Editor’s note: An earlier version of this article incorrectly spelled Mark Rose’s last name in a photo caption. This article has been updated with the correct information. CityView apologizes for this error.
Cape Fear Valley Health’s simulation center on Owen Drive was one of 64 training facilities recognized this year by Becker’s Hospital Review, a health industry trade publication.
The publication told CityView it spotlighted the simulation center because it creates a safe, controlled learning environment for residents to practice their skills, enhancing patient safety and outcomes. It also highlighted that the center will train future medical students through Cape Fear Valley Health’s partnership with Methodist University to create the region’s first medical school.
“We included Cape Fear Valley Health’s simulation program thanks to its use of advanced high-fidelity simulators and surgical platforms, and its role in preparing future care professionals via residency programs and the upcoming medical school,” said Anna Falvey, list writer for Becker’s Healthcare.
Most simulation centers across the county feature an open-concept layout with a lecture hall in the front and simulation technology at the back. Cape Fear Valley’s center looks more like a mini hospital floor. It has a waiting room for residents and physicians to practice working with a patient’s loved ones. There are scrub sinks where they learn proper hygiene before a procedure. There’s a surgical room, one designed to be an ICU and another dedicated to labor and delivery.
Close to 11,000 physicians within and outside the Cape Fear Valley Health system passed through the center’s four simulation rooms last year. Those rooms provided physicians with seven types of lifelike patient mannequins, five surgical science simulators and 19 smaller training devices to improve treatment and teach procedures.
“We really based it off the procedures we do in the hospital, the demographics of the patients we see. That’s really our driving force,” said Mark Rose, Cape Fear Valley Health’s director of workforce development. “We also wanted the capability to use our own equipment that they [physicians] use in the hospital as we’re doing procedures on the simulators. So all the ventilators we use are the same ventilators we use in the hospital. The EKGs are the same EKGs that we use in the hospital. The scrub sinks are the same ones we use.”
Practicing on a patient who never dies
Much of the simulation center’s over 2,100 individual simulations conducted last year use adult and child mannequins that can speak and scream, blink, raise their arms, turn their heads, and make breathing and other noises. Their pupils can dilate, their tongues can swell and their skin can turn blue or red to simulate different conditions. Almost any common symptom experienced by a real patient can be programmed to happen on the mannequins.
While the mannequins have preprogrammed phrases, Rose and his simulation team can also speak through them using microphones in a given simulation area’s control room. These rooms have one-way mirrors that let the team monitor the simulation and choose the mannequin’s symptoms and vitals.
The mannequins can also be programmed to have symptoms change because of a physician’s actions. For example, if a physician fails to perform a procedure by a certain time or does a procedure poorly, the mannequin can be programmed to go into cardiac arrest.
“We’re fortunate for the level of our technology,” Rose said. “But what I’m most proud of is the education we’re doing.”
Rose and his team are in charge of helping physicians create simulations. It’s a collaborative effort; the physicians fill out a template specifying learning objectives and patient characteristics that the team uses to build the simulation. Some physicians want to practice a specific procedure. Others want to practice bedside manners and how to explain diagnoses to patients.
As a result of the training, Rose said units are seeing improved patient outcomes and satisfaction. He said one laboratory team that came in to practice bedside manner saw its satisfaction scores increase within 90 days of running various simulations based on patients’ past feedback.
Rose said the team will never have simulated patients die unless it accomplishes a learning objective.
“I’ve had some [physicians] be like, ‘I want the blood pressure to drop here. I want the heart rate to go up here. I want them to code here. I want them to have a seizure here,’” Rose said. “I’m like, ‘You lost me at the heart rate.’ You’re not learning anything at that point. You’re going backward and then people stop wanting to come. We’re trying to make this a psychologically safe learning environment.”
The simulation center’s two large classrooms provide space for a pre-simulation briefing and post-simulation debriefing, which includes watching a recording of the simulation to determine where it went well and poorly.
A back room in the center provides space for smaller handheld training on “task trainers,” silicon body parts like torsos, arms and throats.
Expanding as a teaching hospital
The simulation center was part of the health system’s $30 million Center for Medical Education and Neuroscience Institute. One of the main purposes of the five-story, 120,000-square-foot building is to support the health system’s residency program and expansion of the Medical Center as a teaching hospital.
“I have brand new residents coming in and being like, ‘I got my first intubation the other day and the only reason I got it so quick is because I did it a hundred times here before I ever saw it,’” Rose said. “So we’re definitely seeing improvement on the procedures we’re doing.”
Since Cape Fear Valley’s residency program began in 2017, it’s graduated physicians into specialties like cardiology and family medicine. Currently, it has over 275 residents practicing and more than half have committed to work in the health system upon graduation.
The development of the Methodist University Cape Fear Valley Health School of Medicine, a medical school partnership between the health system and Methodist University, hopes to increase that figure. The school will have an inaugural cohort of 80 medical students in 2026, all of whom will train in the simulation center.
Sixty-seven percent of physicians who complete medical school and residency in North Carolina remain in the state to practice, according to research from UNC-Chapel Hill’s Cecil G. Sheps Center for Health Services Research. As of September 2024, Methodist University has set up 300 residency and fellowship positions in Cumberland County and the Sandhills region, hoping students will stick around to practice once they graduate.
While excited to train the next generation of medical professionals, Rose said it’ll strain the already jam-packed simulation center. The simulation team ran 58,000 hours of simulation training last year for physicians and residents with just a three-person full-time staff and mannequins approaching and past their eight-year life expectancy. The birth and delivery mannequin, which averages hundreds of simulated deliveries a day, is almost eight years old. Another mannequin is 15.
“We’ll probably double [the number of simulation hours] because of the med school,” Rose said. “And that’s going to be the challenge with the equipment, the time.”
While Methodist University is bringing in staff to help run the simulations, Rose hopes Cape Fear Valley Health’s administration will consider expanding the simulation center and purchasing more mannequins and other simulators to accommodate its increased use.
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the CityView News Fund.
