Plastic Patients And Cyber-Surgery: Center for Virtual Care Promotes Technology Training

In a semi-dark room at the UC Davis Medical Center, Nurse Peter Rutan sits facing half a dozen video monitors, alternately moaning into a microphone and sipping diet Mountain Dew. Every so often, seemingly at random, he shouts "Mother!"

From this view of the Center for Virtual Care, Rutan appears to be a benevolent Wizard of Oz, working from a Mac G4 while acting as the voice of Stan, a human patient simulator mannequin who can be seen in the next room experiencing a heart attack for the benefit of the ER residents vigorously toiling to assist him.

Out of the ER and into the VCR
Across the hall from the ad hoc ER, other interns and senior residents anxiously watch a video monitor on which the medical scenario plays out. As their peers work on Stan, these interns evaluate the decisions they make. Once the virtual emergency ends, the interns working on Stan enter the video room to critique their own actions and thought processes. In this way, sessions perform double duty and lessons learned are shared by all.

Once the debriefing session is complete, those who watched the emergency get their turn in the hot seat. Back and forth these groups go, practicing various medical procedures until they become second nature, thereby boosting students' confidence for facing live patients.

What's Virtual About a Heart Attack?
Attending physicians consult with Rutan prior to each training session, ordering up a host of symptoms to help their students combat real-life medical scenarios. Dr. Erik Laurin glances at his waiting charges and mischievously suggests, "Let's trick them." But his intentions are honorable; real-life emergency room situations rarely follow textbook patterns, and ER doctors in particular must be ready to respond to symptoms that change by the moment.

More than just emergency room residents, however, are trained on the virtual care simulators: nurse practitioners, pediatric specialists, advanced MDs, pa ramedics, certified physician assistants, nurses and more get to work on "Stan" or "Bob," the two adult simulators, the "newly delivered infant," yet to be named, and the "six-year-old child, Morgan." In addition, interventional radiologists and cardiologists train on "Simantha," the interventional catheter training system.

These hominid counterfeits have uncanny abilities to mimic human responses, responses that vary according to the needs of the students they are "training": tracheae that can be intubated, eyes that close upon administering anesthesia, pupils that constrict under bright lights, blood pressure that rises and falls, skin that is malleable, and a lower region that simulates what the staff has dubbed "brown alert." These and other such features make for low-risk, high-quality training.

Sharing Stan with the Neighbors
The family of human simulators is also being used to help the Medical Center reach out to the community. High school students from populations traditionally underrepresented in the medical professions have access to the Center for Virtual Care on hospital field trips. The simulation situations gives these students "a sense of medical language and choreography that might establish an interest in medical careers," explains Health Systems Public Affairs Representative Charles Casey. "We want to share these resources with the community, and high school students often show a real interest in the virtual aspects of their hospital tour."

More than Just a Bunch of Dummies
In addition to the human simulators, the Center for Virtual Care includes a section devoted to robotic surgery, surgery via an apparatus called da Vinci, which combines Lost in Space-style robotic arms with leading-edge virtual reality.

Arising from laparoscopic surgery-in which, rather than make large incisions, surgeons use electronic instruments and microscopic cameras inserted through the navel or into minute incisions-, r obotic surgery has advantages over laparoscopy by permitting surgeons to use their hands as primary instruments, rather than rely upon rudimentary tools to do the job.

Sitting at some remove from the operating table, the surgeon inserts her hands into grasper-like instruments that control the movements of the surgical robot. Just above these cyberhands is a 3-D monitor (not unlike that found at old arcade peep shows) revealing the detailed movements of the surgery in larger than life-size color.

Statistics on robotic surgery are impressive: in prostatectomies (removal of the prostate gland), robotic surgery patients lose an average of 152 milliliters of blood, while their traditional surgery counterparts lose an average of 900, and hospitalization is cut from the typical 3.5 days to 1.2. The patient also experiences a lower risk of infection, reduced post-operative pain, and faster rate of recovery.

Gamey Technology
Clinical specialist Bill Smith predicts that robotic surgery will continue to grow exponentially given the upcoming generation's comfort with and skill at using video and virtual technology.

In fact, video game models have helped UC Davis doctors and computer technicians develop "virtual hallucinations" drawn from the experiences of schizophrenic patients. From commentary played in the "brain" of the patient to disappearing floors and morphing faces, this video features various aspects of a hallucinatory experience, and the simulation is useful for a variety of purposes: educating health care providers and family members about the illness experience, destigmatizing the disease, and training schizophrenics in how to handle their hallucinations.

Virtual reality has been used elsewhere to help distract patients from excessive pain and to treat phobias, post-traumatic stress disorders, and addiction. Cigarette smokers, for example, can "walk" into a party and be offered a smoke along with a drink, a cue many sm okers find tough to pass up. Practicing doing so makes doing so in real scenarios all the easier.

What's in the Works
Further virtual reality additions are in the planning stages. UC Davis researchers are exploring using Second Life-the software program employed for the virtual hallucinations video-in other medical situations: bioterrorism response, for instance, in which countless medical staff must attend to a common event and one that is otherwise nearly impossible to duplicate for training purposes.

Surprisingly, the Second Life system runs on standard Windows and Macintosh computers allowing multiple users to "play" simultaneously and requiring only a broadband Internet connection; thus, teams in numerous parts of the hospital or even the county can be taught to work collectively in complex group situations.

Psychiatrist Dr. Peter Yellowlees, Director of Academic Information Systems at UC Davis and interim Vice Provost of IET, is keenly aware of the crossover potential between information technology and medicine. Having worked on the virtual hallucinations video, Dr. Yellowlees looks forward to "using VR environments increasingly in health education."

Want to Put YOUR Hands into Action?
View a recent KCRA Channel 3 News video featuring the Center for Virtual Care (RealPlayer required for viewing), or read this New Yorker article entitled "A Model Patient," covering medical human simulators. Here you'll find "Simulation-Based Medical Education: An Ethical Imperative," published in Academic Medicine. Note: These article links are available to UC Davis affiliates only (those possessing a Kerberos password).

Click here to visit the Center for Virtual Care Web site.

  • Groopman, J. (2005). A Model Patient. The New Yorker, 81(11), 048.
  • Ziv. (2003). Simulation-Based Medical Education: An Ethical Imperative. Academic Medicine, 78(8), 783.