Transcript Slide 1

Simulator Training:
The Future?
Mike Larvin
RCS Director of Education
Professor of Surgery
University of Nottingham at Derby
Simulation
Imitation of reality for research, testing,
training or education
Requires:
• valid source information
• simplifying approximations and assumptions
• validity, reliability, fidelity
Technological triggers: Cold war
Sputnik 1 (1957)
Launched atop a modified
ballistic missile
“Tennis for Two” (1957)
Higinbotham (Brookhaven)
used missile trajectories
Surgical training has changed
• UG: less practical surgery
• PG1-2: foundation years
• PGY3-4: core MRCS
• PGY5-8+: specialty FRCS
• Less experience, WTD
• New technologies to learn
• Patients and trainees have changed
Public drivers US IOM 2004
• medical errors kill 98,000 people annually
• $37 to $50 billion for adverse events
• resident 80h week, less direct interaction
• bioterrorism threats and crisis management
Generation ‘X’ = most of you
• Followed ‘baby boomer’ generation
• Born 1961 to 1981, ‘13th US generation’
- premarital sex, atheistic, republican,
less respect for parents and authority
- greater formal education
Generation X: Tales for an Accelerated Culture
Douglas Coupland, 1991
Generation ‘Y’ = junior trainees
• Followed ‘Generation X’
• Born early 1980s to mid-1990s
- rapid communication, peer orientation,
instant gratification, stimulating work
- family breakdown, tech-savvy, ‘open’
Hunter-Gatherers of the Knowledge Economy
David Berreby, 1999
Generation ‘Z’ = coming soon
• Followed ‘Generation Y’
• Born early mid-1990s to 2000s - baby boomlet
- highly connected, lifelong use of comms
and media technologies such as WWW
- “digital natives”: instant messaging, texting,
MP3, mobile phones, YouTube
Grown Up Digital: How the Net Generation is Changing Your World
Don Tapscott 2009
Trainees still require:
•
Knowledge
they prefer e-learning
• Skills
technical, decisions, comms: like simulation
• Structure
curriculum and assessment: online is fine
STEP® Foundation and Core
• MMC and ISCP competences
• MRCS preparation
• 8 A4 printed modules
• e-learning, video, web simulation
• e-community and college days
Courses and programmes
Medical School
F1/F2
• Anatomy
• ATLS®
• BSS, FSS, SSS
• CCrISP®
• Communication
• STEP® Core
• STEP® Foundation
• Core Specialty Skills
• Core Surgical Sciences
• e-Surgery (DoH)
ST1/2
ST3/4
• Aesthetics
• Plastics
• Breast
• Cardiothoracics
• Coloproctology
• Emergency & Trauma
• OMFS
• Orthopaedics
• Otorhinolaryngology
• Urology
• MIS
• Neurosurgery
• Paediatrics
• Vascular Surgery
ST5/6
Consultant Plus
• Professional Practice
- Training the Trainers
- Training and Assessment in Practice
• Executive Leadership
• SAS Leadership
• Professional Forum
• Research Network
• International Network
• Operating Theatre Team Project
• Military Operations Surgical Training
(MOST - MoD)
College courses
Regional
Courses
2005 - 6
2006 - 7
2007 - 8
457
441
449
Participants
7806
7373
7368
College
Courses
117
95
135
Total
Participants
2165
1894
2084
574
9971
536
9267
584
9452
Active simulation
• anatomy, physiology, history, behaviour,
physical findings
• cadavers, prosections, plastinates
• plastics
• animal tissue
Interactive simulation
‘Human in the loop’ simulation
Ideal when:
• real environment too expensive or risky
• need to learn in "safe" environment
• test mistakes in safety-critical systems
• ‘type change’ after basic pilot training
Training simulation types
• ‘live’: real people, simulated kit, real world
hi-fidelity, samples likely performance
• ‘virtual’: real people, simulated kit and world
VR training
• ‘constructive’: sim people, kit and world
behavioural training and assessment
High-fidelity live simulation
• Sim Man 3g (Laerdel)
• life-sized mannequin
• responds to injected drugs
• programmed for life
threatening emergencies
• can be changed ‘on the fly’
Laparoscopy
• 1985, K Semm’s
‘pelvi-trainer’
for laparoscopy
• Haptics included
ἅπτεσθαι - to “contact” or “touch”
Virtual simulators
• visual components by computer graphics
• touch components by haptic feedback
• input/output: force feedback
could be widely distributed via standard
web browsers with standard game joysticks
Laparoscopy
• 2010: Symbionix
‘Laparotrainer’
for laparoscopy
• Haptics not included
Eagle project
• Largest capital project since post-war rebuilding
Wolfson Surgical Skills Centre
anatomy teaching
procedural simulation
Simulation Centre
skills laboratory
minimal access,
critical care
operating theatre
Synthetics and animal tissue
Minimal access and critical care
Operating theatre
Teaching suite
Lower cost simulation
Benefits
• improved health outcomes, reduced errors
• reduced health care costs, enhanced quality
• better skills, lower malpractice rates
• more flexible training at correct pace
• allows practice and mistakes, improves skills
without consequence to the patient
Costs
• Despite their
proven effectiveness,
junior surgeons usually
have to pay to attend courses
from their own pocket
Donaldson, 2009
Simulator training: the future?
• More simulation, improved models
• Expensive, collaboration makes sense
• Preparation for work-based training
• NOT a substitute for the ‘real thing’
• More versatile than patient-based training
• Useful in standardising assessment
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