Supratentorian simulation

‘I’d say its probably supratentorian,’ the consultant pronounced, a slight smirk that only one of the gaggle of junior doctors noted, as they loitered at the end of your bed. If you’re ever hospitalised and you overhear this word you should be relieved. At least you know there’s nothing physically wrong with you. The idea that something might be ‘all in the mind,’ and whether doctors and nurses should discuss their patient’s condition in front of them were two themes that came up in the debrief with the students in the simulation training room at Whipps Cross hospital.

I’d been invited to attend an inter-professional training session between medical and nursing students as part of a programme of activities designed by a small group of 5th years keen to explore leadership in medicine and plug gaps in their curriculum. The gaps they are plugging include: no or limited opportunities for student nurses and medical students to work together while training; very limited access to simulation training rooms to practice major clinical scenarios such as a patient suddenly deteriorating as a result of an infection; and a lack of focus on leadership in medicine. 

Bill and Richard, the 5th years running the session, showed me round the simulation suite. The glass window of the control room looked out on a section of a ward, a patient in a bed, a kind of nurses station littered with medical paraphernalia, and movable screens. On the control room desk monitors showed data fields about heart rate, oxygen saturation and split screens of live video feeds from all angles, all of which could be manipulated.

Sim Man himself was out for the count. His straw blond wig gave him an ageing rock star vibe. Bill showed me where to touch his neck and wrist to feel the pulses. The feint throb beneath the rubberised skin felt very real. I tried the stethoscope and could hear a quiet beat of his heart.

There were three final year students and four 2nd and 3rd year medical students. They were all in uniform. Nursing students in their white tops and the medics in their smart casual. Richard set up the first task: a team building, problem solving activity in which the information - shared among the group – had to be sorted and selected. The medics took the lead but the nurses still played a part.

In the debrief, which Richard handled with great tact and skill the group discussed the process. There wasn’t a lot of stepping back and perhaps more guidance at the outset would have helped lead them more in this direction. But it certainly helped to break the ice and familiarise them with each other. I sensed that they were very comfortable talking with Richard and wondered whether his status as fellow student made this easier. The potential for insight into teaching that Bill and Richard get from working in this way can only be of benefit to them as future doctors.

We had time for two clinical scenarios: in the first and more serious, Sim Man was being monitored post-op after a knee replacement. I think there was a possible infection and he was rapidly deteriorating. The mature student nurse took the lead and guided the medical student, who was struggling to find a protocol for managing Sim Man – something like ‘A, B, C, D…’ (Airways, Breathing, Circulation, Disability …). They didn’t find a protocol so the control room team sent a doctor (pretending to be a nurse) into the room to take charge. It ended with a flourish as the medical student kept wanting to check Sim Man’s knee and at one point lifted his gown to reveal that Sim Man was in fact a woman.

There was a very supportive debrief and it was clear that the usual tribalism had been side-stepped. Richard pointed out that as junior doctors they would be very dependent on the expertise and guidance of the nursing staff and that building these relations was crucial. It was clearly a valued and valuable opportunity for all the students involved and a shame that because of limited resources, more students couldn’t be given these opportunities.