Applying Simulation to Surgery

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The health care profession in my mind has not embraced information age. For them it is telemedicine it's electronic medical record and maybe some simple decision support. The area that's been ignored in my mind is the area of simulation. Now this is the big 800 pound gorilla that's been there all along but nobody's been paying attention to.

Simulation is the only of the information sciences that permits us to predict the future. Not perfectly, but with much greater accuracy than what we can today. Now this isn't new. This is decades, as a matter of fact simulation as we know in education training field goes back to 60 and 70 years.

But it allows you to try things that would be too dangerous in the physical world to do, to put things together that you wouldn't be able in the real world. It compresses time and scale magnitude one of the things that I would like to see happen is to be able to develop models of self as we are doing or maybe we shouldn't be and then to do a trial we do that clinical trial on million people and do it over 20 year period time over this we can on a super computer, this is done in every field except for health care and our agencies our government and our individuals aren't even looking at this enormous opportunity, one that we don't have to invent anything we just have to take what's available learn from those who have been doing it for decades and decade.

Military, the aviation industry, the nuclear industry every single one of them does that but we have don't. I as a surgeon, look that from a little different perspective and I looked at simulation to train technical skills, and how to do operate procedure safely. The key stone of simulation in my mind in general is permission to fail safe environment.

That's the big deal here, and so it allows us to train individuals, make mistakes, learn from those mistakes. It allows us also for the very first time to quantitatively measure performance in a technical aspect which we've never done before. We've been able to do cognitive skills by doing various testing computer based examinations and so on and so forth.

But we never really had a very good way of quantitatively measuring performance change for quality, and because of that we have never actually been able to train people to bench mark of competence. We can know built simulations and validate that it measures performance accurately, then we can run our experts through there and find out what a competent expert performance should be.

And then for the very first time what we would do is we would be able to train a person until they scored 100% in technical skills. Right now, we're on a transition but up until this time the apprenticeship model was you would go and you would be a time-based training. Even if you went to a laboratory you would work on an animal for three days and then you get 85% and you'd be able to go out and operate.

Quite frankly, when I go see my patient I don't want to say, And Mrs. Jones, I just finished my training. I got 85% that means when I operate on you tomorrow I'm going to make 15% errors. That's basically what we're training, but I would feel much more comfortable that I continue training until I got this 100% and I would have much, much more confidence when I told this patient that I am very, very confident that I'm going to be able to do this with very little or no errors.