Could medical mistakes be avoided if doctors were trained using interactive three-dimensional visualization techniques instead of learning new procedures on patients? In a review article published in the prestigious British medical journal "The Lancet" this week, Emory Heart Center cardiologist Christopher Cates, M.D., says the answer is yes -- and he adds that virtual reality (VR) training could help reduce medical errors that are estimated to cause between 44,000 and 94,000 deaths in the U.S. each year. Dr. Cates argues that many of these deadly mistakes are caused by human factors associated with invasive, image guided procedures learned in the traditional way (with doctors learning new procedures working on patients with the guidance of experienced teachers).
"The radically novel skills required for minimally invasive surgery or interventional cardiology are so difficult to learn that the standard type of training is simply no longer acceptable," says Dr. Cates, Director of Vascular Intervention at Emory University Hospital and Emory Crawford Long Hospital. "While minimally invasive procedures have advantages for patients because they cause less trauma, they make the operator's job more difficult. You can't see and feel tissues directly and learning the hand-eye coordination of instruments, catheters and guide wires is problematic."
Pointing out that the state of the art for training in many other highly skilled professions is virtual reality (VR), Dr. Cates says VR should be used more widely for training physicians who perform cardiovascular procedures. "The potential of VR to improve training and patients' safety is very exciting," he says. "It allows more than observation. You can interact with and integrate different sensory inputs that simulate important aspects of real world experience doing these procedures."
Dr. Cates notes that VR training was first introduced to surgery in l991, but it has been slow to gain wide acceptance within the medical community due to the lack of well controlled clinical trials. However, several well designed smaller studies have shown that residents trained with VR made fewer intraoperative errors. "In fact, the American College of Surgeons overwhelmingly supports VR training as a way to improve patients' safety, " Dr. Cates says. "In addition, the FDA recently approved carotid stenting as an alternative to carotid endarterectomy (surgically removing plaque from the artery) and VR training will be an FDA requirement before credentials to perform the procedure are granted. This is a real shift in medical training."
The Society for Cardiovascular Angiography and Interventions (SCAI) predicts demand for the carotid stenting procedure will mushroom following FDA approval and the SCAI is working with industry partners to help develop programs on virtual reality simulators to train physicians. Dr. Cates and Anthony Gallagher, Ph.D., Emory University School of Medicine Associate Professor of Surgery (Research) and Research Director of the Emory Endosurgery Unit, designed one of the first of these programs to train physicians in carotid stenting. Using simulators that look like human mannequins, physicians thread a catheter through an artificial circulatory system and view angiograms of the "patient."
"Doctors learn on a simulator until they are proficient, working in life-like settings," says Christopher Cates, MD, Associate Professor of Medicine at the Emory School of Medicine and chair of the SCAI's Board of Governors. Emory has already trained over 103 physicians using the simulator.