Surgical Simulation: Surgical Simulation: We dont need simulation. - PDF document

Typical Surgeon’s Perspective Typical Surgeon’s Perspective Surgical Simulation: Surgical Simulation: “We don’t need simulation.” “We don’t need simulation.” A Clinical Perspective A Clinical Perspective “We have plenty of clinical “We have plenty of clinical material.” material.” Christoph R. Kaufmann, MD, MPH, FACS (patients) Christoph R. Kaufmann, MD, MPH, FACS (patients) Associate Professor of Surgery Associate Professor of Surgery Co Co- -Director, National Capital Area Medical Simulation Center Director, National Capital Area Medical Simulation Center Uniformed Services University, Bethesda, MD USA Uniformed Services University, Bethesda, MD USA http://simcen http:// simcen. .usuhs usuhs.mil/mmvr2002 .mil/mmvr2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Outline Outline � Surgery yesterday and today Surgery yesterday and today � � Surgical simulation yesterday and today Surgical simulation yesterday and today � � Surgical education and certification Surgical education and certification � � Surgical patient care Surgical patient care � � Simulation in trauma care Simulation in trauma care � � Surgical simulator development Surgical simulator development � – – Today’s challenges Today’s challenges – – Ultimate challenges Ultimate challenges A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Surgery: Surgery: Surgery: Surgery: 50 years ago 50 years ago Today Today � Vascular surgery, Vascular surgery, intracardiac intracardiac surgery surgery � No vascular surgery No vascular surgery � � � Minimally invasive surgery Minimally invasive surgery � No No intracardiac intracardiac surgery or pump surgery or pump � � � Expanding knowledge base Expanding knowledge base � Open surgery only Open surgery only � � � More procedures More procedures\ \ increasingly technical increasingly technical � Patients spend weeks in hospital Patients spend weeks in hospital � � � 50% of US surgery is on outpatient basis 50% of US surgery is on outpatient basis � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 1

Surgical Simulation: Surgical Simulation: Patients Patients 50 years ago 50 years ago � Patients Patients � � Animals Animals � � Cadavers Cadavers � � Dolls Dolls � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Animals and Cadavers Animals and Cadavers Dolls Dolls A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Mannequins Surgical Simulation: Surgical Simulation: Mannequins Today Today � Patients Patients � � Animals Animals no no change change � � Cadavers Cadavers � � Dolls Dolls Mannequins Mannequins � � Virtual Reality Virtual Reality � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 2

Virtual Reality Simulators Virtual Reality Simulators Traditional Surgical Education Traditional Surgical Education � Apprenticeship Apprenticeship � � See one, do one, teach one See one, do one, teach one � � Learning on patients Learning on patients � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Surgical Education Today Surgical Education Today � Less physician teaching time Less physician teaching time � � Less resident time Less resident time � � Fewer patient hours available for resident and Fewer patient hours available for resident and � student teaching student teaching � Larger number of procedures to learn Larger number of procedures to learn � � Procedures more technical and high risk Procedures more technical and high risk � � Institute of Medicine report Institute of Medicine report � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Challenges in Surgical Education Challenges in Surgical Education � Need a safe transition from classroom to Need a safe transition from classroom to � patient patient � Solution: Solution: � Surgical Simulators Surgical Simulators A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 3

Definitions Definitions � Virtual Reality (VR) Virtual Reality (VR) � � Immersive Environment Immersive Environment � � Haptics Haptics � � VR Simulators VR Simulators � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Surgical Selection and Surgical Selection and Certification Certification � Selection for training Selection for training � � Selection for completion of training Selection for completion of training � � Written and oral examinations Written and oral examinations � � No technical skills examination No technical skills examination � � Interest exists in using simulators to certify Interest exists in using simulators to certify � surgeons surgeons � ( (Recertification Recertification also) also) � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Surgeon Patient Care Steps: Surgeon Patient Care Steps: Perceived Perceived � See patient See patient � � Cut patient Cut patient � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 4

Surgeon Patient Care Steps: Surgeon Patient Care Steps: Simulation in Trauma Care: Simulation in Trauma Care: Actual Actual Triage Triage (Trauma Patient Care) (Trauma Patient Care) � Triage Triage � � History and Physical Examination History and Physical Examination � � Resuscitation Resuscitation � � Diagnostic Studies Diagnostic Studies � � Decision making Decision making � � Operative care Operative care � � Postoperative care Postoperative care � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Simulation in Trauma Care: Simulation in Trauma Care: Simulation in Trauma Care: Simulation in Trauma Care: History and Physical History and Physical Triage Triage Examination Examination A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Simulation in Trauma Care: Simulation in Trauma Care: Resuscitation Resuscitation � A, B, C’s of trauma care A, B, C’s of trauma care � A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 5

Simulation in Trauma Care: Simulation in Trauma Care: Simulation in Trauma Care: Simulation in Trauma Care: Diagnostic Studies Decision Making Diagnostic Studies Decision Making A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Simulation in Trauma Care: Simulation in Trauma Care: Simulation in Trauma Care: Simulation in Trauma Care: Decision Making Decision Making Operative Care Operative Care • Technique/skill trainer • Partial task trainer • Task trainer • Validity? • Transference rate? A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Simulation in Trauma Care: Simulation in Trauma Care: Patient Counseling Patient Counseling Operative Care Operative Care • Educate/consent/prepare patient • Preoperative planning • Position, scrub, drape patient • Skin and subcutaneous incision • Deep (muscle, fascia) incision • Tissue dissection (sharp,blunt, cautery, hand) • Suturing • Knot tying (instrument, hand) A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 6

Preoperative Planning Preoperative Planning Preoperative Planning Preoperative Planning A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Simulation in Trauma Care: Simulation in Trauma Care: Operative Care Operative Care A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 Simulation in Trauma Care: Simulation in Trauma Care: Postoperative Care Postoperative Care A Tutorial on Surgical Simulation: Past, Present, and Future – MMVR 2002 7