Making virtual surgery a reality: Construction begins on new simulation center
BY CAMILLE MOJICA REY
It's a scene straight out of the TV show "ER." A team of doctors and nurses hover over a patient, moving frantically while shouting orders and vital signs. "Squeeze in that fluid," a doctor cries. In response, a nurse uses both hands to compress an IV bag. A report from the foot of the gurney: "We have tons of blood pouring out over here." The tension mounts; someone yells for paddles. But it's too late. "We're asystolic. This guy's dead." There is silence as members of the team look at each other over their masks, helpless and panting. "This is unacceptable," says the group's leader. "Let's reboot."
The team of physicians and nurses has just experienced a simulated surgery—and the death of a patient.
The vignette is from a Stanford-produced CD on the benefits of simulation, but it's one that physicians here hope to play out over and over again once the medical center opens its new state-of-the-art Center for Simulation in Medicine. Construction on the $4 million facility, which was entirely funded by private donations, began Jan. 24. Medical school officials expect CSIM to be up and running by the fall.
"This center will transform our system of training and continuing education," said Thomas Krummel, MD, who will serve as CSIM's director. "We will have people at every level doing every kind of procedure, from the simple to the complex."
With its Silicon Valley locale, Stanford is uniquely situated to bring together the best in medical education and the latest in computer technology. "This is one of the best places on the planet to do this," said Krummel, who is the Emil Holman Professor and Chair of the Department of Surgery and the Susan B. Ford Surgeon-in-Chief at Lucile Packard Children's Hospital.
"The aviation industry has used simulation training for years, and it has an incredible safety record," Krummel said. He pointed to a 2000 report by the Institute of Medicine titled "To Err is Human," which calls for drastically reducing the number of human medical errors. "The solution to error is better technology and better training," he said. "We will have both."
Once completed, CSIM will allow Stanford's students to get hands-on experience without actually touching a human being. "CSIM will close the gap between classroom learning and patient care," said David Gaba, MD, associate dean for immersive and simulation-based learning and professor of anesthesia. "It will be an important hub for physicians, nurses and others to hone skills and improve clinical care, patient safety and efficiency of care."
The center will include lifelike mannequin simulators. These virtual patients can breathe, blink and speak. They have pulses and humanlike responses to medical procedures and medications.
These virtual patients also offer tactile feedback in response to surgical manipulations. When an instrument is inserted into a surgical training device, for example, the trainee feels counterpressure that approximates the feel of cutting into that particular organ. Meanwhile, a video monitor displays what a surgeon operating on a real patient would be seeing.
CSIM will also offer four specialty simulators that will let students practice the placement of catheters and stents, as well as the use of endoscopes and fiber-optic laparoscopes. High-tech displays in a simulation theater will allow trainees and educators to view both live and recorded simulation sessions.
In addition to use by students, CSIM will allow surgical teams to rehearse and plan for the use of novel techniques, new equipment or complex cases before entering the operating room. CSIM's location is a major strategic advantage in this regard, Krummel said. It will be adjacent to Stanford Hospital's operating rooms and the nearby ICU. "It's like the driving range being located next to the golf course. You practice and then you're right there," he said.
While there is no substitute for interacting with real patients, Krummel continued, virtual ones allow students to make their first mistakes on plastic and wires and not on flesh and blood. They also allow educators to evaluate their own success as teachers. Krummel and his colleagues will use simulation data to refine their teaching and conduct studies on how well simulated experience transfers to bedside performance. "In the end," he said, "that's what really counts."
Camille Mojica Rey is a freelance science journalist who has written previously for Medical Center Report.