AKRON, Ohio — “I’m gonna pass out,” the robot said.

A team of eight doctors rushed about to keep their groaning patient alive, all the while reassuring him that he would be all right.

On this day, the robot portrayed a 19-year-old football player who had fainted on the practice field, and now his heart was beating too fast and his blood pressure wasn’t right.

As his vital signs began wavering, the doctors struggled to give him oxygen, order the right tests and deal with his frantic mother on the phone.

Then the patient stopped breathing.

But the doctors’ instructor applauded her team for managing not to kill the patient.

The patient, a computerized mannequin, lives perpetually in a hospital bed in the newly opened Mount Sinai Skills and Simulation Center in Cleveland.

Although the mannequin can “die,” he made it through this simulated emergency alive. Dr. Kathleen Rosen, the center’s faculty director and the doctors’ instructor for the scenario, only pulled the plug on his heavy breathing once the group was ready to discuss what it had just gone through.

On two recent Thursdays, about 100 doctors from University Hospitals, the health system’s class of newly graduated first-year doctors, came through the simulation center to train in scenarios meant to simulate life.

The 8,500-square-foot center houses “Stan,” the standard man, a $50,000 adult computerized mannequin with a very flexible identity.

While the mannequin is a man anatomically, he can be programmed to be a woman physiologically, to be 80 years old or to have a virtually unlimited number of health conditions.

At his controller’s whim, the mannequin can breathe, have a pulse, blink, cry, bleed or urinate. He speaks in “Wizard of Oz“-fashion, with the help of someone behind the scenes.

The center also has a baby mannequin and eight exam rooms for health-care workers to see standardized patients, locally hired actors trained to portray different kinds of patients.

After several years of planning between departments at Case Western Reserve University, the university opened the center in May with the help of a $10 million grant from Cleveland’s Mount Sinai Health Care Foundation.

A safe place to practice

The center is supposed to provide students and professionals in health care a safe, realistic environment for practice without fear of mistakes, patient death or lawsuits.

“It became apparent that if we want to be on the cutting edge of training and educating all health professionals, (we) needed to have a state-of-the-art simulated environment to do that,” said Dr. Daniel B. Ornt, associate dean for clinical affairs of Case Western’s School of Medicine.

Case Western’s regional, multi-disciplinary center is one of an exponentially growing number of simulation centers like it around the country, said Beverlee Anderson, executive director of the Society for Simulation in Healthcare based in Santa Fe, N.M.

According to Anderson, it’s hard to know how many centers there are in the United States, because there is no standard for what defines them, yet most major medical academic institutions either have one or are in the midst of planning one.

First simulation centers

Medical simulation and standardized patients have been used in health care for decades, but the first major simulation centers sprang up at places like Stanford and Harvard in the 1990s.

Their recent growth, despite their expense, is driven by emerging evidence that simulation training reduces real-life errors and by new demands for the training from the national medical licensing board and health-care agencies, Anderson said.

The main goals of Thursday’s session for University Hospitals’ new residents were to improve the doctors’ communication skills and teach them about diversity, said Dr. Jerry Shuck, director of graduate medical education at University Hospitals.

In the scenario with the computerized mannequin, the doctors were taught to move quickly to appoint a leader in urgent situations and assume designated team roles.

When a caller claimed to be the patient’s mother and demanded details of the patient’s condition, doctors were taught they could not assume that the caller was who she said she was, and they could not legally give out the patient’s information without obtaining his permission.

In another exercise, doctors conducted simulated doctors’ visits in exam rooms with standardized patients, or actors.

Actors have roles

The first patient seen by Dr. Eniko Alicea, a dental resident, was such a good actor that Alicea initially thought he was a real patient.

This man is in a lot of pain and wants a prescription now, she told a program staff member after coming out of the exam room.

By the time Alicea saw her next patient, she knew the scenario wasn’t real, but she tried to handle the situation as she might in real life.

Observers could watch and listen to Alicea from outside the exam room through a one-way mirror and with headphones. As Alicea faced the task of telling a woman she had heart failure, she showed the patient pictures of her heart, explained what it meant and placed her hand on the patient’s as she offered hope for treatment.

Each program director for the residents will be given videos of those simulated patient visits for future instruction, said University Hospitals’ Shuck.

As University Hospitals continues to take advantage of simulation training, Shuck said he will ask supervisors at the hospital whether they are seeing the benefits. Are trainees working better together in teams and more skillfully caring for patients?

Alicea said the simulations gave her practice acting under pressure, delivering bad news and handling situations in which she doesn’t know enough and needs to make a referral — all things she said she will have to deal with in real life.

That’s the point, said Drew Gross, the center’s medical simulations manager. Later on in their experiences, he wants trainees to be able to “look back and say, ‘I’ve dealt with this before.’”

By early fall, the center plans to add another model to its arsenal: Noelle, a woman mannequin who gives birth to a baby mannequin.

The center offers an exciting, better way of teaching, said Rosen, the center’s faculty director. “You can learn very much from (mistakes),” she said. “And you’ve done no actual patient harm.”