HEAPHY 1 & 2PLENARY

Billie MUDIE

Fri 30th Aug 2013Session 3 / Talk 1

13:05 – 13:50

ABSTRACT"VERT™ is a virtual environment of a radiotherapy treatment room. Through captivating 3D views and life size visualizations, VERT offers an excellent platform for supplying radiation therapy training to students, nurses and multidisciplinary team members. From illustration of theoretical concepts through to acquisition of clinical skills in a safe environment VERT delivers benefits for the student, tutor, clinic staff and the patient.“In Jan 2013 the Radiation Therapy Department at the University of Otago, Wellington had New Zealand's first and only VERT system installed. This presentation will demonstrate this virtual environment using a portable version of vert. The session will be interactive with case studies presented and an opportunity for feedback and ideas from delegates

W H E R E H AV E W E B E E N ; W H E R E A R E W E G O I N G

EDUCATION AND SIMULATION

EDUCATION AND SIMULATIONANCIENT EGYPTIANS

• Edward Smith Papyrus• Imhotep 2600BC • Learnt medicine by working with other physicians

Edward Smith Papyrus Ancient Egyptian word for brain

EDUCATION AND SIMULATIONANCIENT GREEKS

• First Medical School at Cnidus in 700BC• Learning through apprenticeship• Hippocrates (460BC – 370BC)

• The Father of Modern Medicine• The Hippocratic Oath• Four Humours

EDUCATION AND SIMULATIONANCIENT ROMANS

• Galen – (129 – c200/216AD)• Accomplished surgeon (cataract surgeries similar to

modern techniques)• Aged 16 learnt medicine at the local Asclepeion• Due to religious restrictions anatomy/physiology learnt

through vivisection and dissection on pigs and Barbary monkeys

EDUCATION AND SIMULATIONUP TO 14OO AD

• Galen’s and Hippocrates theories dominated Western medicine for 1300 years

• Large medical schools throughout Europe• Mostly lectures and readings – very little training

EDUCATION AND SIMULATIONMIDDLE AGES

• Universities established – Padua 1222

• Dissection for anatomical training allowed• Often criminals

• First public dissection recorded in 1315

• Dissection in England not permitted until 16th Century

• Anatomists

EDUCATION AND SIMULATIONEIGHTEENTH CENTURY

• Teaching is still lecture and reading based

• Final year medical students clinical experience limited to following professors through the wards

EDUCATION AND SIMULATION19TH AND 20TH CENTURIES

• Rise of modern medicine

• Apprenticeship model incorporated into medical training

EDUCATION AND SIMULATION

• Radiation Therapy and Medical Imaging

• Apprenticeship model of training

• DCR – degrees, masters and PhDs

EDUCATION AND SIMULATIONWHAT IS SIMULATION?

• “ The technique of imitating the behaviour of some situation or process (whether economic, military, mechanical, etc) by means of a suitably analogous situation or apparatus, especially for the purpose of study or personnel training”

• Medical EducationVolume 40, Issue 3, pages 254-262, 17 FEB 2006 DOI: 10.1111/j.1365-2929.2006.02394.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1365-2929.2006.02394.x/full#f2

EDUCATION AND SIMULATIONSIMULATORS

EDUCATION AND SIMULATIONSIMULATION TYPES

Part-task trainersComputer-based systems – audio and videoVirtual reality and haptic systems

Precision placementSimple manipulation

Complex manipulationSimulated patients – role playSimulated environments Integrated simulatorsInstructor-driven simulatorsModel-driven simulators

EDUCATION AND SIMULATIONHISTORY

• Military• Chess• Jousting

• Aviation• Flight Simulators

• Space Programmes• Zero gravity• Flight simulators

• Nuclear Power Industry

EDUCATION AND SIMULATIONMEDICAL HISTORY

• Anatomical models• 17th Century obstetric mannequin

• Early 1960s• Resusci-Anne

EDUCATION AND SIMULATIONMEDICAL HISTORY

• Mid 1960s• Sim One

• First computer controlled mannequin simulating the entire body

• Originated through “Aerojet needing to develop peacetime applications of its capabilities in the face of diminishing military funding, before the escalation of the Vietnam conflict”

• High fidelity features• Only one created

EDUCATION AND SIMULATIONMEDICAL HISTORY

• Harvey – cardiology simulator• 1987 CASE• GAS

EDUCATION AND SIMULATIONNURSING

• Nursing • Entire simulated wards

EDUCATION AND SIMULATIONNURSING

EDUCATION AND SIMULATIONWHY USE SIMULATION?

• Provides a safe, supportive educational environment

• Duty of care to the patient• Minimise risk of harm• Patient autonomy

• Cost effective

Medical EducationVolume 40, Issue 3, pages 254-262, 17 FEB 2006 DOI: 10.1111/j.1365-2929.2006.02394.xhttp://onlinelibrary.wiley.com/doi/10.1111/j.1365-2929.2006.02394.x/full#f2

EDUCATION AND SIMULATION

EDUCATION AND SIMULATIONADVANTAGES

• Feedback• Identify gap• Provide feedback on the ap• Investigate the basis for the gap• Help close the gap – discussion and targeted instruction

• Risk to patient is avoided• Skill acquisition and maintenance

• repetition• Transfer to practice• Team work training• Mastery learning

• A critical review of simulation-based medical education research: 2003-2009. McGaghie, W et al• Medical Education 2010; 44: 50-63

EDUCATION AND SIMULATIONRADIATION THERAPY

• VERT - Virtual Linear Accelerator and Environment• Released in UK in 200

• Australia 2011

• New Zealand 2013

EDUCATION AND SIMULATIONVERT

EDUCATION AND SIMULATIONSIMULATION VS CLINICAL EXPERIENCE

• Can simulation replace clinical experience?

• Does it replace clinical experience?

• Should it replace clinical experience?