Boston Children’s Hospital has invested in a large, amazing, state-of-the-art, high-fidelity simulator programs to optimize learning in the acute care setting. The Children’s Simulator Suite can faithfully reproduce a variety of hospital room, intensive care, emergency room, operating room, and other spaces. The suite was featured in a recent television report. The physician team that leads the simulation program has partnered with a Hollywood special effects studio to create exceptionally realistic simulations. The suite also contains a video control room to record the simulation sessions and conference rooms with linked closed circuit cameras for video-based debriefing and teaching sessions. An example of training in the suite is shown here. The PL-2 year ICU rotation features weekly mock codes led by the residents with video debriefings. In addition, there are frequent procedure sessions led by the ICU fellows to practice procedures such as intubation, central line placement, and chest tube placement.
Boston Medical Center also has a simulation program. At BMC, simulation sessions occur either in a simulation suite or in the PICU by using a portable SimBaby, which can simulate a range of conditions and enables a number of procedures from intubation to IV placement.
The PICU senior and chief residents develop a weekly mock code for the ward team, which starts with interns learning to use basic equipment and progresses to the ward junior running a complex cardiac code. Recent cases have included severe myocarditis and status epilepticus.
Given the importance and complexity of running a code well, the practice of mock codes is not restricted to ICU rotations. They are scheduled throughout the intern, junior and senior years. The focus is on increasing skill level over time, knowing how and when to call for help and importantly, the basics of good communication in running a successful code.