Neurosurgeons test real skills on virtual brains

Some New York neurosurgeons soon will perform medical procedures while looking through special optics and holding instruments that are connected to a computer.

When surgeons gently touch their tools to the brain, they will feel its pliable tissue. The organ will pulsate in time with the patient’s heartbeat.

But the patient, like the brain in this scenario, is not real. They’re both virtual.

In October, Mount Sinai School of Medicine in New York received a virtual reality neurosurgery simulator called NeuroTouch to improve health outcomes and reduce complications in patients undergoing neurosurgery. It is thought to be the nation’s first virtual reality brain surgery simulator, said Christie Corbett, a Mount Sinai spokeswoman.

While simulation exercises have been used to help train medical students during the past two decades, the technique increasingly is being implemented among practicing physicians, medical experts say. The intent is to allow doctors to hone their skills and practice new medical procedures.

At Mount Sinai, NeuroTouch is being used by neurosurgery residents. Within the next three months, staff neurosurgeons are expected to start practicing procedures on the simulator and eventually rehearsing specific operations that are scheduled for a later date.

“We believe the new brain surgery simulator could potentially revolutionize the way we train and evaluate our surgeons,” said Joshua B. Bederson, MD, chair of neurosurgery at Mount Sinai School of Medicine. “We hope to improve the safety and speed of surgery and to reduce the duration of training. This could translate into better outcomes for our patients.”

The potential benefits of physicians using all types of simulation include improved patient safety, better health outcomes, decreased health care costs and lower medical liability risks, said Michael Seropian, MD, a pediatric anesthesiologist at Oregon Health and Science University in Portland, Ore.

“Simulation is a really important development within health care. It is a catalyst for many of the things we want to achieve” in medicine, said Dr. Seropian, immediate past president of the Society for Simulation in Healthcare. The society aims to improve performance and reduce errors in patient care through use of simulators.

There are challenges, however, in implementing simulation in medicine, health professionals say. Such challenges include the high cost of the equipment, which can involve computers and mannequins, and finding technology that is advanced enough to create realistic scenarios for experienced surgeons.

Another obstacle involves getting busy physicians to find time to participate in simulation activities, medical experts say.

At Mount Sinai, NeuroTouch has sparked mixed emotions from residents and staff physicians, Dr. Bederson said. Some doctors support the concept and are interested in learning how the simulator can be used, he said. Others are concerned that doing poorly on the simulator could hurt their medical careers.

Dr. Bederson is not yet sure if NeuroTouch will be an effective tool for measuring various attributes of a surgeon, including their strengths and weaknesses. But he said the patient-related benefits of the technology are clearer. “It could have a huge impact on patient safety,” he said.

Reducing preventable medical errors

It has become more common for regulatory bodies to discuss and, in some cases, mandate simulation as part of doctors’ recertification process, Dr. Seropian said.

For instance, the American Board of Anesthesiology requires anesthesiologists to participate in a simulation session for recertification. Simulation exercises also are required as part of the recertification process by the American Board of Family Practice, said a report in the January-February issue of the Mount Sinai Journal of Medicine.

The American Board of Internal Medicine offers interventional cardiologists points toward maintenance-of-certification credit if they participate in a medical simulation activity, said Lorie Slass, a spokeswoman for the board.

In addition to improving patient care, simulation use is expected to reduce physicians’ medical liability risks, said David M. Gaba, MD, associate dean for immersive and simulation-based learning at Stanford University School of Medicine in California. He is credited with inventing the modern mannequin-based simulator.

At least one insurance company offers doctors discounts on premiums if they take a simulation course, he said. In cases of litigation, medical facilities that use simulation will be able to portray themselves as trying as hard as they can to optimize physician performance and ensure patient safety, Dr. Gaba said.

“One of the benefits of doing a better job of taking care of patients is it’s going to reduce the bad outcomes and reduce liability,” he said.

Further improving patient care, particularly for complicated and unprecedented procedures, will be doctors’ use of simulators to rehearse a specific surgery before performing it on a patient. Some health professionals anticipate this becoming a reality within the next 10 years.

Surgical rehearsal “is coming,” Dr. Seropian said. “This will definitely be used in the future.”