The secret world of mannequins

Many people associate mannequins with the shop windows of department stores but they have another less well known but vitally important role in training doctors and nurses.

Hidden away on Great Ormond Street Hospital’s (GOSH) fourth floor, the Clinical Simulation Centre (CSC) team is revolutionising the way we think about learning and development. State-of-the-art mannequins are being used to provide groundbreaking training to clinical staff. Many other industries, including aviation and the armed forces use similar cutting-edge technology.

By recreating different crises using a realistic patient mannequin that can mimic the physiology of diseases, the team can test staff’s responses to stress, things going wrong, and all aspects of clinical care.

Dr Richard Paget, Medical Lead for the centre, Children’s Acute Transport Service (CATS) Consultant and Cardiac Intensive Care Consultant, and Elizabeth Akers, Non-Medical Lead for Clinical Simulation are both very excited about how this state of the art technology is improving patient care.

How it works

There are two simulation rooms – a ward bedroom and an intensive treatment unit room. Both aim to replicate the real-life clinical environment.

"We discuss what the expectations are and talk through the learning objectives," Dr Paget explains. “For example – in this exercise, we’ll look at how you diagnose an illness, how you communicate within the room or how you escalate any concerns.”

Candidates are given the back story to each case to make it as realistic as possible.

"By taking part in a simulation, candidates can learn new clinical skills, practice working as a team and, importantly, have the opportunity to run through events that might not happen very often but are considered high risk," says Elizabeth Akers, adding that how staff perform in these situations can be ‘transformative’ or ‘devastating’ for a child.

The control room

Mannequins are controlled and staff are observed from a special control room. New circumstances can be added into the mix from the control room part-way through the training exercise such as equipment failure.

There is a lot of scope to generate a range of clinical signs in the mannequins that require fast diagnosis such as a swollen tummy, a sudden change in heart rate, or interchangeable pupils, which might represent neurological problems. The neonatal mannequin’s face can also change colour and go bright blue to reflect when a child’s oxygen levels are too low.

Afterwards there is a detailed debrief where both trainers and trainees can give feedback.

Teamwork

Teamwork is key to delivering the best outcomes for patients according to Dr Paget: “If you think about teamwork, even the most skilled footballer or virtuoso violinist spends a large proportion of their time practising as part of a team. Team effectiveness relies on efficient, structured communication and understanding from all its members.”

While other hospitals also use mannequins for training GOSH offers unique specialist programmes for areas like anaesthesia and critical illness.

“We have a specialist laparoscopic (keyhole surgery) room, which is used by surgical trainees,” says Elizabeth Akers. “The purpose is to help candidates develop muscle memory and increase dexterity while practising laparoscopic skills."

Mannequins around the world

“I often carry mannequins on the train or in my car!” says Dr Paget. This is because he does a lot of outreach training – locally, nationally and internationally.

“We’re hoping to go back to India this year and run neonatal intensive care courses in three large cities.” He says. “On our last trip, we took what can only be described as an inflatable igloo with us, but when it was inflated, it looked like an intensive care backdrop.”

3D-scanning and virtual reality

In many ways this work is in its infancy but the technology is developing fast.

The team is working with a 3D-scanning company to build mannequins that can open and close their eyes.

There’s also work underway to make prosthethic tissue and skin, and to build on GOSH’s work to develop mannequins for surgery.

“We want to be able to open their chest in a cardiac emergency scenario and have mannequins specially designed for keyhole surgery,” says Dr Paget. “There’s nothing currently on the market for laparoscopy and so this is an exciting area for us to lead. There's lots of exciting possibilities in our future!”