Medical Simulators Take Flight: Replacing Animals in Lifesaving Procedures
By Jonathan Balcombe, Ph.D.

Most people have heard of flight simulators, those virtual environments used to train pilots in routine and emergency operations of aircraft. Given their success, it was only a matter of time before medical simulation followed.

Today's medical simulators place trainees in a virtual environment that mimics the look and feel of performing an actual medical procedure. And, just as flight simulators improve passenger safety, medical simulators enhance patient safety through improved doctor preparedness and procedural competence. They can also replace the use of animals, simulate a variety of both healthy and unhealthy virtual patients, and stage unforeseen complications with the opportunity for unlimited repetition.

Immersion Medical launched its first stand-alone medical simulator for training in needle-stick procedures in 1998. Today, CathSim® has 6 learning modules, with more than 400 installed in medical training facilities around the world. All of Immersion Medical's simulators provide a complete visual, tactile, and auditory learning environment. They also provide a thorough evaluation following each trial run, saving information in a database and allowing individual users to track their progress. The user can even replay the entire simulation to see where mistakes were made.

Immersion Medical has since developed two new lines of simulators for endoscopy and endovascular procedures, such as placement of electrical pacemaker leads in the heart. Endoscopy allows visualization of a patient's internal anatomy using a flexible, snake-like tube with a light and camera on its end, inserted through a body orifice. In colonoscopy, for instance, trainees learn how to navigate through a patient's lower bowel, take biopsy samples, and remove pre-cancerous polyps. Some 1.5 million colonoscopies are performed yearly in the United States. These procedures are tricky, and poor technique can cause serious injury. With simulation, the doctor-in-training can practice repeatedly with no risk to patients.

A recent study documented significant improvements in trainee skill in performing bronchoscopies on patients following training on the simulator.¹ Another study found that novice bronchoscopists performed more thorough exams on a manikin following training with Immersion Medical's simulator than did skilled physicians with two years of training without a simulator.² Other studies have found that Immersion Medical's simulators for flexible bronchoscopy,³ flexible sigmoidoscopy,⁴ and placement of cardiac pacemaker leads⁵ can discriminate among expert, novice, and intermediate practitioners.

For several of these procedures, animals—especially dogs and pigs—are still used at many training sites. As simulators replace animals at training centers around the world, both humans and other animals will benefit.

References
1. Rowe R, Cohen R. Virtual reality bronchoscopy simulator (abstract). Anesthesiology 2000; 93(3A):A-1219.
2. Colt HG, Crawford SW, Galbraith O. Virtual reality bronchoscopy simulation: a revolution in procedural training. CHEST In press.
3. Mehta AC, Ost D, Salinas SG, et al. Objective assessment of bronchoscopy skills by a bronchoscopy training simulator. Am J Respir Crit Care Med 2000;161:A234.
4. Datta VK, Mandalia M, Mackay SD, Darzi AW. Evaluation and validation of a virtual reality based flexible sigmoidoscopy trainer. Gut 2001;(Suppl)48:A97-8.
5. Wong T, Darzi A, Foale R, Schilling RJ. Virtual reality permanent pacing: validation of a novel computerized permanent pacemaker implantation simulator. J Am Coll Cardiol 2001;(Suppl)37(2):493A-4A.

Jonathan Balcombe is reseach coordinator for Immersion Medical. For more information on the company's simulators, visit www.immersion.com or call 301-984-3706, ext. 345.