Case Study: Case Study: Outline Outline Integrating Integrating - PDF document

Case Study: Case Study: Outline Outline Integrating Integrating • Current U.S. military trauma training Current U.S. military trauma training • Simulation into a Simulation into a challenges and solutions challenges and solutions Surgical Orientation Surgical Orientation • Basic trauma care education challenges Basic trauma care education challenges • • Solutions Solutions • Christoph R. Kaufmann, MD, MPH, FACS Christoph R. Kaufmann, MD, MPH, FACS • National Capital Area Medical Simulation • National Capital Area Medical Simulation Chief, Division of Trauma and Combat Surgery Chief, Division of Trauma and Combat Surgery Center Center Co- Co -Director, National Capital Area Medical Simulation Center Director, National Capital Area Medical Simulation Center Uniformed Services University Uniformed Services University • • Medical student surgical orientation Medical student surgical orientation Bethesda, MD, USA Bethesda, MD, USA http://simcen http:// simcen. .usuhs usuhs.mil/mmvr2002 .mil/mmvr2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Special Challenges in Trauma Current U.S. Military Trauma Special Challenges in Trauma Current U.S. Military Trauma Experience Surgery Training Surgery Training Experience • Military hospitals don’t see enough Military hospitals don’t see enough • Blunt trauma infrequently requires Blunt trauma infrequently requires • • trauma to train all personnel trauma to train all personnel operative care operative care internally internally • U.S. incidence of penetrating trauma U.S. incidence of penetrating trauma • • DoD DoD should have sufficient expertise should have sufficient expertise is decreasing is decreasing • & personnel to ensure capable trauma capable trauma & personnel to ensure • Use of animals becoming less Use of animals becoming less • surgical care in earliest stages of war surgical care in earliest stages of war appealing appealing • All medical care providers All medical care providers • • Cadavers don’t bleed Cadavers don’t bleed • A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Solutions Solutions But… But… • Military medical center Level I Military medical center Level I • What about the beginners? What about the beginners? • • trauma centers trauma centers • What about teaching rare scenarios? What about teaching rare scenarios? • • Civilian/military trauma training Civilian/military trauma training • • What about testing competency? What about testing competency? • centers centers • … … • • Individual rotations through trauma Individual rotations through trauma • centers centers • Other trauma experience/courses Other trauma experience/courses • A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 1

National Capital Area Medical National Capital Area Medical Simulation Center (NCAMSC) Simulation Center (NCAMSC) • unique facility dedicated to the unique facility dedicated to the • education of military medical students education of military medical students • modern educational techniques/devices modern educational techniques/devices • • 12 clinical exam rooms 12 clinical exam rooms • • 16 PC computer lab 16 PC computer lab • • Conference rooms Conference rooms • • surgical simulation suite surgical simulation suite • A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 USUHS Orientation to Surgery USUHS Orientation to Surgery New 3 Day Program New 3 Day Program 2 Day Program 2 Day Program • All parts of the simulation center are All parts of the simulation center are • • Third year medical students Third year medical students • being used to introduce third- -year year being used to introduce third • Two day animal lab Two day animal lab • medical students to surgery medical students to surgery • Laparotomy Laparotomy day 1 day 1 • • First day of 3 day orientation at the First day of 3 day orientation at the • • Thoracotomy Thoracotomy day 2 day 2 Simulation Center (days 2 and 3 = Simulation Center (days 2 and 3 = • animal lab as previously) • Lectures Lectures animal lab as previously) • A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Standardized Patient Examinations Standardized Patient Examinations 12 Clinical Exam Rooms 12 Clinical Exam Rooms • 97% of U.S. Medical Schools use 97% of U.S. Medical Schools use • • Teaching through Teaching through • Standardized Patients for instruction; Standardized Patients for instruction; the use of the use of 85 % use them for assessment 85 % use them for assessment simulated patients simulated patients – actors taught by – actors taught by • Increasing use of Standardized Patients Increasing use of Standardized Patients • a patient trainer to a patient trainer to in residency training programs in residency training programs mimic signs and mimic signs and • SP use in “high stakes” testing: SP use in “high stakes” testing: • symptoms of symptoms of USMLE (2002/2003) USMLE (2002/2003) specific diseases. specific diseases. A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 2

Clinical Exam Rooms Faculty Monitoring Area Clinical Exam Rooms Faculty Monitoring Area • Take a medical history and a Take a medical history and a • perform a focused physical exam for perform a focused physical exam for a variety of acute abdominal diseases a variety of acute abdominal diseases (2 patients each) (2 patients each) • These encounters are videotaped and These encounters are videotaped and • the tapes are reviewed with the the tapes are reviewed with the teaching surgeon during the teaching surgeon during the subsequent 45 minutes subsequent 45 minutes A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Computer Lab Two Conference Rooms Computer Lab Two Conference Rooms • Used to teach a suturing and knot Used to teach a suturing and knot- - • • Introductory talk and a lecture Introductory talk and a lecture • tying lab using web- -based based tying lab using web preparing the students for the preparing the students for the applications (vesalius applications ( vesalius.com) and .com) and laparotomy lab lab laparotomy hands- hands -on surgeon instruction using on surgeon instruction using • Plastic mechanical models are used Plastic mechanical models are used • suture trainers suture trainers to teach such skills as endotracheal to teach such skills as endotracheal intubation, chest tube insertion, and intubation , chest tube insertion, and • Triage principles Triage principles • the surgical airway the surgical airway A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Surgical Simulation Suite Surgical Simulation Suite • state state- -of of- -the the- -art virtual reality lab art virtual reality lab • and an operating room complete and an operating room complete with human patient simulator with human patient simulator mannequins mannequins A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 3

Virtual Reality Lab: Trauma Virtual Reality Lab: Trauma Training Simulators Training Simulators • BDI BDI Anastomosis Anastomosis Simulator Simulator • • MGI Limb Trauma Simulator MGI Limb Trauma Simulator • • HT HT CathSim CathSim and and Bronchoscopy Bronchoscopy Simulator Simulator • • MedSim MedSim UltraSim UltraSim • • USU DPL and Pericardiocentesis USU DPL and Pericardiocentesis • A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 FAST: Focused Abdominal FAST: Focused Abdominal Simulators Developed by the Simulators Developed by the Sonography for Trauma Sonography for Trauma USU Surgical Simulation Lab USU Surgical Simulation Lab UltraSim: Ultrasound Simulator Diagnostic Peritoneal Lavage ATLS Surgical Skills Practicum ATLS Surgical Skills Practicum Pericardiocentesis Diagnostic Peritoneal Lavage Pericardiocentesis A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Chest Tube Cricothyroidotomy 4