From simulation to application

March 2

by Alison

Last time I wrote about how helpful our Harvey session was for learning to identify and characterize cardiac pathology.  At the suggestion of our supervisor, today we went to examine real patients for cardiac findings, to see if we could apply the skills we practiced with the simulator. 

With the help of the chief resident we identified two patients with cardiac findings and went to see them on the ward.  With a newfound confidence, I performed a cardiac exam on the first patient.  However, I had an enormous amount of difficulty hearing the patient’s murmur.  He was in a noisy four-bed room and was breathing quite loudly.  I could barely hear the heart sounds, let alone characterize the abnormal findings.  Unlike with Harvey, I couldn’t just turn up the volume to better assess the patient.  The new comfort I had with murmurs from spending time with Harvey was certainly diminished.  The second patient was in a quiet single room and was breathing very comfortably.  With him, it was easy to hear his murmur and to characterize it, providing me with some reassurance.

This experience served to highlight the limitations of simulators in learning.  Simulators generally operate under optimal conditions, and therefore cannot replicate a real patient-care experience.  Ideally learning incorporates elements of both: simulators to help with skill development and confidence, and patient-care experiences to reflect reality.