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Medical Meeting Reports

American College of Surgery Clinical Congress

October 10-15, 1999

font=>by Karen Sandrick

Thomas Krummel, MD, of Stanford Medical School, predicted that in the next ten years practicing surgeons will be selected, trained, credentialed, remediated, and recredentialed using computerized virtual reality simulation devices. Surgeons in the future will rehearse operations on palpable holograms that were derived from patient-specific data before they actually perform the procedures on those patients the following day. Endoscopic phantoms, holographic patient simulators, and virtual surgical laboratories will revolutionize the way surgical students, interns, and residents learn and refine their techniques.

Virtual Devices

Virtual reality technology is rapidly moving into the operating room and the medical school. With phantoms, surgeons are practicing new endoscopic techniques by watching their movements on a computer screen or through virtual reality goggles--and feeling the tension of moving through human tissue--as they manipulate surgical tools in life-like situations. Mannequins are reproducing in exquisite detail as many as 80 different physiological events in reaction to the actions of surgical residents. Full-scale simulated operating rooms, complete with working monitors, are recreating surgical crises for teams of faculty and surgeons-in-training.

Dr. Krummel believes virtual reality will become more widespread as medical schools intensify their efforts to cut the costs of surgical education. The current method of teaching interns and residents in the operating room can cost as much as $20 million a year at an institution such as Stanford. Virtual reality also will help teaching hospitals protect the safety of students as well as patients.

The Penn State Program

Four years ago, when Dr. Krummel was on staff at Penn State University Medical School, the department of surgery decided to try to respond to the changing world of physician education. The department chose to adopt virtual reality to reduce the time demands on faculty, expose students to a wide variety of new technologies, and correct what Dr. Krummel calls teaching by random opportunity--that is, instructing students to respond to whatever surgical problem happens to occur in a hospital on any given day. The flaw with this form of teaching is that it does not present material in an orderly fashion or build on students' previous knowledge so they are ready for each new lesson.

One of the programs developed by Penn State is the "First Three Days in Surgery," which seeks to increase the confidence and preparedness of incoming surgical interns and residents. On each of three days before the actual fall term begins, interns spend 10 to 12 hours in lectures, collaborative interactions with nurses and faculty, and simulated virtual reality exercises designed to address the most common problems the newcomers face and the areas in which students feel most deficient, particularly their technical skills.

Performance Improvement

The program is improving students' confidence levels. Students report an average confidence level of 6.36 before taking the course and an 8.38 confidence level afterward, which is statistically significant. The program also is demonstrating increasing proficiency in performing simulated surgical techniques. After practicing on a virtual reality anastomosis device for only 15 minutes a day, surgical residents show steady sequential improvement across all parameters. The total score, which includes measurements of total time, accuracy in reaching defined target areas on the intestine or blood vessel, precision in passing the needle through each target, and avoiding force tear, rose from 39.8 on day one to 56.3 for 11 surgical residents in one study published recently in the Journal of the American College of Surgeons.

New Focus for Surgical Education

Based on his experience, Dr. Krummel believes that virtual reality devices have educational value for the surgeons of today and those of tomorrow. The devices are helping surgical educators rethink "the way we training those who follow us," he said. For professional correspondence, contact Dr. Krummel at tkrummel@leland.stanford.edu.

Ortho Biotech

Funded through an unrestricted educational grant by Ortho Biotech.

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