Faster and Better
Translated from an article in NYT H:S, a Copenhagen journal for the Hospitals of Copenhagen Hospital Corporation, January 2001.

In the recent past it took several years to learn to do endoscopy. A new project will show whether doctors can achieve better skills by training on a computer-controlled mannequin before they are allowed to work on actual patients.

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Ach! The patient sounds like he is going to vomit when the doctor with his right hand introduces the thin flexible tube down through the esophagus down to the stomach. The doctor is concentrated on the computer's color screen where he can follow the path of the scope. His left hand has a grip on the small handle with two wheels where he can control the movement of the end of the scope. With a light pressure on one of the buttons on the handle he is blowing water and air in turn in to the stomach.

Gastroenterological surgeon, Sven Adamsen, is turning down the sound.
The patient is plastic. The realistic sounds and pictures are from the connected computer that shows how the patient looks inside when an endoscopy is being performed.

The endoscopy simulator is the main component in a new educational offering for younger doctors in the area of Copenhagen.

Who would dream of going into an airplane where the pilot has not practiced in a simulator first? It is only in the last few years that powerful computers have become small and cheap enough for computer based simulation techniques to be available in the health sector, says Dr Sven Adamsen.

Behind the offer is Copenhagen Hospital Corporation's Post Graduate Medical Institute (CHC PMI), which has the task of developing further postgraduate education for doctors through research and development.

Take for example colonoscopy. Proper training demands at least 160-180 examinations done during supervision - it takes several years. We have hope that the simulator can help to give doctors the necessary skills in a shorter time, says Sven Adamsen, who is doing research on endoscopic and surgical training skills at CHC PMI.

Personal Training Program

Endoscopy in particular has come into focus with the national plan for cancer, and a newly published report from the Danish Institute of Medical Technology Evaluation that recommends a project in screening for colon cancer. A link in the screening program will be a greater need for doctors that have mastered endoscopy to the level of expertise. Here the traditional training falls short. Only a few doctors have the necessary work routine to enable teaching, along with their other tasks including operations. What this means is that the educational capacity is too small.

With the purchase of the simulator CHC solves 2 problems - by proper use of the technology one can hopefully learn good examination techniques in a shorter time period, and spare the patients from a beginner spending too much time on the examination because of lack of proper control of the scope, says Sven Adamsen. He estimates that 62 physicians at different levels of expertise in gastroenterology and surgery this year will benefit from the training program the simulator can offer. They will each get their own personal password for use in accessing their personal training program that is adjusted to their individual needs. After a short introduction with supervisors, they will go through 20 different examinations with increasing level of difficulty on their own. The computer saves all the examinations so the trainee may go through them later, and the supervisor can also follow the trainees training via the Internet and adjust the training program if necessary.

Evaluation and Development

A physician who enrolls in the training program commits her- or himself to record his training - even if she or he has previously been through a training program. The recorded program will be analyzed closely by CHC PMI.

We have created a pilot project with 8 physicians. The initial experience from there shows that training on the simulator is efficient, but so far we do not know for sure. Is it better and/or faster than the training we so far have been able to give? We would like to know that. Also, to be able to modify and develop our training programs so we can get the most out of the simulator and the limited time available is exciting for the trainees, says Sven Adamsen.

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