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Wm. LeRoy Heinrichs
MD, PhD, SUMMIT “Looking Back; Thinking
Forward About Surgical Simulation” The
history of Man is characterized by descriptions of people, places, and
things! In the context of surgical simulation, the earliest advocate
of the training of surgeons more than two millennia ago utilized common
objects for “going through the motions”, an expression that still describes
surgical practice. Some of these objects remain in use currently in
“in vitro” labs for videoendoscopic
surgery. In the 16th Century, paper and wax models became
the surrogates for cadavers for students of anatomy, and soon thereafter
in the Qing Dynasty, ‘Chinese medicine dolls’ made of ivory became the
vehicles for transferring information between patients and healers.
Also in the 16th Century, the articulated metal manikin attributed
to Hieronymus Fabricius, was assembled for teaching about fractures
and their clinical repair. Another simulation ‘machine’ used in medical
education was the pelvic and fetal models made of wood, leather, and
cloth for teaching obstetrical delivery. Hundreds of these were made
and used throughout France during the 18th Century by Madam
du Coudray, the King’s Midwife; one exists today in a French museum.
In the 19th Century, moulages (molds) were used to teach
restorative surgery of the face. In the late 20th Century,
development of computer-based simulators mushroomed to include multiple
anatomic regions and surgical procedures. The Visible Human Project
of the National Library of Medicine and the Stanford Visible Female
(Lucy 2.0), a set of 3D models created of a reproductive age female
(pelvis), are being used to support physics-based surgical simulation.
Most simulators remain to be formally evaluated and successfully incorporated
into clinical education, except by early adopters. An exception may
be the ePelvis that is being used on two continents, but even this simulator
of the female pelvic exam is mainly used in a research mode. As we enter
the 21st Century, medical simulations are being prepared
for distance learning via the Next Generation Internet, which will also
enable haptic perceptions. The common quest of simulation approaches
over the centuries has been the creation of a hands-on experience for
learning that substitutes for the ‘real thing’. Even now, we continue
the quest for ideal simulations to inform classroom learning; only the
technology changes! But, current methods that enable both visualization
and haptics, providing immediate feedback to learners, and the quantitative
assessment of the simulators’ efficacy and learners’ performance – that’s
new, and changes how we must think! http://summit.stanford.edu/Lucy/ http://haiti.stanford.edu/~ngi/final/ leroy.heinrichs@stanford.edu |