WHEN JET PILOTS BEGAN CRASHING PLANES ON A DAILY BASIS WITHOUT DISTURBING A SINGLE PASSENGER, SURGEONS LIKE EMORY'S DANIEL SMITH TOOK NOTE. The cockpits looked and felt real, but the flight path and landing strips were video simulations that continually presented new challenges and feedback on how well the pilot was handling both the plane and the unpredictability of weather, engine failure, air traffic, even a bird strayed into the intake. Learn first. Then—and only then—get in a plane. Or an operating room.
     Surgical procedures increasingly are performed via videoscopy with customized instruments and tiny cameras placed through incisions far too small to admit a surgeon’s hand. The surgical team “sees” the tissue being operated on through two-dimensional images on an overhead television monitor, and remotely controlled surgical robots provide greater precision than ever possible with the human hand alone. In the future, the surgeon can operate with exacting care on what appears on the monitor to be a motionless heart or brain tumor or pancreas while the robot monitors heart rate, breathing, and other movement and corrects placement of the instrumentation.
     The Emory Simulation, Training and Robotics (ESTAR) program headed by Smith has made Emory one of the leading schools in the nation for teaching surgical procedures via simulation and for research validating this innovative type of training.
     Surgeons come to Emory from across the world to learn and master the tricky hand-eye coordination required to navigate instruments in a laparoscopic environment. Soon, Emory will be “going home” with many of them. Surgeons who learn new procedures at ESTAR can continue their simulation training back in their own institutions, while Emory faculty monitor their progress over the Internet. When the surgeons are ready to perform a new procedure for the first time on a real patient, an Emory surgeon will use Internet-connected robots to be virtually present in the operating room, wherever in the world that may be.

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Raising the score
The aptly named uro-mentor is like a video game. A urology resident snakes a scope up through a virtual urethra into the kidney. Eyes intent on the computer screen, he takes aim at a kidney stone, activates the laser with a foot pedal, and smiles with satisfaction as the stone explodes into powder. If this were a video game, the score would read Accurate! Cured! Studies show that training on a simulator makes surgeons better at operating simulators, says Emory’s Ken Ogan. But the real goal is to reduce the learning curve and improve skills in the operating room. To evaluate this teaching technology, Ogan is using the uro-mentor to teach Emory urology residents to treat kidney stones. Their performance during actual procedures in the OR will then be compared with that of residents trained via traditional methods. Bottom line, he says, the hope is that the virtual reality training will improve patient care and reduce cost and complications.


Disseminate new knowledge:
> HELP A SURGEON FEEL BETTER. As physicians and engineers work together on new tools to make simulated and actual surgery more akin to one another, the focus increasingly is on haptics, or improved tactile feedback for the surgeon. Emory’s goal is to establish a $1 million fund to perfect and customize this new technology to train surgeons everywhere.
> HELP STUDENTS GET REAL. A gift of $5 million would outfit a simulation laboratory in a new teaching building under construction for the medical school. Here, using patient models, students will gain clinical experience, ranging from taking histories to handling trauma cases.
> ENCOURAGE PLAYING WELL TOGETHER. SimMan patient mannequins in the nursing school’s Evans Simulation Center are used to teach medical and nursing students how to work together in crisis and other situations. An investment of $30,000 would allow a faculty member to spend up to 20 hours per month evaluating students in the simulation lab.
> TEACH A TEACHER NEW TRICKS. Finding faculty skilled enough in new simulation technology to teach it is no easy task. Endowed fellowships, at a cost of $300,000 each, would help train faculty in this area.
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