"Smart Technologies, Safer Healthcare in the Biointelligence Age

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"Smart Technologies, Safer Healthcare in the
Biointelligence Age

• Charles J. Shanley MD, FACS
• William Hamman MD, PhD

April 28, 2009
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Center of Excellence for Simulation Education and
Research
The Marcia Eugene Applebaum Surgical Learning
Center
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Center of Excellence in Simulation Education and
Research (CESER)

• Leverage collaboration to promote integration in
  health care
• Accelerate the application of advanced
  technologies, modeling and simulation to improve
  clinical outcomes and enhance patient safety
• Promote the development of objective training and
  curricula
• Validate individual and team performance metrics
• Develop assessment tools for proficiency-based
  (technical) and competency-based (cognitive)
  skills

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The Marcia Eugene Applebaum Surgical Learning
Center

• Telemedicine/distance learning
• Physical- and virtual reality-based simulators
• Human physiologic simulators,
• Tissue laboratory
• DaVinci robot
• Full-immersion (cockpit) mock operating rooms
  with central control room
• Multi-point audio and video data acquisition and
  storage (individual and team-training)
• Advanced simulation and educational research
  technologies
• Applied simulation RD

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Technical Skills (Proficiency-based)

• Specialty specific and objectively measured
• Error identification and immediate trainee
  feedback
• Individual- and team-specific targeted training
• Customized training paradigms for rapid skills
  acquisition, longitudinal retention, focused
  retraining

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Data Driven Optimization of Surgeon Skills for
Enhanced Training, Simulation Assessment

• Clinical Question What is the performance
  effect of prolonged absence from surgical
  practice?
• Research Question Can an individual- and
  skill-specific simulators be used to to enhance
  proficiency and performance, improve and
  accelerate skill acquisition and to facilitate
  reset training following prolonged absence
• Hypothesis Digital video analysis combined with
  sophisticated motion-, vision- and
  haptic-technologies can be used to design
  enhanced physical-based surgical simulators to
  enhance skill acquisition and retention over time.

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Smart Sensors and Integrated Microsystems
(SSIM)(Wayne State University, Gregory Auner,
Ph.D.)
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Telemedicine Advanced Technology Research
Center (TATRC)
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Data Driven Optimization of Surgeon Skills for
Enhanced Training, Simulation Assessment

• Phase I Innovation Grant (TATRC/USAMRMC)
• Develop physical-based surgical simulator to
  objectively measure and quantitate
  individual-specific skill set deterioration
  (Laparoscopic Skills)
• Leverage motion-tracking, advanced vision, and
  augmented reality technologies to facilitate
  individual-specific retraining following
  prolonged absence from surgical practice

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Advanced Physical-based Simulator Augmented and
Virtual Reality System

• Motion Tracking Sensors Live Video View
  Virtual Objects Force Feedback Error
  Detection and Analysis Enhanced Readiness
  Patient Safety

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Motion Tracking Example
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Augmented Reality Example
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Data Driven Optimization of Surgeon Skills for
Enhanced Training, Simulation Assessment

• Enhanced surgical test bed with sensor and vision
  technology (Fundamentals of Laparoscopic Surgery)
• Determine elemental psychomotor components of
  expert surgeon performance
• Education and testing paradigm
• Development of a focused reset training protocol

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Cognitive Skills (Competency-based)

• Specialty specific and objectively measured
• Error identification and immediate trainee
  feedback
• Individual- and team-specific targeted training
• Customized training paradigms for rapid skills
  acquisition, longitudinal retention, focused
  retraining

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APTIMA IMPACT (Jeffery Beaubien, PhD)

• Surgical Skills Trainer
• Phase I SBIR, US Army Telemedicine and Advanced
  Technologies Research Center (TATRC)
• Trains higher-order skills such as communication,
  situation awareness, decision-making (cognitive
  skills)
• Leverages well-established deliberate practice
  approach to complex skill acquisition
• Contains built-in expert feedback, so the
  training can be run with or without a surgical
  instructor present
• Training program can be accessed online Can also
  be run on a local PC
• Training content is SCORM-conformant and will
  work with any DoD learning management system

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Building the Foundation for Patient Safety
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The Science of Healthcare Simulation for Team
Training (In-situ Simulation)
William Hamman MD, PhD, Director, Medical
Simulation Research
Key Elements

• Scenario/Event-Set methodology
• Identifiable/teachable skills
• In Situ Simulation (Venue)
• Real world challenges
• Real-time audio/video
• Constructive Debriefing Format
• Elicits participant insights

Center of Excellence in Simulation Education and
Research
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Military/Civilian Relevance

• Improving the skills and efficiency of care
  providers
• Rapid new skill acquisition and existing skill
  enhancement
• Measurement and correction of specialty-specific
  skill deterioration
• Well-trained and well-prepared front line
  military and civilian medical professionals

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US Army Reserves MEDCOM (Advanced Training
Partnership)

• One of six distributed AR-MEDCOM training
  partnerships nationally
• Pre-deployment and post-deployment training and
  evaluation (individual/team)
• Triage, stabilization, transport, evacuation,
  disaster preparedness
• Metrics development and validation
• Proficiency- and competency-based skills
  assessment
• Credentialing/re-credentialing

Army Bases
In Theatre Training
Other Sites
SLC
Army Medical Command Centers
Beaumont On-site Training
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Applied Smart Sensors in Surgery(Advanced
Technology Partnerships)

• Mild Traumatic Brain Injury Assessment Triage
  Beaumont/SSIM partnership to develop and deploy
  real-time force sensors for military head gear
  and vehicles, to improve outcomes for
  head-injured soldiers and evaluate the cumulative
  effects of repeated mild traumatic brain injury.
  Other applications athletic helmets, smart
  vehicles, other?
• Raman Spectroscopy in cancer diagnosis
  Beaumont/SSIM partnership to develop and deploy a
  real-time Raman spectroscopy probe for
  non-invasive clinical decision-making in
  melanoma. Other applications lung cancer,
  thyroid cancer, Barretts esophagus, others?

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Center of Excellence in Simulation Education and
Research (CESER)
Vision To accelerate the integration of
advanced technologies and applied simulation into
healthcare and other high risk industries through
collaboration, education and research. Goal To
develop a continuous learning process for
individual, system and process improvement in
order to improve clinical outcomes and enhance
patient safety.
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Center of Excellence for Simulation Education and
Research (CESER)
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Please join us in collaboration