Medical training institutions face a number of challenges when it comes to training junior doctors. One, of course, is how to train them in a realistic way, without putting patients at risk.
Then, there is pressure on funding and on the time that students are available for training, as steps are taken to reduce the hours they work.
A potential solution to some of these issues is the widespread introduction of medical simulation. The Making it Real conference held in Birmingham this week explored the possibilities – and the boundaries – of technologies such as virtual and augmented reality and serious gaming.
Stitching a banana
Subui Subramonian from University Hospital Birmingham told the event that the surgical skills required of doctors have changed in recent years, as the rate of laparoscopic surgery – popularly known as keyhole surgery - has increased.
Rather than practicing on cadavers – which is also expensive - students are frequently using the 'dry lab' method of training.
This involves using laparoscopic tools to conduct exercises, such as suturing a banana, within a box while looking at a screen to navigate the challenge. The problem is that this makes students "very quick and rough," Subramonian said.
Virtual simulation devices aim to help students to learn the hand/eye coordination required to use laparoscopic tools by using physical tools connected to a visual display.
More and more of these types of devices are coming to market, but they are very expensive. In addition, they can't provide the haptic feedback needed to give doctors an idea of the pressure they need to exert to effectively cut or sew matter, or what different organs feel like.
"We have got to be able to feel what we are cutting and how much to cut, which is the problem with these models," said Subramonian.
An aptly named company, UK Haptics, has attempted to overcome this issue. Its first product is focused on injections. It enables clinicians to virtually pick up a needle, and feel the resistance when pushing the needle into a patient’s skin or a suitable vein.
The same company has also created a system specifically for German company Bayer, for use with its Mirena IUD.
The product is being used in 46 countries to teach physicians how to properly insert the IUD. It includes information and scenarios for different challenges facing physicians - such as uniquely shaped cervixes.
However, incorporating the haptic component is not a cheap business. UK Haptics chief founder Gary Todd told eHealth Insider he could not disclose how much Bayer had paid for its product. However, £1m was spent on developing the virtual veins simulator.
The National Blood Transfer Unit and the North East Ambulance service are set to collaborate with UK Haptics on a trial of the vascular simulator, as a proof of concept exercise. But Todd would like NHS organisations to be bolder about working with commercial entities, and buying good ideas instead of continually testing them.
Trusts seem keener on serious games as a virtual training tool. Entertainment games manufacturers have moved into this area by creating medical training exercises.
For example, the serious gaming division of Blitz Games Studios, TruSim, has worked in collaboration with County Durham and Darlington NHS Foundation Trust to develop the ‘Patient Rescue’ game.
This is intended to teach junior doctors how to correctly identify the signs of patient deterioration; and do something about it.
A virtual patient can be seen improving or deteriorating as various actions are taken or not taken, and the game ends when he either improves satisfactorily, or dies.
The trust approached TruSim to develop the game because of the limited amount of time its junior doctors are able to spend training on hospital wards.
TruSim strategy and business development director Mary Matthews told EHI the product is currently in prototype stage. Further investment is needed to take it further.
Another example presented at the conference came from immersive learning specialist company Daden, which is working with students in virtual environments.
For example, it has a program that enables students to play out an exercise focused on genetic coding and it is hoping to get the same platform used to train nurses in appropriate bereavement behavior.
However, augmented reality (AR) appears to be the ultimate goal for many developers. AR combines 3-D graphics with an actual surrounding to create an experience viewed through components such as head-mounted glasses, tablets and PDAs.
Microsoft has created the Kinect CT scan, which overlays x-rays images onto the user’s body, allowing users to ‘peer’ inside it.
The five scientists and researchers who have been working on Kinect at Microsoft’s UK research base in Cambridge won Britain’s top technology prize for their initial work, which fed into the Xbox 360 games console.
The researchers won the £50,000 MacRobert award from the Royal Academy of Engineering. Microsoft’s researchers are now collaborating with surgeons with a view to letting them use hand gestures to call up imaging and other information on screens while carrying out operations.
Dominic Cushnan from augmented reality design company Mixed Reality Studio, says this type of technology could also be used as an alternative to dry lab type set ups, in which doctors are required to look at a screen to see what their hands are doing.
The benefits of virtual systems are becoming accepted. The problem seems to be securing initial investment, at a time when the NHS is facing serious demands for efficiency savings.
Taking research and exploiting itJean Roberts 162 weeks ago
The tools presented at the event have tremendous potential but still have similarities with some I evaluated for the European Commission some years ago; indicating the route to market may be convoluted. The challenging area seems to be getting research into practice via turning deliverables into market products. Only a few universities have transition units to take their research forward. More are now involving end-users in their developments which guarantees proof of concept. I think the UK needs to look more at the facilitation of the logistics of this transition -- perhaps using IDEAGORAS more, as outlined in the Wikinomics book of a few years ago??
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