With surgical simulation, practice makes perfect

On a recent day in the School of Medicine’s new Surgical Skills and Simulation Center on Cedar Street, a colonoscopy patient groaned in discomfort as residents discussed increasing his sedation. But Assistant Professor of Surgery Andrew Duffy, M.D., said nothing, knowing that young doctors must learn to make decisions independently. Besides, this was no flesh-and-blood patient: the images of the bowel on a video screen, the vital signs readings, even the groans were generated by a computer.

In minimally invasive surgery, surgeons manipulate instruments remotely while watching the results on video screens. The simulation center, made possible by donations from Yale-New Haven Hospital; Norwalk, Conn.-based U.S. Surgical, a manufacturer of surgical devices; and Karl Storz Endoscopy-America, a surgical instrument company, allows future surgeons to log many hours of practice with endoscopic instruments before they operate on their first patient. “It has huge implications for patient safety,” Duffy says.

Regulations passed in 2003 prohibit medical residents from working more than 80 hours per week, which gives surgical residents fewer opportunities to participate in operations. Duffy has developed curricula based around the new technology so that faculty can give residents a competency exam before they may assist in the operating room. Since the center’s opening in January, attending physicians are reporting that residents and medical students are more skilled when they begin assisting in real surgeries.

As Duffy looked on, Rachel Friedman, a third-year medical student, was working on one of the center’s Storz Box Trainers to develop basic skills and dexterity. Using hand controls to guide an endoscope and long narrow instruments used in minimally invasive surgery, she picked up blocks the size of blueberries, transferred them from her right-hand instrument to her left-hand instrument and threaded them on pegs.

Few medical schools are fortunate enough to have such facilities, according to Duffy. But the technology will soon be considered essential, he says. “This is how we’re going to be training surgeons for the rest of the 21st century.”