George Smith is sick. Sick enough to land him in the hospital, covered in used tissues and attended closely by two nurses as his worried granddaughter looks on.

George can blink (and wink, if he likes you), breathe, talk, cough and moan. He has a pulse, and his bowels gurgle. He can cry, drool and pee. He can be catheterized and injected with drugs. You can even switch out his body parts to make him into a female. He cost Fanshawe over $70,000, and he's a vital learning tool for students in programs like Nursing, Paramedic, Respiratory Therapy and more.

A few rooms on the second floor of D building resemble hospital rooms, full of gurneys and high-tech equipment. In each gurney lies a mannequin — some, like George, are high-tech (also called high-fidelity) and breathe, have a pulse and have advanced computerized features. Others are mid-fidelity (meaning they have vital signs, wound plates and can have IVs placed in them) and low-fi (they may be just a torso with very specific function). Fanshawe has 10 high-fi, six to eight mid-fi and four lowfi mannequins. "Depending on how much money you want to spend, you can make the mannequins as real and as close to being physiologically capable as possible," explained Carol Butler, the Coordinator for Clinical Learning and Simulation at Fanshawe.

The newest addition to the mannequin family is Noelle, a high-fidelity female mannequin. She has all of the same features as George, with one major difference: lift her gown and open her stomach and she has a uterus, complete with a mechanism that pushes a baby out to simulate a real birth.

The new Noelle replaced the older model, which Fanshawe bought five or six years ago with a simulation equipment grant from the provincial government for nursing programs at post-secondary institutions. But since then, said Butler, the technology has advanced a lot. "The (Noelle) that we had really is pretty simplistic compared to the one that we have now."

"Every year you get some equipment funds, and our older Noelle, all she can really do is give birth, and we don't do that too often during the year," she explained. "We really wanted a mannequin we could use more frequently and that we could even use as a female patient in a scenario, so she wasn't always giving birth, she could be used for other things."

The new Noelle mannequin was delivered in early February. She was purchased for around $44,000. Like George, she has a pulse and can blink, breathe and talk. Her baby, high-tech Newborn Hal, can be born headfirst or breeched (butt or feet first), and has a heartbeat. There is also a prop placenta that can be placed in the womb.

"There are lots of different programs that might use that mannequin," said Butler. Anesthesia Assistant students may use her to practice dealing with people who have birth complications, Paramedic and Nursing students could practice birth scenarios or other clinical scenarios and Respiratory Therapy students can use her to practice working with babies and mothers, she said.

The mannequins' blinking and breathing are controlled in a back room, where someone (often one of the Clinical Learning staff) manipulates these and the mannequins' vital signs. This person also provides the mannequins' voices. "A lot of students are quite fascinated by these mannequins, because they breathe and do all these things," said Butler. "When you add the dialogue, it just makes it a much richer piece."

Butler and the other Clinical Learning and Simulation staff present the mannequins in a variety of everyday situations that the students will encounter in a clinical setting. Students are broken up into groups of four to six, with two students acting as the health care professionals (such as nurses), one student acting as a family member and one observer sitting behind a two-way mirror. "It's important to work together in that," said Butler. "A lot of times they work alone, so to work with someone else and communicate and all that, I think that's another good skill."

The scenarios, and what happens during each one, are kept confidential so the students can speak freely about what they may or may not have done. They can give and receive feedback, and it allows students to learn from their mistakes in a supportive environment, said Butler.

"Students go in and make their own decisions," said Butler. "There's no one telling them what to do." It's okay to do something wrong, she said, adding that this is the best part about doing the simulations. "You learn by doing. You learn by making mistakes and troubleshooting them and correcting them. If you can't do it, then you can't really learn it. You might learn it intellectually, but putting it all together involves more than just your mind: your body, your spirit, the whole thing. This way you can show what you've learned and you can really see what you know and what you don't."

Each simulation is videotaped, and after the scenario is played out, the students and staff have a debriefing session where they watch the tape and discuss what happened. "I think the debriefing is pretty important — more important, almost, than the scenario itself — because it's really talking about how it went and what the learning was from it," said Butler.

"They do take it seriously, and they do really like it. The evaluations for this kind of activity are always very positive," she said.

"Simulations helped my critical thinking skills and showed me the importance of my actions as well as showed me how important listening and communication are when helping clients," wrote a second-year Bachelor of Science in Nursing student on an evaluation. Other students wrote about how valuable a learning tool the mannequins were, and that the mannequins should be used more regularly with future students.

"(Simulation is) probably one of the most active forms of learning. It engages all the senses, so it makes it most effective," Butler said. "(In simulations,) the biggest rule is to have fun ... When you have fun when you're learning, you're going to remember it better."