Medical simulation participants often struggle to connect with human patient simulators, which may in part detract participants from achieving learning objectives. Significant effort is placed into setting the scene for participants, allowing them to explore the simulators and environments, and emphasizing the use of good practices associated with simulation education.

Comments, however, often still arise about inadequacies in the reality associated with their learning experience, and this impacts the learning experience for some.

To help combat this problem, the 10,000-square-foot Women's Guild Simulation Center has been developed to represent the clinical environment at Cedars-Sinai Medical Center in Los Angeles.

The clinical environments are exact replicas of the relevant clinical areas within the institution. The rooms are additionally equipped with nurse call systems as well as the hospital's patient record system. Each "patient" has its own medical record that can be accessed using the clinical systems that staff use daily.

Despite the significant effort to reduce the need to suspend reality, limitations still existed that related to physiological parameters — such as invasive lines and waveform capnography — that are commonly required in many of the simulations. The desire to enable staff to use actual clinical monitors was a driver to seek a solution that was achieved in two forms.

The decision to purchase human patient simulators that connect to real clinical equipment was a first priority. The simulators allowed the recording of continuous ECGs, pulse oximetry, NIBP and ETC02, and they helped break down many of the barriers of simulation. However, this still did not meet the challenges associated with invasive lines on real patient monitors.

Around 60 percent of all activity within the simulation center involves team-based simulation, and a lot of the simulation involves patients in higher-dependency environments. Typical simulations involve anesthesia, ECMO and ventricular-assist devices, thus most require the display of invasive lines. The traditional simulated monitors did not meet our needs and desire to "make it real," so alternatives were needed.

The solution has been found in the form of biomedical-testing devices. When placed behind actual patient monitors, these devices can be programmed from the control room. The integration of these devices allows staff to use the patient monitors they use daily, in the exact area they work in daily with the real medical equipment they use daily.

The innovative use of this technology combined with curriculum design, facilitation and debriefing provides an experience that offers candidates an immersive learning environment. While such approaches are not essential to achieve learning objectives, they certainly help some learners engage in in this learning style — especially those who may have experienced difficulties previously.