Inter-professional Collaboration in Simulation Technologies
Healthcare as we know is continuously evolving as it adapts to advancements made in research and medical innovation as well as in the increase in demonstrated training to be taken outside of operating rooms. More importantly, training costs, the reduced funds for the upkeep and support of operating rooms and patient safety precautions from novice surgeons errors demand the use of simulation technologies and alikesimulative methods. Nowadays, the re-modelling of surgical training practices to encourage the use of simulation procedures is becoming more and more substantive. [1] But before diving any deeper into the abyss of simulation technologies and their applications in health care, let’s clear out what a simulation device sophisticated and developed for medical
purposes actually is.
Simulation is the act of imitating how real-world processes or systems operate in a controlled environment designed for trainees. [1] Already, there have been a number of surgical simulators developed such us:
- cadavers,
- animals,
- virtual reality systems,
- robotic simulators, and more. [1]
All aim to provide the most immersive and realistically possible surgical training experience for trainees.
The goal here is to create an error forgivable environment so that trainees can practice numerous times until they achieve the level of expertise they aim for while cultivating their technical skills, psychomotor development and various other competencies needed in real-life surgical occurrences such as judgment skills and team collaboration. [1]
A positive outcome of simulation technologies in surgical training is that operative costs of operative rooms and complication rates in surgical procedures decrease and overall surgical results concerning patient satisfaction increase exponentially. [1] Therefore, virtual reality is being endorsed by medical and health scientists at an increasingly fast rate. It is no wonder that that the fruitful and seamless collaboration between IT and health professionals is needed more than ever.
Applications of Simulation Technologies in Healthcare
Simulation based training for novice surgeons and surgeons in general is one of the most constructive ways for successful surgical operations to eventuate. There are multiple types of simulation activities, but we are going to focus onto the ones that require collaboration between IT and health professionals.
Human Patient Simulator
Our first paradigm of why inter-professional collaboration is essential between health and IT professionals is the utilization of the Human patient simulation (HPS). This is the quintessential teaching method used by health educators to cultivate critical thinking and clinical decision-making to trainees while they practice on a full-sized patient mannequin.
HPS simulates most of the main functions of the human body such as respiratory sounds, heartbeat, pulse, blinks and breathing. This technologically advanced mannequin can display in real time information to the trainees concerning vital signs and major body functions. [1] The development of such highly sophisticated electronic equipment is the result of the collaboration between hardware and software engineers, material design engineers, graphics specialists and related health specialists who need to built, program, test and put into practice this simulator.
A positive outcome of simulation technologies in surgical training is that operative costs of operative rooms and complication rates in surgical procedures decrease and overall surgical results concerning patient satisfaction increase exponentially.
Virtual Reality
Virtual reality (VR) is among the best and most effective simulation technologies currently on use for surgical training.
Its applications have been developed with the surgeons in mind as it allows for interaction with 3D computerized databases in real time. [2] Considering its long term benefits like low-cost surgical training, more practicing hours for trainees and a repetitive error-free learning process, virtual reality is starting to become the norm in many high tech medical centers and health institutions. [2]
For example, the NeuroTouch VR is a neurosurgery simulator used for a variety of different simulations such as that of microdessections, tumor aspiration, debulking and hemostasis. All of the above can be operated by one single VR unit.
The increase in the computers processing power and their graphical capabilities as a result have made VR devices capable of simulating extremely realistic environments. It is worth noting that it is not all about what the surgeon sees during a simulation but what he/she feels as well. VR simulators similar to the NeuroTouch VR simulator offer haptic feedback functionality to the trainees and surgeons while in themiddle of the simulation. Metrics are also derived as results of the performance of the user and can be later assessed and reviewed by educators. Such metrics are the time completion of tasks, errors, and economy of movement. [1]
In order to build effective VR surgery simulators, a complete team of specialists from ergonomics and applied psychology to software engineering, digital 3D design, electromechanical engineering, robotics and micro-technology are needed. [2]
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As of now, commercially available virtual reality simulators for educational purposes are in use in therapeutic gastroscopy, endoscopic retrograde cholangiopancreatography, colonoscopic procedures as well as in venepuncture. More complex simulators are provided for gastroenterology students. [2] Continuing, radiological simulators for cardiac catheterisation and angiography are also provided, to mention lumbar puncture and brain ventricular tap simulators that trainees can exploit freely on the internet. [2]
Furthermore VR performs splendidly in surgical planning. Its applications allow for surgeons to practice on the simulator surgical procedures before
the patients surgery. Basically, the surgeon inputs into the simulator patient related information and then the simulator creates a virtual environment where he/she can rehearse prior to the procedure and review possible outcomes. [1]
RAS Simulators
One of the most modern developments in health simulators is the Robot-assisted laparoscopic surgery (RAS) simulator. It is a complete surgical unit consisted of foot pedals, dual hand controls, a 3D camera and a robot. As
it is most commonly referred to as the “Da Vinci Surgical System” this simulator can be equipped with virtual reality technology and use the virtual environment instead of the live endoscopic feed from a patient for surgical simulation purposes. [1] The Da Vinci Simulators produce similar metrics to the ones of other simulation systems. Some of them are, task completion time, error metrics and motion analysis. [1]
Benefits of Simulation Practices
Simulation technologies are considered among surgeons and students truly beneficial since they offer a wide variety of educative assistance. More specifically, simulation training increases confidence in surgeons as well as trainees since they can exercise on a variety of medical situations.
High fidelity surgical training is costly for most medical institutions and alternative educational means such as simulators, even though the units on their own can be regarded as expensive in both installation and maintenance, in the long-run they can be proven to be bargainous since trainees can reuse them as often as it is required, allowing for the trainee to repeat surgical procedures as long as necessary and in an error-free manner while at the same time compensating for the higher costs of high fidelity training. [1] Particular procedures, treatment protocols and unusual cases or scenarios can also be simulated thoroughly allowing for a more effective learning curve. [1]
Most Anticipated Technological Advancements in Simulation
It is clear that future technological leaps are going to revolutionize the way surgery operations happen.
Some notable advances are no other than telesurgery, 3D printing, VIPAR (Virtual interactive presence and augmented reality), AR (augmented reality) and further improvements and practices in virtual reality. It can be said that we are not far away from evaluating medical school candidates on their performances on simulation devices. [1] Moreover, medical education practices might have to establish gaming approaches that increase the comprehensibility of the learning material. [1] Further study is needed to validate this assumption. Let’s analyze some of the future prospects in simulation.
3D Rapid Prototyping
3D rapid prototyping uses medical imaging in creating and planning a variety of procedures. For example, 3D printers can replicate the anatomy of patients and surgeons can practise and plan ahead for the operation while also considering possible outcomes before the actual surgery. [1] More specifically in neurosurgical simulation, 3D printers can create patient — reminiscent models, print them and then use them in the procedural planning of the surgical operation. [1]
Virtual Interactive Presence and Augmented Reality (VIPAR)
VIPAR is a system used for remote surgical cooperation that converts the visual field of a surgeon to the one of another surgeon with AR technology in real time. This enables over-the-air collaboration and communication or even over-the-air guidance by an expert surgeon to a novice one. Potentially, surgeons can collaborate by distance in surgical discussions, surgical maneuvering and anatomical structures identification. [1]
Further Applications of Virtual Reality
Virtual reality has also many applications in microsurgery and even nanosurgery. Microbots and nanobots are being developed for use inside the human body. Along with nano cameras, surgeons can find themselves immersed inside the patient’s body with real time live imagery, consider metrics that are transmitted also in real-time, and make high quality observations. [1]
practice laparoscopic procedures over this setup.
Surgical simulators have gone a long way since the 1990s and as of now are considered among medical professionals more intuitive in use, more engaging, realistic and effective than some decades ago. [2]
Their practicality in education and effectiveness in surgical planning is undoubted. It is certainly expected that the simulators of the future will be evolving similarly and accordingly to the evolution in precision medicine and the ongoing trend of adapting surgical practices to the patients characteristics. In addition, VR simulators in laparoscopic surgery have confirmed that simulative technologies reduce complication rates, improve trainees skills and increase the completion rates of surgical operations. [2]
Therefore it is logical to expect more of these simulators to be taken advantage of in surgical education.
Nevertheless, inhibitor factors are the questionable level of computer literacy among most medical professionals above the age of 30; the belief most surgeons have is that VR and robots are impractical and even in some cases dangerous and that the cost of simulation training is still considered to be unbearable for most medical institutions. [2]
As technology evolves in meteoric speeds,the collaboration between health and IT professionals will become more and more seamless and effective.
Through this collaboration, sophisticated technological equipments such as simulators, will truly raise the bar when it comes to efficient, safe and effective surgery. Simulation technology will be an inseparable part of surgical education and surgical operations. We must embrace this new technology and all the benefits it provides for educators, surgeons and, most importantly, patients.
References
[1] Ido Badash, Karen Burtt, Carlos A. Solorzano, and Joseph N. Innovations
in surgery simulation: a review of past, current and future
techniques Carey, 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC5220028/
[2] Science, medicine, and the future, Virtual reality in surgery, Rory
McCloy, Robert Stone, 2001, https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC1121442/
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