Training Systems

As technologies have become more and more advanced, so has the need to teach students, residents, and physicians how to use them.

9.1. Simulator Mannequins

New products to enhance medical training are rapidly entering the marketplace. The most impressive new systems incorporate computerized mannequins, complex graphics, and sophisticated operator controls in state-of-the-art patient simulators. Students, residents, or physicians learn both medical concepts and manual procedures on life-size, interactive equipment that provides the benefits of anatomical correctness, unlimited repetition, scheduling convenience, and variable "health" conditions. One such system, the Human Patient Simulator, was developed by the University of Florida's College of Medicine to train anesthesiologists in routine and crisis situations. This interactive technology is considered to provide a realistic learning experience adaptable for a wide range of health care practitioners, including medical students, residents, nurses, and biomedical engineers.

The simulator mannequin typically has palpable pulses, heart and lung sounds, simulated muscle twitch responses to nerve

Simplicity 4415
Fig. 12. HEARTSTRING Proximal Seal System (Guidant, Indianapolis, IN) is a surgically intuitive system that meets the challenge of clampless hemostasis with a design that is elegant in its simplicity and profound in its implications for a patient.

stimulation, and a body temperature. Thus, trainees can monitor its heart rate, cardiac rhythms, cardiac output, and blood pressure. Commonly equipped with interface software and an instructor's remote control, the simulator also gives accurate patient responses to over 60 different drugs, mechanical ventilation, and other medical therapies and allows the instructor to introduce new conditions.

Another such device that is currently available is the ultrasound training simulator, which allows students to perform sonographic examinations on a mannequin while viewing realtime sonographic images. The scanning motions and techniques that can be employed by the user realistically simulate the same skills necessary to examine a patient. It is considered that, by allowing trainees to practice on the simulator for as much time as needed to achieve initial competency, users should be able to perform more effectively in a shorter period of time in the actual clinical setting.

9.2. Endovascular Implant Simulators

A new generation of implant simulators that employs both visual and tactile feedback for practicing either right or left heart catheter-based procedures is currently available (e.g., AccuTouch® Endovascular Simulator, Immersion Medical, San Jose, CA, endovascular/). In addition, such devices can be used to simulate the placement of coronary stents (Procedicus VIST™, Mentice AB, Göteborg, Sweden, More specifically, the VIST system allows highly realistic simulation-based training of angiography, angioplasty, and coronary stenting using realistic 3D patient anatomies, real nested tools, tactile feedback, as well as different cases/scenarios and complications.

Such systems consist of an interface device, a computer, and one or more displays (e.g., one for the simulated fluoroscopic image and another for the instructional system). The interface device is a virtual patient with an introducer in place; such systems will become more and more realistic in the future. Through this, the different real-life tools and devices can be introduced, and actual tools are used (and reused). All tools are

Medtronic Loop Recorder
Fig. 13. Reveal Plus is the second-generation Reveal ILR (Medtronic, Inc., Minneapolis, MN). Now with auto-activation, the Reveal Plus ILR is a high-yield, long-term, subcutaneous, and leadless electrocardiogram (ECG) monitor that offers continuous 14-month monitoring. IR, insertable loop recorder.

active and can be manipulated at any time in the procedure. In the VIST system, the interface and the tools (catheters, balloons, guidewires, etc.) interact with the simulation through a software package that generates the fluoroscopic display, the forces that are reflected in the tools (for tactile feedback), the contrast flow, hemodynamics, and the results of the simulated intervention; a Web-based user interface guides the user through the procedure and facilitates self-learning.

Many training centers around the world, in both academic and corporate settings, have been created, and they utilize various types of simulators; for instance, the Karolinska's training center uses a number of such devices (

Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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