Before the transition from novice to expert, a clinician -- whether physician, nurse, or allied health professional -- needs to gain experience. One method is through repetition, and human patient simulators provide an interactive and immersive learning experience without risk to actual patients.

Historically, patient simulators such as CPR manikins and IV arms have been decidedly low-tech, but recent technical advances have dramatically expanded simulators' capacity for complexity.

This new generation of simulators incorporates virtual reality, giving the learner the opportunity to engage in practice with haptic feedback. At Duke, a high-fidelity life-sized medical manikin called SimMan 3G joined the Clinical Education & Professional Development (CEPD) department in 2009, enabling the simulation of hundreds of clinical situations, even high-risk procedures that occur with low frequency.

"You can set up any scenario you want, including code situations where resuscitation attempts succeed or fail, then discuss what went right or wrong. That helps recently licensed nurses and resident physicians recognize their anxiety, learn from mistakes, and be better prepared for real-life emergencies, where every second counts to save lives," said Pam Edwards, RN, EdD, associate chief nursing officer for education, in an interview published in the October 24 - 25, 2009, issue of the Wall Street Journal.

In the case of a simulation where the patient's condition is deteriorating, the SimMan's vital signs will change, the "patient" will begin to sweat, and even will talk in an anxious tone.

While performing CPR on the SimMan, the learner is able to get a visual of how well the lungs are being ventilated and how deep and fast the chest compressions are, indicating effective and high-quality CPR.

Learners can even shock the SimMan using real defibrillators. When coding patients, these two factors -- early defibrillation and high-quality CPR -- positively affect outcomes.

Creating this real-life simulated experience provides the learners with an opportunity to practice the basics and advanced skills together to enhance patient care and safety.

The SimMan 3G's capabilities extend beyond medical procedure simulation. According to a 2006 statistic from the Institute of Medicine, at least 1.5 million medication errors take place in the United States each year, resulting in billions of dollars in extra medical costs. The most common errors are omission and giving the wrong dose, and the SimMan 3G has protocols to address both issues.

SimMan 3G contains a large drug formulary and provides the learner with the opportunity to administer medications using RFID (radio frequency identification) technology. With RFID tags transmitting information to a networked system, the medication can be administered and the exact physiologic responses can be elicited from the simulated patient.

It presents the learner with the complete cycle of administering medications -- identifying the drug and the dosage, confirming the route of administration, observing for side effects, and evaluating the drug's efficacy -- one more essential element in providing safe and quality patient care.