Scenario teaches students to treat patients with intellectual disability

The man lying on the hospital bed seemed confused, uncooperative and fearful. Then Brea Davidson approaches him with a colorful blue bandage and a genuine smile.

It is exactly the kind of lesson Callie Ray was hoping she and the other students would learn.

Ray, a fourth year student at Medical College of Georgia at Augusta University, is the first to complete a new elective course on creating her own medical simulation scenario for students and she chose to focus on one of her special interests, treating patients with intellectual disabilities. The scenario involved a 30-year old man named Tom Smith, really a medical simulation mannequin where Ray in an adjacent control room provided the voice, who was being prepped for surgery but whose IV had fallen out and whose caregiver had stepped away to go home.

The five third-year medical students who cautiously entered the room in the Interdisciplinary Simulation Center have to convince the patient to allow the nurse to put the IV back. Jackson Reynolds squats down next to the bed so his face is at the same level with the patient, a move he saw when he was shadowing physicians in high school, "because it's intimidating" to tower over a patient.

He tries explaining what will happen without using medical jargon but Ray as the patient stubbornly resists it. Maya Milton finds his panda bear nearby and holds it out to him and he eagerly accepts it. Heeyah Song remembers being told the patient likes art and offers to let him color. The colorful bandages are the final piece to gain acceptance as the scenario ends with a successful IV placement.

"Nice work, said Dr. Matthew Tews, associate dean for educational simulation, as he watched from the control room. "That was fantastic."

Leaving the students on their own in the room is a big part of the learning experience, said Dr. A.J. Kleinkeksel, course director and assistant professor in the Department of Medicine.

"Our goal is to get them to do as much as they can" themselves, she said. But it can also produce some anxiety for the students, even though they know the scenario is not real.

"The feeling of being responsible for something is not something they are used to" at this stage of their education, Kleinheksel said. One student told her that he has been disciplined to think in terms of "multiple choice answers" and simulations allow them to think more openly and creatively.

"I hear this all the time," Tews said. "Why didn't we get this sooner?"

A big part of running a simulation is the debriefing process and Tews compliments the students on how they approached the scenario. Adam Aston said they were more expecting to have their clinical skills challenged "and this one tested us as far as our human abilities." Milton said she too was prepared for a medical challenge, "then it's like bringing us back to reality. You need to know how to talk to people first."

Ray, who wants to go into child neurology, said it can be difficult to treat patients with intellectual disability who may also have a limited ability to convey what is wrong.

"With an intellectual disability, sometimes they may not understand why they are in a hospital," she said. "So really the No. 1 goal is to make them comfortable and to make them understand as much as possible when they are in that uncomfortable situation."

Ultimately, it is to help the students become better communicators and caregivers, Ray said.

"We're trying to figure out different ways we can expose students to learning how to communicate with people that are different from them," she said.

The Interdisciplinary Simulation Center at Augusta University helps train all of the health-related professions at the university in high-tech simulation labs that allow students to hone their skills without risk to actual patients.

Simulation health care training