technology, and touchscreen displays for faculty; and
a staffed control room. Like contestants on Who Wants to Be a Millionaire,
students can respond to an instructor's questions via a hand-held
remote keypad, rather than with a show of hands. Statistics are
immediately tabulated and projected at the front of the room. Faculty
can poll students with mini-quizzes to get an idea of their understanding
of a concept in the middle of a teaching session. The keypad also
can be used by the students in the auditorium who are observing
and helping call the shots—via video—of a scenario in
the nearby Simulation Center.
"We'll get them to a decision point, and then you're not
putting the four or five people [in the Simulation Center] on the
spot," Hobbs says. "Instead, they're making a decision
as a group."
Across West Campus at the Fuqua School of Business, telepresence
is one of the hottest topics, and it has nothing to do with television
psychic Miss Cleo. Telepresence is high-performance videoconferencing
used in Fuqua's Global Conference System, a high-speed, cross-continent
video connection using Internet2, the next generation Internet,
which features much faster data transmission through a bigger pipeline.
The system allows Fuqua staff and faculty to meet, as needed, just
by walking into a conference room linked to Frankfurt. In March,
a virtual "ribbon cutting" was held to celebrate Fuqua's
achievement of being the first institution—academic or corporate
—to use Internet2 for telepresence.
"This is exciting stuff, and the future use of this is going
to be powerful," says Nevin Fouts, associate dean for information
technology at Fuqua. Eventually, Fuqua hopes to expand telepresence
into the classroom for presenting guest speakers and other education
programs.
On a recent demo of the system, Fouts began speaking with Felix
Mueller, director of marketing and operations for Fuqua Europe;
and Falko Friebe, IT coordinator in Frankfurt. The benefits are
apparent. Both men appear relatively life-size and at eye level.
It doesn't feel much different than sitting down and speaking to
someone across the table. "This is a very useful tool because
it allows us to sit down face-to-face," says Tim Searles, director
of multimedia services for Fuqua. "You can't do that in a telephone
call."
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