Immersion Medical simulators successfully validated in virtual bronchoscopy training tests by two medical studies

San Jose 24 January 2002Two new medical studies validate the use of medical simulators as an effective method of training doctors and ultimately delivering higher quality patient care, as announced by Immersion Medical, a wholly owned subsidiary of Immersion Corporation, a developer of medical simulators. These two independent studies, conducted by the University of California at San Diego and Cleveland Clinic Foundation with the University of Maryland and North Shore University Hospital, reveal positive results about how simulators can objectively measure and improve a physician's level of skill.


According to the National Academy of Sciences' Institute of Medicine, up to 98.000 people die each year in hospitals because of mistakes by medical professionals. As the problem of medical errors increases, there is a growing need for improvements in doctor training. Both studies tested Immersion's AccuTouch Endoscopy Simulator with the Bronchoscopy module. The Bronchoscopy module includes Immersion's patented TouchSense technology, extensive videos covering the practice procedures, an interactive 3D model showing the tracheobronchial tree and adjoining anatomic structures, and software teaching the navigation of a bronchoscope in the simulated anatomy.

The University of California study stated that the AccuTouch Endoscopy Simulator could significantly improve a physician's performance. In the study, trainees were given 4 hours of supervised training and allowed 4 hours of unsupervised training to perform flexible fiberoptic bronchoscopy (FFB) on the simulators. Five novices were taught to perform inspection flexible bronchoscopy using a VR bronchoscopy skill centre. Dexterity, speed, and accuracy were tested using the skill centre and an inanimate airway model before and after the 4 hours of group instruction and 4 hours of individual unsupervised practice.

Results were compared to those of a control group of four skilled physicians who had performed at least 200 bronchoscopies during 2 years of training. Novices significantly improved their dexterity and accuracy in both models. They missed fewer segments after training than before training, and had fewer contacts with the bronchial wall. There was no statistically significant improvement in speed or total time spent not visualising airway anatomy.

As a result of this training, the trainee's skill level could equal a physician with several years worth of bronchoscopy experience. Novices performed more thorough examinations and missed significantly fewer segments in both the inanimate and virtual simulation models.

The study clearly illustrated that technical and manual skills can be rapidly acquired in a computer-simulated environment. These skills, although tested with a virtual environment, could be transferred to direct patient care. The study predicted that the incorporation of simulation technology for training bronchoscopists will engender a revolution in pulmonary procedural training and dramatically change training strategies for endoscopists and the medical industry as a whole.

In a separate study, the Cleveland Clinic Foundation validated the AccuTouch Endoscopy Simulator as an effective measurement tool at quantifying a physician's skill level. Three cohorts were evaluated based on the number of bronchoscopies previously performed: experts, intermediates, and novices. Each participant performed two simulated cases with performance measures being recorded by the simulator.

Novice trainees performed the bronchoscopy on the simulator at a different level when compared with expert bronchoscopy specialists who performed the same procedure. Performance measures which distinguished between groups were used to evaluate the learning curve for new fellows training on the simulator. A randomized-controlled trial was conducted comparing the quality of bronchoscopy performance for new pulmonary fellows who were trained either with conventional methods or with the simulator.

Expert bronchoscopists performed better on the simulator than intermediates who performed better than novices in terms of procedure time, percentage of segments visualised, time in red-out during which airway anatomy cannot be visualised because of improper positioning of the bronchoscope, and wall collisions. Training of new fellows demonstrated that after performing 20 bronchoscopic simulations, the skill level acquired with the simulator significantly improved in terms of speed, percentage of segments visualised, time in red-out, and collisions.

Fellows trained on the simulator performed better than fellows trained using conventional methods during their first actual bronchoscopies as assessed by procedure time, a bronchoscopy nurse's subjective quality assessment score, and by a quantitative bronchoscopy quality score using the percentage of segments correctly identified measured against the procedure time.

"Medicine, like many other fields, requires the use of manual and technical skills which doctors traditionally learned over time through many years of practice", stated Atul Mehta, M.D., Vice Chairman of Pulmonary and Critical Care Medicine at the Cleveland Clinic Foundation. "Now, new physicians can learn difficult procedures much faster on virtual patients using Immersion Medical's simulators, thus decreasing risks to real patients."

According to the study, the simulator looked, felt and responded realistically despite the fact that the bronchoscopy was being performed on a virtual patient. Finally, the study concluded that bronchoscopy simulation might prove an important tool for initial physician training, on-going competency assessment, continuing training, and general medical education.

"These studies are significant because they illustrate the value of medical simulators", stated Greg Merril, founder and chief visionary officer of Immersion Medical. "Our technology will change traditional medical training as doctors look for new technology to help them perfect their skill level and give better care to real patients. We have received feedback from doctors that practising procedures on our simulators feel as real as performing them on actual patients."

More news about Immersion Medical's simulation software can be found in the VMW November 2001 article U.S. Army to invest in Immersion's trauma related medical simulators. Copies of both studies are available at the Immersion Medical Web site.

Leslie Versweyveld

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