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Virtual medicine - Students train on simulation mannequin

By Alison C. Burggren -- Bee Staff Writer
Published 2:15 a.m. PDT Friday, July 25, 2003

Nervous fingers on the gloved hands of the medical student trembled slightly as he slid the catheter into the patient's body. The 59-year-old patient had a blocked artery leading to his kidney and needed a cylindrical stent, or piece of tubing, inserted to open up the clogged artery.

All at once the worst happened -- the student nicked the artery, machines started beeping and the student's heart sank.

The patient's life, however, was not top priority in this case. Instead, it was all about training the doctor.

This scenario is one of many expected to play out within the walls of a simulation suite at UC Davis' Center for Virtual Care.

Robert Chason, chief operating officer of the UC Davis Health System, said the old adage "See one, do one, teach one," may soon be a thing of the past in medical training.

At the center of this revolution in medical training is the third simulation mannequin of its kind in the country. "Simantha," from Medical Simulation Corp., arrived this month at UC Davis and is so realistic that physicians can "feel" lesions in blood vessels and hear the patient's voice throughout the procedure.

Dr. David Dawson, associate professor of clinical surgery and specialist in vascular surgery at UC Davis, said he's had to take months off at a time to travel around the country to learn new surgical techniques throughout his career.

With Simantha, physicians can learn new surgeries within weeks without ever putting a patient's life in danger.

Simulation training is not a new technology. The military and airlines use flight simulators to train pilots, and other medical simulation equipment has allowed students to learn basic techniques such as inserting an IV line.

What makes Simantha different is the level of detail that makes it realistic. At the beginning of the procedure, a computer-generated face representing the admitting emergency room physician appears on the screen and in a chatty sort of voice lists the patient's history, heart rate, blood pressure, allergies and medication.

It's up to the physician to diagnose the problem, dispense medications and take computer-generated X-rays with a foot pedal while implanting a stent to repair a damaged blood vessel. All of the simulation procedures revolve around implantation of a stent in the patient to repair damaged blood vessels.

The expected payoff is fewer mistakes, complications and deaths due to a botched procedure. The simulation computers give physicians feedback immediately after the procedure, comparing the decisions they made to textbook procedures. All of the programs are written by physcians, and new ones can be added to the system as they are created.

A recent study published in the Annals of Surgery, a major medical publication, supports the expectation of reduced mistakes with virtual training. Surgical residents trained in a new way to remove gallbladders using simulation technology committed one-fifth fewer errors than the group trained with the usual video materials and lectures.

There are important differences from practicing on a live patient. No scalpel is used to open the patient, and a catheter to guide the stent is already inserted into the skin when the doctor begins the procedure. It's the surgeon's responsibility to move the stent to the right location as guided by interactive computer images.

But the environment is made to feel as real as possible -- with surgical drapes around the patient and EKG results displayed on computers hovering over the patient's body. The surgeon can even feel resistance in the catheter when it "hits" the end of a blood vessel displayed on the X-ray screens.

An entire simulation can take three to four hours, similar to the actual length of the corresponding surgery in a live patient.

Catheter-based surgeries can be delicate, more delicate than replacing the damaged vessel completely, and require a great deal of coordination among a team of physicians. Surgeons often choose between putting a catheter in a damaged blood vessel or replacing the damaged part of the vessel completely.

"But catheters are the way the industry is going," Dawson said. It's less invasive and often has a much faster recovery time for the patient.

Dawson said that one procedure last week involved one of the physicians in the surgical team, chief resident Lisa Abramson, who had extensive surgical experience but had never performed this exact operation before. Dawson said surgeons like Abramson will benefit from simulation technology.

Simulation surgery can mimic real-life complications, giving surgeons and operating teams the skills to reduce the time of real surgeries.

The system, Dawson and Chason said separately, could also be used to test physicians' skills after training. One day it could be required on the medical licensing exam.

Chason said that this is just "one more piece of technology" in an effort to create a virtual hospital within the UC Davis medical system. There is also a surgical robot intended to allow surgeons at UC Davis one day to perform surgeries at remote hospitals.

The realism of the simulation can be striking, even to professionals.

Simantha's introduction, Chason said, was on televisions in front of a roomful of cardiologists, none of whom knew the surgery they were watching was being done on a simulation model until the surgeon touched his headphones, essentially breaking the sterile field around the patient, and went directly back to surgery. A perplexed murmur immediately filled the confused room of clinicians.

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