Medical Simulation: Limited Funding Limits the Possibilities: Part 2 of 2 articles

With Don Stredney, PhD, Director of OSU’s Supercomputer Center, Dr. Wiet obtained critical funding from several sources, especially the National Institutes of Health, to standardize CT and high-resolution MRI studies on which to build a T-bone dissection simulation. It’s a multidisciplinary effort including otolaryngologists, neurosurgeons, CT and MRI experts, physicists, biomedical engineers, and computer experts to develop these standards to the level where they could impact otolaryngology and surgical training, Dr. Wiet said.

Dr. Stredney said that getting funding for validation can be frustrating, but is critical for success. It’s too bad that we’re not on the video game industry’s radar, because they sell a million units a month, but what we’re doing doesn’t interest them.…The data sets we arrive at are the sine qua non of simulation. That’s what you need for an ENT surgical simulation, he concluded.

Not everyone is comfortable with simulation’s current stage of development. Bruce Gantz, MD, Professor of Otolaryngology at the University of Iowa and a specialist in cochlear implants and acoustic neuromas, has had his program’s surgical residents use TBD simulators. Our feedback is that they like it and it’s interesting, but not good enough to truly simulate surgery. It does not have the same ergonomics, the same feel as the real thing, he said.

Dr. Gantz has tried simulators from different vendors, but said he’d prefer his residents to spend their time with real temporal bones, which are in good supply in Iowa. Simulation is intriguing, but all of the systems I’ve tried have drag to them. Until it feels right in my hand, I’m not comfortable relying heavily on simulators to train residents, he added.

Trying to close the gap between simulation and the OR at Stanford University’s Center for Immersive and Simulation-Based Learning are Otolaryngology Associate Professor Nikolas Blevins, MD, and Kenneth Salisbury, PhD, head of the Bio-Robotics Laboratory and a scientific advisor to Intuitive Surgical. Their respective teams have targeted the physical interaction between human beings and computer-driven actuators to develop human-friendly robotics in simulation. Put simply, working on the feel of the simulator in the surgeon’s hand is a current interest. They also are reducing the amount of time surgeons have to spend on developing simulations by using simulator-generated algorithms and teaching tools. For example, in developing a mastoidectomy simulation, they had both novice and experienced surgeons perform virtual surgeries, and have collected data on drilling and suctioning techniques. They validate metrics by correlating the scores generated by algorithms versus seasoned surgeons’ ratings.