Conceptually, the idea behind a Virtual Medical Simulation goes all the way back to the 5th Century Chinese philosopher Confucius, who is thought to have said, "Tell me and I'll forget, show me and I may remember, involve me and I will understand. "

As a broad category, medical simulations are not new. Mannequin-based human simulators; physical-object anatomical simulators, including performing surgical procedures on fruit and vegetables; on-site medical scenario simulations; and haptic technology-based, pressure-sensitive apparatus simulators have been available for years. Additionally, some device- or procedure-specific surgical simulators are available, generally in the form of kiosk-like dedicated computer-based machines.

Second Life Virtual World (secondlife.com), a free 3d virtual world, is also being used to provide medical simulation experiences, usually from an observational, as opposed to a hands-on, point-of-view, and for a limited audience of Second Life participants. Each has value as a training tool, and inherent limitations that limit their practicality from a distribution, cost, participation, or experience point-of-view.

Adding consistency to training
Adobe Flash or HTML, Web-browser based, Virtual Medical Simulations (VMS), especially as developed for medical device training is new and relatively untapped. Web-based Virtual Medical Simulations (VMS) offer significant potential to enhance clinician training, satisfy regulatory demands, and added repeatability, efficiency, and convenience, to an often difficult and uneven training process, all while easing the burden on medical device management and cutting costs.

Virtual Medical Simulations for device training becomes increasingly compelling as the level of medical device complexity grows. While increasingly sophisticated device technology drives the need, it also supplies the solution. As in most industries, software and machines have become vastly more capable and complex over the last few decades, and the trend is ongoing and accelerating.

A clinician's role today can be correlated roughly with that of a fighter pilot. Personal challenges and requirements grow in direct relation to the level of complexity and capability of the machine or device. To be competent operating a complex medical device, a clinician must possess an expert level of understanding of the underlying medical issues, a basic theoretical technical understanding of how the device functions, a thorough understanding of how to operate the device and manage the information generated, good hand-eye coordination, quick reaction times, and a game plan to utilize when things don't go as planned.

The skill and experience set required is consistent with what you would get if you blended a physician with an IT consultant and a video gamer. Currently, competency in all three areas can, and is, being achieved through clinical training in our schools, office procedure rooms, and hospitals. However, the challenge for the medical community, and the promise of VMS, is to be able to improve training results, accelerate the training process, optimize the time expenditure needed to reach competency, standardize the training to provide repeatability and reduce liability exposure, cut costs, and allow medical device designers and manufacturers to facilitate the safe and effective use of software and devices featuring ever-increasing levels of complexity. All this while limiting or eliminating the need to learn device operation on living subjects or on actual medical devices. A medical device VMS can provide the safe, convenient, repeatable, trackable, memory retaining exercise, and blended sensory experience that satisfies the challenges of maximizing the potential of medical devices, while minimizing many of the shortcomings and obstacles associated with today's traditional person-to-person or instructional manual and conventional website based learning practices.

Medical Device VMS is an effective solution for the trainee, as it stimulates and satisfies what is commonly thought of as characteristics of both the right and left sides of the brain. The user experience, when executed properly, offers an engaging mix of logical process flow, strong reference indicators to mark the step-by-step progression of the operation, easy navigation for review or "jumps" to specific areas of interest; a multimedia, sensory-rich presentation; the learning benefits; and the enjoyable interaction of a "hands-on" training experience. Plus, there’s the convenience that comes from having the user select the location, date, time, and platform: mobile, pad, or desktop.

The potential benefits for medical device manufacturers begins with a more engaged, satisfied, and well-trained pool of trainees. Personnel time expenditure for training management, scheduling, and implementation are minimized. Costs to gather, and in many cases, feed and house groups of trainees are eliminated. Education specialist positions can, in many cases, be reduced in number, and the cost for their travel, food, and housing also can be eliminated. Traditional training efforts are often uneven with the quality of education specialist’s competency ranging from excellent to poor. A standardized didactic method can help present the material in an optimized manner each time. Reporting can provide confidence that users took the course, spent "X" amount of time, passed certification, and, when devices evolve, received updated training. Additionally, the device manufacturer is given the ability to centrally control the dispersed training information. Updates to the Web-based, or app distributed tool, assures that changes are immediately and globally available to all educational specialists, organizations, trainees, and even graduates, if appropriate.

Case study
Philips Healthcare wanted to enhance its training tools and methods for its Vascular Division's, Alura Interventional Suite with XperGuide. DDA Medical proposed building a VMS. The recently launched simulation features a unique navigation system, a virtual interventional lab environment, a video introduction, a passive procedure simulation, where the trainee watches and listens as the device and software is operated, and an active simulation where the trainee is cued to virtually operate the device and software, and is corrected when an erroneous step is taken. The trainee, when stymied and upon request, is also offered hints.

The VMS also allows the trainee to learn how to set up and run a rotational scan for image acquisition and perform percutaneous needle procedures with live 3D image visualization. Procedures for which XperGuide is suitable:

  • Biopsies
  • Drainages
  • Pain treatment
  • Thermal ablations
  • Ventriculostomy
  • Vertebroplasty

DDA Medical has also developed an iPad app and a mobile app version that is available for most brands of smartphones.

The newly launched Philips Virtual Medical Simulation is proving to be a remarkably productive training tool. The initial test group of clinician trainees have enthusiastically reviewed the VMS and have been eager to spend more than the allotted time using the virtual training tool.

Adding to the previously discussed potential benefits of VMS, as applied to complex medical devices, theoretical advantages continue to mount as a VMS platform grows and expands overtime. Leveraging the core simulation is an obvious next step, extending the simulation to reflect additional capabilities, add-on technology and software, and related procedure applications. Additional variations on each simulated procedure allow for safe and effective clinician training for dealing with patient- and condition-specific characteristics and unplanned inter-procedure events.

As with any training investment, a cost-benefits analysis can determine the relative practicality and potential value. There is an intersection at the point where ongoing traditional training cost development, maintenance costs, and update costs and results are measured against the development, deployment, update costs, and results of a VMS. VMS development makes sense for complex medical device training when traditional training costs are high, ongoing, and subject to frequent change. Conversely, the benefits of VMS are less obvious when devices are simpler, training is needed for few(er) individuals, and the device configuration and training information is stable and less likely to change.