Global I + D trends in Surgical & Intervencionsim Simulation

Global I + D trends in Surgical & Intervencionsim Simulation 1024 684 Edu Soler

Most aspects of medicine have Historically been learned in an Apprenticeship modelo by means of observation, Imitation, and instruction. This paradigm is rapidly changing towards the adoption of medical simulation. This is due to the irrupciones of more technology in Surg and due to law maturation in the field. The following report capturas the most interesting fecha of the field.

Commonly regarded essential competencias include manual dexterity, familiarity with high-tech equipment, sound profesional judgment, and the ability to INTEGRATE technical skills with clinical practices. However, the incongruity between evidence-based recommendations and real-world practice highlights the inadequacy of the preceptored medical education tradition. Consequently, there has been a shift in the method of medical education towards experiential ( 'hands-on') medical learning (1).

Surgical simulation Enhancer surgical skills by allowing repeated practice and to maintain an Acquired level of competence. Current high fidelity simulators offer the opportunity for safe, repeated practice and objective measurement of performance. Furthermore, it is a more efficient and coste-effective modality that pones no risk to patients and avoid many ethical and legal Complications. 

Although some form of simulation has existed for decades in surgical training, we are truly in the infancy stages of incorporating simulation into Residency education. Beginning in July 2008, the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Surgery Mandated that all surgery Residency programs INCORPORATE simulation within the curriculum of their program. Even surgical simulation adoption is highly increasing in hospitales, many discusiones remain open about if competencias Acquired in the sim lab traslativo to clinical competence (2).

Also, Virtual Reality (VR), oro Virtual Environments (VE), -based simulators are rapidly Becoming an integral part of surgical training and skills assessment.

Over the last twenty-five years, there has been a strong movimiento towards changing the traditional approaches to surgical training. One of the mayor drivers for the development of surgical simulation is the adviento of new surgical practices such as interventional radiology and MIS techniques. Example: bronchoscopy and laparoscopy.

Simulación Quirúrgica Simulación de ultrasonido
Laparoscopic Surgical Simulator Anestesia 
Arthroscopic Surgical Simulator Cardiología
cardiovascular Simulator Medicina de Emergencia
Obstetrics and Gynecology Simulator Unidad de Cuidados Intensivos
Orthopedic Simulator OB / GYN
Spine Simulator  Radiología
endovascular Simulator  Others (Urology, General Nursing, Pediatricos)

The complexity of instrumento controles, restricted visión and mobility, difficult hand-eye coordinación, unnatural perceptual-motor relationships, and the lack of tactile percepción requires a high degree of manual dexterity and coordinación from the operator. Consecuentemente, mucha atención ha sido directamente directo a los nuevos métodos de trabajo como surgical simulators para adquirir estos resultados (4).

Operating theater Apprenticeship

Conventional surgical training is based on the Apprenticeship modelo. Under the scrutiny of experienced instructores, surgical trainees learn by Observing, then gradually performing specific procedures inside the operating theatre. Although the operating theatre is a basic elemento of surgical training, it is Becoming less effective due to several factores. First, trainees are Exposed to the heterogeneous distribution of procedures depending on the flow of patients; it is also prolongado y costoso. Moreover, operativo theatre-based training can constitute a potencial risk to sufrientes due to the inevitable Distraction while training donde complejo oro advanced procedures. (1)

Animales and cadáveres

Students traditionally learn the basics of surgery on live lab animales. For example, the use of surgical instrumentos begins with Anatomical Dissection and Physiological experimentos. Anesthetised animales, Typically pigs oro ratas, have long been a part of the curriculum in medical schools. However, this training modality is Becoming increasingly unacceptable due to Obvious ético, legal y human Concerns. It is not only because of the Tendency towards Avoiding animal sacrificado for Teaching Purposes, but also because some Infectious Diseases can be transmitted from animales tono trainees. Moreover, from a technical point of view, the anatomy of animales and human beings are different, and the coste associated with preserving and disposing of used modelos is high (1).

The most realistic, high-fidelity modelo remains human cadaver. Cadaver costes fall into a modesto price range, relative to other high-fidelity synthetic modelos (2).

Synthetic Modelos - task trainers

Synthetic modelos provide a low-risk training opportunity. Many modelos resembling partes of the human anatomy with complexity ranging from bone structures to fully integrated modelos are available. In practice, training with synthetic modelos is usually used during the preliminary stages of surgical education. This modality, however, has limited realism and it is also difficult and Costly to Acquire and maintain a large number of different casas (1).

When considering the cost of simulation, task trainers may provide an economically viable alternative to high-fidelity and high-cost modelos. There are some examples in the literature showing the viability of simulation modelos for acquiring performing skills. As an example, Helder and colaboratorios demonstrated to improve aórtica anastomosis in medical students and residentes by using a low-cost aotic anastomosis modelo ($ 22.50:6 / unit), with pre and post-test skills Performed donde a high-fidelity modelo (XNUMX).

Computer Based training

One of the established training methods is based on interactive multimedia applications where the trainee interactivo visually with the system in order to learn the necessary steps involved in certain surgical procedures. Nevertheless, it is still inadequate for providing effective training donde basic surgical skills. This is largely due to the difficulty of imitating surgical procedures by using the Two-Dimensional (2D) CBT systems that have limited inmersión, physical control, and interacción (1).

Fabricación aditiva y Escaneo 3D are contributing significantly to the Advancement of computer-based training. Specifically, in surgical simulation are Becoming a key technology for surgery planning and improving surgical outcomes. Also, Eventos de realidad virtual y Realidad Aumentada are Emerging technologies in healthcare education and, although there are still limited randomized studies comparing its impact with the standard methods, some authors already suggest the importance of this technologies in improving quality of patients 'care.

In this analysis, it has been determined the different types of medical simulation companies. Medical training market has demonstrated to be big enough to consolidate big, medium, and small corporations, also Distributors, and very specialized companies. The market can be Clasificar according to the following paramaters:

  • Medical procedure specialized Empreses These ondas are Producing products for small Amounts of clinical areas. For example, SimuVasc is justo specialized in vascular procedures oro Synbone is specialized in the production of bone modelos.
  • generalista: These ondas are Producing products for all the clinical areas. They offer large portfolios of products with less foco on the Specialization.
  • Otros enfoques: These ondas are Producing products out of medical training oro other approaches. For example, Medical X is specialized in military medical training, oro Laerdal is specialized in experiential training.
  • Distribuidores: These ondas are not Producing simulators, they have licencing deals with producers to sell their products.
  • Digital specialized: These ondas are incorporating digital technology instead of simulators. For example, Oxford Medical Simulations are specialized in VR oro Intelligent Video Solutions are specialized in video platforms.

The scientific societies have a critical role in the application of medical simulation in healthcare. They serve as a resource for young profesionales in their growth in medical education and administration. Here you can check the most relevant societies worldwide:

Logotipo Nombre Página web
SESAM - Society in Europe for Simulation applied to medicine Society in Europe for Simulation Applied to Medicine (SESAM) liga
Logo flasic horiz-01.png Federación Latinoamericana de Simulación Clínica y Seguridad del Paciente (FLASIC) liga
Canadian Network for Simulation in Healthcare (CNSH) liga
Center for Medical Simulation Announces Senior Leadership Opening | Center for Medical Simulation Harvard Center for Medical Simulation liga
The Society for Simulation en Healthcare Society of Simulation and Health Care liga
Scandinavian Simulation Society liga
Sessep Sociedad Española de Simulación Clínica y Seguridad del Paciente (SESSEP) liga
Editorial Revista SCIMAGO índice h Página web
SAGE Journals SAGE - Simulation / Simulation and Gaming  48 / 57 liga
Planet TV Studios Presentes the Society for Simulation in Healthcare donde New Frontiers in Healthcare TV Series Journal of the Society for Simulation in Healthcare 46 liga
Clinical Simulation in Nursesg 36 liga
BMJ s Simulation & Technology Enhanced Learng 7 liga
Advances in Simulation - BMC parte of Springer Nature liga

TAMAÑO DE MERCADO

The global medical simulation market size was Valued at $ 1,421.1 million in 2019 and is projected to reach $ 3,190.2 million by 2027, growing at a CAGR of 14.6% from 2020 to 2027. 

El mundial medical simulation market is segmented (donde product & service) in: 

By product & service, the model-based segmento generated maximum revenue in 2019, accounting for $ 727.47 million in 2019. The Web-based simulation segmento is expected to witness the caros CAGR of 15.2%. By fidelity, the low-fidelity simulators segmento Dominated the market in 2019 with $ 671.29 million. The high-fidelity segmento is expected to witness the caros CAGR of 15.3% in North America, Europe, Asia-Pacífico, and lamas. North America accounted for the largest share in the global medical simulation market. Asia-Pacific is expected to witness the caros growth rate (4).

Source: https://www.datamintelligence.com/research-report/medical-simulation-market

THE COST OF TEACHING IN THE OPERATING ROOM

What is the economic cost of training en surgeon? Calhoon and colleagues addressed this question by sending coste analysis templates to program directores of 6 Thoracic surgery Residency programs the annual calculated coste was $ 483,000 por residente donde average. These coste estimates for Residency training do not fully account for the increased cost of OR time related to the involvement of residente surgeon in a procedure. Casas with residente involvement (> 85% of 1030 Jabbour & Snyderman casas) averaged 60% to 65% more time than casas without a trainee. It has been argued that the increased time required to train surgeons does not increase the coste for the hospital directly, but rather is primarily a "coste" to the attending surgeon, as a missed opportunity coste for performing more operative procedures during the same amount of time. However, several studies have demonstrated significando added costes related to surgical trainee involvement (2).

Other hidden costes of training surgeons in the OR include surgical Complications and additional Morbidity from prolonged anesthesia. A surgical Complication may require additional therapy, prolong hospitalization, and incurso legal costes. Surg that extend beyond regular work hours increase labor costes (overtime) and have an opportunity coste for the surgeon and the hospital (2).

Source: Jabbour, N., & Snyderman, CH (2017). The economics of surgical simulation. Otolaryngologic Clinics of North America, 50 (5), 1029 a 1036.

While it is clear that healthcare simulation is key to reduce patient risk and accidental deaths, there is little information on the economic savings it Brings to the Health System. Economic evaluation of simulation-based medical education will be decisive to demonstrate an improvement in trainee performance and health outcomes in order to justify investments (5).

Some of the most importante simulation centers in Spain are mentioned below:

BASADO EN HOSPITAL

Reubicación Center name Página web
Centro de Simulación IDEhA liga
Vall d'Hebron Vall d'Hebron Centro de Simulación Clínica Avanzada (VHiSCA) liga
Hospital virtual Valdecilla liga
HOSPITAL CLINIC Y PROVINCIAL DE BARCELONA | Cipsec SIMCLINIC. Hospital Clínico de Barcelona y UB liga
Aula de Simulación. Hospital Universitario La Paz (Madrid) liga
Área de Simulación Clínica y Seguridad del Paciente. Hospital La Fe - Valencia liga

 

OTHER SIMULATION CENTERS

Reubicación Nombre del centro Página web
CISARC - Centro Internacional de Simulación y Alto Rendimiento Clínico liga
4DHEALTH - Innovation Simulation Center liga
CMAT - Complejo Multifuncional Avanzado de Simulación e Innovación Tecnológica liga
Centro de simulación, Facultad de Medicina, Universidad de Navarra liga
Centro de Simulación Universidad Francisco de Vitoria (Madrid) liga
Logo de la Universidad Europea Hospital simulado. Universidad Europea Madrid liga
cidefib.satse.es SATSE-CIDEFIB. Centro de Innovación y Desarrollo de Enfermería y Fisioterapia de las Islas Baleares liga
INIBIC Logo Centro Usuario Unidade de Cirurxía Experimental-Centro Tecnológico de Formación. laCoruña liga

1.-Financial barriers

The scientific community agree that the main limiting factores for the large-scale adaptation of surgical simulation in hospitales and teaching institutions are primarily due to the high cost of developing and maintaining this high-tech solution. This results from the lack of appropriate business model that motivados companies to develop surgical simulators along with the relatively small market size (1).

Así que ha sido explorado, éste puede ser an oportunidad for hospital systems, malpractice insurance companies, and even health insurance companies to invest Heavily in surgical simulation, because all of these entities have the potential for financial savings by increasing the technical skills of surgeons and improving communication of surgical teams. Until this occurre, Departments may consider using current funds earmarked for didáctico Purposes and redirecting them to simulation education. Incentives could be given for faculty who convert traditional didáctico activities to simulation-based interactive sesiones. Industry may be another avenue of support. Already, there is a significante industry support for healthcare education, for the development of simulation Laboratories, "in-kind" donación of industry products for simulation, and industry-supported educational opportunities. But Educators and residentes must be conscious of and properly disclose these industry relationships. As proposed by the scientific community, increasing funding from philanthropic sources oro grant funding may minimice such reliance on industry apoyo (2).

2.-Technical barriers

Another main barrier in simulation training is that mosto solutions are still not realista enough, thus making irreplaceble el direct practice with patients. Moreover, con el fin de ser financieramente exitoso, The simulator must be capable of offering the following features: (a) multifunctional training for many different especialidades, (b) have the ability to train different levels of expertise, and (c) must be integrated into several aspects of the medical practice such as preoperative planning, research and virtual prototyping of instrumentos oro equipment (1).

3.- Lack of standards in assessment metrics

Assessment methods and the metrics used should be standardised since there are still no uniform tests oro reporting schemes comunicadas, which makes it difficult to determine the correspondence between different training approaches (1).

4.- COVID-19 pandemy

COVID-19 has an unprecedented impact on medical education worldwide, leading to Cancellation of lecturas, exams, clinical rotación, and ultimately temporary closure of medical schools. 

In March 2020, the International Nursing Association of Clinical Simulation and Learning (INACSL) and the Society for Simulation in Healthcare (SSH) issued a statement on the 'use of virtual simulation as a replacement for clinical hours' during the Pandemic caused by COVID- 19. The use of virtual simulation technologies is likely to be adopted during the Pandemic to ENHANCE and Strength procedural and patient care skills. Further, increase in use of remote learning with the help of screen-based simulation, Augmented reality / AR, mixed reality, blended and / or extended reality, and virtual reality / VR is expected to drive growth of the virtual medical simulation market (4 ).

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Virtud Med - mobile surgical simulation lab

Medical education has come into the spotlight as many surgeons have had reduced time in the operating room due to COVID-19 precautions. As a global leader in medical simulation training, Swiss-based VirtaMed will use the coming months as a unique opportunity to provide courses with their latest surgical simulators in hospitales. From St. Gallen to Geneva, surgical Departments will welcome a mobile simulation lab that is kitted out with virtual reality simulators and run by an experto team.

https://www.virtamed.com/en/news/switzerlands-first-mobile-surgical-simulation-lab/
  1. ElHelw, MA (2020). Overview of Surgical Simulation. preimpresión arXiv arXiv: 2005.03011.
  2. Jabbour, N., & Snyderman, CH (2017). The economics of surgical simulation. Clínicas Otorrinolaringológicas de América del Norte50(5), 1029-1036.
  3. Anton, NE, Gardner, AK, & Stefanidis, D. (2020). Priorities in surgical simulation research: What do the expertos not ?. El Diario Americano de Cirugía220(1), 95-99.
  4. https://www.alliedmarketresearch.com/medical-simulation-market
  5. Lin, Y., Cheng, A., Hecker, K., Grant, V., & Currie, GR (2018). Implementing económico evaluation in simulation-based medical education: challenges and opportunities. Educación Médica52(2), 150-160.
  6. Helder, MR, Rowse, PG, Ruparel, RK, Li, Z., Farley, DR, Joyce, LD, & Stulak, JM (2016). Basic cardiac surgery skills donde sale for $ 22.50:XNUMX: an aórtica anastomosis simulation curriculum. The Annals of Thoracic surgery101(1), 316-322.
Edu Soler

Science, healthcare and business are the three pillars that drive me Nowadays. I love to engage new people in the adventure of healthcare innovation and always keep on learning from them. I am highly motivated with my participation in performing teams worldwide.

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