Practiced Precision

IT’S A BUSY day in the arcade. At the controls of each machine, the operator seeks to shave seconds from their personal best, using robotic graspers to quickly and accurately move pegs on a board.

This isn’t a game. It’s a skills test. These are future surgeons.

The Department of Surgery Simulation Arcade, located in the expanded Surgical Skills Center on the second floor of the new Medical Education and Research Building at the Indiana University School of Medicine, serves as the primary training ground. Here, trainees and experienced surgeons alike learn and refine surgical techniques.

“It’s an incredible simulation center, and not every program is fortunate to have something like this right on their campus,” said Noosha Deravi, MD, a general surgery resident and IU Research and Innovation in Surgical Education (IU RISE) fellow. “There’s a very robust simulation experience here for all the residents.”

Across the hall from the arcade, in the Surgical Skills Lab, the scene is reminiscent of scouts earning their knot-tying badge. Medical students stand at shiny surgical tables forming square knots with thick cords wrapped around rubber bands, mounted to clipboards. The session’s instructor, Nathan Behrens, MD, tempers their confidence: “You might think you’re doing square knots when you’re actually throwing slips.”

Much more than a badge is at stake here. These future surgeons need to master knot-tying before moving to surgical sutures with simulated skin — and eventually, to real, live patients.

As Behrens, an IU RISE fellow, demonstrates proper knot-tying techniques, the medical students get a zoomed-in view on a big screen at each station. Similar high-tech camera systems are used for laparoscopic surgeries.

 

In the Surgical Skills Lab, medical students work through knot-tying on simulated pads, a foundational step before moving to sutures, cadavers and eventually live patients. "You might think you're doing square knots," instructor Nathan Behrens, MD, tells them, "when you're actually throwing slips." (Photos by AJ Mast)

 

The clarity of the new Stryker monitors is “10 times better” than the lab’s older equipment, noted Lisa Fisher, skills lab manager for the past 30 years. When her team moved into the new facility, they couldn’t get over the prep and storage space.

“It’s three times what we had,” she said, showing off glass-front cabinets that allow items to be located quickly.

The new skills lab includes 10 operating stations that can be used with cadavers, an upgrade from eight tables at the lab’s previous location in the Van Nuys Medical Science Building. The center also has the latest virtual reality simulation, including the da Vinci Surgical System for robot-assisted procedures.

Simulation allows trainees to learn in a “low-stakes, high-fidelity environment,” explained Amy Holmstrom, MD, director of the Surgical Skills Center. “Low stakes means no harm will come to an actual patient, but high fidelity means it’s as realistic as possible.”

Expanding hands-on experience further, the center now includes a simulated operating room that can be used for scenario-based training with manikins or live actors. Instructors can observe everything from a nearby control room with one-sided glass.

There’s also a new lead-lined training room for fluoroscopy, an imaging technique that uses a series of X-rays to show the inside of a person’s body in real time, like a video. It’s used in heart catheterization, endovascular repair of blood vessels and other precision procedures.
The skills center isn’t just for trainees. Experienced surgeons use simulation to keep up with new technologies.

Nicholas Zyromski, MD, is a professor of surgery and a gastrointestinal surgeon with 21 years of experience who is part of the busiest pancreatic surgery group in the nation. When robotic surgery was introduced to the field a few years ago, Zyromski purposefully set aside about six months to explore the new platform in the skills lab before introducing it into his clinical practice.

 

Trainees fill the Surgical Skills Lab at IU School of Medicine. The new facility includes 10 operating stations — an upgrade from eight at its previous location — and enough room to train the next generation of surgeons without anyone crowding around a single table.

 

“I had tremendous experience with these technically complex operations, but the approach is a little different within the robotic platform,” he said. “I wanted to learn its advantages and limitations.”

As someone who trains fellows in minimally invasive hepato-pancreato-biliary surgeries, Zyromski calls the skills center “invaluable.”

“It’s a huge advantage to have a simulation space adjacent to your clinical space,”he said.

The center is a national testing site for two exams required for licensing and the only site nationwide approved by the Society of American Gastrointestinal and Endoscopic Surgeons to administer these exams to select medical students. Earning the Fundamentals of Laparoscopic Surgery and Fundamentals of Endoscopic Surgery certificates before residency gives these IU students a head start and greater confidence as they begin their careers. Passing those tests is required to graduate from General Surgery Residency.

All the upgrades at the new skills lab reinforce IU’s longstanding commitment to surgical education.

“The IU School of Medicine Department of Surgery has been at the forefront of surgical simulation and using skills labs for our trainees for decades,” Zyromski said. “It’s important for us, as leaders in this field, to be using the latest technology and using it properly.”