NO DUMMY: Smith-Coggins and Harter show how SimMan can be intubated. Glenn Matsumura

“I feel terrible,” the 20-year-old emergency-room patient moans. She’s wheezing badly and getting dizzier by the minute.

Doctors move quickly to fit a nasal cannula over her nose and start administering oxygen. They check her heart rate and blood pressure, call for an EKG and put their stethoscopes on her chest to listen to her lungs. Detecting severe bronchospasms, they decide to hook her up to an albuterol inhaler and do an epinephrine IV drip. As her stats drop, they begin manually bagging her, forcing air into her lungs. It’s touch and go.

Well, sort of. The patient is actually a $35,000 patient simulator—a plastic mannequin that speaks, breathes, and has carotid and femoral pulses. An invaluable teaching tool, SimMan can go by the alias of Josephine or Joe, depending upon which genitalia and wig s/he is outfitted with on any given day. “Standardized patient actors are also simulators,” says David Gaba, professor of anesthesia and associate dean for immersive and simulation-based learning. “But they don’t like to get stuck with needles, have tubes put in them, or have serious diseases and die.”

Gaba is fondly known as the “father of simulation” by physicians at the Veterans Administration Hospital, where one of Stanford’s simulation centers—the oldest in the nation—is located. The School of Medicine also trains students on simulators at the Stanford Center for Advanced Pediatric Education, in the Stanford Barn, and this fall will open a third center, for the department of surgery. Gaba adds, “when the big new medical education building opens in 2009, one-quarter [of it] will be a learning center that will combine all the modes of immersive learning—standardized patients, mannequin-based simulators, virtual reality and part-task trainers,” which are simulated portions of the body, like an arm on which to practice sutures.

The voices behind Josephine and Joe at the VA center belong to Rebecca Smith-Coggins, associate professor of surgery, and Phil Harter, assistant professor of surgery. They take turns sitting behind a one-way mirror in a control room next to the simulated emergency room, turning up the dial on heart rates and contributing the occasional “Ohhhh, I think I’m gonna die.”

In addition to training interns and residents, the pair also teaches Introduction to the Management of the Ill Patient, a course for second-year medical students. Working on the mannequins, aspiring doctors learn how to start IV lines, insert breathing tubes, treat severe allergic reactions and defibrillate patients in full arrest. Says Practice of Medicine course director Clarence Braddock, “It gets them as close to what it’s like to take care of a really sick patient as we can.”