Call me HAL: UTC nursing students learning from state-of-the-art patient simulator

The patient, according to the nurse practitioner, was in distress.

“My chest hurts. I feel really nauseous.”

The nurse practitioner was Dr. Chris Doneski, a new adult gerontology acute care nurse practitioner (AGACNP) faculty member at the University of Tennessee at Chattanooga.

The patient was HAL® S5301, a manikin manufactured by Gaumard billed as the world’s most advanced interdisciplinary patient simulator.

HAL has artificial intelligence capabilities and can speak, mimic many different emergent situations such as strokes and heart attacks, and be utilized to practice numerous invasive procedures.

“If I had to put a number to it with HAL, we’re almost 90-to-95% there as far as a real scenario,” Doneski said. “Obviously, you aren’t going to get some of the talk back or some of the cues that you would get from a real person, but as far as the skin feel, the lung feel, the feel of doing a procedure, the feel of utilizing your room, that’s all there here at UTC with this new manikin.”

Welcome to the next generation of simulation.

Dr. Chris Doneski performs an intubation on HAL, the School of Nursing's new simulator. Photo by Angela Foster.

Dr. Chris Doneski demonstrates an endotracheal intubation on HAL, the School of Nursing’s new simulator. Photo by Angela Foster.

Doneski, a nurse since 2008, joined the UTC School of Nursing in January as a part-time faculty member alternating weeks with Assistant Clinical Professor Dee Blanken-Little. When Doneski isn’t at UTC, he is a nurse practitioner at CHI Memorial Glenwood Hospital in Hixson.

Doneski came to UTC with a long history of teaching simulation through the use of medical manikins. He was immediately tasked with working on a project—along with Blanken-Little and Assistant Professor and AGACNP Coordinator Christi Denton—which he has affectionately dubbed “Project Guinea Pig.”

The assignment: bring a newly purchased revolutionary manikin to life for School of Nursing students.

HAL, like Doneski, was also an early 2024 School of Nursing arrival.

“It has been a whirlwind. This was my first foray into creating a whole personalized experience,” Doneski said. “You have to build a scenario on paper, then create the computer software scenario. But once you get it done, it’s absolutely magical. It can be utilized over and over and over again.”

AGACNP focuses on managing complex health needs and commonly works with critically ill adult patients in an acute setting such as a hospital emergency room or a special care unit.

After programming HAL, Doneski said the manikin’s “maiden voyage” with the UTC AGACNP students was a high-fidelity simulation.

High fidelity refers to the degree of realism and accuracy incorporated into the simulation scenario—including equipment and environment utilized to mimic real-life clinical situations. The School of Nursing has a safe hospital setting for simulation.

“Our acute care students utilized this manikin for an endotracheal intubation/ventilation management midterm and the fidelity and actions were superb,” Doneski explained. “We had this manikin become distressed and it was awake, distressed, talking, and then—suddenly—just goes unresponsive. So they had to get the manikin intubated.

“It was an excellent opportunity for hands-on practice, and it allowed for a safe environment to hone skills for real-life situations.”

HAL, Doneski explained, has many AI capabilities.

“We can make him have a stroke. It can have full facial droop. You can change the eyeballs. It can sweat, it can cry,” he said. “You can have it to where … it’s almost creepy. It can track with its eyes. It can follow you around the room to make sure you’re getting the most realistic aspect of patient care.”

HAL’s cost—approximately $85,000—was bought outright with tuition differential money to improve the experiential learning for UTC School of Nursing students focusing on acute care.

According to Doneski, UTC is the only facility in Tennessee that owns and utilizes the cutting-edge advanced simulator. There are only around 100 HAL S5301 models in the United States.

Due to the manikin’s advanced capabilities, HAL has many uses for both undergraduate and graduate students, Doneski said. Off the top of his head, he talked about procedures such as putting in a chest tube, inserting tubes to inflate lungs that have collapsed, and putting in invasive monitoring lines.

“We try to make it as realistic as possible,” he said. “That’s the whole point of sim.

“That’s what makes this so great and important … just being able to have all these things in a safe environment. That way, they can practice and they can make mistakes. When they get to a real patient, those mistakes shouldn’t happen.”

As patient simulators become increasingly high-tech, the AI advancements in this model of HAL are potentially game-changers for the students learning from them.

The technology allows things not to be “so cut and dry,” Doneski said. It will enable “a little bit of fluidity and a little bit of a flow.”

“Before AI was put into these manikins, they just laid there; they didn’t do anything,” he said, “and you as an instructor or a sim leader had to create the fidelity for the simulation through your voice and through the room setup.

“With AI, you’re getting eyeballs able to track, you’re getting a manikin that’s able to listen and speak back simple things like what’s your name, what’s your date of birth. AI is lending more of a realistic feel to the patient experience so that you can have improved patient outcomes.”

Doneski said student reactions have been positive across the board.

“They harken on the fidelity of it being more lifelike. A lot of the students utilizing this manikin have done some work in the hospital or have had some clinical time in the hospital, so they’re not naive in what a real patient looks like,” he said.

“They really feel like this adds to the fidelity—that kind of safe, cozy feeling that I can work on this patient without the high stakes of potentially hurting the patient while I’m trying to learn.”

What are Doneski and HAL collaborating on for finals?

“In medicine, everything that we do has a potential to also hurt the patient, so this patient is going to be critically ill and needing multiple invasive procedures,” Doneski explained. “One of those procedures is called a central line or a central venous catheter insertion. You have to use a very large needle to go into a vein in the neck.”

The problem, he said, is that you can accidentally puncture a lung with the needle.

“There’s going to be some findings that will show, ‘Hey, you have now caused a problem with your procedure. Now, you have to fix that problem.’ It’s really cool to know how to do these procedures, but you have to know how to fix problems that come from these procedures, too.”