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New Jersey : The days of new doctors practising on real patients may be numbered. Today, many doctors in training are making their first diagnoses and their first mistakes on plastic, wires and computer circuits rather than flesh and blood.
These virtual patients come in different shapes and sizes, much like the real ones. Some are almost lifelike mannequins with plastics ears and hair, veins that can be injected, eyes that can move and inter-changeable genitals. They can't be hurt or killed, even though they have a pulse, a beating heart and lungs that breathe. The most sophisticated can be programmed to simulate every imaginable medical crisis and then respond as a doctor works on the "Patients". Other, virtual reality-type simulators combine video or computer images with tactile feedback. Trainees insert needles or surgical tools into a plastic box whose innards give the sensation of cutting flesh or pushing through body parts such as the throat or colon. A video screen shows A video screen shows what a doctor would watch during the procedure, such as ultrasound images.
"Do I think this is a wave of the future? No question," said Dr Stephen Miller of the American Board of Medical Specialties, which oversees certification for medical specialists. "This is a major goal of the medical education and evaluation system."
The top systems are pricey but so realistic that experts predict they'll become standard for training new doctors and for testing experienced ones who soon will face tougher recertification.
The technology is barely 10 years old, and already simulators are widely used for training US military medics and nurses and medical technicians at many community colleges. At least half of the nation's 120 medical schools already use simulators such as Medical Education Technologies Inc's Human Patient Simulator mannequin and Laerdal Medical's SimMan to teach students and residents, or or graduates completing training at hospitals.
"The mannequin is excellent," said Dr Eric Chang, a second-year surgical resident who has trained in the simulation centre at Robert Wood Johnson Medical School in New Brunswick. "This kind of buffs you up in terms of encountering certain problems...You have to react to what's happening" and select the right treatment. Cynthia Yuan, a second-year resident in anaesthesia, said the mannequin "helps them to think when they're in a real situation. I think they should do more of this."
Medical school professors say simulator help their students and residents build confidence and make mistakes-before they treat real patients. "It's an extraordinary advantage," said Dr Adam I Levine, director of the anaesthesiology residency program at Mount Sinai School of Medicine in New York. "If you have to think through the problem yourself and get your answer, you learn it better."
Students sometimes get so caught up in a training scenario that they are upset if a monitor shows the patient has died. One anaesthesiology resident who had sedated a "patient" for surgery, then couldn't insert a breathing tube, frantically resorted to mouth-to-mouth resuscitation, Levine recalled. "They just were so desperate to come up with a way to get oxygen to this patient... who was dying in front of them," Levine said.
(Ref: TOI July 20, 2004)
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