This 8-pound robotic baby cries, grunts and blinks, all while helping to educate medical students
By Doug Bennett
As the newborn boy struggles to breathe, the UF Health pediatric residents gather around him. They need to act quickly and work together to
One resident organizes the five-person team, assigns roles for medications, the baby’s airway, charting and other duties. In mere moments, they are immersed in treatment.
Elizabeth Donner, M.D, then a third-year resident, notes the baby’s rapid, shallow breathing.
“What’s our respiratory rate and oxygen saturations?” she asks. Then, a decisive move: “Let’s prepare intubation materials.”
Among the group, there is focused determination. Donner calls for saline and broad-spectrum antibiotic. A few steps away, Kourtney Guthrie, M.D., writes furiously on a whiteboard, documenting a cascade of medical details. The baby’s heart rate is fluctuating, she tells the group.
As Donner orders a chest X-ray and electrocardiogram, a nurse notices the baby was jittery. Then, without warning, the infant’s heart stops. Another resident, Brittany Bruggeman, M.D., starts chest compressions. The residents decide on defibrillation, an electrical pulse to restore a normal heartbeat.After three shocks, it works: The baby is stabilized and survives.
The medical scenario was true to life, even if the baby wasn’t.
The residents who participated in the scenario worked on Super Tory, a state-of-the-art simulator. The 8-pound, 21-inch baby is astonishingly lifelike: Supple skin, bony points, moving joints, variable breathing and an umbilical cord. It even cries, grunts and blinks.
Residents use it to practice medical interventions, including airway intubation, mechanical ventilation, and IV insertion. The baby reacts in real time and can depict many conditions: seizures, bluish skin that indicates poor circulation, the yellow tinge of jaundice, abnormal bowel sounds and other medical issues.
The simulator lets residents learn and practice without the high stakes of a real patient, said Jennifer Munoz-Pareja, M.D., an assistant professor, pediatric simulation director and pediatric critical care fellowship director in the UF College of Medicine’s department of pediatrics.
Human simulators have been shown to increase patient safety by allowing residents to practice a variety of medical procedures including airway treatments, life-support procedures and blood vessel access. They also help residents hone their organizational skills.
“One of the most important reasons we do simulation is that we want to know how they work as a team and handle crisis resource management,” Munoz-Pareja said.
She especially likes the simulator’s look, feel and versatility. Residents can learn how to access an infant internally through the umbilical cord, perform injections into the bone marrow or insert an intravenous line in a scalp vein. As a pediatric critical care specialist, Munoz-Pareja appreciates how the simulator lets residents practice specific, crucial procedures like inserting a chest tube or connecting an infant to a ventilator.
“It’s very realistic. You feel like you’re dealing with a real patient,” she said.
The simulator does more than react. It also tracks residents’ performance in real time. Was the intubation done correctly? Were the chest compressions the correct rate and depth? Was CPR started in time? Super Tory knows, and it shares those details with clinical instructors.
As the residents worked on the simulator, Munoz-Pareja took detailed notes. Her observations and the simulator’s data became part of an extended debriefing with a larger group of pediatric residents. Managing the patient’s condition is crucial but so is optimizing the care team’s actions and making the best use of medical resources, she told the group.
On this day, it was about more than just saving the baby. The residents were evaluated on how their team managed itself, how they allocated the available medical resources and whether the patient’s conditions were addressed.
The five residents did well in assigning specific roles, establishing a group leader and overall patient management, Munoz-Pareja said. She also found some teachable moments and challenged the residents with pertinent questions: One medication could have been a slightly larger dose. Did the baby’s temperature suggest that sepsis — a dangerous infection response — was a possibility? Would sedation have increased the odds of success?
Munoz-Pareja used the debriefing to make the residents think broadly: What other medications did you have available?
Outcomes matter, she said, but so does the process. She probed and pushed the five residents, going beyond just the medical results: What were you feeling during the procedure?
What was your thought process?
Donner, the team leader, said she wanted more hands to help. Another group member admitted that the baby’s high temperature threw her off momentarily.
Since Super Tory arrived at UF Health in late 2017, it has become an indispensable medical education tool, Munoz- Pareja said.
“It gives you an opportunity to evaluate your students in a way that isn’t threatening to their confidence,” she said. “I can evaluate, step by step, how they’re treating a patient. The residents can see and treat seizures. If they intubate incorrectly, it will tell them. It’s a pretty wonderful tool.”
MEET SUPER TORY
AGE: Full-term newborn
WEIGHT: 8 pounds
LENGTH: 21 inches
MOVEMENT: Mouth; arms and legs (flex and extend); blinking eyes and visible chest rise (all programmable); head tilt; chin lift; jaw thrust and forearm rotation
SELECTED ANATOMICAL/MEDICAL FEATURES:
Crying and grunting with visible mouth movement; seizures/convulsions; anatomically accurate airway; realistic skin for cutting and suturing; healthy and abnormal heart and bowel sounds; programmable abdominal distension; recognizable bony landmarks
TECHNOLOGY: Detects and logs intubation depth; real-time quality feedback for breathing and cardiac treatments; comprehensive library of electrical heart signals; CPR voice coach; visible, variable jaundice and skin redness/paleness
MANUFACTURER: Gaumard Scientific, Miami.
Visit https://bit.ly/2TWbx7t to see a
UF Health video about the
Super Tory pediatric simulator.