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.
Ellen Deutsch, MD, a pediatric otolaryngologist at the Alfred I. duPont Hospital for Children, is excited about simulation’s providing opportunities for adult learners and for their teachers to be rejuvenated as they incorporate simulation in their curricula. Describing a simulation using a high-fidelity infant mannequin, Dr. Deutsch has the resident discern if the infant has aspirated a foreign body in the left main bronchus. The baby’s oxygen level is in the low 90s, with stridor, and only the right chest moves during respiration, indicating a possible obstruction. The learner must select the endoscopic equipment to expose the airway, perform endoscopy, see the foreign body, and remove it. The endoscopist must also have a conversation with the anesthesiologist. If the anesthesia is too light, the baby may experience laryngospasm, or if the endoscopy takes too long without the anesthesiologist ventilating the patient, the baby’s oxygen level could drop. The beauty of simulation is that the learner can do it over repeatedly, turning fumbles into competent fluency, said Dr. Deutsch.
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