Simulator Training at the New Bakken Education Centre and Virtual Catheterization Laboratory

Interview by Jodie Elrod
Interview by Jodie Elrod
Medtronic Africa has announced the launch of its Therapy and Procedure Training Centre (TPTC) — the Bakken Education Centre — at its Bedfordview headquarters in Johannesburg. The centre, which is its first on the African continent, will provide training in implantable devices. Read more about the new centre here. When did the Centre open? How long did it take to build? What was the cost of the project? The Bakken Education Centre opened on February 17, 2009 after 8 months of building. Medtronic's investment in this project to date has been several million rand. Further investments will continue to be made over the next few months and years as we acquire new technology in the field of simulation. How large is the Centre and VCL? Will the virtual catheterization laboratory be housed inside the Bakken Education Centre? The total Centre space is 225 square meters, which includes a lecture auditorium, virtual patient clinic, virtual cath lab, and wetlab. The VCL is housed in a dedicated room specifically for implant simulation. Explain the simulator technology. What procedures can be simulated at the Centre? What other technology is included in the lab? The VCL system includes the simulator, which is the hardware that acts as the patient and allows for tool insertion into the body. This is connected to a computer that contains software with various modules for cardiac rhythm, vascular, and cardiac surgery. The software is presented on two monitors that act as an interface and allow for tool selection, patient vitals, graphic display of fluoroscopy and cine screens. The tools consist of actual wires, guide catheters and balloons, devices such as stents, pacing leads and valves, inflation devices, and contrast syringes instrumented to work in the simulator. The c-arm provides a realistic yet radiation-free simulation environment for the physician to change x-ray projections when needed to visualize various anatomies and heart structures from different angles. The system creates an environment that mimics a real implant environment to allow for the user to: • Become familiar with the cardiac anatomy through fluoroscopy, contrast angiography and venography, virtual three-dimensional modeling and the virtual heart overlay; • Practice accessing and maneuvering wires and leads through various parts of the cardiac anatomy including arteries, veins and chambers; • Become familiar and comfortable with new procedures and using new tools and medical devices before an actual case; • Discuss clinical case management and treatment options and strategies for varying patient profiles. Our simulator offers visual, physiological and tactile realism that mimics the look and feel of performing the actual procedure. The simulator heart anatomy is based on MRI images of actual human hearts. C-arms are instrumented with sensors simulating the full range of anatomy projections while eliminating any radiation exposure. The simulation experience includes 3-D models utilizing computer graphics, anatomic or pathologic variations, modules including various degrees of difficulty allowing the user to be assessed for improvement, appropriate responsive physiology and complications, physics-based navigation, haptics technology, and objective data for skills assessment and monitoring. The Therapy and Procedure Training Centre is a state-of-the-art facility, as demonstrated by the following: • Its simulation technology is continuously improved and updated to fit the current clinical environment and offerings; • It is a high-tech facility with outfitted rooms with the ability to conduct worldwide videoconferencing and telesurgery; • There is also a virtual patient clinic to practice device interrogations; • Various heart models allow for catheter manipulation and anatomy visualizations; • Also included is a wetlab where high-resolution videos of synthetic and tissue dissections will be recorded and streamed between rooms to provide ease of view and accommodate large audiences. Who will be trained at this facility? How many have used the center thus far? How many can use the facility at one time? With the center having just opened in mid-February, we are planning to host hundreds of health care personnel including specialist physicians, fellows, clinical technologists, and nursing sisters in the next year through our formal and informal training programs. Our strategy is to offer quality courses by limiting attendance to 4-6 per session to best utilize our hands-on simulation facilities. How many instructors will there be, and who will serve as instructors? Medtronic’s commitment is to help healthcare professionals apply new technologies safely and appropriately. We hope to create real impact through education with our Academia curriculum, which emphasizes safe, anatomically and physiologically accurate simulation training in an interactive learning environment. Medtronic Academia is a professional healthcare education and training program that focuses on patient care and delivering immediate value in practice. Academia courses enhance the skills needed to meet the evolving field of medical technology and bring knowledge of real-world clinical issues to the classroom. Theory is supported by practical application through action learning and peer-to-peer training. Our courses are developed and delivered in partnership with leading physicians and medical bodies and in collaboration with South African professional societies. Programs accredited by local professional societies will qualify for continuing professional development points. Our courses are intended to complement existing training at academic institutions, and are developed under the guidance of these institutions to ensure their relevance for South African physicians. The broad educational curriculum extends to all allied professionals. Why was it important to have a center of this kind in South Africa? Research by the Medical Research Council confirms that heart disease is responsible for the deaths of 195 South Africans each day and that the incidence is expected to increase by 41% by 2030. Coronary artery disease, cardiac arrhythmias, and heart failure affect many of these patients. Implantable devices such as pacemakers, implantable cardioverter defibrillators (ICDs), cardiac resynchronization therapy (CRT) devices, and coronary stents play a vital role in the treatment of these disorders. The implantation of these devices is complex and requires highly specialized and skilled practitioners. The VCL will help to bridge the gap between academic training and actual practice, providing cardiologists with the confidence and experience needed to execute implantation procedures. Medtronic is committed to utilizing the latest, cutting-edge medical technology in order to ensure that our products are implanted by confident, well-practiced specialists. The techniques practiced in the Bakken Centre target diseases that, sadly, are increasing in incidence in South Africa every year. We hope that our centre will have a real impact in ensuring that sufficient doctors are well-trained to deal with the increasing number of surgeries needed. Tell us about the state of cardiac electrophysiology in South Africa. How many cardiac EP labs are there? How many cardiologists or electrophysiologists are there? Are device implants common? Cardiac electrophysiology is growing in South Africa with quick adoption of the latest treatments and therapies available for patients. According to the Cardiac Arrhythmia Society of Southern Africa (CASSA), there are 7 EP labs in the country, with 8 electrophysiologists out of approximately 150 cardiologists. Device implants are common, with about 4,000 patients receiving pacemakers and 350 patients receiving ICDs every year. However, there are many indicated patients not being considered for device therapy, requiring the need for more education and awareness throughout the community. Is there anything else you’d like to add? There are currently 19 Therapy and Procedure Training Centres around the world, collectively hosting several thousand health care professionals. Medtronic began investing in simulation in 2001, and its first VCL was operational in 2002. High-fidelity medical simulators were introduced to the healthcare field in the 1990s (the first ones targeted anesthesia training). Today, simulators are revolutionizing the practice of medicine. Currently hundreds of medical schools in the United States and around the world provide hands-on health care education to medical, nursing and allied health students. Virtual reality medical simulators used in combination with traditional training methods can provide a comprehensive learning opportunity. Medical simulation training has been adopted by these institutions in order to improve performance and reduce errors in patient care. A variety of simulation techniques are used for education, testing, and research in health care. Please see “www.immersion.com” and “www.ssih.org” for more information.