The simulator to improve skills in the delicate insertion of an epidural needle
RADIO AUSTRALIA TRANSCRIPT:
BLANCH : Simulation technology is fast becoming the next big thing particularly as a training tool in the medical and surgical fields where mistakes can be debilitating or even fatal. The Mediseus Epidural simulator has been developed to teach and improve clinicians' epidural analgesia skills. Created by electrical engineer, Ross Horley, from Melbourne, the device gives students first hand experience of what it feels like to navigate a needle through skin, which would seem a vast improvement on traditional training methods that include practising inserting needles in oranges or erasers.
The inventor, Ross Horley today is accompanied by Dr Brendan Flanagan, an anaesthetist and Medical Director of the Southern Health Simulation and Skill Centre at Monash Medical Centre in Melbourne.
BLANCH : And Brendan, it's somewhat disturbing to know that prior to Ross Horley's epidural training simulator; the clinician's first experience of epidural needle insertion can be on a live patient. So that we can gain an understanding of how precise a clinician needs to be, give us a word picture of an epidural anaesthetic procedure.
DR BRENDAN FLANAGAN : Okay Desley, so it is a precise procedure which involved putting a needle into a space in a patient's back, often a woman undergoing childbirth, so it's a matter of navigating a needle between some of the bones in the back. The needle needs to end up in a fairly small space, which is adjacent to the covering of a patient's spinal cord, after which a tiny plastic catheter is threaded through the needle, the needle is removed, so there's no sharp things staying in the back. The tiny catheter stays in the back, so that we can continue to administer medications over time, because obviously we don't know how long the labour is going to last.
BLANCH : So how high is the error rate in operating theatres for these?
DR BRENDAN FLANAGAN : In relation to epidurals? Really it's very, very low. It's hard to give a precise figure on that. But despite the absence of these devices, we do undertake quite rigorous and closely supervised training to ensure that the complication rate is extremely low.
BLANCH : And apart from oranges and erasers, how do clinicians gain their experience under current training methods?
DR BRENDAN FLANAGAN : So apart from those somewhat crude devices you've described, we do learn this and other procedures on patients, but it's done in a closely supervised fashion with an experienced anaesthetist immediately on hand and we, of course, would start procedures such as epidurals on patients other than patients who would have difficulty keeping still. So it's done in quite a controlled and highly supervised fashion, which is why the complication rate overall is quite low, but, of course, it's not zero.
BLANCH : Well Ross, your claim is that this is the first full procedure epidural simulator. So what makes it different from others that may be out there?
ROSS HORLEY : There has been attempts at manufacturing epidural simulators before, but these are really focused about the training and the task itself, so the handling of the needle-the insertion of the needle.
What we've done is we've looked at the training program required to teach a student how to perform an epidural procedure and have taken a validated course from Sydney University which is run from a skills training centre at Royal North Shore Hospital and basically shoe-horned that course into the simulator. So it consists of a multi-media component and a hands-on component that you could actually grab a syringe and a needle and place it into a virtual back and get all the force feedback and the feel as it actually would be on a patient and have all the cues and audible feedbacks of the patient. The virtual patient will talk to the clinician or the trainee and we can...
BLANCH : What, say they're wrong or something or?
ROSS HORLEY: Basically, complain of pain.
BRENDAN FLANAGAN : Say "ouch"!
ROSS HORLEY : Exactly! And in a very Australian voice which makes it very good to market it internationally. And also say that they're about to go into contractions and so the procedure will need to stop for a time and then continue, so in other words the patient will be moving. But the most important thing is that every interaction that the user has with the program is measurable, not only just the lead up to placing the needle and putting the needle into the back as you know, but what we call the didactic component, which is the lecture component. The questions are posed to the student and the student needs to answer and then the student needs to perform the procedure and then the student needs to follow up with the patient--all virtually of course--to see how the patient was. Now all that entire process is measured and a report produced at the end of that exercise to see how well the student did. That's the power of simulation. It's that matrix and being able to measure very precisely on how the student went.
BLANCH : Patients would present differently though with various physical sizes and ages and so on. So how does the device accommodate those variables?
ROSS HORLEY : Because we're dealing in the virtual reality space, we can have a number of data sets which are modelled on specific types of patients. So we can have obese patients, we have thin patients, we have patients with anatomical abnormalities and we can alter the graphics and the data set within the computer to simulate different types of patients and we can do it randomly as well. So the user may not know that they're about to come up against some abnormality in anatomy. And once again that is also the power of simulation, to be able to dynamically change and so the patient can be virtually fat, thin, the sort of deformed back, or whatever the deformity may be, but the student needs to cope with those unknowns.
BLANCH : The simulator's currently being used by a number of training institutions and hospitals. Is this part of a trial of the device itself?
ROSS HORLEY: Yes, we produced the simulator early in 2006 and since then we're going through a number of trials and with a number of institutions in Australia and then this will flow off into overseas. And the idea -the whole concept of these trials is to get the clinicians' feedback into how we need to tweak and adjust the simulator to make it more real than what it is now.
BLANCH : Ross, your company Medic Vision has developed the simulator. So what was your incentive to create such a product?
ROSS HORLEY : Our incentive has been all about the business that we're in which is really to provide technical tools to assist in medical education. And we do a number of activities in relation to that, that broad business scope, including designing medical skills training facilities and developing simulators and selling simulators internationally that are produced by others. We have quite a range of products that we deal with, surgical simulators, anaesthetic simulators and even to the extent of cardiac simulators, some mannequin-based simulators. But our real incentive and our drive is to assist technically to produce better training tools which will ultimately produce better outcomes, better students. They can train quicker, more measurable so you can pick up weaknesses of students quicker and then focus on those weaknesses.
BLANCH : It wasn't Brendan over a drink one night saying I need one of these gadgets for my set-up?
ROSS HORLEY : There's been many things with Brendan over a drink one night, but it wasn't that.
DR BRENDAN FLANAGAN : But in truth as just to support what Ross is saying--of course the technology supports initiatives in regard to patient safety, and there are multiple measures going on. We are very fortunate that despite what we may think or what we might read in the papers that in fact Australia does have one of the best health care systems in the world and part of the reflection of that is that there are pockets of people all around the countryside doing great work, constantly trying to find ways to improve the system and part of that involves education and training, obviously, and any manoeuvres that industry can afford to help educators with training devices has got to be a good thing, because it helps add more structure, as Ross said, to the training programs.
BLANCH : Ross, you mentioned that this device records and has a wonderful store of knowledge about how that particular student is going. Is it a problem for hospitals to monitor proficiency of their skills amongst their clinicians?
ROSS HORLEY : It certainly is in the training side of things, because in the traditional method of training whether using static devices or even oranges and erasers or other types of things, it's very hard to get any measurement out of any of that. There's a saying-"See one, Do one, Teach one", which is common throughout the medical industry. In other words, the training program is all about seeing something being performed, then doing it, and then teaching it in very quick succession I must say, and learning on whatever materials are available at the time is pretty much how it all happens and including at a point, moving from a static model into training on a person.
The technology that's available now and the virtual reality technology, they would have been used very effectively to augment that process, to speed up that process. But certainly to get proficiency standards and measure proficiency in situ and certainly in the training programs, it is very hard unless you had some way of measuring and monitoring activity.
BLANCH : So what are the plans that you have for getting the device more widely distributed and to that international market?
ROSS HORLEY : Well, we've just done a deal with an American company to sell our product in America and this is the largest computer-based simulation company in the United States. So in fact our first simulator's already been shipped out to that organisation and they cover the United States and Canada. We're already marketing our simulator in the UK. Medic Vision actually has an office in the UK, we're very active in the United Kingdom and Ireland and we have interest in Europe, Germany, Spain, Italy and certainly in China. We have an office in Hong Kong. We're already marketing our products in Hong Kong, Macau, Taiwan, China.
BLANCH : Is there nothing else like this?
ROSS HORLEY : With this particular simulator it is a world first in what it is, being a curriculum-based simulator in teaching of epidural. The future development that we have with other simulators which are currently in the production line, we're following in that same model. So that a user merely needs to turn on the machine and on the computer and get the interface device in front of them and they can start the process with little knowledge and if they go through the entire process, including all the E-learning packages which are associated with it, at the end of it, they have a very good understanding of the procedure and they've had some hands on experience and they've been marked and measured.
BLANCH : In terms of keeping people safe, we have airline pilots who do simulation. Are we finding this in the medical world that doctors and people automatically go through refreshers and so on in simulation set-ups?
DR BRENDAN FLANAGAN : I think we're an early phase in the terms of the spread or the availability of simulation technologies across the health care system. So I'm sure that Ross's and mine and others' visions for the future in terms of the use of simulation in health care would be somewhat akin to what people would be aware happens in the aviation industry, where, for instance, no matter how junior or senior you are, it's built into your training or it's built into your work practices really, not just your training, that once every four or six months you spend a day in the simulator doing training and that's been common practice in the aviation industries for 30, 40, 50 years now, and I think we look forward to a future where that's more true as well in health care and I think we're just on the cusp of that.
BLANCH : Dr Brendan Flanagan, from Southern Health Simulation and Skills Centre at Monash Medical Centre and Ross Horley, inventor of the Mediseus Epidural training simulator, both from Melbourne, in Victoria.
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