Surgical Simulation: Bronchoscopy Simulation Case Studies

The Endoscopy AccuTouch® System with bronchoscopy modules was introduced in 1999, and since that time hundreds of customers have installed the system into their training programs. They report that the system provides faster learning and more realistic experiences, no-risk training, and therefore improved patient safety, increased student satisfaction, and the ability to act as a qualification tool for clinical procedures. Some of their experiences are documented here:

Case Studies

• Northwestern University


• Beth Israel Deaconess Medical Center
• University of Chicago Hospitals

Testimonials

• St. Mary's Hospital, London, England


• Mount Sinai School of Medicine

Northwestern University

Dr. Matthew Blum, section chief of Thoracic Surgery at Northwestern University found that use of the AccuTouch Endoscopy System helped residents acquire skills faster and achieve a better understanding of anatomy. In his experience, patient comfort is also enhanced. He believes that when residents can practice on the simulator before doing an actual procedure, they don’t have to be so focused on the actual operation of the scope. Instead, they can focus on what path they need to take and on identifying any unusual features.

“Residents assigned to the simulator spent about 45 minutes on it. I was not told who had worked on the simulator, but it was immediately obvious when they began their intraoperative bronchoscopy. Within 30 seconds I could tell — by the way they held the scope, their understanding of anatomy, and their understanding of the maneuvers that they needed to do to get to where they needed to go.”

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Beth Israel Deaconess Medical Center

Dr. Armin Ernst, assistant professor of medicine, Harvard Medical School, says that the training program set up within Beth Israel Deaconess Medical Center stipulates that if residents have not performed satisfactorily on the similar, they aren’t allowed to practice on patients. He says that the real measure of the simulator training is how well it prepares students for real procedures, and that the realism of Immersion Medical’s simulator is “quite good,” whereas competitive products were cumbersome and the tactile feel and visual feedback were not on par.

“There are two training issues that led to our acquiring the simulator,” says Ernst. “One, if you don’t have simulation, you train as you go. And, as a patient, do you want to be the first one trained on? There’s a patient safety issue.”

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University of Chicago Hospitals

Dr. Andranik Ovassapian, professor of Anesthesiology and Critical Care, and director, Airway Study and Training Center at the University of Chicago Hospitals uses the Endoscopy AccuTouch System to teach intubation of difficult and compromised airways. He says that anesthesiologists need all the skills of bronchoscopy to navigate through distorted airways, and that there’s no doubt the endoscopy simulator is an invaluable training tool that cuts down on O.R. time to some extent and eliminates patients from being used as models.

“I haven’t had one person yet who hasn’t liked it. The unanimous opinion has been it is great, and they enjoy it. The physicians who attend continuing education courses have said they’re able to revisit lots of techniques and tricks that they haven’t used in five years.

“[Anesthesiology] residents have a hard time learning how to handle the bronchoscope because they do so few intubations. If flexible bronchoscopy is mastered for airway management, then unnecessary complications such as tracheotomy, hypoxic brain damage, and death can be prevented.”

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St. Mary's Hospital

Doctors at the Imperial College School of Medicine at St. Mary's Hospital, London, UK, are currently working with both the Bronchoscopy and Flexible Sigmoidoscopy modules. This department, which has an international reputation for its work in medical/surgical skills assessment, was recently honored by the award of a Queen's Anniversary Prize for Excellence in Higher and Further Education.

"We believe the benefits of this kind of high-fidelity simulation are enormous. Before such systems became available, students had to learn endoscopic procedures by performing them on real patients under the direction of an experienced clinician; this was less than ideal for the trainee, instructor or patient. Simulation, however, improves the teaching process. A trainee at the beginning of the learning curve can practice skills without the distracting worry of causing discomfort to a patient; the less distracted trainees are, the more they learn. Moreover, instructors can direct trainees to repeat any part of a procedure as many times as necessary, which would be impossible to do while working with a patient. The improved learning environment and ability to repeatedly practice skills benefit patients, who are less likely to be exposed to discomfort during an actual procedure. In addition, the simulators provide far more objective feedback than is possible with traditional teaching methods. We hope to see them incorporated directly into the accreditation and re-accreditation process."

Dr. Sean Mackay, FRACS
Surgeon, Imperial College School of Medicine
St. Mary's Hospital

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London, UK

Mount Sinai School of Medicine

The Mount Sinai School of Medicine in New York incorporates the Endoscopy AccuTouch® System with Flexible Bronchoscopy module into its anesthesiology training program.

"This system is so superior that no other available training tool is even close to being considered a comparable device. The realism and dynamic response of the simulator gives residents and students an opportunity to practice the psychomotor skills and understand the anatomy needed to perfect these procedures without subjecting patients to the steep learning curve. With better preparation, the clinicians in training can provide safer and more efficient care to our patients, while potentially reducing expensive O.R. time."

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