Russian doctors train on use of simulations at CAPE

Lucile Packard Children's Hospital

A medical team that includes visiting Russian doctors treat a "patient" -- played by Julie Arafeh of CAPE -- during a simulation.

A Russian delegation recently visited the Center for Advanced Pediatric and Perinatal Education, known as CAPE, at Stanford to learn how it uses simulations to prepare health-care professionals for managing emergencies in the delivery room.The delegation comprised five obstetricians, two neonatologists and a neonatology student from the Pirogov Russian National Research Medical University; one anesthesiologist from the N.V. Sklifosovskogo Research Institute of Emergency Medicine; and two medical education specialists from Aribris, a continuing medical education center in Moscow.

The group attended the four-day simulation instructor program at CAPE. "We learned a new way to teach, which we might not only use in simulation but also in our faculty practice," said Marina Osanova, general director of Aribris.

CAPE, which is affiliated with Lucile Packard Children's Hospital and the School of Medicine, replicates a modern American hospital environment. It uses lifelike mannequins, complete with beating hearts, pumping lungs and auditory cues (provided by staff members working in a separate control room) to generate a high degree of realism during the simulated clinical crises.

Center for Advanced Pediatric and Perinatal Education

From left: Russians Marina Degtyareva, Maria Degtyareva and Yulia Vorontsova participate in the simulation instructor program at CAPE.

The Russians took part in simulated birthing scenarios in which problems developed for the mother or her newborn, or both. Program instructors were physicians and simulation specialists from CAPE, led by Packard Children's neonatologist Louis Halamek, MD, professor of neonatal and developmental medicine and the center's founding director.

"With simulation-based training, it's all about interactivity of the trainees," said CAPE business manager Barbara Beebe.

Effectively interacting with nonphysician members of the health-care team was one of the biggest challenges for the Russian physicians. Because they work in a hospital culture that is more hierarchical than that of the United States, skills such as teamwork and communication receive less emphasis.

"In the U.S., we've been evolving toward a multidisciplinary team model, with doctors, nurses and other team members functioning as equals when they're dealing with a crisis," Halamek said. "Exposure to the American style of professional interaction was an important part of the Russian doctors' experience here."

This was not lost on the team from Russia. "We need to change our culture to promote better communication between physicians and nurses," said Marina Degtyareva, MD, head of neonatology at Pirogov.

After every simulation, instructors debriefed the trainees, asking questions about how the scenario unfolded — what worked, what didn't and what could be changed for the better.

Not all the Russians were fluent in English, so CAPE employed several local health-care professionals who were fluent in Russian: A Stanford-trained neonatologist, a local nurse midwife and a Stanford emergency-medicine nurse. They participated in the scenarios, facilitating communication during the simulated clinical scenarios and the debriefings. In addition, a professional interpreter provided instantaneous translation during the entire program.

Members of the delegation plan to use what they learned at CAPE to promote the use of simulation to train health-care professionals in Russia. "Well-run simulation-based training reflects a systemic understanding of how many different parts work together to improve patient care," Degtyareva said.

As one of the foremost simulation-based training and research centers in the fetal, neonatal, pediatric and obstetric sciences, CAPE has received increasing interest in its programs, Halamek said.

"We have our own unique approach, which is modeled after that taken by many other high-risk industries," said Halamek, who was inspired to create CAPE by the rigorous training required of NASA astronauts. "These international programs are a tremendous opportunity to disseminate our approach to hands-on, simulation-based training to health-care professionals around the world and also to gain insights and learn new strategies from them."