Simulator Training: The Future? Mike Larvin RCS Director of Education Professor of Surgery University of Nottingham at Derby.
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Simulator Training: The Future?
Mike Larvin
RCS Director of Education
Professor of Surgery
University of Nottingham at Derby
Imitation of reality for research, testing,
training or education
Requires:
• valid source information
• simplifying approximations and assumptions
• validity, reliability, fidelity
Simulation
Technological triggers: Cold war
“Tennis for Two” (1957) Higinbotham (Brookhaven)
used missile trajectories
Sputnik 1 (1957)Launched atop a modified
ballistic missile
• 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
Surgical training has changed
• 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
Public drivers US IOM 2004
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 CultureDouglas Coupland, 1991
• 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 EconomyDavid Berreby, 1999
Generation ‘Y’ = junior trainees
• 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 WorldDon Tapscott 2009
Generation ‘Z’ = coming soon
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 programmesMedical School F1/F2 ST1/2 ST3/4 ST5/6 Consultant Plus
• Anatomy• ATLS® • BSS, FSS, SSS• CCrISP®• Communication• STEP® Core• STEP® Foundation• Core Specialty Skills• Core Surgical Sciences• e-Surgery (DoH)
• Aesthetics• Plastics • Breast• Cardiothoracics • Coloproctology• Emergency & Trauma• OMFS• Orthopaedics• Otorhinolaryngology• Urology• MIS• Neurosurgery• Paediatrics• Vascular Surgery
• 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 College Total
Courses Participants Courses Participants
2005 - 6 457 7806 117 2165574
9971
2006 - 7 441 7373 95 1894536
9267
2007 - 8 449 7368 135 2084584
9452
• anatomy, physiology, history, behaviour,
physical findings
• cadavers, prosections, plastinates
• plastics
• animal tissue
Active 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
Interactive simulation
• ‘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
Training simulation types
• Sim Man 3g (Laerdel)
• life-sized mannequin
• responds to injected drugs
• programmed for life
threatening emergencies
• can be changed ‘on the fly’
High-fidelity live simulation
• 1985, K Semm’s
‘pelvi-trainer’
for laparoscopy
• Haptics included
ἅπτεσθαι - to “contact” or “touch”
Laparoscopy
• 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
Virtual simulators
• 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
Benefits
• Despite their
proven effectiveness,
junior surgeons usually
have to pay to attend courses
from their own pocket
Donaldson, 2009
Costs
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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