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Practicing the Practice of Medicine

How do doctors learn the many procedures they must perform during their careers? At some point, medical students and residents must be able to safely and efficiently move from studying textbooks and practicing on models to working on human patients. But d'es injecting a needle into an orange really prepare them to do the same to people?

Someone has to be the first human a medical student will work on—putting an IV into a vein, drawing blood, inserting a catheter, or putting a scope safely down the trachea. Thankfully, technology advancements have bridged the gap between the orange and the patient. Many medical and nursing schools now use simulation technology that enables students to observe and practice complex procedures in a setting that replicates real conditions. At Mount Sinai School of Medicine in New York City, medical residents and fellows use simulators from Immersion Medical to learn a variety of procedures, including bronchoscopy, colonoscopy, and catheterization. For instance, anesthesiology residents use Immersion Medical’s AccuTouch Endoscopy Simulator to learn various techniques for inserting breathing tubes into patients. According to Adam Levine, director of residency training, the simulator closely resembles the experience of working with patients.

“The simulator behaves much like a real patient,” he notes. “The student introduces the bronchoscope into the simulator. You can manipulate the bronchoscope and feel the resistance as it g'es in.” The simulator also gives feedback: “If you manipulate the bronchoscope incorrectly, it will not go where you want it to go. If you do it wrong, the image on the lens fogs up, just as it would in a person. The patient also coughs and bucks, just like in real life.”

Mount Sinai uses several Immersion Medical simulators. “Our goal,” Levine says, “is to replicate the entire human body with simulators.”

Also, Levine notes, simulators hasten learning. “You can see the difference in [students’] understanding with the simulators,” he says. “They’re goal-directed; they manipulate the complicated devices correctly. They overcome the steep learning curve more quickly.” The results are better-trained physicians and probably cost savings, because students learn techniques more quickly and efficiently and can practice them over and over until they are fully competent.

Immersion offers three products, each of which features realistic simulations of common procedures. CathSim Vascular Access Simulator allows students to practice inserting needles for starting an IV or drawing blood. AccuTouch Endoscopy Simulator covers three types of endoscopic procedures: colonoscopy, bronchoscopy, and sigmoidoscopy. AccuTouch Endovascular Simulator enables students to practice such procedures as pacemaker leads placement, angiography, and angioplasty.

All of Immersion Medical’s products combine cognitive and motor skills training into an integrated educational experience. They use real-time computer graphics and anatomic models drawn from real patients representing a range of ages, skin colors, and health conditions.

At Mount Sinai, the faculty use simulators for both didactic instruction and hands-on practice. Says Levine: “One of the advantages of using a simulator as opposed to a real patient is that, as the teacher, you can focus completely on the student’s technique. It’s easy to make mistakes, and it’s better for students to be able to make their mistakes in a safe environment where we can work with them to learn from those mistakes.”

For more information, contact Immersion Medical, Gaithersburg, Md., at (301) 984-3706 or

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