Speech-language pathology simulator provides unique educational opportunities

With internal and external anatomy akin to a human, the SimMan reacts physiologically in many of the same ways that a live patient would, such as through pupil dilation, verbal responses, breathing pattern changes, and saliva and tear production.

Speech-language pathologists assess many different aspects in a patient, including swallowing, speech disorders and cognitive communication disorders. UBC is the first speech-language pathology program in Canada with a simulator like the SimMan, known formally as a high-fidelity patient simulator. Such simulators are often used in healthcare training for nurses, physicians or emergency medical professionals.

“Basically, the ultimate goal for the simulation is to enhance the education experience for the students, afford them the opportunities that … they might not get before they are out in the workforce, and then to give them a safe space for learning and a place where they can get … really systematic mentorship and then an opportunity to redo things,” said Dr. Stacey Skoretz, an assistant professor in the School of Audiology and Speech Sciences and director of the Swallowing Innovations Lab at UBC.

Skoretz has programmed the simulator to respond to different actions and instruments used in swallowing assessments, and has also created unique scenarios for her students. To develop a range of skills that they can eventually apply to a live patient, students can practice both instrumental and clinical assessments on the SimMan. Instrumental assessments, as the name suggests, involve using diagnostic tools or imaging to conduct swallowing tests. Clinical assessments, by contrast, are more like visiting a doctor’s office, where instruments and imaging are not usually involved.

“What simulators can do is they can afford the opportunity for students to practice different things before they go out and do it on live patients,” said Skoretz. Unlike with a live patient — where one mistake may lead to serious consequences — the simulator creates a low-risk environment where students have multiple opportunities to repeat cases and improve their approach.

By harnessing the SimMan’s technology, Skoretz can also simulate important but rare cases for her students to practice with. “It helps [students] to learn about situations … [like] health emergencies that are very important, but a lot of students don’t necessarily get the opportunity to learn that out in clinical practice because thankfully, you know, critical things don’t happen all the time,” she explained. “But [students] need to be prepared for them.”

Skoretz noted that swallowing is linked to many other body systems — like the respiratory system — and that difficulties in one will often affect another. The SimMan is programmed to help students understand how patients react across multiple body systems by allowing them to observe reactions like throat-clearing or coughing that may occur simultaneously with swallowing.

“What I’m trying to help the students bring together is ... the multiple systems that are involved in swallowing,” Skoretz explained. “It’s not just [that] you just look at the swallow — we look at many other components of the human body because … they’re all so interconnected.”

To provide students with a realistic experience, Skoretz has synchronized swallowing video footage from real patients with the corresponding physiological responses in the SimMan.

For example, some tests involve special instruments, such as the fiberoptic endoscopic evaluation of swallowing, where students can pass a thin tube with a camera on the end through the simulator’s nose and through a part of the body called the nasopharynx. They are then able to see the SimMan’s airway and swallowing on another screen, like with a real patient. If fed by a student, the simulator responds accordingly, producing responses with synchronized imaging that helps students learn about the effects of their decision-making during their assessments.

“What I’ve done is I’ve superimposed it, so as the students are feeding the simulator different things, I’ve got real images of those things being swallowed, and then the simulator is programmed to respond accordingly,” Skoretz explained. If the student feeds the simulator and food goes down the wrong pipe, for example, the simulator is programmed to react the same way a human would. This allows the student to link what the simulator does to what happens inside of a live patient, painting a holistic picture of inner and outer processes across multiple body systems.

After conducting a swallowing assessment on the SimMan, students make treatment decisions in consultation with the patient.

Skoretz also added that the SimMan reflects a patient’s psychological state as well as their physical one. During simulations, a real person is miked into the SimMan. The actor can alter their speech, language and energy level in response to treatment, allowing students to practice assessing a patient’s cognitive state.

Although the SimMan provides a novel way for speech-language pathology students to develop their skills, it still has some limitations. For example, the simulator’s cheeks and tongue are immobile and its lips cannot close together like a real human’s. Though formal plans have yet to be established, Skoretz has ideas to improve the simulator and create a more seamless experience for her students, potentially by introducing augmented reality.

“I think there’d be ways that we can work with 3D imaging and 3D projection to enhance the experience for the students, so that they don’t have to switch between … looking at a flat screen in a multimedia file, but yet draw it all together so that the experience is kind of all-in-one,” Skoretz added. With these integrated aspects, the SimMan would better model a live patient, further enhancing a learning environment where UBC students can assess, practice and develop their skills.

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