April 15, 2019

This spring, fourth-year School of Medicine students were once again on the front lines of a pandemic.

Whoa, nothing to worry about! You don’t need to check Twitter, these are fictional pandemics. It’s an annual tabletop exercise designed to teach students preparedness and effective communication in emergency situations. Originally developed by internal medicine doctors Linda Overholser, MD, and Nichole Zehnder, MD, Associate Professor of Emergency Medicine Charles Little, DO, has run the exercise since 2012.

CU Anschutz Today sat down with Little to ask him about his perspective in organizing and running the event the past eight years.

Charles Little, DO, associate professor of emergency medicine

What is the purpose of this exercise?

Medical students don’t really get any exposure to disaster or emergency management throughout their medical school curriculum, unless they show a special interest in doing an elective in some of that type of work. But almost all physicians at some point in their career will be involved in some emergency incident, and we want them to have at least some basic understanding of what the process is.

The exercise does several things:

First, it outlines what happens in pandemic influenza, which historically occurs every 10 to 20 years.

Second, it gives them an overview of what the health emergency response system looks like. It’s not just hospitals; it’s the entire community including clinics:

  • Public health has a very big role in infectious disease outbreaks.
  • Emergency management has an important role in any big event like that.
  • And then, EMS (emergency medical services) and transportation also play key roles.

We want them to have an understanding about all the players, other than just physicians, hospitals and clinics.

The third thing is to give them an opportunity to work in small groups on a “novel event” they really haven’t thought about before, and then do decision-making and generate a plan with limited background and limited understanding of what’s actually going on. They have to work a little bit through the fog of events.

How are students grouped together for this exercise?

We generate the number of spots we’re going to have, which this year was based on the number of community experts we had who were available to come help.  

The one group that we let self-select is the ethics group, because we want people who actually have an interest in that who will participate in those discussions. Right before the exercise starts, we’ve got all the other groups assigned, and then we ask for a show of hands and pick approximately 10 people out of the audience to do ethics.

You break students into six different groups (public health agencies, cities, hospitals, clinics, ethics and the media). Do the students do better at specific “roles”?

I think it’s probably a little easier for them to grasp the clinics and the hospitals. They actually do very well in any of the groups, just because they’re overall pretty high performers, and they’ve worked in groups before. Things like the Office of Emergency Management are pretty far from their kind of previous training and understanding, so I think that and public health are a little harder. I think they all have some limited exposure to EMS, so I think they probably understand that a little better. But overall, they do well in all the groups.

Similarly, are there any roles students are challenged by more than others?

For all the groups, they actually really jump into it pretty well.

Even in things that [don’t] have anything to do with medicine, like the media group, they actually take to it pretty well. They’ll take out cell phones and they’ll start shooting videos of themselves as reporters. They figure out fairly early on in the process what the challenges are, and the goal of the media group is to get them to understand how the media can help you or hinder you, and you have to be forthcoming with reliable information, but not overshare things you’re speculating about.

What trends have you noticed year over year with this exercise? How has the simulation changed?

In terms of the exercise design, I refine it each year, and early on, what I did was I started to refine it to be more in the structure of the tabletop exercises that we do in the emergency management and disaster realm. And that helped to streamline it and make it somewhat easier to administer.

‘It’s a pretty huge undertaking … It’s pretty intense. I think the students understand a little bit about what it feels like to actually manage a real disaster.’ – Charles Little, DO, pandemic simulation organizer

This is actually, as these exercises go, a pretty huge undertaking. We’ve got 180 students, and we’ve usually got about 40 to 50 subject matter experts, and they all have to be coordinated. We’ve gotten better at that over the years.

From the student’s standpoint, it’s very interesting that different classes seem to have slightly different personalities, and some classes are a little more engaged, other classes are a little more reserved. But I think every year, they all get something out of it.

How would you describe the energy in the room during the simulation?

The students are actually very engaged in trying to work through problems, and it’s a pretty high-energy event. Usually they’re pretty tired by the end of two to three hours of doing this, because it’s a lot of decision-making, a lot of concentration, and a lot of active thinking, and responding to information they’re getting both by email from us, but also the requests they’re getting from other groups for support and information-sharing and things like that.

It’s pretty intense in that fashion. I think they understand a little bit about what it feels like to actually manage a real disaster.

What kind of feedback do you get from students afterward?

The vast majority of students find it very interesting and engaging. There are a couple people who clearly don’t like making decisions with no information that are high consequence, and that seems a little distressing to them. Overall, it’s generally a very engaging exercise with something they don’t do frequently. And they recognize that once they leave school, they may be involved in these type of events.

What do you hope the students take away from the simulation?

We want them to understand what any type of public health disaster kind of looks and feels like, and how you would go about managing it. And who your partners would be.

What is your favorite aspect of running the simulation?

It’s really fascinating to watch the students work through this with the subject matter experts. And that, I think, is the greatest thing.

And one other thing I’ll point out is we have about 45 subject matter experts who come year after year and help support this, and that goes from city emergency managers to county and state public health leadership, to people who do emergency management in clinics and hospitals. And I think they do it for a couple reasons.

One is they realize it’s important for the doctors who are generally leaders to have an appreciation of this, but they also have quite a bit of fun doing it. They’re willing to carve out an entire half-day once a year, year after year. That’s been tremendously helpful.

What have you learned personally by doing the simulation?

That’s a good question. I think I’m really impressed with how engaged the students will get with something when there’s a goal set in front of them that’s something they didn’t really consider was probably part of the responsibilities they would ever have, or something they would ever engage in.

I’m pretty impressed with how quickly they adapt, and move forward with that.

I’m also really impressed by the way the community has stepped forward to help support this exercise. I have to do some work to recruit people every year, but it’s been really rewarding to see how people come back and support this because they feel it’s a valuable event for the students.

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