[Editor's note: while the audience of this web site is not the target group to use such simulators, you are the designers of these devices. See what's available and what is expected, as multiple sensory techniques and technologies, signal and image processing and graphic presentation, and more, are integrated into sophisticated simulation units.]
Practice makes perfect, and in medical training, there is a push for more practice assisted by technology. Advanced simulation technology for medical education has been widely advocated as a better way to train and demonstrate competency than traditional see one, do one, teach one apprenticeship.
In an era of intense concern over training more and better clinicians and improving patient safety while battling rising costs, simulators allow unlimited practice opportunities. Clinicians can document competency levels without running afoul of U.S. restrictions regarding resident in-hospital hours, now capped at 80 hours a week. Simulators also alleviate the demands on senior clinicians with limited time to teach, assuage concerns about animal rights, and provide an alternative to practicing with cadaveric parts, which are often in limited supply. Some experts assert that as patients have become more involved in making decisions about their healthcare, more are asking clinicians how many times they have performed a given procedure—a question for which every healthcare professional wants to give a reassuring answer.
As procedural specialization continues unabated, more medical device companies have commissioned advanced simulators to train those who use their complex and often costly products. These advanced medical simulators typically include computer hardware, software, sophisticated 3-D graphics, audio, and, sometimes, haptic (force feedback) devices that provide the highly realistic feel of performing a procedure.
Minimally invasive surgery (MIS) is also a key factor behind the drive for advanced simulators. MIS is performed using a small video camera, a video display, and a few customized surgical tools. For example, in gall bladder removal (laparoscopic cholesystectomy) surgeons insert a camera and long, slender tools into the abdomen through small incisions in the skin. They can then explore the internal cavity and manipulate organs from outside the body as they view their actions on a video display. Because the development of minimally invasive techniques has reduced the sense of touch compared with open surgery, surgeons must rely more on the feeling of net forces resulting from tool-tissue interactions and need more training to successfully operate on patients. Thus, haptics is a valuable tool in training surgeons for MIS.
Certainly, the role of device makers in providing clinicians with anatomical representations is not new, nor is their role in selling training as an adjunct revenue stream. However, these lessons have been transformed of late. Where they once involved just a static mannequin or simple demo devices, now they are virtual experiences offering new levels of realism. Even so-called dummies are far smarter, built as integrated systems wired with sensors, haptics, and body fluids. These computer-based virtual reality simulators are being used to practice blind procedures that require clinicians to operate more by feel than by visual markers. These simulators provide unlimited lifelike rehearsal opportunities that allow surgeons to gain experience without the risks, similar to how pilots train in flight simulators.
Experts within medical specialties continue to question whether the traditional apprenticeship model of training healthcare professionals is still the best approach. Sophisticated simulators allow surgeons to practice to perfection, without risk to patients, a blind procedure or the use of a particular device. Simulators help surgeons keep their skills intact and can provide testing and documentation of competency. They’re also becoming more widespread, as designers create shippable, easy-to-carry cases that can bring the training and certification to more clinicians.
This article looks at various simulator approaches and characteristics; to read it, click here.
About the authors
Venkat Gourishankar is a senior haptics engineer, and Laura Wallace is director of marketing; both are at Sensable (Wilmington, MA).