The decision by one Philadelphia medical center to do away with using animals as part of its pediatric training in favor of sticking to simulators reflects a national trend for training in relatively simple procedures. Although animals have been critical in driving healthcare innovation, simulators have grown increasingly sophisticated, so much so that surgical residencies have scaled back on using animals until residents first prove themselves competent on a simulator. Here are four things that are contributing to the use of simulators for training, particularly for surgeons.
Improving performance: “Two big advantages simulators have over animals is they can measure the performance of a procedure accurately and quantitatively,” Dr. Richard Satava, professor of surgery at the University of Washington, told MedCity News. Satava’s career has been steeped in developing virtual reality tools for surgery and he has worked with NASA and the Defense Advanced Research Projects Agency. They not only show whether a procedure was done correctly, they can also measure speed, accuracy and more subtle gauges of failure or success. The student or resident knows what skills they need to hone and he or she won’t be allowed to operate on an animal until they’ve done it right.
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Referred to as training to proficiency, Satava says using simulators in this way has been the second-greatest revolution in medical training since the Flexner Report’s publication in 1910 and he points to JAMA’s publication of a study quantifying the use of simulators by Yale University School of Medicine in 2002.
Training proper catheter insertion has been one area where simulators are particularly effective.
Although he acknowledges that no one particularly likes performing surgery on animals, Satava said it remains a critical test of ability that won’t be phased out anytime soon. “We want that test to be as real as it would be in the real world. But a time will come when simulators will be good enough to be used for a final exam.”
Surgical rehearsal: The technology that’s being developed is not only to train surgical residents, it is also helping surgical teams of anesthesiologists, nurses, surgeons and assistants rehearse complex surgeries together.
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Last year, Simbionix’s simulator for operating on the carotid artery, PROcedure Rehearsal Studio, secured 510(k) clearance from the U.S. Food and Drug Administration to simulate surgery on a carotid artery. Earlier this year, the system was approved for an additional indication — to simulate surgery on an endovascular aneurysm. The system is designed for surgeons to evaluate surgical treatment options before surgery.
“No other technology allows users to plan and rehearse in this way,” claimed Tom Andersson, product manager for Simbionix’s patient procedure rehearsal studios.
Laparoscopic surgery requirement: The American Board of Surgeons added a requirement that, starting in 2009, surgical residents have to get certified in the basics of laparoscopic surgery to qualify for certification as a surgeon. The complexities of that surgery, which involves inserting a camera through the belly button and making small incisions to do complex, delicate, minimally invasive procedures to help patients heal faster, will more than likely lead to more virtual reality simulators.
Medical schools phasing out use of animals: As for medical schools, the widespread shift to adopt simulators and phase out animals has been due to the student ethical considerations, but financial concerns as well. Animals have to be fed and housed, and they eventually die. Simulators can be used repeatedly, although they can come with a big price tag.
Aliye Runyan is an American Medical Student Association Education and Research Fellow and recent grad from the University of Miami Medical School. She said simulators are used to run full codes, simulate breathing, enact responses to certain drugs. “Our stance is we do actually urge med school classes and labs make use of live animals be optional if people feel it’s against their moral compass,” she said. “At least with simulators, if you make a mistake, you’re not harming anything.”
