HEAPHY 1 & 2 PLENARY Billie MUDIE Fri 30 th Aug 2013 Session 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

WHERE HAVE WE BEEN; WHERE ARE WE GOING EDUCATION AND SIMULATION

EDUCATION AND SIMULATION ANCIENT EGYPTIANS Edward Smith Papyrus Imhotep 2600BC Learnt medicine by working with other physicians Edward Smith PapyrusAncient Egyptian word for brain

EDUCATION AND SIMULATION ANCIENT 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 SIMULATION ANCIENT 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 SIMULATION UP 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 SIMULATION MIDDLE AGES Universities established – Padua 1222 Dissection for anatomical training allowed Often criminals First public dissection recorded in 1315 Dissection in England not permitted until 16 th Century Anatomists

EDUCATION AND SIMULATION EIGHTEENTH CENTURY Teaching is still lecture and reading based Final year medical students clinical experience limited to following professors through the wards

EDUCATION AND SIMULATION 19 TH AND 20 TH 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 SIMULATION WHAT 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 Education Volume 40, Issue 3, pages , 17 FEB 2006 DOI: /j x Volume 40, Issue 3,

EDUCATION AND SIMULATION SIMULATORS

EDUCATION AND SIMULATION SIMULATION TYPES Part-task trainers Computer-based systems – audio and video Virtual reality and haptic systems Precision placement Simple manipulation Complex manipulation Simulated patients – role play Simulated environments Integrated simulators Instructor-driven simulators Model-driven simulators

EDUCATION AND SIMULATION HISTORY Military Chess Jousting Aviation Flight Simulators Space Programmes Zero gravity Flight simulators Nuclear Power Industry

EDUCATION AND SIMULATION MEDICAL HISTORY Anatomical models 17 th Century obstetric mannequin Early 1960s Resusci-Anne

EDUCATION AND SIMULATION MEDICAL 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 SIMULATION MEDICAL HISTORY Harvey – cardiology simulator 1987 CASE GAS

EDUCATION AND SIMULATION NURSING Nursing Entire simulated wards

EDUCATION AND SIMULATION NURSING

EDUCATION AND SIMULATION WHY USE SIMULATION? Provides a safe, supportive educational environment Duty of care to the patient Minimise risk of harm Patient autonomy Cost effective

Medical Education Volume 40, Issue 3, pages , 17 FEB 2006 DOI: /j x Volume 40, Issue 3, EDUCATION AND SIMULATION

EDUCATION AND SIMULATION ADVANTAGES 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: McGaghie, W et al Medical Education 2010; 44: 50-63

EDUCATION AND SIMULATION RADIATION THERAPY VERT - Virtual Linear Accelerator and Environment Released in UK in 200 Australia 2011 New Zealand 2013

EDUCATION AND SIMULATION VERT

EDUCATION AND SIMULATION SIMULATION VS CLINICAL EXPERIENCE Can simulation replace clinical experience? Does it replace clinical experience? Should it replace clinical experience?