MURFREESBORO, Tenn. — In the heart of the Cason-Kennedy Nursing Building on the campus of Middle Tennessee State University, Physician Assistant Studies students scramble to deal with a mass casualty event — a simulation that is as close to the real thing as possible.
With each simulation, paid actors play carefully scripted characters with varying injuries and acuities for students to assess and treat.
“They have to stay calm and deal with whatever situation they have while they evaluate everybody and figure out who needs advanced treatment,” said Marie Patterson, assistant professor and Physician Assistant Studies director.
The scenario for the hands-on exam held over the summer: There’s been a tornado and the mock rural hospital emergency room is filled with patients, but there are limited resources to respond to injuries.
“The nearest trauma center is 20 miles away, but the road is blocked,” clinical assistant professor Dr. Jennifer Rayburn told the students during the simulation. “We have one med evac (air ambulance), no ICU (intensive care unit) and no cardiologist. An orthopedist and a general surgeon are what we have.”
Preparing future workforce for clinical settings
Physician assistants, also called PAs, are licensed clinicians who practice medicine in every specialty and setting. Trusted, rigorously educated and trained health care professionals, PAs are dedicated to expanding access to care and transforming health and wellness through patient-centered, team-based medical practice, Patterson explained.
In the first four semesters of the 27-month program, students spend most of their time in classroom settings. But they do get hands-on experience through multiple mock simulations using the “latest and greatest technology” like task trainers and high-fidelity mannequins, Patterson said.
Called an objective structured clinical examination, or OSCE, these simulations are aimed at preparing students for the day-to-day of health care — especially in rural facilities, where there are limited resources and smaller staffs.
By 2035, Tennessee is projected to have a shortfall of more than 15,000 in-demand health care positions, according to statistics from the Tennessee Hospital Association.
“We want them to go out into the real world and be prepared when they do move into clinical rotations, because you’re not always going to have a full medical staff to work with — especially in rural facilities. So they need to develop critical thinking skills because they’ll be the ones making the call on medical treatments,” Patterson said.
Student: Simulation a ‘great team-building exercise’
For each mock mass casualty, first-year students are split into smaller groups and each is given 40 minutes to triage and treat the pretend patients with varying degrees of injuries. It’s a race for time — and treatment can be tricky.
Students must decide who is most critical and needs to be airlifted to a trauma center, who needs to go by ambulance to another facility, who needs to be admitted to this hospital, and which patients are well enough to be released, Patterson said.
“It’s a great team-building exercise,” said first-year student Jesse Scobee of Antioch, a U.S. Navy veteran who earned his undergraduate degree from MTSU in 2023 before enrolling in the PA program last year. “Situations like this test us on our ability to recall knowledge that we’ve learned over the last year … in a high-stress simulation, and to come together and accomplish a goal.”
Students are graded on their performance, from the swiftness of their responses to the diagnoses and decisions made for treatment, Patterson explained.
“These types of scenarios are valuable because it gives them practice with patients. So when they go out on clinical rotations and they’re seeing real patients, they are so much more prepared and more comfortable in those situations,” said Ashley Bjork, clinical assistant professor in the PA program.
Faculty create the scenarios, and students are tested on how well they assess each patient — who is critical and who can wait?
“In addition to utilizing critical thinking skills and medical knowledge, students are required to act professionally with patients,” Patterson said. “Professionalism is part of it; interpersonal skills is part of it. If they don’t handle the situation well, they’ll fail the test. And we’re pretty strict.”
During a previous mass casualty simulation, students dealt with a mock automobile accident.
“One year we had the sound of a baby crying during the entire simulation,” Patterson recalled. “One of the students wanted to send the baby to a trauma center because it was crying,” but other patients were far more critical, Patterson said.
This year, one of the patients sustained a head wound and kept asking about his wife, signaling a potential traumatic brain injury. But the patient with the most life-threatening circumstances didn’t appear critical.
“As I went on with the exam, I did find the patient was higher acuity and needed more attention. I found out she had fluid in her abdomen and it could kill her,” explained Nayatuil “Twilly” Tongyik, of Gallatin, who was the first in her group to diagnose the issue in the simulation.
Although the OSCE was stressful, Tongyik said it was a good exercise to prepare her and fellow first-year students for a year of clinical rotations.
“I think they do a lot of great things on being more interactive and doing these practice OSCEs to simulate what it’s going to be like in the real world, and I feel like that’s really important because I would rather have that experience now than to go out there not knowing anything,” Tongyik said.
To learn more about the Physician Assistant Studies program in the MTSU College of Behavioral and Health Sciences, visit https://www.mtsu.edu/program/physician-assistant-studies-m-s/.
