RALEIGH — Graham Snyder holds degrees in engineering and medicine, speaks three languages and has logged countless hours saving lives amid the adrenaline rush of the emergency room.
But the WakeMed doctor's pet project involves screaming like an ornery patient into a microphone and writing scripts that dramatize medical emergencies.
Snyder, 38, is an emergency physician at WakeMed and medical director of the hospital's Center for Innovative Learning, where doctors hone their skills using high-tech dummies and dramatic portrayals of clinical scenes.
"It's a lot of showbiz," Snyder says of the simulations he has helped develop for the center. "We want to have a high degree of realism."
WakeMed is one of only 1 percent of hospitals nationwide to have such a center, said WakeMed CEO Bill Atkinson.
The 3,800-square-foot facility has trained doctors from across the state - and as far away as Colorado - since opening in 2006.
Atkinson said Snyder has been a key player in the center's success, helping to found it and continuing to lend his time, expertise and talent for teaching - in addition to his other duties at WakeMed and his leadership role in the residency program at UNC-Chapel Hill.
"He believes in this, and we believe in him," Atkinson says. "He's not only a superb physician but also a great teacher."
Snyder says the idea for a more realistic type of training came to him after seeing the same mistakes happen over and over - not because the doctors didn't know better, but because their knowledge failed them amid the panic and chaos of the emergency room.
He cites the example of a patient who is allergic to aspirin having a heart attack. In the heat of the moment, some doctors will go against their training and administer aspirin.
After facing the doomed result in the safety of the simulation lab, though, those doctors will learn the lesson in a way that sticks.
"The only way they viscerally understand not to do that is to let them do it and see the consequences," he says. "After that, I'm going to remember it in my core."
An unusual path
Snyder says he wanted to be a doctor - at WakeMed, specifically - since he was 4 years old.
He grew up in west Raleigh, though he spent two years of his childhood abroad. His father, a professor of electrical engineering at N.C. State University, was a visiting scientist with the space program in West Germany.
He graduated from Enloe High School, a school whose embrace of individuality suited him - he was an avid skateboarder who also played violin. He sports a goatee, and his low-key demeanor belies his considerable accomplishments.
Outside the hospital, he has tackled challenges such as climbing Mount Kilimanjaro and riding a bike from Raleigh to San Francisco.
His engineering degree from N.C. State was both a concession to his father and a back-up plan if he didn't get accepted to medical school.
The training also taught him to work through problems in a systematic way.
"You get used to being presented a problem and saying, 'I have no idea, but I know if I put it in the right perspective, I can find a solution,' " he says.
While in medical school at UNC-CH, an encounter with a severely abused young girl prompted Snyder to co-found a group to educate health care providers on the topic.
He went on to do his residency in emergency medicine at North Shore University Hospital on Long Island, N.Y., where he was leading a seminar when terrorists toppled the twin towers of the World Trade Center on Sept. 11, 2001.
The hospital prepared for mass casualties, even converting cafeteria tables into makeshift beds.
But after both towers collapsed, there were no patients for them to treat.
Making it real
Snyder came to WakeMed in 2002, and soon after started developing ideas for the simulation lab, which imitates the sights, sounds - even the smells - a doctor would encounter in the field.
The lab uses lifelike dummies that allow doctors to practice actual techniques. Snyder has been known to personally act as a dummy's voice, channeling the type of difficult patient he's seen in the emergency room.
The simulation lab often employs actors for patients in more elaborate scenarios.
Once, it produced a drill on evacuating the hospital during a power outage, a la Hurricane Katrina, including carrying patients on life support down several flights of stairs.
Future plans include virtual reality technology that would allow a wider variety of even more realistic scenarios.
Unlike most hospitals, where many individual departments use some form of simulation, the center trains doctors from all departments and at all skill levels, some of whom request help with particular procedures.
Simulations are developed to respond to, or prevent, common medical errors. Others teach interpersonal skills such as talking with patients about their medical histories and dealing with family members, in addition to clinical skills.
In a recent simulation, a group of medical students looked on as one student tried to hook a dummy up to a respirator with her right hand using a laryngoscope, a left-handed instrument.
In another, a pregnant patient wore a medication patch that was the key to her illness. But the students could only find it if they examined her skin, an important step that is often overlooked.
'Making the magic'
UNC-CH medical student Tyler Jorgensen said the realistic scenarios prepare students for cases that don't play out in textbook fashion.
He says his simulations have gotten more complex as he advanced in medical school, including one in which his mistake nearly led to the simulated death of a child.
"That's something I'm going to remember," Jorgensen says.
As the center's medical director, Snyder works with director Amar Patel to make sure the scenarios faithfully imitate real-life hospital scenes and teach doctors the appropriate techniques.
They also must walk a fine line between letting doctors experience the weight of their failures and letting those failures paralyze them.
Snyder says he tries not to let patients die, for instance, even in simulations, unless it's necessary to teach a particular skill.
Cameras record the simulations so doctors can study their mistakes and hospital officials can make note of the most common errors.
Snyder says some hospitals buy equipment such as the high-tech dummies, but don't utilize it to its fullest potential.
"Someone has to be making the magic happen," Snyder says.
"You need to make it walk, bite, throw up...to make it a real person."
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