Tucson Region

Dummy helps make smart surgeons

The badly injured patient is barely breathing on collapsed lungs, while internal bleeding is reducing his blood pressure. With a broken leg bone piercing his flesh, he's also showing signs of a heart attack. Medical students crowd the room, trying to decide how best to stabilize and ultimately save this patient's life. But as they plunge a breathing tube down the throat, inject potent heart drugs and probe for the bleeding source, any mistakes these doctors in training may make will not hurt this "patient" at the University of Arizona College of Medicine. Instead of flesh and bones, the "patient" is plastic and metal, a computer-controlled, high-tech mannequin that can get himself into some 60 complex medical emergencies that students must solve. So while they may not always "save" him as they learn these lifesaving skills, they mercifully cannot kill him either. The hyperrealistic, fully responsive patient mannequin is part of a just-opened medical simulation laboratory designed to take the training of UA medical students to a higher level - where they can practice performing major surgical and medical procedures in near-reality situations before they ever touch a living, breathing human patient. "The med students who go through this kind of training are going to be the best-trained doctors we have ever turned out," said Dr. Allan Hamilton, a UA neurosurgeon and executive director of the new laboratory, the Arizona Simulation Technology and Education Center. "Think of the way a 747 pilot simulates everything that can go wrong before ever flying a plane full of passengers. "With this lab, we can now measure our students' skill level before we allow them to go on to real patients. This is a very safety-oriented approach that's going to reduce errors, ultimately saving thousands of lives a year," Hamilton said. In the lab with the bionic patient are two machines that simulate hands-on minimally invasive abdominal surgeries, along with a state-of-the-art simulated operating room, plus a 1-ton surgical microscope at which students can practice delicate vascular microsurgery. Also, extensive telecommunications technology allows physicians - broadcasting from the lab or even an actual operating room - to teach students, nurses or other doctors in remote locations. The whole show - nearly $1 million worth of simulation and virtual-reality equipment - has been donated to the UA by manufacturers wanting to demonstrate the evolving technology. "Doing this gives us the ability to find out how our technology integrates with various medical settings," said Kevin Sandler, chief executive officer of ExhibitOne, a manufacturer of medical telecommunications equipment. "And it's a great showcase for us." Medical simulation techniques and technology have come of age in the last decade, gradually working their way into medical schools across the country. More than 100 medical teaching centers now have some form of it. Long gone from the UA - since the late 1980s - are the live animals once used for medical training. And soon to go, Hamilton predicts, are the human cadavers still used to teach basic anatomy. "As this technology gets more and more realistic, even cadavers are on the way out. They are the last vestige of that earlier age," he said. What reality technology can do for a student that live animals or patients cannot is give them a chance to build their confidence along with their skills before having to cut into real flesh. "Today, students watch and watch and watch a procedure being done, until a physician finally allows them to do a tiny part of it, learning very gradually," Hamilton said. "Often, we see students who are afraid to try something new on a real person. "This technology changes all that. Students can practice over and over, as much as necessary until the confidence is there, without having to subject a patient or themselves to anxiety or pain." As he practiced intubating the simulated patient - a very tricky but vital maneuver - third-year UA medical student Judah Pifer said trying to learn medicine by watching is "a whole lot different" from actually doing it. "When you start doing something new, you really are not sure where you are, what is right," said Pifer, 30, aiming to specialize in orthopedic surgery. "These simulators let you get to know the territory and what's abnormal or normal. "So by the time you finally put your hands on a human being, you know where you are. Absolutely, this is going to be good for me, for my training."