The rigours of medical school teach the information required to become a physician, but when it comes to surgery, the greatest teacher is experience. Traditional surgical training is done through a type of immersive apprenticeship, with experienced surgeons teaching residents in the operating room over a period of years. Now, doctors-in-training can practise their skills on extremely realistic simulators.
"We're working to enhance patient safety and the quality of patient care. At the same time, we're dedicated to the process of education and the assurance of competency, so the advanced technologies in our Clinical Simulation Center help us to meet all these goals", stated Paul Gauger, M.D., associate chair for education, University of Michigan Department of Surgery.
Some simulators are now able to replicate complete surgical procedures, so trainees are forced to make judgments and complete complex tasks based on their visual perception and, to a certain extent, their sense of touch. Some of the simulators even have force feedback technology, where trainees can feel resistance against the instrument when it presses or pulls.
Dr. Gauger notes that surgeons, no matter what their level of experience, are vested in the well-being of their patients. While surgical trainees are less experienced in some advanced techniques, simulations remove the stress related to patient well-being so trainees can increase their confidence, along with their competence.
For example, laparoscopic procedures, where surgeons use long instruments through small incisions in the abdominal cavity, enable the surgeon to "see" inside the abdominal cavity through a small camera mounted on one of the instruments. So laparoscopic procedures take away the opportunity for the surgeon to touch and feel tissue.
"In laparoscopic procedures", Dr. Gauger explained, "you're actually interacting with a two-dimensional image at the same time you're operating within a three-dimensional space. These skills can be hard to develop, so the simulators allow us to practise co-ordinating our hand movements within both 2D and 3D virtual environments."
Dr. Gauger noted that the Clinical Simulation Center works to prepare doctors-in-training for a wide variety of difficult situations. "We really have very little control over what specific problems our patients come to us with, so we don't have complete control over what kinds of learning opportunities exist. The Clinical Simulation Center provides those learning opportunities on demand", Dr. Gauger stated.
Derek Woodrum, M.D., is in his fifth year of residency training in surgery at the University of Michigan Health System, with two more years of training to complete. He recalls the first time he operated on a patient. "I was nervous beforehand, but as soon as I was in the operating room with the attending surgeon who was instructing me, time slowed down and I was focused, so it wasn't a nervous undertaking by any means", he stated.
Dr. Woodrum practises in the Clinical Simulation Center. He stated that the higher-end simulators are eerily similar to what goes on in a real operating room. The anatomy is correct, including the variations that are common in humans, and this adds to the sense of realism in simulations. He noted that the simulators range from devices that teach manual dexterity by picking up balls and putting them into buckets, to ones doing complete operations where all the steps are just as they would be in a real operating room.
"The simulators have been very beneficial in my training, which is a lot different than it would have been 15 or 20 years ago. This technology has been incredibly valuable in order to prepare for what we'll be called upon to do in the operating room", Dr. Woodrum stated.
Will this technology help medical schools to train better doctors? And, will the technology help improve patient outcomes? Dr. Gauger stated that the Clinical Simulation Center is rigorously evaluating the level of learning that takes place at the Center in order to answer these questions and help other centres determine how best to use simulation technologies.
Dr. Woodrum, who is also involved in evaluating the quality of learning through simulation, stated that the evaluations aim to prove to the academic community that there are benefits, both to the surgeon trainee, and to the patient. For more information, you can visit the Web site of the University of Michigan Medical School's Clinical Simulation Center.