The following is a transcript from Mimic’s Art Director Gordon Nealy who spoke about Mimic’s approach to training, instruction and education during the recent Association of Medical Illustrators (AMI) Annual Conference. In his speech, Nealy explains how Mimic has created new training, instruction, and educational approaches to robotic surgery simulation and how surgeons and patients are benefiting.
“At the core of our training for robotic surgeons is the performance and assessment of psycho-motor skills. We train medical students, residents, fellows, experienced surgeons, and practicing robotic surgeons.
I want to draw your attention to the master grips which are the interactive element of the Simulator.
They manipulate the virtual instruments within the skills exercise environments. Performing these exercises is how the learner acquires and develops psycho-motor skills for application to the surgical robotic system. Surgeries on the da Vinci are performed using hand/eye coordination only. It is truly amazing how these surgeons can operate without tactile feedback from the tissues, the cavity walls, sutures and needles.
In psycho-motor training, competence requires practice. At Mimic, we have devised over 59 exercises that trainees can use to advance their skills on the da Vinci robotic system.
However, a well-structured simulation program contains not only performance based exercises, but also a solid assessment program.
Our simulator uses an assessment program we developed called MScore™. MScore is an objective and reliable evaluation of the user’s performance because it breaks down exercises into individual actions. From these, we’ve created the measurements, or metrics, that we use to score the completion of tasks within an exercise. It allows us to evaluate how many times a user dropped an object, whether they collided their instruments, if they missed any targets, and whether the activity was completed within the time limit. The scoring is important for two reasons – one, it provides feedback to the individual as to how they are progressing and two, it informs us how effective the instruction is and if we need to alter it.
Simulation is one of the few areas where one has permission to fail because it is a safe environment. Learning to perform surgery on the da Vinci system is difficult. One of our principal intentions is to reduce the steep learning curve associated with developing robotic surgical skills.
We’ve created instructional materials in the form of text and images, video, and user guides. This step- by- step text instruction example provides the trainee with learning objectives, what they will learn, as well as specific task objectives and what actions are they expected to accomplish in the exercise. The instructional materials also describe the layout of the foot pedals, the types of targets, tips for obtaining a better score, and tips for developing a good technique.
For those who learn better by watching we’ve created video instructions which also contain audio narration. These videos demonstrate how to perform the skills as executed by an accomplished user. By watching the videos users can observe insightful techniques for correct instrument positioning, hand-offs, avoiding pitfalls, task transitions, and principally absorb a mental image of how to perform the exercise.
It is extremely important to develop proper techniques because the ultimate goal is patient safety. Nothing replaces practice but these instructions will assist in advancing the user more quickly and therefore reduce the steep learning curve.
A while ago, our company created a division called MimicMED to address educating the novice and practicing robotic surgeons. MimicMED teaches classes using the dV-Trainer, surgical associated anatomy, and surgical procedure to provide a complete educational experience. Ultimately, this improves the learner’s cognitive and psycho-motor skills.
Why are established robotic surgeons using this additional practice? Because there may be long periods of time when they haven’t performed a robotic surgery because they are performing open surgeries. This means that their skills can get a little rusty. They come to MimicMED to take a class and refresh their skills. Afterwards, they can get back on the robot with confidence.
We recently created a couple of products that further the cognitive skills of our trainees, one of which is the Xperience Team Trainer™. This setup enables two users – a console-side surgeon (who sits at the dV-Trainer) and an assistant (who stands at the Team Trainer). The two hardware units are connected allowing the two users to collaborate in performing the same skills exercise. We’re hoping this will educate them in team dynamics through their practice of collaboration and communication on the simulators.
The other product is our Augmented Reality video exercise. This exercise features virtual instruments, layered over actual surgical video (with actual instruments). The exercise walks robotic surgeons through a partial nephrectomy procedure performed by an expert robotic surgeon.
During this procedure the learner’s cognitive skills are challenged. The user is quizzed on things such as the sequence of steps of the surgery and what was accomplished in a step. They must also identify anatomy and pathology and where to cut or cauterize tissue.
In short, these are the important considerations of our company’s approach to simulation as defined by training, instruction and education.”