SAP Training Simulator (Includes All Modules) | Added By 50
Rubie Mccloughan
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The development of a medical simulator that incorporates substantial training value and realism into an affordable product has been a huge challenge for the simulation community. A large hurdle to making an inexpensive simulator has been the high cost of the computers needed for adequate realism. We have met this challenge by developing CathSim, a low-cost medical simulator that integrates force feedback, multimedia, and 3D graphics simulation technology on an industry standard PC. This product is commercially available and is currently being used by numerous training institutions and hospitals. The CathSim system includes software and a force feedback interface device. The platform and device can be used to train health care providers to perform needle-stick medical procedures. Our first module teaches users the techniques of peripheral intravenous (i.v.) catheterization. Other training modules that will be added to the CathSim platform include central venous catheter (CVC) insertion and peripherally inserted central catheter (PICC) placement. This paper discusses the challenges of this project and the trade-offs and solutions that we developed to overcome them. We describe our process of analyzing and prioritizing the medical tasks necessary to correctly perform peripheral intravenous catheterization. This analysis and prioritization was used to decide which tasks would be included in the simulator and how the included tasks would be replicated. We discuss the method by which we obtained the needed realism in the 3D graphics rendering and in the tactile feedback of the input device. We illustrate how we blended together simulation and multimedia technology to ensure adequate immersion and training efficacy, while keeping the system cost to a minimum.
FORT CAMPBELL, Ky., Sept. 29, 2011 -- It looked like a scene out of a science fiction movie on post Wednesday morning as a group of 101st Combat Aviation Brigade noncommissioned officers trained on a new simulator for the first time.
The Non-rated Crew Member Manned Module, or NCM3, came to post last week to be used for the first time beyond the testing stages. The module is a simulator that was created to train helicopter crews on the rear of both the CH-47 Chinook and UH-60 Black Hawk.
Through specially created virtual reality glasses, which fit as night vision goggles would, Soldiers can perfect gunnery tasks. Also included in the simulator are ways to perfect and practice sling load and hoist operations without ever leaving the ground.
The training can be linked with the Aviation Combined Arms Tactical Trainer, allowing crew chiefs and other Soldiers to communicate seamlessly with the helicopter's pilot who may be training in a different simulator.
"The weapons are M240[H]s that we actually use in the Army," explained Sgt. 1st Class Richard Madill. "The only thing they did was they took the mechanism out that allows it to fire. That's the big modification that's made. It has sensors all over to allow you to control it. It tells you when you have your mock ammo loaded, it tells you when they pull the triggers and different things like that."
The realism goes beyond what the gunners or other crew members might see on the screen during the simulated flight. The weaponry is also affected by a control load box, which gives the Soldier a sense of wind resistance on the gun.
The simulator is good for a number of reasons, mainly because of safety, efficiency and flexibility. The simulator eliminates the need to schedule a helicopter for training, saves on fuel and ammunition costs, and lessens many of the risks faced during real flights. Inclement weather outside also does not affect the progression of training in the simulator.
"Prior to this trailer, we [didn't] have a trainer for the backseaters," Madill said. "For the crew chiefs, door gunners, we don't have a trainer to be able to do that. And this allows us to bring a guy out here and start some sort of aircraft progression, without actually using blade time."
"This allows us to train on tasks that we don't get a chance to do normally," Madill said. "We're able to do this rescue hoist, which in real life, it's dangerous to put a live person on the hoist. It's dangerous, but we need to be able to train it. This allows us to train it here. We don't have to use blade time to do that, we don't have to (risk) someone's life."
Madill added the simulator should increase "unit cohesion, crew cohesion and crew coordination." Sgt. Weston Williams, 101st CAB, spent a significant amount of time in the gunner's position in the simulator's UH-60 Black Hawk setup. He agreed with Madill's assessment, adding that the "high-tech video game" feel would be ideal for training first-time crew members.
"You'd be surprised how many similarities there are between this and the real [helicopter]," he said. "I think it is fantastic. You can do a whole lot of things. This is going to actually make it where I can at least get people talking correctly on the radios before I'm actually putting them in [a helicopter]."
In recent years, the medical community has benefited from technological advances that simulate surgical environments. Ophthalmologists now have access to commercially available virtual reality systems, including the Eyesi Ophthalmic Surgical Simulator (VRMagic, Mannheim, Germany). Aided by this system, ophthalmology residents at the Mayo Clinic in Rochester, Minnesota, are learning how to perform cataract surgery.
ALTERNATIVE EDUCATIONAL TECHNIQUE
VRMagic originally developed the Eyesi system to simulate vitreoretinal surgery. Recently, however, the company added a training module for the anterior segment (Figure 1). In addition to simulating the use of forceps, precise navigational tasks, the capsulorhexis' formation, and phacoemulsification, the Eyesi's anterior segment module evaluates the user's performance and measures instructor-defined, standardized surgical tasks in a virtual environment.1
The ophthalmic training system is based at the Mayo Clinic's Multidisciplinary Simulation Center (www.mayo.edu/simulationcenter), a 10,000-square foot clinical training facility dedicated to simulation-based clinical education and research.
Gone are the days when residents first learned the basics of handling intraocular instruments and a surgical microscope in the OR or a variable wet lab environment. Instead, they now complete a structured curriculum that combines one-on-one instruction and independent study with the Eyesi simulator. Instructors create courses that residents repeat and practice until they achieve passing scores. The surgeons-in-training then advance to the Eyesi system's higher levels of difficulty until they master all of the simulator's training tasks. Residents are enthusiastic about the technology and its constant availability (24 hours a day, 7 days a week).
HOW IT WORKS
In studies, the Eyesi Ophthalmic Surgical Simulator demonstrated construct validity (the ability to reliably distinguish between novice and expert surgeons) for training tasks in the posterior and anterior segments.2,3 Anecdotally, I have found that the device's stereoscopic view and foot-pedal controls are excellent proxies for the "real" environment of cataract surgery.
Using the anterior segment training module and the built-in forceps tool, residents learn how to manipulate instruments in the eye, pivot them at the wound, and avoid inadvertently injuring the cornea or crystalline lens. The simulator's scoring system rewards users for the efficiency of their intraocular manipulations and the precision with which they complete their tasks. The capsulorhexis training module (Figure 2) is actually more challenging than "the real thing," an acceptable and desirable quality for a surgical training system.
The posterior segment training modules simulate the manipulation of forceps, the precise movement of instruments in the posterior segment, antitremor training/control, and procedures such as vitrectomy, epiretinal membrane peeling, and internal limiting membrane peeling. Residents at the Mayo Clinic have reported that the Eyesi's retinal simulations "suspend reality" quite effectively. For example, my colleagues and I have watched inexperienced surgeons become so engrossed in virtually peeling an epiretinal membrane that they actually started sweating.
ARE WET LABS STILL RELEVANT?
Hands-on experience in traditional surgical wet labs is still the gold standard for training residents to perform corneal and scleral suturing techniques. Currently available surgical simulators do not attempt to replace the experience of working with real cadaveric eyes. Instead, the simulator provides a realistic, repeatable, and measurable intraocular surgical environment that is difficult to duplicate in the traditional wet lab setting.
In my experience, the Eyesi's on/off setup eliminates the significant time and effort typically involved in preparing and dismantling a wet lab. In addition, the surgical simulator measures and documents the user's efforts and performance.
Depending on which module is used during a training session, the system tracks and scores up to 74 different performance variables (Table 1). The Eyesi's screen displays the data for each trial, which can also be summarized and graphed at the end of each simulated surgical session or exported to a spreadsheet program for statistical analysis. I believe that, by allowing our residents to repeatedly perform standardized tasks and measuring their performance in a realistic environment, the Eyesi system helps us train surgeons to perform cataract surgery safely and competently without putting patients at risk.
CONCLUSION
Keeping up to date with the rapid advances and complexity of modern intraocular surgery is a challenging but ultimately satisfying and rewarding endeavor. Surgical simulators based in virtual reality allow residents to develop and hone their surgical skills so that they provide patients with the safest and highest-quality surgical outcomes possible. Currently, a barrier to the Eyesi's broad adoption appears to be the system's cost (between $100,000 and $200,000, depending on optional features and the date of purchase).