MEDICINAL TRAINING SIMULATIONS Erica Osher

“You're lying on the operating table, heart pounding, palms sweaty. The anesthesiologist tells you to start counting backward from 10. “10” - Things are starting to look a little fuzzy. “9” - The lights are starting to swirl. “8” - The room is starting to go dark, the surgeon steps to the side of the operating table and the last thing you hear is “oh cool, my first bypass!” - Dr. Steve Dawson

Pilots learn how to fly and maintaining their proficiency by using flight simulators –flight simulations didn't make flying safer for the pilots, it made it safer for the passengers.

DESIGN QUESTION Can computer-mediated instruction be used to effectively teach medical students and residents where the medical training system currently fails?

RESEARCH SIM Labs Virtual Surgery Institute for Creative Technologies (ICT) – Virtual Reality Theater

RESEARCH Interactive 3D Simulation of Head and Neck and Vascular Anatomy with Radiologic Correlates: A First-Person Shooter ‘Serious Gaming’ Project COMETS

PROTOTYPE 1: DIGITAL HEARTBEAT SIMULATOR

PROTOTYPE 2: USER SCENARIO

The Patient: Jim, a 55-year-old Photographer who has been a working in the magazine industry has just been given the opportunity to document a documentary production in Africa. This opportunity is just what James needs, he’s grown sick of shooting stars and models and is looking for something new and exciting. He has a couple of weeks before he embarks on his way to Liberia and needs to go to the doctor for a routine check up and get some necessary vaccines. For the past 7 years, Jim’s weight has gone up and has since been diagnosed with high cholesterol and high blood pressure, which he’s currently on medication for. Lately, he’s been feeling a little light- headed and “just not right,” but assumes it’s because he’s fed up with work. The Doctor: Dr. Phyllis, a 33-year-old family doctor and mother of toddler twin boys. She’s been working in a private practice for the past 4 years, ever since she got back from working in Africa with Doctors Without Borders. The Scene: Dr. Phyllis checks Jim’s blood pressure, temperature, ears and throat. All normal. The doctor moves on to checking his breaths and heart and hears this. Play sounds

PROTOTYPE 3: EXTENSIVE CASE SCENARIO Case: Irregular heart beat Chief Complaint: Lightheaded and fatigued History of Present Illness (HPI): James is a 51yo M with past medical history of hypertension and hypercholesterolemia who presents to your office for a routine follow-up. When you ask him how he’s been he tells you that he has been very fatigued and lightheaded. He feels like his heart is racing. He says this has been going on for a few days. He would have called you sooner but he knew he had an appointment with you today. He denies any chest pain but is having some shortness of breath on exertion and occasionally feels like he’s having a difficult time catching his breath at rest.. Past Med Hx: Hypertension and hypercholesterolemia PSurgHX- tonsillectomy as child Meds: Hydrochlorothiazide 25mg daily Simvastatin 40 mg by mouth at night Allergies: Penicillin

PROTOTYPE 3: EXTENSIVE CASE SCENARIO Social history: Smoking- 1 pack a day x 30 years. Alcohol- 6 pack of beer on the weekends Drugs- denies Family History: Father with heart disease- first MI at age 54 Review of Systems: All negative except what was noted above Exam: Vitals: pulse 174, respirations 18, BP: 140/90, oxygen – 98% on room air General: NAD, conversant and appropriate Neck: no thyromegaly or masses Chest: (audio clip clear) Clear to auscultation bilaterally. Cardiovascular: (audio clip of atrial fibrillation). Irregularly irregular and tachycardic. Extremities- no peripheral edema

PROTOTYPE 3: EXTENSIVE CASE SCENARIO Labs/studies: EKG – show EKG of atrial fibrillation with rapid ventricular response.

NARROWING THE SCOPE Explore the medical situation Sensor Technology Sensor Gloves Wiimote Procedural Training Laceration Repair Space and Movement Different Levels with tutorials and feedback

NEXT STEPS Tufts Healthcare Institute Procedure Curriculum Explore the ins and outs of the procedure