Medical Modeling and Simulation Database

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Excerpts from the Literature

Medical Modeling and Simulation: The Problem

The apprentice model used to train physicians and healthcare providers has remained virtually unchanged for centuries.

--William F. Dunn, Simulators in Critical Care Education and Beyond, The Society of Critical Care Medicine; 2004:1-2.

The decision about how we learn is at a crossroads: we can continue to use the same methods we've used for centuries, or we can keep the best of the traditional methods and simultaneously leverage new technologies that we derive from the revolutions in computing and information technologies that are occurring in parallel with our own revolutions. We can invest in the science that will create revolutionary ways to learn, making our mistakes in realistic, but not real, situations where patients are not put at risk.

--Steven L. Dawson, A Critical Approach to Medical Simulation, Bulletin of the American College of Surgeons, 2002:87(11):12-18.

For many decades we have employed a model of educating physicians that emerged in the nineteenth century. We assume we know, and can impart during medical school, a finite body of facts that all medical students must know. Following medical school, we rely on an apprenticeship method, in which each succeeding cohort of residents is taught primarily by the one just ahead of it. We rely on "master clinicians" - the teaching attending physicians - to impart their clinical wisdom patient by patient, as the young physicians-in-training gather closely around.

--Mark R. Chassin "Is Health Care Ready for Six Sigma Quality?" The Milbank Quarterly, 1998;76:565-591.

However, the apprenticeship model is becoming increasingly difficult to sustain. As insurers reduce reimbursements to hospitals, senior doctors are under pressure to focus on revenue-generating work - treating sick people and conducting procedures - rather than on teaching. Moreover, in order to cut costs, operations and therapies that once took place over several days are now performed in a few hours, or in outpatient settings. As a result, students are spending less time with individual patients and have fewer opportunities to observe a case from diagnosis to resolution. Some life-threatening conditions, such as anaphylactic shock or a ruptured aortic aneurysm, occur infrequently enough that a trainee may become a licensed physician without encountering such disorders or mastering the skills to treat them. Health care may be unique among high-risk fields in that learning takes place largely on human beings.

--Jerome Groopman, A Model Patient, The New Yorker, May 2, 2005.

The skills required for the practice of modern procedure-based medicine are frequently so difficult to learn that traditional training is no longer acceptable, and learning on patients is increasingly suboptimal. Eleven years after Satava reported his vision of virtual reality for training procedural skills in minimally invasive surgery, this technology and proficiency-based training method are beginning to change the training paradigm in all of procedural-based medicine. Hereafter, physicians performing the procedure on patients for the first time will have a more homogeneous skill set, which will lead to safer, objectively assessed intraoperative performance. The ultimate goal is for this shift in procedural skills training to result in improved quality of care for patients.

--Anthony G. Gallagher and Christopher U. Cates, Approval of Virtual Reality Training for Carotid Stenting, JAMA. 2004;292(24):3024-3026.

The real world of patient care is one of scarce resources, enormous time pressure, increasingly complicated clinical problems, and high expectations for both the patients and the professionals. The best way to reduce the bite is to become more specific about what the standards of performance for the technologies should be, about the process of validating compliance with the standards, and about the effectiveness of applications, both in improved training and skills and in improved outcomes for the patient.

--C. Donald Combs, Analyzing the MMVR Research Space, Past Emphases, Future Directions, Medicine Meets Virtual Reality, 2003, IOS Press:36-41.

Traditional training methods for new [medical and surgical] procedures include performing the procedure on animals, cadavers, or mechanical models or supervised performance of the procedure on patients. Inherent problems with these traditional training strategies include the ethical and anatomical problems of training on animals, risks posed with repeated exposure to radiation, and the expense of consuming real medical devices.

--Anthony G. Gallagher and Christopher U. Cates, Approval of Virtual Reality Training for Carotid Stenting, JAMA. 2004;292(24):3024-3026.