LAUSR

In previous columns in this series on standardized patients (SPs), we have explored creative uses for this simulation modality for a variety of clinical scenarios, including care of gerontology patients, managing largescale disaster drills, and special circumstances related to pediatric patients. For this column, I interviewed two individuals who have partnered to developwearable technology for SPs to increase the fidelity of their educational efforts. Amy Cowperthwait, MSN, CNS, is Co-Director of Healthcare Theatre, Simulation Faculty in the College of Health Science at the University of Delaware. Amy Bucha, MS, is a mechanical engineer and serves as the liaison between the College of Health Sciences and Engineering at the University of Delaware, and is both a researcher and a simulation technician. Amy Cowperthwait and Amy Bucha have partnered to develop technological devices that SPs can wear to increase simulation fidelity, including a chest vest for tracheostomy care. The vest is not seen by the learner as a gown is placed over it, yet it has sensors in it that trigger the SP to initiate a severe reactionwhen the learner touches the carina during suctioning. MEH: Please describe your experience with SPs and how you are incorporating technology use. AC: I have worked with both high-fidelity manikins and SPs and have always incorporated patient-centered care into simulations. I appreciate the ways that SPs can provide verbal feedback to learners and help them with their communication skills. I also appreciate how SPs can display nonverbal behavior in how they react to what learners do and say. Even though they can enhance learning, they have limitations in critical care scenarios. For example, I find it frustrating to have a SP portray a critically ill patient, but yet have to put an artificial IV arm in the bed with them. Implementing this so-called hybrid simulation is not very realistic and can detract from the learning. I found this also to be true with tracheostomy care, as low-fidelity task trainers, and even high-fidelity computerizedmanikins, do not provide feedback on how deep the learner suctions. In order to help solve this pain point, I consulted with Amy Bucha to see if we could develop a device to help increase the fidelity of our tracheostomy care scenarios. AB: As a mechanical engineer with a focus on biomechanics, I work as a simulation technician and researcher and thus deal with a variety of technology. I am taught to look at issues with technology and help solve problems. When Amy Cowperthwait identified that tracheostomy care on a lowor high-fidelity manikin does not provide adequate feedback to the learner, we developed a chest piece that can beput on a SP. It is essentially a tracheostomy teaching device that actually interacts with the SP and is not seen by the learner. If the learner suctions too deeply, it sends a buzz signal to the SP that tells the SP how to react. AC: One thing we learned during this process is that SPs do not knowhow to react to suctioning that is too deep unless we properly train them. So, we interviewed former tracheostomy patients so that SPs can hear firsthand about the patients" thoughts, feelings, and emotions. We have found that this training has been helpful to the SPs in performing their role and giving objective feedback during the debriefing. In addition, we train the SPs to remain nonverbal throughout the simulation. Many of them have to work on their improvisation skills as they are used to being verbal in most other types of simulations. MEH: It sounds like the two of you have partnered well to develop a useful, high-fidelity device that a SP can wear. What other devices are you implementing? Mary Edel Holtschneider, MEd, MPA, BSN, RN-BC, NREMT-P, CPLP, is Simulation Education Coordinator and Co-Director, Interprofessional Advanced Fellowship in Clinical Simulation, U.S. Department of Veterans Affairs, Durham VA Medical Center, North Carolina.