SMCSR Cardiologist Accompanies New Vascular Simulator on Training Mission to China

Sutter Medical Center of Santa Rosa (SMCSR) cardiologist Patrick Coleman, M.D., enjoyed his first trip to mainland China in October. But it wasn’t the typical sightseeing excursion that would result in multiple photographs of him atop the Great Wall. Rather, Dr. Coleman spent what he describes as a "very intensive week" introducing a group of 30 Chinese cardiologists to a remarkable technology that helps train them in highly complex procedures with no risk to patients.

The credit goes to a high-tech computer simulator developed by Medtronic Corporation, in conjunction with Immersion Technologies. The Medtronic "Accutouch" Vascular Simulator mimics a cardiac catheterization procedure that helps cardiologists determine whether a patient has a blockage in a coronary artery.

Useful Experience
Once a blockage is discovered, the physician can take immediate steps to either break up the obstruction or create a path for blood to flow around it. The great advantage of the simulator is that cardiologists can practice and refine those procedures countless times without ever seeing a real patient.

"One of the founders of open-heart surgery had an expression that I’ve now made into a sign on my desk and that I look at every day," says Dr. Coleman. "He said, ‘Good judgment comes from experience, and experience comes from bad judgment.’ What the simulator does is lets you exercise some of that bad judgment to make mistakes, to try different things so that you can see what works, what doesn’t work and why. You don’t have that freedom to make mistakes when you’re working on a live patient."

Aiding in Development
Dr. Coleman, medical director of the SMCSR Cardiac Catheterization Lab, was among a group of interventional cardiologists who reviewed early versions of the technology over the past several years and offered feedback to Medtronic designers and software engineers. The SMCSR unit is one of only three currently operating in the United States.

"Simulation has been used for a long time, with great success in training airline pilots, and now we’re getting to experience what the technology can do for cardiologists," Dr. Coleman says. "We spent the early part of 2003 helping engineers and software designers get the bugs out of the system. By the summer, the technology had been developed into an amazing simulation that offers direct and immediate feedback to the physician."

Safety Through Simulation
Chief among the system’s benefits, says Dr. Coleman, is that it gives physicians a lifelike experience without risking any harm to patients. "There’s no comparable way to get this kind of practice. It’s a great tool for interventional cardiologists undergoing fellowship training or those in smaller or rural hospitals who might not perform enough procedures to keep their skills well-honed."

Dr. Coleman adds that even he can benefit from the Medtronic simulator, despite his more than 20 years of experience and a steady stream of patients coming through the SMCSR Cath Lab. "Everyone can always get better. In the future, the simulator will allow us to take images for the next day’s cases and develop a ‘virtual’ patient. We’ll go through several dry runs on the ‘virtual’ patient before setting foot in the cath lab," he says. "Later, as new devices are developed for the field, we’ll be able to use them on the simulator before we encounter a real patient."

Cultural Differences
Dr. Coleman, who joined the SMCSR medical staff in 1992, was one of three training physicians who participated in the China trip. The others were from Stanford University Medical Center and from the Royal Alfred Hospital in Australia. The trio was accompanied by several officials from Medtronic. All activities took place in a hotel in Beijing.

"We worked from 8 in the morning till 6 or 7 at night," Dr. Coleman says. "The 30 Chinese cardiologists were accompanied by a handful of their faculty members. All the Chinese were English-speaking to varying degrees, but we also had translators on hand. We didn’t have a lot of interaction the first day. The Chinese teaching style is quite hierarchical, with very little give-and-take between faculty and students. But once we let them know that asking questions and even admitting mistakes was ok with us, they warmed up and became very open."

Bridging Technology
Rather than becoming a sticking point between the two groups, such cultural differences became a rich source of education for both, Dr. Coleman says. "Some of the Chinese faculty were young and as excited as anyone with this new teaching tool. Their traditional Chinese medicine is a system unto itself, and it coexists quite well there with the kind of western technology we were sharing with them."

Having experienced the simulator over many months, Dr. Coleman had become a firm believer in its practical benefits. Everything he saw in the training program with Chinese doctors confirmed his feelings.

"In just the one week of training, we witnessed a tremendous leap in the Chinese physicians’ technical skills," he says. "They had largely been trained in one way to do most procedures, but the simulator offered them a safe means to try out many other ways. It gave them immediate feedback on how they did, on whether their judgment was good or bad. Their improvement from the beginning of the week to the end dramatically highlighted the value of a good simulation program."