By: Victoria Brazil (@SocraticEM)
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Long before the advent of fancy mannikins and plastic part-task trainers, doctors practised medical procedures on cadavers and live, anaesthetised animals. For a host of good ethical and practical reasons, there has been a shift away from these practices, assisted by improved synthetic alternatives – plastics, hydrogels, 3D bioprinting and XR/ VR advances. However there remain gaps in adequate realism of the training experience for some procedures – visual appearance, tactile realism and dynamic challenges such as active bleeding. How should we proceed if we are to move away from using animals in medical training while still creating optimal educational experiences?
Cara Swain and colleagues have given us a helpful overview of the state of the art in their recent paper – Trauma surgical simulation: discussing the replacement of live animals used as human patient simulators (1). In this article they direct us to the foundational position statement from 1959, advocating the 3Rs – replacement, reduction, and refinement – of animal use in research, also relevant to use in medical training. The authors present a literature review of studies comparing live tissue training with other modalities and conclude that the key gaps are in “tissue tactility, physiological responsiveness and psychological engagement during the simulation” (1). Blood feels ‘sticky’ and warm, uncontrolled bleeding is stressful, tissue ‘feel’ is nuanced. The article then describes the deliberations of a working group on this topic at at SESAM conference, and presents a series of recommendations, concluding that “no single model can presently meet the rationale for using a live animal model” (1).
The conclusion is hardly surprising. Issues of ‘functional task alignment’ and clear learning objectives for any given educational experience are highly relevant. Few training experiences (including real clinical experience) are ‘one stop shop’, and how experience is reflected upon and repeated may be as relevant as the experience itself. My personal prediction is that the technology is catching up fast. Laparoscopic VR trainers have been able to emulate many of the technical challenges in laparoscopic surgery, with training effectiveness at least comparable to real world practice. Materials science combined with 3D printing advances has meant that part task trainers can be much more realistic than previously. But is likely that VR will be the ‘killer app’ – able to replicate visual, tactile, and auditory cues to a high degree of realism, and maybe even team dynamics in these encounters.
Exciting times!
Laparoscopic cholestectomy. Image courtesy of Jump Simulation and Simbionix. https://www.youtube.com/watch?v=qStd4C9bLmc
References
- Swain, C., Stathakarou, N., Alzuguren, P. et al. Trauma surgical simulation: discussing the replacement of live animals used as human patient simulators. Adv Simul 9, 7 (2024).
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