Mr. Field is not having a good day. First, a metal girder fell on his leg at a construction site, and he landed in a hospital emergency room. Then, after being stabilized in the ER and moved to another floor, he began to have chest pains.

Fortunately, Mr. Field is a patient simulator. Still, his medical problems are just what the doctor ordered to help Emory University's medical and nursing students learn to work as a team.

Photos by BARRY WILLIAMS/Special (ENLARGE)

Whitney Petrosa (wearing blue scrubs), a student at Emory University's Nell Hodgson Woodruff School of Nursing, reviews a chart with other students after a simulation of a medical emergency.

(ENLARGE)

Third-year medical student Caroline Jones (left) and senior nursing student Sheena Kumanomido (right) treat a patient simulator during a training exercise.

(ENLARGE)

Nursing instructor Corrine Abraham (left) and assistant professor Dr. Jeremy Ackerman lead a debriefing after an emergency-medical simulation.

On Feb. 4, Mr. Field (and other patient simulators) starred in Emory's first exercise in collaborative, simulated, emergency-medical training.

"Many people assume that medical and nursing professionals train together as part of their education, but, for many physicians and nurses, this isn't the case," said Barbara Kaplan, MSN, RN, an instructor at the Nell Hodgson Woodruff School of Nursing and simulation training co-coordinator. "They train independently in their respective disciplines, and their first interactions are typically in the hospital emergency room or clinic.

"At Emory, we are trying to create an environment where health care professionals can learn teamwork skills before they enter the real-world, patient-care setting."

Dr. Douglas S. Ander — director of the Emory Center for Experiential Learning, associate professor of emergency medicine in the Emory School of Medicine and simulation training co-coordinator — believes that interdisciplinary training should be integrated into more medical and nursing programs.

"When health care teams are properly trained on how to work together, the result is better teamwork, reduced medical mistakes and improved patient care," he said.

About 200 third-year medical students and fourth-year nursing students at Emory University participated in the joint exercise, which included an introductory course in basic teamwork structure and skills, Web-based learning modules, video vignettes, simulation exercises and debriefing sessions.

Five-person teams assessed and treated Mr. Field and his counterparts in mock emergency rooms, with each team member playing an assigned role. After about 15 minutes, the "patient" was transferred to a second team, which dealt with the simulator's chest pains.

Changing conditions

Unlike the instructors in the control booth, the students had no idea what they would be facing when they entered the room.

While nursing and medical instructors groaned and spoke for the patients, ever-changing vital signs flashed on monitors. Student teams assessed the patients, took medical histories, ordered tests and gave medications.

At one point, a team turned its patient over to a second team as part of the assessment, while the patient was asking for pain medication.

It was the correct approach, but it came a little late, said Dr. Jeremy Ackerman, assistant professor at the Emory School of Medicine.

"In the ER, we would have turned the patient on his side, using five pairs of hands, in the first 30 seconds, and he would probably be screaming his head off," Ackerman said. "The priority is to get a full assessment and check for other injuries."

Team members failed to note the changing vital signs. In a trauma setting, someone would have called out that information, Ackerman said, "but we're more interested to see that they're communicating with one another. They are and also [are] doing what they need to do."

Nursing and medical instructors watched closely as first teams gave information to second teams.

"This is the point where misinformation happens, and teamwork is a real priority," said Kaplan, also coordinator of Emory's Charles F. and Peggy Evans Center for Caring Skills.

The teams discussed the experience in a debriefing session facilitated by a medical and a nursing instructor.

Kelly Kachta, a nursing student who worked in an emergency room last summer, said that the simulation reinforced the need to make assessments under pressure. "You really have to think on your toes in the ER," she said.

Earl Johnson, a medical student without ER experience, found it awkward having a team member doing something that he would normally have done himself, but he was pleased to see people performing their roles and listening to one another.

When Ackerman spoke to the group, he talked about how roles are more fluid in real trauma situations and how leadership shifts, depending on who is in the room.

Quick decisions

"Communication was happening, but the formal processes weren't happening," he told them. "We call out and repeat things for the patient's safety. In the team approach to trauma, there are diagrams showing where people stand and protocols to follow, because so much needs to happen quickly.

"But you were talking to each other, and you took your patient in the right direction."

Nursing instructor Corrine Abraham, RN, MN, said that the frustration of getting a medical history while other things were happening was real. She was pleased to see students giving patient-centered care and asking the right questions about drug allergies and other issues.

Abraham referred to a video the group had watched about auto-racing pit crews, saying that the example was applicable to health care but that health care was more difficult.

"In an emergency room, you need to work with that kind of precision, but you won't know the make or model of the car you're working on, and you'll find that all the cars are broken a little differently," she said. "That's when the need for open communication between team members is critical."

Ackerman encourages student nurses to anticipate how a patient will be treated by doctors and to speak up when something radically different is ordered.

"I can't tell you how many mistakes I would have made as a resident, if it hadn't been for more-experienced nurses or team members speaking up," he said.