Transcript Future technology using full body simulation: What educators and evaluators want to know. 2020 and beyond Richard M.

Future technology using full body simulation:
What educators and evaluators want to know.
2020 and beyond
Richard M. Satava, MD FACS
Professor of Surgery
University of Washington School of Medicine
and
Program Manager, Advanced Biomedical Technologies
Defense Advanced Research Projects Agency (DARPA)
and
Special Assistant, Advance Medical Technologies
US Army Medical Research and Materiel Command
IMMS Futures Panel
International Conference Human Machine Interfaces
Miami, FL
January 16, 200
Classical Education and Examination
Opportunity
This is a unique moment in history to:
• Begin defining Surgical Education with clean slate
• Integrate modeling and simulation into the curricula
• Establish an international consensus for uniformity
Fundamental Principles
to Revolutionize
Medical Education and Training
1. Assume the student knows everything
2. Person specific image for Electronic Health Record
3. Integrate education and assessment into clinical care
4. Must be standardized and tied to the 6 competencies
5. All education must be criterion (proficiency)-based
1. Assume the student knows everything
Battlefield Medical Information Systems – Tactical (BMIS-T)
Point-of-care
ubiquitous knowledge
2. Person specific image for Electronic Health Record
Holomer
(HOLOgraphic Medical Electronic Representation)
Total body-scan for total simulation
From visible human to Virtual
Soldier
Multi-modal total body scan on every person in 15 seconds
Satava
March, 2004
2. Person specific image from the Electronic Health Record
Vascular Interventional System Trainer – VIST
Pre-operative planning
Surgical rehearsal
Disease-specific training
Courtesy Mentice, Inc. Gothenborg, Sweden 2001
2. Person specific image from the Electronic Health Record
Pre-operative Planning - AAA
Courtesy Medical Media Systems, Inc, Lebanon, NH 2003
6. Must be standardized and tied to the 6 competencies
Pre-operative Planning – Facial Deformity
Courtesy David Altobelli, Brigham Womens Hospital, Boston MA
2. Person specific image from the Electronic Health Record
Virtual Autopsy
Wound Tract
• Patient and disease (injury) specific lessons
• Less than 2% of hospital deaths have autopsy
• Statistics from autopsy drive national policies
3 Integrate education and assessment into clinical care
Why robotics, imaging and
modeling & simulation
• Healthcare is the only industry without a
computer representation of its “product”
•A robot is not a machine . . .
it is an information system with arms . . .
• A CT scanner is not an imaging system
it is an information system with eyes . . .
thus
• An operating room is an information system with . . .
3 Integrate education and assessment into clinical care
Engines of Change
Total Integration of Surgical Care
Minimally Invasive
Surgery
Remote Surgery
Simulation & Training
Pre-operative planning
Intra-operative navigation
Joel Jensen,
SRI International, Menlo Park, CA
3 Integrate education and assessment into clinical care
Quantified objective assessment
“Blue Dragon” passive recording device
Correlation of motion analysis with
qualitative assessment- OSATS
Courtesy Blake Hannaford, University of Washington, Seattle
Courtesy Richard Reznick, Toronto, CANADA
3 Integrate education and assessment into clinical care
Tissue Properties Measurements
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E

fz
2a
z
Mark P. Ottensmeyer, Ph.D.
CIMIT, MIT/MGH, Boston
3(1   )
8a 3
(1  2 ) f z
Eslip 
2a z
Daniel Kalanovic, M.D., Joachim Gross, Ph.D.
University of Tübingen, Germany
3 Integrate education and assessment into clinical care
Objective Assessment
Novice
Intermediate
Expert
Hand motion tracking patterns
Ara Darzi, MD. Imperial College, London, 2000
3 Integrate education and assessment into clinical care
Train in a Virtual Hospital on virtual patients
Virtual Battlefield for Medic (NCAMSC) COL Boyer
Operating room of the Future - DARPA
6. Must be standardized and tied to the 6 competencies
The 6 Competencies
2001 Consensus by the AGCME & ABMS
• Knowledge
• Patient Care
•
Interpersonal and communication skills
• Professionalism
• Practice-based learning and improvement
• Systems-based practice
6. Must be standardized and tied to the 6 competencies
Surgical Proficiency
Levels of Proficiency
•
•
•
•
•
Novice
Competent
Proficient
Expert
Master
6. Must be standardized and tied to the 6 competencies
The 5 Conferences
• Metrics
• Errors
•
Methodology
• Curriculum
• Outcomes
6. Must be standardized and tied to the 6 competencies
Standardized Curriculum
• Anatomy
• Steps of the Procedures
• Errors
TEST
• Skills Training
• Outcomes
6. Must be standardized and tied to the 6 competencies
Validation Methodology
• Validities
Face
Content
Construct
Concurrent
Predictive
• Reliabilities
Test - retest
Inter-rater (IRR)
6. Must be standardized and tied to the 6 competencies
Abstract mimics real tasks
Laparoscopic hysterectomy
Surgical
Simulators
Courtesy Michael vanLent, ICT, Los Angeles, CA
LapSim simulator tasks - abstract & texture mapped
Courtesy Andres Hytland, Sugical Science,
Gothenburg, Sweden, 2000
Laparoscopic Simulator with tactile feedback
Courtesy Murielle Launay, Xitact, Lausanne Switzerland
6. Must be standardized and tied to the 6 competencies
Totally integrated curriculum
Full System
ENT Sinusoscopy Simulator
Haptics
Lockheed Martin 1999
Paradigm Change
Traditional
• Halstedian - “See one, do one, teach one”
•
•
•
•
Determined by patient flow
“Conventional” fixed didactic lectures
Subjective personal evaluation
Specific time and place
Next Generation
•
•
•
•
•
Simulation – “Do many, mentored always”
Each student every variation at own pace
Interactive, updated (web based) lecture
Standardized, objective, criterion based evaluation
Continuous at point of clinical care
The Message
Simulators are only a tool, and must be
integrated into a comprehensive curriculum that
integrates into daily clinical care
Only through stringent validation of simulators
and their curricula will it be possible to have
acceptance by the training and regulation bodies
It is not “Build it and they will come …”
but
“… validate it and they will come.
Critical foundation
for
surgical education
Criterion – based training
Conclusions
It’s all about curriculum
Training must be objectively assessed
The new paradigm is “criterion-based”
Validation is key to acceptance
Do Robots Dream ?