When a Macy scholar met “Stan, ” a new career path began

When you first meet “Stan,” a computer-controlled mannequin used in Harvard’s medical education curriculum, it seems impersonal to call him by his non-human name: the patient simulator. It doesn’t do justice to Stan—which is short for standard patient—given the enormous influence this human-like teaching tool has had on Dr. James A. Gordon and the students at Harvard Medical School.

“When I first saw the patient simulator, I thought it was the greatest thing I’d ever seen,” said Gordon, director of the MEC Program in Medical Simulation and HMS instructor in medicine at Massachusetts General Hospital, where he is on staff in the Department of Emergency Medicine. “It blinked, talked, moved, had a pulse, heartbeat, and breathed; it was the closest thing I’d seen to a re-creation of the clinical experience.” (Although often referred to as a “he,” Stan has interchangeable parts and can be a man or a woman.)

The simulator is used in teaching first- and second-year medical students, who are not ordinarily exposed to clinical medicine, as well as third- and fourth-year students during their clinical rotations. Simulated drugs and other therapies can be administered to Stan, with resultant changes in vital signs that can be seen, heard, and felt by the students.

Gordon was introduced to the patient simulator at the Boston Center for Medical Simulation, a world-renowned facility founded in 1993 by the HMS Department of Anesthesia, while he was a scholar at the Harvard Macy Institute in 1998. It turned out to be a match made in heaven. “Ultimately, the Macy Institute and my introduction to the anesthesia simulator group during the Macy program changed the focus of my career,” said Gordon, 35, who was a health policy fellow in the Robert Wood Johnson Clinical Scholars Program at the University of Michigan Health System when he came to study at the Macy Institute. Gordon is now on faculty at the Boston Center for Medical Simulation, and is also on the steering committee of the Macy Institute, where he is the section leader on information technology.

James Gordon demonstrates the patient simulator to a group of visiting Macy scholars

Created in 1994 through a grant from the Josiah Macy, Jr. Foundation, the Harvard Macy Institute offers cutting-edge training in medical education for mid-career physicians and spearheads medical education reform. Gordon was a scholar in the Institute’s Program for Physician Educators, and has subsequently completed Program for Leaders in Medical Education as well.

“We designed these programs to address the needs of faculty members who saw themselves as leading education reform efforts and who wanted to learn more about the most effective methods to implement change at their home institutions,” said Elizabeth Armstrong, director of the Harvard Macy Institute, who also directs Education Programs at Harvard Medical International and is associate professor of pediatrics at HMS.

Since the Institute began, it has graduated more than 600 alumni scholars. “The program creates a community of people who have been mentored by leaders in the field of medical education, and who go back to their own institutions with an expertise and credibility that can be used to enhance the entire educational enterprise,” said Gordon.

As the Institute’s resident expert on information technology, Gordon teaches Macy scholars about the patient simulator, as well as other computer and digital technologies that enhance the learning process.

But it’s safe to say his first love is Stan. And he hopes to further evaluate the simulator’s value and cost-effectiveness in medical education. He already has pilot data indicating that 80 percent of patients and educators that have used the simulator believe it should be required for all medical students. In a May 5, 2001 report, published in Academic Medicine, Gordon and co-authors describe their small, pilot study of student and educator responses to the patient simulator. Students said they felt the simulator promoted critical thinking skills and allowed them to build confidence and practice skills, allowing them to integrate basic and clinical sciences. The medical educators said they found the experience realistic, and thought the simulation enhanced learning while fostering teamwork and critical thought.

Whether the mannequins will join the mainstream of medical education remains to be seen, but Gordon thinks the cost of the technology, which is decreasing from near $200,000 to under $50,000, may be a small price to pay to increase knowledge, efficiency, and critical thinking in young doctors-in-training. “We don’t yet know to what extent the simulator can distinguish levels of competence, or enhance understanding and performance in a way that makes a doctor more efficient and less prone to error, but we hope to find out,” he said.

Gordon points out that cockpit simulation training is widely used in aviation, another high-risk, high-stress field where minor errors can lead to disaster and a cool head can save the day.

Indeed, Gordon notes that students often say the patient simulator helps them think on their feet, and that it teaches them judgment, communication, and teamwork skills—all of which could conceivably save a real patient’s life.