INNOVATION


Virtual training


Adam Campbell explores a range of new developments in gaming and other simulation technologies being used to help train doctors and dentists


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AY the words “computer game” and the image most people will conjure up is that of a spotty youth bathed in an electron glow of his TV screen shooting alien warships out of a virtual sky until the early hours. But as the technology behind such games has advanced in leaps and bounds, developers and educators have begun to see advantages in what it can offer to the business of medical and dental training. In a climate of cuts, reduced availability of cadavers, increased litigiousness and a limitation in junior doctors’ training time, virtual simulation training is increasingly being seen as a safe and cost-effective solution in these testing times.


Right at the forefront of the developments in virtual reality (VR) training are the surgical simulators that allow trainees to learn and practise a host of laparoscopic skills, from tissue manipulation and suturing to cholecystectomy and angioplasty.


Haptic feedback


Professor Mike Larvin, director of education at the Royal College of Surgeons of England, which recently opened a state- of-the-art clinical skills unit with a simulated operating theatre, is a leading proponent of simulation as a training tool in general and believes it is just a matter of time before VR plays its part. He says: “Te great thing about simulation is you can make mistakes that would rarely happen in real life. You can set up a scenario where a mistake is likely to happen, just as a pilot might learn to fly with only one engine. It’s probably not going to happen oſten in the pilot’s career, but it means you can prepare for the rare and dangerous situation that you are unlikely to face as a trainee because you don’t have enough years under your belt.”


Virtual reality is still in the evaluative stage at the College as certain technological limitations are ironed out, in particular the question of ‘haptic feedback’. Tis is the simulator’s ability


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to mimic, for example, the feel of probing, cutting or suturing tissue.


“We regard electronic haptic simulation as being very much still in its infancy. We’re only using it on a research basis. Te trouble is, if you’re putting a stitch into an artery, your technique is governed by the feedback you get, the firmness of the tissue.


“Tat’s the reason it’s still in evaluation. And that’s also why we use fresh frozen cadavers. You just can’t beat that at the moment. It’s the next best thing to operating on a real human being.”


But there’s a limit to the number of human cadavers we get donated, he adds. “If we had really good VR with the proper haptic feedback, we could get trainees through far more exercises before they got on to a real patient. So when it comes it is going to contribute greatly to safety.”


Drill skills


If lack of haptic feedback is currently holding back VR simulator adoption in surgical training, the same is not true in the dental school at King’s College London. Here dentists, in collaboration with scientists from the University of Reading and Birmingham City University, have created a ‘hapTEL’ (haptic technology-enhanced learning) workstation that allows trainees wearing VR glasses to drill into an imaginary tooth, visualised on a computer screen. Tey can both see inside the virtual patient’s mouth and feel the difference, say, between drilling hard enamel and soſter decayed tooth. Te system has won a number of major awards and the team behind it are currently in the process of negotiating its manufacture for commercial distribution. At a fiſth the price of the traditional phantom head chair, one key advantage is cost. Another is the ability to record the students’ actions. Project manager Dr Jonathan San Diego says: “Te hapTEL


Main picture: VR simulation of liver surgery at INRIA at Sophia Antipolis in France. Upper right: hapTEL work station with VR dental drill. Centre: visual display of Virtual Veins.


SUMMONS


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