What’s It Like to Use the Simulators?
Writer James Tobin gives them a try.

Possessing all the medical skill of a dad who knows how to put a band-aid on a six-year-old’s knee, I walked into the Clinical Simulation Center with no illusions about mastering the elements of surgery. I just wanted to see what it’s like to use one of the computer-based trainers.

Before attempting a simulated procedure, writer Jim Tobin gets a few pointers from residents in the Sim Center. Photo: Martin Vloet

There are six of them, ranging in cost from about $50,000 to just under $200,000. (The center has acquired so much equipment that a new space, four times the current size, will soon be built to house the simulators, the human-simulation mannequins, and related equipment.) The simulators teach dozens of procedures ranging from stenting the carotid artery to ovarian tubal ligations to colonoscopies.

I chose a laparoscopy trainer call the LapMentor, with a scenario — one of many on this machine alone, ranging from simple drills to complex procedures — that would ask me to remove a simulated gall bladder.

The base of the LapMentor is about the size and shape of “Star Wars’” R2-D2. A post on top supports a big monitor at eye-level. The operator works with two thin poles at belt-level, each with handles that look like the handles of a pair of scissors, and a foot pedal.

I grasped the handles and moved the poles around a little — in and out, right and left, up and down. Then I looked at the screen, and realized my movements were manipulating little surgical tools inside a simulated abdomen.

I’ve never seen a gall bladder, but the doctors say the graphics are spot on. What I saw was a brownish lump connected by tubes to other masses. Woojin Shim, the center’s systems analyst, explained that one tube was an artery, the other the bile duct, leading to the liver. My job was to clip the tubes so the gall bladder could be pulled free. The idea was to grab the tubes with little pincers, then step on the foot pedal to administer an electric current, cauterizing them.

That sounded pretty easy. It wasn’t. I was moving my hands in three dimensions while controlling instruments on a two-dimensional screen. It’s a problem in depth perception, not to mention basic coordination. I reached and missed, reached and missed.

What I lacked was the relevant psychomotor skill — the combination of mental and physical acuity that comes only with repeated practice, like riding a bike. That’s a key purpose of the simulators — to enable students and residents to practice and practice until they acquire the psychomotor skills they need, but with no risk to human patients.

Finally I got hold of the artery and pressed the foot pedal. A little puff of simulated smoke billowed up. I had cauterized it. I think.

The spooky part of the simulator is “haptic feedback,” the feature that endows the handles with the physical sensations of touching, even though you’re not actually touching anything at all.

I told the staffers I didn’t notice any such feedback in the play of the instruments. They told me to grab the bile duct and pull. I did; then I felt the haptic feedback. The harder I pulled, the more resistance, until it felt like I was pulling hard on a thick, tough rubber band.

This maneuver had a predictable effect on the poor simulated patient. Suddenly, simulated blood and bile were spurting all over the inside of the simulated abdomen. I let go, but too late. My pretend patient was in serious pretend trouble.

I had failed at my first try. And, of course, there’s a little more to surgery than figuring out how to work this high-stakes video game. Starting with a course in anatomy.

“We used to have eighth-graders come in and do the basic skill drills as well as any first-year resident,” said Michael Marsh, manager of the simulation center. “Does that make them surgeons? No.”

But I bet they did better with gall bladders than I did.

—James Tobin

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