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 [email protected]