Abstract:
A computerized education system with a physiological simulator for interactively teaching patient care to a user is described. The system comprises a computer program for displaying a selection of selectable modules for providing different interactive training sessions, and a virtual stethoscope for use with the simulator in performing patient care, and cooperating with corresponding sensors on the simulator, thus providing feedback to confirm proper use of the virtual stethoscope on the simulator. The system also comprises an interface module for interfacing the sensors with the computer program, the module comprising a processor for receiving signals from the sensors and converting the signals to provide feedback.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application is a continuation-in-part of U.S. Ser. No. 09/199,599, now U.S. Pat. No. 6,193,519, filed Nov. 25, 1998, which is a continuation of U.S. Ser. No. 08/643,435, now U.S. Pat. No. 5,853,292, filed May 8,1996. 
    
    
     BACKGROUND 
     The present embodiment relates generally to an interactive, computerized education system for teaching patient care, and more particularly to such a system for use in conducting patient care training sessions using virtual instruments in cooperation with a manikin, or patient simulator. 
     While providing a low-cost source for learning theory, textbooks and flash cards lack the important benefit to students that they can get from “hands-on” training and practice. Thus, some patient care training has been taught using training devices, including a training manikin configured to simulate a human patient. In some instances, the training devices allow students to use instruments to assess the manikin&#39;s vital signs and to take further action, such as perform CPR. 
     However, one disadvantage of prior systems is that large capital outlays must be made for the required equipment, especially for the medical instruments used to respond to an emergency, or Code, situation. Consequently, the use of these prior systems and associated instruments is prohibitively expensive, and as a result, many users must settle for less realistic training methods. For example, many manikin systems do not contain a broad variety of instruments to save expense. Some systems even fail to supply instruments commonly used in Code situations. 
     Therefore, what is needed is a system for an interactive, computerized education system for use in conducting patient care training sessions using relatively inexpensive virtual instruments in cooperation with simulated patient treatment, thereby enabling a user to learn comprehensive multiple and interrelated patient care skills. 
     SUMMARY 
     The present embodiment, accordingly, provides a computerized education system with a physiological simulator for interactively teaching patient care to a user. The system comprises a computer program for displaying a selection of selectable modules for providing different interactive training sessions, and a virtual stethoscope for use with the simulator in performing patient care, and cooperating with corresponding sensors on the simulator, thus providing feedback to confirm proper use of the virtual stethoscope on the simulator. The system also comprises an interface module for interfacing the sensors with the computer program, the module comprising a processor for receiving signals from the sensors and converting the signals to provide feedback. 
     One advantage of the present embodiment is that it provides an interactive, computerized education system for use in conducting patient care training sessions using relatively inexpensive virtual instruments in cooperation with a realistic simulated patient. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     FIG. 1 is a schematic view of a computerized education system according to the present embodiment. 
     FIG. 2 is a schematic view of the interaction between the virtual instruments and a simulator of the present system. 
     FIG. 3 is a perspective view of a virtual instrument of the present system. 
     FIG. 4 is a perspective view of another virtual instrument of the present system. 
     FIGS. 5-7 are views of screen displays generated by a program comprising part of the present system. 
     FIGS. 8-17 are schematic views of modules contained in the program of the present system. 
     FIGS. 18-23 are views of screen displays generated by the program relating to a group of virtual instruments of the present system. 
    
    
     DETAILED DESCRIPTION 
     In FIG. 1, the reference numeral  10  refers, in general, to a computerized education system of the present embodiment for teaching patient care protocols to a user. The system  10  includes a computer  12  for operation with a training program  14  having selectable patient care protocols, or modules (not illustrated). Each module represents an interactive patient care training session for the user, as described herein and in U.S. Pat. No. 5,853,292, the entire disclosure of which is hereby incorporated by reference. 
     A computer interface module (“CIM”)  16  is connected to the computer  12 . The CIM  16  receives operating power from a conventional power source  18 , and contains a processor circuit  20 . The CIM  16  additionally includes an audio chip  22  which is responsive to the processor circuit  20  for causing a speaker  24  to produce realistic patient sounds, for example, heart, lung, intestinal, and the like. A rheostat control  26  is included in the CIM  16  for adjusting the volume of the speaker  24 . Alternatively, the program  14 , or another portion of the system  10 , may supply the sounds. 
     The CIM  16  has a plurality of ports, collectively  28 , for receiving a plurality of connectors, as will be explained. The CIM  16  is connected to simulated medical instruments (virtual instruments)  30 , which look, feel, and operate like real medical devices, but are designed to interact with the program  14  and a patient simulator device  32  having sensors  34 . The sensors  34  are also connected to the CIM  16 . It is understood that there may be more than one CIM  16  to manage the required connections. As will be explained, when the user brings the virtual instruments  30  within a predetermined proximity of the sensors  34  of the simulator  32 , the activity is sensed, and thereafter reported to the program  14 , via the CIM  16 . The program  14  compares the information pertaining to the user&#39;s activity with predetermined standards, and thus provides an interactive training session. 
     It is understood that the simulator  32  is designed to represent a patient and receive treatment, and as such, the simulator  32  could take a variety of forms, including a fully articulating and adult-sized simulator, or a newborn baby, a child, or a youth, as well as a portion of simulated patient, for example, the arm, head, or pelvic region. In the present embodiment (not depicted), the simulator  32  has a head, eyes, a nose, and a mouth. The head assembly contains a realistic airway capable of accepting conventional airway adjuncts. A sensor  34  may be disposed in the airway for determining whether an airway adjunct has been placed, or whether a fluid has passed. The airway configuration can be adjusted to display a large tongue, an obstructed pharynx, or closed vocal cords. 
     The head of the simulator  32  is connected to a torso containing simulated heart, lungs, and other organs. Palpable pulses may be found at carotid, brachial, radial, femoral, and pedis dorsis locations in response to the initial condition of the simulated patient and upon therapeutic interventions, for example, specific pulse locations may become non-palpable as the systolic pressure falls. Heart sounds are heard at appropriate locations through the use of a virtual instrument  30 , as will be described. The simulator  32  may display a combination of ventilation means, and lung and airway sounds are heard at appropriate locations through the use of a virtual instrument  30 , as will be described. Normal gas exchange lung dynamics are virtual and are controlled by the program  14 , which may also determine tidal volumes (TV) and functional residual capacity (FRC). The hands, feet, face, and upper torso change color based upon proper oxygenation or an oxygen deficit. As oxygenation decreases, the extremities change color first, followed by the face and upper torso. Such change is reversible as oxygenation is improved. This is simulated by having applied a conventional photochrome to the simulator, such that upon exposure to an associated adjustable UV light, the simulator appears to turn blue. The intensity of the UV light may be controlled by the program  14 . 
     The heart and lungs are connected to pressure transducers confirming airway ventilation and cardiac compression. For example, an air line may be mounted in tracheal wall of the simulator  32  and connected to a sensor  34  connected to the CIM  16 , so that when cardiopulmonary resuscitation (CPR) ventilation is performed on the simulator, the CIM  16  monitors the timing and magnitude of the pressure and volume of the ventilation procedure, via the air line and the sensor. Similarly, a compression bladder may be embedded within the chest cavity of the simulator  32  for sensing and confirming proper timing and magnitude of a CPR chest compression procedure, when connected by an air line to a compression sensor  34  attached to the CIM  16 . At least one arm of the simulator  32  contains an IV receptacle capable of accepting medications, and sensors  34  are placed within the receptacle to ascertain whether an IV has been started. The lower torso contains an interchangeable male/female genitourinary system which provides a means for catheterization. 
     Referring to FIG. 2, the virtual instruments  30  include at least one IV needle, an ET tube, an EKG monitor, a BP cuff, a pulse oximeter cuff, a temporary external pacer, an AED, a manual defibrillator, a PA catheter, and a virtual stethoscope,  30   a-j,  respectively. As shown, the virtual instruments  30   a-j  may be connected to the port  28  of the CIM  16  via lines  36   a-j,  respectively. As will be discussed in greater detail below, each virtual instrument  30   a-j  has at least one corresponding sensor, respectively  34   a-j,  disposed on the simulator  32 . The sensors  34   a-j  may be connected the port  28  of the CIM  16  via lines  36   a′-j′,  respectively, for reasons to be described. 
     It is understood that the lines, collectively  36 , are shown schematically, and merely represent a functional relationship for reporting activity between the virtual instruments  30  and the sensors  34 . In some cases, the reporting of activity will be accomplished via a virtual instrument  30  with two nodes and a sensor  34  formed of conductive material, or vice versa, only one of which may be physically connected to the CIM  16  via an electrical lead. Likewise, the embodiment encompasses a virtual instrument  30  with one node and a sensor  34  with another node, both of which may be physically connected to the CIM  16 . Similarly, the activity may be reported via means using optical, air pressure, tactile, temperature controlled, or wireless technology. Furthermore, although depicted as having individual lines, it is understood that the embodiment encompasses the sharing of lines among instruments  30 , or sensors  34 , as well. 
     The IV needle  30   a  has a selectable group of specific drugs and dosages provided by the program  14 , and in one embodiment is part of a medication tray with an assortment of labeled syringes for dispensing the drugs to the simulator  32 , with the effects of administration controlled by the program  14 . In operation, the IV needle  30   a  may be used to confirm venous cannulation, for example, the antecubital region of an arm of the simulator  32  may have a sensor  34   a  comprising an insulator sandwiched between two layers of conductive material having an appropriate thickness and weave density for permitting the needle  30   a  to pass through the cloth at a low acute angle (e.g., 20°). The conductive layers of the sensor  34   a  are electrically coupled to the CIM  16  via line  36   a′,  such that when the needle  30   a  is correctly passed through the two conductive layers, simulating cannulation of a vein of the simulator  32 , a circuit is completed between the layers and sensed by the CIM  16 . 
     The ET tube  30   b  is used in simulated patient airway management, and in order to confirm proper placement in the tracheal airway of the simulator  32 , an optical sensor  34   b  is mounted in the wall of the trachea of the simulator  32  and connected to the CIM  16  via line  36   b′.  Correct placement of the ET tube  30   b  in the trachea is confirmed when the tip of the ET tube interrupts the beam of the optical sensor  34   b.    
     The EKG monitor  30   c  comprises a multi-lead system, including a real-time trace monitor and R-wave sonic markers, and a line  36   c  that connects to the CIM  16  at one end, and has a plurality of color-coded patches at the opposite end for attachment to a plurality of sensors, collectively  34   c,  mounted on the correct regions of the torso of the simulator  32  to confirm proper placement, as sensed by the CIM  16 . 
     The BP cuff  30   d  attaches to the simulator  32 , for example around an arm, and includes a line  36   d  that attaches to the CIM  16 . The cuff  30   d  includes means  34   d  for sensing proper positioning of the cuff  30   d  on the simulator  32 , the means being attached to the CIM  16  via line  36   d′.    
     The pulse oximeter finger cuff  30   e  attaches to the simulator  32 , for example around a finger, and includes a line  36   e  that attaches to the CIM  16 . The cuff  30   e  includes means  34   e  for sensing proper positioning of the cuff  30   e  on the simulator  32 , the means being attached to the CIM  16  via line  36   e′.    
     The temporary external pacer  30   f  contains a line  36   f  that connects to the CIM  16  at one end, and has a plurality of anterior and posterior pacer pads at the opposite end for attachment to a plurality of sensors, collectively  34   f , mounted on the correct regions of the torso of the simulator  32 . In this manner, the CIM  16  confirms proper placement of the temporary external pacer  30   f  on the simulator  32 . The pacer  30   f  has means for controlling pacer rate and current, as well as exhibiting rhythm pacing, which is controlled by the program  14 . 
     The automatic external defibrillator (AED)  30   g  contains a line  36   g  that connects to the CIM  16  at one end, and has a plurality of apex and sternum AED pads at the opposite end for attachment to a plurality of sensors, collectively  34   g,  mounted on the correct regions of the torso of the simulator  32 , confirming via the CIM  16  that the AED  30   g  is properly placed on the simulator. Upon selecting a software generated shock button, the system  10  simulates defibrillation shock, with the resultant conditions controlled by the program  14 . 
     The manual defibrillator  30   h  contains a line  36   h  that connects to the CIM  16  at one end, and has a plurality of apex and sternum defibrillator paddles at the opposite end for attachment to a plurality of sensors, collectively  34   h , mounted on the correct regions of the torso of the simulator  32 , confirming via the CIM  16  that the manual defibrillator  30   h  is properly placed on the simulator. Upon selecting a software-generated shock button, or alternatively, by using dual shock buttons associated with manual defibrillator  30   h,  the system  10  simulates defibrillation shock, with the resultant conditions controlled by the program  14 . 
     Referring to FIGS. 2 and 3, the PA catheter  30   i  is a medically accurate insertable catheter for use in vein sites (not depicted) of the simulator  32 . The PA catheter  30   i  comprises a long tube  300 , with an inflatable balloon  302  at one distal end. The opposite end of the tube  300  contains a divider  304 , having a plurality of connectors  306 , at least one connector being connected to a syringe  308 . Proper placement of the balloon  302  is determined by sensors  34   i  placed in the simulator  32 , and catheter data comprising important hemodynamic indices such as PA occlusion pressure, cardiac output, and mixed venous oxygen saturation are created by the program  14 . 
     Referring to FIGS. 2 and 4, the stethoscope  30   j  is moved from location to location on the simulator  32  to hear sounds that would be heard in a real patient. A portion of the stethoscope  30   j  resembles a standard stethoscope, having earpieces  350   a-b,  ear tubes  352   a-b,  a bell tube  354 , and a bell  356 . However, unlike a standard stethoscope, the stethoscope  30   j  has an RF acquisition coil, or receiver disposed in the interior of the bell  356 . 
     Correspondingly, the simulator  32  has a number of sensors, collectively  34   j,  disposed beneath the simulator&#39;s skin (not depicted) at anatomical locations where specific heart lung or other sounds are normally heard. Each sensor  34   j  comprises a small coil, or transmitter, and circuitry which is potted to prevent damage, and to obscure the transmitter from the user&#39;s view to avoid visual detection. The transmitter broadcasts a unique signal that serves to identify the particular sensor  34   j.  The strength to noise (S/N) ratio of the signal determines the proximity to the transmitter wherein the signal may be detected by the acquisition coil of the stethoscope  30   j.  Thus, control of the S/N ratio allows the sensor  34   j  to be pinpointed to exact locations on the simulator  32 . The transmitter may broadcast continually, or alternatively may be activated when interrogated by the acquisition coil in the bell  356  of the stethoscope  30   j,  such as when the acquisition coil is brought within a predetermined proximity of the sensor  34   j.    
     As noted above, each sensor  34   j  emits a unique train of frequencies which are received by the acquisition coil. The acquisition coil transfers the signal to an electronic box  358  disposed on the stethoscope  30   j.  The electronic box  358  contains a small battery and circuitry for reading the signals acquired by the acquisition coil of the bell  356 , determining the identity of the transmitting sensor. The box  358  contains a chip for producing sounds, and plays a predetermined sound appropriate for the anatomical location of the identified sensor  34   j,  for as long as the bell  356  is within the predetermined proximity of the sensor. A small speaker  360  is disposed in the box  358  for allowing the user to hear the sounds in the earpieces  350   a-b,  and a jack  362  is provided for output to an external speaker (not depicted). A switch  364  is disposed on the box  358  for switching between playing normal and abnormal sounds. 
     The stethoscope  30   j  is a vast improvement on prior art systems for several reasons; first, the predetermined body sounds can be pinpointed to exact locations on the simulator  32  by selecting the proximity (via the S/N ratio) required between the acquisition coil and the sensor  34   j.  Second, only the selected body sound is heard by the user, unlike systems using speakers disposed in the simulator, which have a tendency to reverberate throughout the simulator. Alternatively, the SIN ratio for signals from two sensors (and corresponding sounds) could be adjusted to overlap, allowing the sound to get clearer as the user moved the bell  356  closer to one sensor and away from the other sensor. 
     Referring now to FIG. 5, an introductory screen display  40  of the program  14  is presented on the computer  12 . The display  40  includes several decorative features: a title box  42 , an EKG box  44 , and a vital signs box  46 . The display  40  also contains a teaching box  48 , a testing box  50 , and a virtual instruments box  52 . 
     The screen  40  also displays a group of selectable patient care modules  54   a-   54   p  provided by the program  14 , which furnish an interactive training session for the user, dispensing information based on BLS and ACLS guidelines set forth by the American Heart Association, and associated topics. The modules  54   a-g  are disposed in the teaching box  48 , the modules  54   h-j  and an exit box  56  for exiting the program  14 , are disposed in the testing box  50 , and the modules  54   k-p  are disposed in the virtual instruments tutor box  52 . 
     Referring to FIGS. 5 and 6, if one of the modules is selected by the user, such as by voice recognition or selection with a mouse of the computer  12 , the program  14  displays a menu screen, listing information categories specific to the topic of the selected module. For example, if the BLS module  54   a  is selected by a user, the program  14  displays an instruction screen  60 , as shown in FIG.  3 . The instruction screen  60  contains an information box  62 , which contains information regarding a menu  64  of the Basic Life Support information items of module  54   a.  It is understood that an item, such as items  66 - 70  of the BLS module  54   a,  may be selected from the screen  60 . It can be appreciated that each module  54   a-p  has its own instruction screen with a menu of specific informational items, as will be described. 
     Referring to FIG. 7, selection of an item from a menu causes an information display screen  76  to be displayed. The screen  76  has an information box  78 , which may contain text and/or illustrations topical to the selected menu item. It is understood that the information screen  76  is used as an example of any number of screens, and furthermore, such screens can be displayed in sequential order, or a series, for each item. A series of screens comprises a tutorial regarding patient treatment protocols for the selected menu item. Thus, the user can review information from a library of topics by selecting the appropriate module from the teaching box  48 , and navigating through a series. Navigation in a series of screens by the user is attained by selection between three boxes:  80 ,  82 , and  84 , comprising “Back”, “Next”, and “Exit”, respectively, with corresponding function among the screens. If no “Back” or “Next” function is possible, as respectively would be the case of the first and last screen of a series, the boxes  80  or  82  may be unselectable. The display screen  76  also has a menu, in this example the pull down menu  64  corresponding to the selected module  54   a &#39;s menu items, and thus the user may switch between items within the selected module at any point during a series. 
     Referring to FIG. 8, the module  54   a  contains a group of items: an Intro item  66 , a CPR item  68 , an FBO item  70 , a Practice item  72 , and an Exit item  74  for returning to the display screen  40 . Selection of an item begins a series of information display screens (FIG.  7 ), or an item may also be divided into sub-items before the screens appear, for example, if the CPR item  68  is selected, the user must select between a set of sub-items  68   a  and  68   b,  for one person and two person CPR, respectively, with appropriate information being supplied by the program  14 . If the Practice item  72  is selected, the user may practice CPR on the simulator  32 , and the program  14  compares the user&#39;s compression and ventilation, via the CIM and sensors  34 , with accepted standards. The Practice  72  item contains a group of sub-items  86 - 100  displayed by the program  14 , as shown. The Product Type sub-item  86  is provided for specifying the type of simulator  32 . Upon selection of the CPR Practice sub-item  88 , the user may select among a plurality of action sequences  88   a-f,  to receive training in CPR with one rescuer, CPR with two rescuers, CPR ventilation/compression techniques with one rescuer, or with two rescuers, rescue breathing, or chest compression, respectively. The CPR test speed sub-item  90  prompts the user to select between action sequences  90   a  or  90   b  for either one or two rescuers, respectively. The Setup sub-item  92  enables the user to specify that the action sequences comprise 2, 4, 6, 8, 10, or 20 compression/ventilation cycles, respectively  92   a-f.  The Results/Print sub-item  94  directs the program  14  to record the time and magnitude of the compression and ventilation activity executed by the user on the simulator  32 . The Sound sub-item  96  comprises a group of choices (not depicted) for CIM beeps, realistic sounds, or no sound. The Comm port sub-item  98  allows selection between a group of choices (not depicted) for serial port  1  and serial port  2 . Selection of the Exit sub-item  100  directs the program  14  to exit from the Practice item  72 , and return to the module  54   a.    
     Referring to FIG. 9, selection of the Airways module  54   b  (FIG. 5) directs execution of the program  14  to provide information items  102 - 108  directed to Anatomy, Opening the Airway, Action Sequence, and Exit, respectively. The Anatomy item  102  can be selected to display a series of informational screens pertaining to airway anatomy, including the upper torso, neck, head, mouth, and vocal cords. The Opening the Airway item  104  includes sub-items  104   a-f  regarding introduction, hyperventilation, patient position, vocal cords, endotracheal tube, and confirming placement, respectively. The Action Sequence item  106  includes sub-items  106   a  and  106   b  regarding situations where the patient is breathing, and where the patient is not breathing, respectively. The Exit item  108  is selected to exit the Airways module  54   b  and return to the display  40  (FIG.  5 ). 
     Referring to FIG. 10, selection of the Intravenous module  54   c  (FIG. 5) directs execution of the program  14  to a provide information items  110 - 118  directed to Introduction, Peripheral, Endotracheal, Central, and Exit, respectively. The Peripheral item  112  can be selected to display a series of informational screens pertaining to peripheral sites such as the antecubital vein, external jugular vein, saphenous vein, and intraosseous access. The Endotracheal item  114  can be selected to display a series of informational screens pertaining to the administration of ALE drugs in an ET tube. The Central item  116  can be selected to display a series of informational screens pertaining to central sites including the femoral vein, subclavian vein, and internal jugular vein. The Exit item  118  is selected to direct the program to exit the Intravenous module  54   c  and return to the display  40  (FIG.  5 ). 
     Referring to FIG. 11, selection of the Electrical module  54   d  (FIG. 5) directs execution of the program  14  to provide information items  120 - 136  for EKG, Defib/Cardio, Vital Signs, Ext. Pacing, Implants, Virtual Stethoscope, Instrumentation, EKG Sounds, and Exit, respectively. The EKG item  120  can be selected to display a series of informational screens pertaining to theory, use, and virtual EKG. The Defib/Cardio item  122  includes sub-items for manual defibrillation  122   a  and automatic defibrillation  122   b  (“AED”). The Vital signs item  124  can be selected to display a series of informational screens pertaining to blood pressure, heart rate, and oxygen saturation. The External Pacing item  126  can be selected to display a series of informational screens pertaining to theory, use, virtual defibrillation, and a virtual pacer. The Implants item  128  has sub-items for a pacemaker  128   a  and a defibrillator  128   b.  The Virtual stethoscope item  130  can be selected to display a series of informational screens pertaining to using the software-generated stethoscope of the program  14 , which will be described in greater detail below, with respect to the virtual instruments tutor box  52 . The Instrumentation item  132  has a set of choices (not depicted) for enabling, disabling, or checking the connections between the virtual instruments  30 , the sensors  34 , and the CIM  16 . The EKG Sounds item  134  has set of choices (not depicted) for enabling or disabling the sounds. Exit item  136  is selected to direct the program  14  to exit from the Electrical module  54   d,  and return to the display  40  (FIG.  5 ). 
     Referring to FIG. 12, selection of the Arrhythmias module  54   e  directs execution of the program  14  to a provide information regarding Arrhythmias, Treatment, Trace, and Exit, respectively items  138 - 146 . The items  138  and  140  include a group of choices for information about a number of problems and treatments, respectively  138   a  and  140   a.  The Trace item  142  has controls for starting and stopping the trace, collectively  142   a.  The EKG Sounds item  144  has set of choices (not depicted) for enabling or disabling the sounds. Selection of the Exit item  146  directs the program  14  to exit from the Arrhythmias module  54   e,  and return to the display  40  (FIG.  5 ). 
     Referring to FIG. 13, selection of the Drugs module  54   f  directs execution of the program  14  to provide information regarding drugs, divided alphabetically into items  150 - 154 , respectively Medications A-D, E-N, and O-V. These items include a group of choices  150   a-   154   a  for information including the dosage, indications, uses, actions, side effects, and precautions for the alphabetically grouped drugs. Selection of the Exit item  156  directs the program  14  to exit from the Drugs module  54   f,  and return to the display  40  (FIG.  5 ). 
     Referring to FIG. 14, selection of the Treatments module  54   g  directs execution of the program  14  to provide informational algorithms regarding treatment action sequences, including the items General Algorithm  158 , Treatments  160 , Help  162 , and Exit  164 . The General Algorithm  158  allows the user to work through a treatment scenario by answering questions as to a program-simulated patient&#39;s status. The Treatments item  160  includes a group of choices  160   a  to receive information on topics including atrial flutter, AMI heart attack, asystole, automatic external defibrillation, bradycardia, cardioversion, shock, hypothermia,manual external defibrillation, pulseless electrical activity, PSVT, temporary external pacer, tachycardia, ventricular fibrillation, ventricular tachycardia, and wide complex tachycardia. The Help item  162  provides information regarding using the Treatments module  54   g.  Selection of the Exit item  164  directs the program  14  to exit from the Treatments module  54   g,  and return to the display  40  (FIG.  5 ). 
     Referring back to FIG. 5, selection of a test module  54   h-j  from the test box  50  directs execution of the program  14  to provide a sequence to help test the user on patient care protocols, such as CPR and other responses to Code scenarios. The program  14  paces through the steps of a patient distress scenario, giving the user a predetermined time to respond or complete the task required, thus, the user is able to experience the pressure of a Code situation. For example, the program  14  may test the user by presenting choices from which the user must select in order to treat the patient, wherein the user must complete the correct choice before the sequence proceeds to the next event. The program  14  enables the user to enable, disable, or check the virtual instruments  30  and sensors  34  for connection to supply input to the CIM  16 . If the virtual instruments are enabled, the user may implement patient care activity on the simulator  32  using the virtual instruments  30 , with the results and quality of response being monitored by the program  14 . Alternatively, the user may use software-simulated instruments generated by the program  14 . The program  14  advances through the scenario until the patient recovers, and provides a running critique of the user&#39;s responses, with an explanation of each incorrect choice or action. Features of the test modules  54   h-j  include items that enable the user to specify that action sequences prescribed by the scenario comprise a predetermined number of compression/ventilation cycles, or to allow the user to record the time and magnitude of the compression and ventilation activity performed on the simulator  32 , or to select among a group of choices for hearing realistic sounds. 
     Referring to FIG. 15, selection of the BLS Test module  54   h  (FIG. 5) directs execution of the program  14  to provide items  170 - 182 , respectively, Product type, CPR Test, Setup, Print, Sound, and Comm port, to help test the user on CPR techniques. The Product type item  170  is provided for specifying the type of simulator  32 . Upon selection of the CPR test item  172 , the user may select among a plurality of action sequences, to receive training in CPR with one rescuer  172   a,  or with two rescuers  172   b.  The Setup item  174  enables the user to specify that the action sequence comprises 2, 4, 6, 8, 10, or 20 compression/ventilation cycles, respectively  174   a-f.  The Print item  176  directs the program  14  to record the time and magnitude of the compression and ventilation activity executed by the user on the simulator  32 . The Sound item  178  comprises a group of choices for CIM beeps, realistic sounds, or no sound, respectively  178   a-c.  The Comm port item  180  allows selection between a group of choices for serial port  1  and serial port  2 , respectively  180   a-b.  Selection of the Exit item  182  directs the program  14  to exit from the BLS test module  54   h , and return to the display  40  (FIG.  5 ). 
     Referring to FIG. 16, selection of the ACLS Test module  54   i  allows the user to select among a plurality of items  184 - 194 , for Scenarios, Instrumentation, Logging, Scene Response, EKG Sounds, and Exit, respectively. The Scenarios item  184  contains a group of action sequences  184   a,  comprising a pulseless 77 year old female, a 55 year old male with chest pain, an 18 year old male short of breath, a 50 year old pulseless male, a 65 year old male short of breath, a 72 year old unresponsive female, a 50 year old female with weakness and fatigue, a 60 year old male with chest pain in a rural area, a 40 year old male marathon runner, and a 22 year old football player. The user selects from the group  184   a  and then navigates a series of information screens while responding to queries as to the proper procedure for the selected action sequence. More specifically, the program  14  supplies details of the selected sequence, as well as a box (not depicted) showing the patient&#39;s EKG trace and vital signs. The Instrumentation item  186  enables the user to enable  186   a,  disable  186   b,  or check for connection  186   c,  the virtual instruments  30  and sensors  34  that supply input from the simulator  32  to the CIM  16 . The user may use software-simulated instruments generated in the module  54   i  by the program  14 , or, alternatively, if the instrumentation is enabled by selecting sub-item  186   a,  the user may implement patient care activity on the simulator  32 , with the results and quality of response being monitored by the program  14 . The Logging item  188  comprises sub-items  188   a-c  to enable, disable, or view a record of the time and magnitude of the compression and ventilation activity executed by the user on the simulator  32 . The Scene Response item  190  has a group of choices  190   a-c  for selecting between a two, eight, or fifteen second scene response. The EKG Sounds item  192  has a group of choices (not depicted) for enabling or disabling the sounds. Selection of the Exit item  194  directs the program  14  to exit from the ACLS module  54   i,  and return to the display  40  (FIG.  5 ). 
     Testing may be defined by the program  14 , as above, or by the user. For example, selection of the Codemaker Test module  54   j  (FIG. 5) allows one user, for example, an instructor, to create a scenario to test another user, for example, a student. The module  54   j  allows the instructor to define the testing scenario by entering a set of preliminary patient parameters regarding information such as sex, weight, and age, as well as patient indications, like shortness of breath, chest pain, mental awareness, and circulation. Benefits of this module include flexibility and the ability to detect mastery of the subject. An instructor-defined algorithm would presumably vary from well-known, structured algorithms, and thus avoid the problem of rote memorization of responses by the student. 
     Referring to FIG. 17, the Codemaker test module  54   j  includes a plurality of items  200 - 210 , for Instrumentation, Logging, EKG Sounds, Comm. Port, Help, and Exit, respectively. The Instrumentation item  200  enables the user, by further selecting from a group of choices  200   a-c  to enable or disable or check the virtual instruments  30  and sensors  34  that supply input from the simulator  32  to the CIM  16 . The Logging item  202  comprises a group of choices  202   a-b  to hide or view a record of the time and magnitude of the compression and ventilation activity executed by the user on the simulator  32 . The EKG Sounds item  204  has a group of choices  204   a  and  204   b  for enabling or disabling the sounds. The Comm port item  206  allows selection between a group of choices  206   a  and  206   b  for communication ports one and two, respectively. The Help item  208  provides direction for using the module  54   j.  Selection of the Exit item  210  directs the program  14  to exit from the Codemaker module  54   j,  and return to the display  40  (FIG.  5 ). 
     Use of the modules  54   k-p  of the virtual instruments tutor box  52  provides information about instruments commonly used in Code scenarios. In some instances, opportunities to practice using some of the virtual instruments  30  in patient care protocols with the simulator  32  are provided. Referring to FIG. 18, selection of the Sounds module  54   k  (FIG. 5) by the user causes the program  14  to display a series of screens, such as display  220 . The display  220  includes a Sounds box  222  containing an On/Off button  222   a,  and a list of selectable heart and lung sounds, respectively  222   b  and  222   c.  Selection of a sound from the lists  222   b-c  will direct the program  14  to display a tutorial box  222   d  with information relating to the selected sound. The display is navigated by the Back, Next, and Exit buttons, respectively  80 - 84 , and additionally contains a representation of a human torso  224 , such that when a stethoscope icon  226 , corresponding to the position of a mouse (not depicted) of the computer  12 , is moved around the torso, the stethoscope icon glows when placed in the correct anatomical area for hearing the selected sound and the program  14  plays the sound. An Exit item  228  is provided for exiting the module  54   k  and returning to the display  40  (FIG.  5 ). 
     Referring to FIG. 19, selection of the Vital Signs module  541  (FIG. 5) causes the program  14  to display a series of screens, such as display  230 . The display  230  includes a Vital signs monitor box  232  containing indicator boxes for systolic pressure, diastolic pressure, heart rate, and oxygen saturation,  232   a-d , respectively. The display  230  is navigated by the Back, Next, and Exit buttons, respectively  80 - 84 . A Sample Rhythms item  234  contains a group of selectable rhythms for the user to observe, such as a normal sinus rhythm, sinus bradycardia, idioventricular rhythm, ventricular tachycardia, and ventricular fibrillation. An Exit item  236  is provided for exiting the module  541  and returning to the display  40  (FIG.  5 ). 
     Referring to FIG. 20, selection of the Virtual EKG Monitor module  54   m  (FIG. 5) causes the program  14  to display a series of screens, such as display  240 . The display  240  includes an Electrocardiograph box  242  for displaying the EKG sweep  242   a,  and having a heart rate indicator  242   b  and On/Off button  242   c.  The display  240  is navigated by the Back, Next, and Exit buttons, respectively  80 - 84 . A Sample Rhythms item  244  contains a group of selectable rhythms for the user to observe, such as a normal sinus rhythm, sinus bradycardia, idioventricular rhythm, ventricular tachycardia, and ventricular fibrillation. An EKG Sounds item  246  allows the user to enable or disable the associated sounds. An Exit item  248  is provided for exiting the module  54   m  and returning to the display  40  (FIG.  5 ). 
     Referring to FIG. 21, selection of the Automatic Defibrillator module  54   n  (FIG. 5) causes the program  14  to display a series of screens, such as display  250 . The display  250  includes a Control box  252  having an advisories box  252   a,  and On/Off, Analyze, and Shock buttons  252   b-d.  The display  250  also has an EKG box  254  having a sweep  254   a,  and On/Off button  254   b.  The display  250  is navigated by the Back, Next, and Exit buttons, respectively  80 - 84 . A Sample Rhythms item  256  contains a group of selectable rhythms for the user to observe, such as a normal sinus rhythm, sinus bradycardia, idioventricular rhythm, ventricular tachycardia, and ventricular fibrillation. An EKG Sounds item  258  allows the user to enable or disable the associated sounds. An Exit item  259  is provided for exiting the module  54   n  and returning to the display  40  (FIG.  5 ). 
     Referring to FIG. 22, selection of the Manual Defibrillator module  54   o  (FIG. 5) causes the program  14  to display a series of screens, such as display  260 . The display  260  includes a Control box  262 , having an imbedded EKG sweep  262   a,  an advisories box  262   b,  buttons  262   c-g,  respectively On/Off, Energy Select, Charge, Shock, and Synchronize, as well as a heart rate display  262   h , and a selected energy indicator  262   i.  The display  260  is navigated by the Back, Next, and Exit buttons, respectively  80 - 84 . A Sample Rhythms item  264  contains a group of selectable rhythms for the user to observe, such as a normal sinus rhythm, sinus bradycardia, idioventricular rhythm, ventricular tachycardia, and ventricular fibrillation. An EKG Sounds item  266  allows the user to enable or disable the associated sounds. An Exit item  268  is provided for exiting the module  54   o  and returning to the display  40  (FIG.  5 ). 
     Referring to FIG. 23, selection of the Electrocardiograph module  54   p  (FIG. 5) causes the program  14  to display a series of screens, such as display  270 . The display  270  includes an EKG box  272 , having an associated EKG sweep  272   a,  a heart rate indicator  272   b,  and an On/Off button  272   c.  A Pacer box  274  is also provided by the program  14  and has buttons for power, mode, rate, and output,  274   a-d,  respectively, having associated status indicators  274   e-h.  The display  270  is navigated by the Back, Next, and Exit buttons, respectively  80 - 84 . A Sample Rhythms item  276  contains a group of selectable rhythms for the user to observe, such as sinus bradycardia and idioventricular rhythm. An EKG Sounds item  278  allows the user to enable or disable the associated sounds. An Exit item  279  is provided for exiting the module  54   p  and returning to the display  40  (FIG.  5 ). 
     Although illustrative embodiments have been shown and described, a wide range of modification, change, and substitution is contemplated in the foregoing disclosure and in some instances, some features of the present embodiment may be employed without a corresponding use of the other features. It is understood that several variations may be made in the foregoing without departing from the scope of the embodiment. For example, the system  10  may be modified and adapted for training in pediatric advanced life support (PALS), gynecological treatment, spinal treatment, catheterization, head trauma, burn emergencies, and the like. Such modification may be implemented by simply modifying the program  14  and/or the virtual instruments  30  and sensors  34 . Accordingly, it is appropriate that the appended claims be construed broadly and in a manner consistent with the scope of the embodiment.