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Education Review

Playing doctor: Learning about slips of the knife better on 'patients' than patients

Video developers apply virtual reality technology to teach difficult medical techniques before students try them on real patients.

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By Julie Wan
Sunday, November 7, 2010

Tameka Clanton sits before a 61-inch screen wearing a pair of 3-D eyeglasses. As if ready to do battle in a video game, she clicks the avocado-size hand controllers and sweeps her arms back and forth. The X-ray-like image on the screen expands, shrinks, then rotates, following her hand movements.

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But Clanton is not trying to rack up points. More serious matters are at stake. A biomechanics researcher at the University of Maryland Medical Center in Baltimore, Clanton is demonstrating new software that uses the virtual reality technology employed by video game developers to view human anatomy. Called iMedic, the program creates a 3-D X-ray that allows doctors to examine the body from every angle.

This software exemplifies how the video gaming industry has penetrated academia, offering researchers and students a new way to understand techniques that aren't always easy to teach. In pockets around the country, some video game companies are veering away from the entertainment industry to focus solely on creating what they call "serious games." One company, Breakaway Games in Hunt Valley, an East Coast gaming development hub just outside Baltimore, has switched completely in the past three years to developing only games for training. Its clients include the medical schools at the University of Maryland and Johns Hopkins University.

Over the past decade, an entire movement has formed around applying state-of-the-art computer games to new sectors. In 2002, the Woodrow Wilson Center for International Scholars in Washington and Digitalmill in Portland, Maine, created the Serious Games Initiative, which has led the quest to develop computer and video games to help solve world problems in education, health care, public policy, corporate management and national defense.

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"The sentiment to use games in learning has always existed," said Ben Sawyer, president of Digitalmill and co-founder of the Serious Games Initiative and one of its offshoots, the Games for Health Project. Flight simulators, computerized war games and practice space stations have been used for decades to train pilots, soldiers and astronauts. "What's changing drastically now is the capability to inject much more robust and usable applications in the form of video games and computer simulations into these environments like never before."

Nowhere is this more difficult than in the medical field, where doctors are making critical decisions and responding to unpredictable reactions from the human body. The interplay between these factors has presented serious game developers one of their greatest challenges yet. But as the technology becomes more refined, it is gradually earning the trust of medical professionals.

For example, the University of Maryland Medical Center has transformed an entire wing of its seventh floor into the Maryland Advanced Simulation, Training, Research and Innovation (MASTRI) Center, which officially opened at the end of 2006 and has been growing ever since. Every Tuesday, surgical residents meet for training in once-functional operating rooms converted into simulation labs. The trainees are presented an emergency scenario -- say, a "patient" with a blocked airway -- and must respond using either a virtual reality computer program or a hybrid that includes a mannequin simulator.

The residents must identify a course of action, and staff members remotely control whether the "patient" will improve or decline based on the residents' decisions. When mistakes are made, the panic for trainees sometimes lingers long after the simulation is over. "It's purposely stressful," said Ivan George, director of advanced technologies and special projects in general surgery. "One time, it got so real one of the residents wouldn't talk to me for 20 minutes after the procedure."

Afterward, the residents watch a video of the session, much like football players reviewing plays after a game.

Beyond emergency training scenarios, though, the use of gaming and simulation technology in medicine has been slow to gain footing, mainly because the technology still lacks the ultra-high-fidelity realistic simulations that can accurately reproduce what doctors encounter in the field. "The most complex human-made machine, such as a space shuttle and the simulator that comes with it, is ultimately less complex to model than a single organ, like a pancreas," said Adrian E. Park, chair of the MASTRI Center and head of general surgery at the University of Maryland Medical Center.

"We are in the earliest days of trying to simulate all the possible biological possibilities in one single organ," he said. "We can do things to simulate fairly basic steps. But if you want the full reaction of a pancreas or liver as it functions in health and disease, boy, we are just a long, long way from that."


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