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Leading Medicine Magazine, Vol 7, No 1 - 2013

“The great thing about MITIE is that it’s designed to provide comprehensive, procedurally based instruction and education for surgeons and their teams.” MITIE training for the laparoscopic colectomy, Bass explains, begins with physicians and other surgical team members using the center’s amphitheaterlike MedPresence room to observe the procedure via video as it is performed in one of Methodist’s operating rooms. Each seat in the MedPresence room includes a computerized, interactive learning station, so students not only watch the surgery as it happens, but also can ask questions, manipulate camera angles to personalize views, and access relevant educational materials. Once he or she has become familiar with how to perform the technique, the surgeon moves to one of the stations in the procedural skills laboratory for individual practice using the latest equipment and a virtual model of the abdomen. This is followed by a chance for the entire surgical team to train together in a MITIE suite arranged so that it duplicates the conditions found in a typical laparoscopy operating room. However, in this simulated environment, the “patient” is a full-body mannequin that breathes, talks and responds to medications. Even the evaluation process is high-tech. “Methodist faculty can observe the trainees in action via MITIE’s telepresence network, which not only includes cameras in the virtual operating room, but also a cameraequipped headgear worn by the surgeon,” Bass says. “This lets the evaluator see what the team sees in real time.” Dr. Brian J. Dunkin is medical director of MITIE and section head of endoscopic surgery at The Methodist Hospital. He is also a professor of clinical surgery at Weill Cornell Medical College and the John F. Jr. and Carolyn Bookout Chair in Surgical Innovation and Technology. “The great thing about MITIE is that it’s designed to provide comprehensive, procedurally based instruction and education for surgeons and their teams,” Dunkin says. “First, the individuals learn at their own pace and with their own unique ways of processing information, and then the individual abilities are blended through team training into a unit that can do a procedure at the best-of-practice level.” However, it’s not only the students who learn at MITIE. The program, Dunkin says, also provides lessons for the teachers as well. “Along with instituting best practices in the operating room, we are using MITIE as an experimental platform to define, refine and establish the best practices for delivering the training itself,” Dunkin says. “We are studying how our students learn, what stresses they encounter while learning, and in what ways we can measure how well they have learned.” For example, the MITIE staff uses thermal imagery of a surgeon’s face to record the stress he or she is feeling while trying to master a new technique. “We find that once a surgeon becomes stressed in this situation, hot spots appear across the face and these regions expand and get hotter as the nervousness increases,” he explains. “As the stress level rises, we see a corresponding jump in speed, carelessness and the number of mistakes. So, we look for what factors cause the learning anxiety and suggest ways to reduce or eliminate them in order to increase proficiency and confidence.” MITIE also serves as a testbed for the research and development of technologies that can greatly improve the retooling process for surgical teams. “In one case, we are exploring the use of telepresence and teleproctoring to train and evaluate practitioners in one region while the faculty is in another, perhaps thousands of miles away,” Dunkin notes. “If we can show that such a system works, then we can use it to set up accredited standards 52 methodisthealth.com/leadingmedicine


Leading Medicine Magazine, Vol 7, No 1 - 2013
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