Department of Surgery

TO ERR IS TO ERR IS HUMANHUMAN

Department of Surgery

• 1.2 Trillion dollars

• 12-14% of GDP

• Affects every American

HEALTHCARE IN AMERICA

Department of Surgery

MEDICAL EDUCATION

• Largely unchanged in last 100 years

• Apprenticeship model

• “See one, Do one, Teach one”

Education by Random Opportunity

Department of Surgery

WHAT’S WRONG WITH MEDICAL EDUCATION?

Imagine:

As your plane (a packed 747) approaches SFO Airport, the pilot announces: “Folks, our co-pilot hasn’t had the opportunity to do a solo instrument landing, so she will be practicing one shortly. I’ll join you in the cabin while she lands the plane.”

Department of Surgery

WHAT’S WRONG WITH MEDICAL EDUCATION?

Imagine:

A squadron commander, in the United States Army during Operation Desert Storm, tells his troops on the eve of battle: “While none of you have actually fought under these conditions, I hope you will figure it out”.

Department of Surgery

WHAT’S WRONG WITH MEDICAL EDUCATION?

These two scenarios are Unthinkable

Why?

For quality, safety and cost reasons, neither the airlines nor the military would demand performance without extensive prior practice.

Department of Surgery

Department of Surgery

Department of Surgery

WHO ARE STUDENTS OF MEDICINE?

Medical Students

Residents

Practicing Surgeons

Nursing Students

Practicing Nurses

Department of Surgery

EDUCATION: KEY CONCEPT

I Hear, I Forget

I See, I Remember

I Do, I Understand

Lao-Tsu604-531BC

Department of Surgery

In the last 50 years, mankind’s most profound

advancements have been in Biomedicine and Computer

Science.

They are converging!

Department of Surgery

Department of Surgery

MEDICAL EDUCATION

Cognitive

Sensory

Five senses + common sense

Motor*

Department of Surgery

We will use VR to select, train, credentialand retrain physicians and surgeons.

Surgeons will rehearse an operation ona patient-specific palpable hologram and deliver the data set of that operationwith robotic assistance.

Ubiquitous computing will revolutionizemedical education and patient care.

INFORMATION TECHNOLOGYIN MEDICINE

Department of Surgery

Not Science Fiction

But

Scientific Eventuality

S. Spielberg

? SCIENCE FICTION ?

Department of Surgery

Radio has no future.

LORD KELVINScottish mathematician and physicist,former president of the Royal Society,

1897

Department of Surgery

Everything that can be invented has been

invented.

CHARLES H. DUELLU.S. commissioner of patents, 1899

Department of Surgery

There is no reason for any individual to have

a computer in their home.

KENNETH OLSENpresident and founder of

Digital Equipment Corp., 1977

Department of Surgerylearning to be a learning to be a doctordoctor

what makes a skilled practitioner?what makes a skilled practitioner?

©2000 David Williamson Shaffer

Department of Surgerylearning learning curvecurve

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0

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150

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©2000 David Williamson Shaffer

Department of Surgery complication complication raterate

from pratt, laparoscopic gastric bypass, 2000from pratt, laparoscopic gastric bypass, 2000

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©2000 David Williamson Shaffer

Department of Surgery

the part-task problemthe part-task problem

It is not true that a complex reactionconsists of a chain of separate processeswhich may be arbitrarily added andsubtracted.

--- l.s. vygotsky,mind in society

©2000 David Williamson Shaffer

Department of Surgery

IMPEDIMENTS

• Tradition

• Service Roles

• Finances

• Efficacy?

Department of Surgery

WHO WILL DEVELOP?

• Academics

• Military

• Industry

Department of Surgery

INDUSTRY

• Start-Up

• Simulation Company

• Consumer Electronics

Department of Surgery

HOW WILL IT BE FUNDED?

• Federal GovernmentGrantSBIR

• Industry

• Insurance Industry

Department of Surgery

motor skills

perceptionthought

in action

knowledge

analysis

judgementmentorship

breadth

thoughtabout action

build on what medical education does right

use the power of simulation to make it better

a learning system©2000 David Williamson Shaffer

Department of Surgery

The best way to predict the future is to invent it.

Alan Kay

Department of Surgery