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Blazing a New Trail in Training

Matthew W. Zackoff, MD, MEd

Our primary responsibility as clinicians is to care for children. We spend our days working at the bedside to provide the best interdisciplinary (physician, nurse, respiratory therapist, pharmacist, child life, social work, etc.) care we can – saving children when we are able and supporting them and their family when we are not. We additionally work on several fronts to improve the care for children either through research into new therapies or approaches, implementing new safety processes, or improving our clinical care.

One of our most fundamental responsibilities is as teachers, to train care providers within and without of the PICU to recognize sick children and appropriately and efficiently intervene. The Division of Critical Care Medicine is internationally recognized for our work in innovating new approaches to training to improve the care we provide to children. Our work leverages established and new technology to enhance training, including high quality videos and animations, cutting edge computerized mannikins, augmented reality, and virtual reality.

Nearly every week, a member of the Division of Critical Care Medicine is using a computerized mannikin, with the help of our Center for Simulation and Research, to train teams of care providers on the inpatient wards or in the PICU. These highly advanced tools are constructed to look like our patients, connect to vital sign monitors, and allow the administration of medications, chest compressions, breathing tube insertions, and pretty much anything else we do caring for patients. The scenarios we create focus on core skills that are reinforced on a regular basis – such as roles and tasks during a code event – or are in response to unexpected events to allow us to learn from our experiences and prepare for their occurrence in the future.

We have gone a step further than any other center in the country with the incorporation of augmented reality into some of these training scenarios. Through the use of mobile computerized headsets, we can project a virtual patient on top of the computerized manikin, allowing the participants to see the clinical findings (facial expressions, speech, skin color changes, work of breathing) of a real-life patient. This brings the realism of the experience way beyond what is otherwise possible and gives us new insights into what care team members notice – providing an opportunity for training on more nuanced or subtle findings that can have profound impact on a patient’s trajectory.

Going a step further, we have created completely immersive virtual training experiences through the use of virtual reality. When participants wear the headset, they are transported to a completely virtual hospital room that includes virtual staff, virtual patients, and virtual equipment. This allows us to simulate experiences that are not otherwise possible. Our work has included a scenario with an infant with severe respiratory distress, to train frontline staff on how to recognize which children require an escalation of care to the PICU. We’ve recently implemented a scenario that allows a team (physicians and nurses) to work together in a virtual environment to take care of a patient with sepsis – a severe infection – focusing on key findings and what interventions need to happen quickly in order to prevent worsening. Through this work we are driving increased clinical knowledge in skill, which promotes a safer care environment and better outcomes for patients throughout Cincinnati Children’s and with time throughout the world.

Blazing A New Trail In Training
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