1. Department of Surgery TO ERR IS HUMAN

2. Department of Surgery 1.2 Trillion dollars 12-14% of GDP Affects every American HEALTHCARE IN AMERICA

3. Department of Surgery MEDICAL EDUCATION Largely unchanged in last 100 years Apprenticeship model “See one, Do one, Teach one” Education by Random Opportunity

4. Department of Surgery WHAT’S WRONG WITH MEDICAL EDUCATION? Imagine: As your plane (a packed 747) approaches SFO Airport, the pilot announces: “Folks, our co-pilot hasn’t had the opportunity to do a solo instrument landing, so she will be practicing one shortly. I’ll join you in the cabin while she lands the plane.”

5. Department of Surgery WHAT’S WRONG WITH MEDICAL EDUCATION? Imagine: A squadron commander, in the United States Army during Operation Desert Storm, tells his troops on the eve of battle: “While none of you have actually fought under these conditions, I hope you will figure it out”.

6. Department of Surgery WHAT’S WRONG WITH MEDICAL EDUCATION? These two scenarios are Unthinkable Why? For quality, safety and cost reasons, neither the airlines nor the military would demand performance without extensive prior practice.

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9. WHO ARE STUDENTS OF MEDICINE? Medical Students Residents Practicing Surgeons Nursing Students Practicing Nurses

10. Department of Surgery EDUCATION: KEY CONCEPT I Hear, I Forget I See, I Remember I Do, I Understand Lao-Tsu 604-531BC

11. Department of Surgery In the last 50 years, mankind’s most profound advancements have been in Biomedicine and Computer Science. They are converging!

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13. MEDICAL EDUCATION Cognitive Sensory Five senses + common sense Motor*

14. Department of Surgery We will use VR to select, train, credential and retrain physicians and surgeons. Surgeons will rehearse an operation on a patient-specific palpable hologram and deliver the data set of that operation with robotic assistance. Ubiquitous computing will revolutionize medical education and patient care. INFORMATION TECHNOLOGY IN MEDICINE

15. Department of Surgery Not Science Fiction But Scientific Eventuality S. Spielberg ? SCIENCE FICTION ?

16. Department of Surgery Radio has no future. LORD KELVIN Scottish mathematician and physicist, former president of the Royal Society, 1897

17. Department of Surgery Everything that can be invented has been invented. CHARLES H. DUELL U.S. commissioner of patents, 1899

18. Department of Surgery There is no reason for any individual to have a computer in their home. KENNETH OLSEN president and founder of Digital Equipment Corp., 1977

19. Department of Surgery learning to be a doctor what makes a skilled practitioner? what makes a skilled practitioner? ©2000 David Williamson Shaffer

20. Department of Surgery learning curve from chaudhry et al., “learning rate for laparoscopic surgical skills on mist vr…,” annals of the royal college of surgeons of england, 1999 from chaudhry et al., “learning rate for laparoscopic surgical skills on mist vr…,” annals of the royal college of surgeons of england, 1999 ©2000 David Williamson Shaffer

21. Department of Surgery complication rate complication rate from pratt, laparoscopic gastric bypass, 2000 from pratt, laparoscopic gastric bypass, 2000 1 -33 34-66 67- 99 ©2000 David Williamson Shaffer

22. Department of Surgery the part-task problem It is not true that a complex reaction consists of a chain of separate processes which may be arbitrarily added and subtracted. --- l.s. vygotsky, mind in society ©2000 David Williamson Shaffer

23. Department of Surgery IMPEDIMENTS Tradition Service Roles Finances Efficacy?

24. Department of Surgery WHO WILL DEVELOP? Academics Military Industry

25. Department of Surgery INDUSTRY Start-Up Simulation Company Consumer Electronics

26. Department of Surgery HOW WILL IT BE FUNDED? Federal Government Grant SBIR Industry Insurance Industry

27. Department of Surgery motor skills perception thought in action knowledge analysis judgement mentorship breadth thought about action build on what medical education does right use the power of simulation to make it better a learning system ©2000 David Williamson Shaffer

28. Department of Surgery The best way to predict the future is to invent it. Alan Kay

29. Department of Surgery