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| Archive : Fall 2005 |
Put Away Your Textbooks, Class, and:
Figure out what's wrong as a patient cries in agony // Stand up to your superiors // Try not to stab a soldier's liver // When he dies, thank God he's not real.
All Too Human [page 3]
 By Charles Slack // Photographs by Ken Schles
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But what really excites Dawson are simulators that combine such on-screen wizardry with tactile realism. The Vascular Intervention System Training, or VIST, lets physicians re-create a patient's veins, arteries and tissue, and then practice threading a catheter through this anatomically identical system contained in a rectangular box. Developed by members of Dawson's team in collaboration with Japanese electronics giant Mitsubishi, VIST feeds information to a display monitor, which helps doctors guide the catheter along its circuitous route.
Another system, VIRGIL, is designed to train medics to diagnose and treat battlefield chest wounds. Working on a life-size model developed by and for the U.S. military just before the terrorist attacks on Sept. 11, 2001, a physician preps an area with Betadine (an antibacterial solution), cuts a hole, inserts a clamp and then sweeps a finger inside to make room for the tube. When the tube goes in, there's a rush of either blood or air, depending on the type of injury the computer randomly selects. Push in too far and damage the liver—a relatively common error among inexperienced medics in the heat of combat—and the computer announces, ominously, "You've killed the soldier. Do you want to try again?"
Dawson demonstrates another simulator, a fleshy cylinder with the heft and density of a Marine's muscular arm that duplicates the difficulties of administering a smallpox vaccination, a surprisingly delicate procedure. (One pokes lightly at the skin using a small instrument with two pointed tips like a miniature fondue fork.) Proper vaccination produces a faint bloom of blood. Excessive bleeding, or none at all, means you've done it wrong. Dawson jabs at the arm and watches with satisfaction as tiny red dots appear on the surface.
Dawson's team is working toward one of the holy grails of simulation technology: a synthesized, full-size model whose materials and software enable it to reflect and reproduce almost any system or condition of an actual human body. "I don't believe in virtual reality," Dawson says. "I believe in real reality."
But others envision a future in which mannequins are replaced by 3-D imaging so sharp that physicians-in-training actually "feel" the patients they are treating in a computer-generated operating room. "Mannequins have their place, but as 3-D reality becomes more and more sophisticated, our need for them is likely to diminish," says Jeffrey Taekman, director of the Human Simulation and Patient Safety Center at Duke University.
The idea of learning in a virtual world seems natural to many of today's students. "Most have been raised on computers and rapid-fire multimedia," says Taekman. "They are a new age of learner. They're comfortable with all kinds of computer resources, and that's how they prefer to get their information."
But virtual or not, patient simulators are going to become a ubiquitous presence in medicine, predicts Cooper, who foresees myriad devices and approaches suited to an equally vast array of needs. "A generation ago people questioned whether computers would ever have a place in medicine," Cooper says. "Now they're so common you don't even think about them—you just realize the benefits. That's where simulators are headed."
 Dossier
1. "A Brief History of the Development of Mannequin Simulators for Clinical Education and Training," by J.B. Cooper and V.R. Taqueti, Quality & Safety in Health Care, Oct. 2004. An excellent grounding in the history of simulators.
2. www.thesimgroup.org The next best thing to playing with them: detailed descriptions and demonstrations of VIRGIL and other simulation devices being produced at The Sim Group.
3. "The Future Vision of Simulation in Health Care," by David Gaba, Quality & Safety in Health Care, Oct. 2004 (Supplement 1). One of the pioneers of modern simulation offers his outlook on the field's future.
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