Failing safely: video games invade the OR (part two)

Guest blogger Devin Griffiths

In 1999, the Institute of Medicine published a study that concluded the following: medical errors in the US cost the lives of as many as 98,000 people each year (and run up a $17- $29 billion bill to boot). Ten years later, the Safe Patient Project reported that, rather than showing improvement, in the intervening decade the situation may have actually gotten worse—to the tune of more than 100,000 deaths each year as a result of “preventable medical harm.” Given that the CDC puts the number of deaths from hospital infections alone at around 99,000 annually, the SPP’s number seems conservative.

Let me put this into perspective. A Boeing 737—the most popular aircraft family in service today—seats 360 people, give or take. Consider this, then: the Safe Patient Project’s estimate of preventable fatalities is akin to 277 airliners plummeting to Earth and killing everyone on board—every year. How long do you think the FAA—or the public, for that matter—would stand for that?

Fortunately there’s a solution: video games.

“Being a videogamer doesn’t get a lot of respect in a lot of mainstream professions, but it has been instrumental to me in becoming a surgeon.”

That’s Dr. Andy Wright, surgeon and core faculty member at the University of Washington’s Institute for Simulation and Interprofessional Studies (ISIS). He believes that skills developed through gaming can contribute to success in the operating room and ultimately help reduce accidental deaths. According to Wright,

“Gamers have a higher level of executive function. They have the ability to process information and make decisions quickly, they have to remember cues to what’s going around [them] and [they] have to make split-second decisions.”

Skilled gamers regularly show heightened abilities to focus on critical elements while maintaining peripheral awareness of the larger situation, function amidst distraction, and effectively improvise if a situation doesn’t go according to plan; success in gaming demands it. These skills translate very well into many real-world situations—including the operating room.

Take gaming into the land of simulation, though, and you can start tapping into the medium’s real power. Virtual reality (VR) simulators are an effective means of getting fledgling surgeons comfortable with a variety of procedures, allowing them to perform a given surgery dozens of times before ever opening up a live patient. They also provide an environment in which surgeons can, in essence, fail safely. Within a simulation, they can develop critical skills and expertise without putting anyone at risk, experimenting with different techniques, learning what does—and doesn’t—work, and becoming safer and more effective. A 2002 Yale University study provided strong evidence for this: surgical residents trained in VR were 29 percent faster and six times less likely to make mistakes than their non-VR trained colleagues.

You can also customize a simulation to closely reflect reality, matching the conditions and characteristics of actual patients. In 2009, Halifax neurosurgeon Dr. David Clarke made history when he became the first person to remove a brain tumor in a patient less than 24 hours after removing the same tumor virtually, on a 3D rendering of that same patient. Two years later, doctors in Mumbai performed PSI knee replacement surgery on a patient after first running the operation virtually on an exact 3D replica of the patient’s knee.

Earlier this year, VR training took another leap forward: using the online virtual world Second Life, London’s St. Mary’s Hospital developed three VR environments—a standard hospital ward, an intensive care unit, and an emergency room—and built modules for three common scenarios (at three levels of complexity, for interns, junior residents, and senior residents) within them. According to Dr. Rajesh Aggarwal, a National Institute for Health Research (NIHR) clinician scientist in surgery at St. Mary’s Imperial College,

“The way we learn in residency currently has been called ‘training by chance,’ because you don’t know what is coming through the door next. What we are doing is taking the chance encounters out of the way residents learn and forming a structured approach to training. What we want to do—using this simulation platform—is to bring all the junior residents and senior residents up to the level of the attending surgeon, so that the time is shortened in terms of their learning curve in learning how to look after surgical patients.”

After running interns and junior and senior residents through the VR training, researchers compared their performances of specific procedures against those of attending surgeons. They found substantial performance gaps between interns, residents, and attendings—validating the VR scenarios as training tools. As Dr. Aggarwal explained,

“What we have shown scientifically is that these three simulated scenarios at the three different levels are appropriate for the assessment of interns, junior residents, and senior residents and their management of these cases.”

In the future, the team at St. Mary’s plans to study how this type of VR training can improve clinical outcomes of patients treated by residents—ultimately using this tool to bring their interns’ and residents’ skills up to the level of the attendings, help them better manage clinical patients, and, at the end of the day save lives.

About the Guest Blogger:

Devin C. Griffiths has been writing all his life and gaming almost as long. He grew up during the great video game boom of the late ‘70s/early ‘80s, and spent many hours (and more quarters) in their company. He studied science journalism at Hampshire College, and launched his own PR and marketing company, Catamount Communications, in the early 2000s. His first book, Virtual Ascendance: Video Games and the Remaking of Reality (published October 2013, by Rowman & Littlefield) examines the impact of games and the video game industry on society, health, education, economics, and culture—a topic he also explores on his blog, Reality Evolved: videogames and the end of the world (as we know it). You can follow Devin at http://devingriffiths.wordpress.com.

Not Just For Fun: Video Games Invade the OR (Part 1)

I am not a gamer, but a share a home with a gaming-obsessed teenager. In this series of blogs on the applications of gaming to medicine, guest blogger Devin Griffiths attempts to educate me and my readers about the wisdom of allowing my fourteen-year old son to indulge (at least a bit) in his gaming obsession. Last month, Devin published a book on gaming entitled, Virtual Ascendance: Video Games and the Remaking of Reality (Rowman & Littlefield, October 2013.)

Six minutes to better surgery. Sounds impossible, doesn’t it? Yet laparoscopic surgeons are finding that they can improve performance by engaging in one simple activity for less time than it takes to boil water. By what magical means can they achieve this, you ask?

Playing video gamesPlaying video games.

I can hear the protests already. Video games are a scourge, a blight. They’re responsible for the downfall of modern society. They can’t possibly offer anything positive.

Actually, they can—and in 2002, Dr. James C. Rosser, then at Beth Israel Medical Center, proved it. He had 33 surgeons participate in a three-month study that involved, among other activities, playing a series of video games before simulating laparoscopic surgery. About half of the participants had a history of game play, though all of them played during this study. Researchers compared the results between participants, as well as against non-gaming colleagues. What they found was dramatic: Surgeons who were playing currently, but hadn’t in the past, were 32 percent more accurate and 24 percent faster than non-gamers. Those with a history of game play made 37 percent fewer errors and were 27 percent faster than their colleagues who’d only recently begun playing. And the most skilled gamers in the group made 47 percent fewer errors and were 39 percent faster than those at the bottom of the heap. Further, after controlling for extent of training and number of cases completed, the best predictors of surgical success were video game skill and amount of past gaming experience. Said surgeon and study participant Asaf Yalif,

“We were surprised and actually awed by the fact that your video game skill, meaning how well you play, as well as the number of hours you have spent on video games were very highly correlating — meaning if you do this well you will be less error-prone, you will be faster and you will perform better at laparoscopic surgery.”

Now at Florida’s Celebration Health hospital, Dr. Rosser recently conducted a follow-up study with 300 laparoscopic surgeons, half playing a video game just prior to scrubbing in. The results? A six-minute video game warm-up resulted in more effective performance and better patient outcomes.

Another study at the University of Rome, Italy, published this past February in the journal PLOS ONE, provides further evidence of gaming’s impact on laparoscopy. Researchers gathered forty-two post graduate students in general, vascular and endoscopic surgery, and split them into two groups. Both groups received standard training, but one group also trained on the Nintendo Wii. After four weeks, the Wii group showed significant performance improvement in several areas, including economy of instrument movements and efficient cautery. The authors’ conclusions? The Wii could be a valuable tool for laparoscopic training, and an effective, inexpensive, and entertaining means of enhancing standard surgical education.

You can find Dr. Rosser’s JAMA Surgery article here

The New York Times has a piece about Dr. Rosser here

And you can learn more about Dr. Rosser’s recent work here

For information about the study at the University of Rome, go to the PLOS ONE article

… and the write-up in Science Daily here

For more information about video games and their impact on society, check out Devin’s blog

About the Guest Blogger:

Devin C. Griffiths has been writing all his life and gaming almost as long. He grew up during the great video game boom of the late ‘70s/early ‘80s, and spent many hours (and more quarters) in their company. He studied science journalism at Hampshire College, and launched his own PR and marketing company, Catamount Communications, in the early 2000s. His first book, Virtual Ascendance: Video Games and the Remaking of Reality (published October 2013, by Rowman & Littlefield) examines the impact of games and the video game industry on society, health, education, economics, and culture—a topic he also explores on his blog, Reality Evolved: videogames and the end of the world (as we know it). You can follow Devin at http://devingriffiths.wordpress.com.