From Physics-Based Simulation to Surgical Robots| Show Me The Evidence E8- Dr Dwight Meglan copertina

From Physics-Based Simulation to Surgical Robots| Show Me The Evidence E8- Dr Dwight Meglan

From Physics-Based Simulation to Surgical Robots| Show Me The Evidence E8- Dr Dwight Meglan

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Show Me the Evidence, Episode 8Guest: Dr Dwight Meglan Topic: Physics-Based Simulation, Surgical Robotics and Why Simulators Still Don't Measure What MattersEpisode SummaryIn this episode, Professor Tony Gallagher is joined by Dr Dwight Meglan, the engineer who developed one of the first physics-based virtual reality simulators for endovascular procedures in the late 1990s, and who has spent the last two decades building surgical robots. Together they trace 30 years of simulation-based training and ask why so little has changed: simulators are still not verified against real-world physics, the field still measures process rather than skill, and device manufacturers, not educators, still set the agenda. The conversation ranges from haptics and instrumented torquers to Likert scales, credentialing committees, telesurgery risk, and why autonomous surgical robots are a regulatory and financial impossibility rather than a technical one. It closes with the evidence for Proficiency-Based Progression (PBP) and the leadership needed to adopt it.Key Topics Covered1. Building the first physics-based VR simulators | 0:00Meeting at Medicine Meets Virtual Reality in the late 1990sReal-time physics of tool and tissue interaction, fluoroscopy and haptic feedbackWhy the goal was to replicate reality, not design a user experiencePhysics tests to verify simulator correctness still do not exist, 25 years on2. Who really drives simulation: the device manufacturers | 2:24Manufacturers pay for simulation, so manufacturers shape itTraining to use the device versus training to perform the procedureSimulators in exhibition booths: marketing tools first, training tools second3. Haptics and the sensory threshold problem | 3:55The instrumented torquer: measuring what cardiologists actually feelJust noticeable difference thresholds vary between cliniciansStill no published datasets on the forces a cardiologist feels during catheterisationClinicians praising the haptics on simulators where the haptics were switched off4. Using devices safely: the stapler and the defibrillator | 8:52A stapling device with a 6 to 27 per cent leak rate, where one third of patients who develop a leak dieTraining to the instructions for use is device safety training, not surgical skills trainingCardiac defibrillator implantation: clinicians departing from the instructions for useConstruct validity findings: some very senior clinicians perform worse than the worst trainee when assessed with objective, peer-derived metrics5. What should a simulator measure? | 13:19The original approach: record everything, then find the measures that matterMetrics for mechanical thrombectomy for acute stroke, developed from the human procedure with MenticeHow clinician-led metrics forced a redesign of contrast injection, later patentedIt works when you insist on it, but you must start with the metrics6. The state of simulation metrics today | 17:35At a recent conference, almost none of the exhibited simulators had any metrics at allSome manufacturers avoid measurement deliberately: plausible deniabilityValidated metrics as a purchasing condition: if you cannot build them in, we will not buy7. From simulation to surgical robotics | 21:52Why simulation felt like a capped market and robotics did notThe analogous DNA of simulators and robots as real-time information processing systemsVerification versus validation: robots are bench-tested against dozens of specifications, simulators almost never are8. Measuring process, not skill | 26:49Motion tracking and path length: lessons not learned from laparoscopic surgeryAI-driven pattern hunting as a fishing expedition without a hypothesisSuturing as the test case: the physics of tissue apposition has never been publishedPhysical intelligence and humanoid robotics will improve simulation from the outside in9. Likert scales are not measurement | 36:47Binary, procedure-specific metrics require scoring the entire video, reliably, in pairsOne-to-five ratings after watching a few minutes of video are hand waving, not assessmentRing exercises on robotic simulators have never been verified against real forces10. Whose job is it? Credentialing and privileging | 39:27Manufacturers certify device use; professional societies and hospitals grant privilegesPer-procedure privileging in the United States versus broad qualification in EuropeThe credentialing committee problem: standards set by the least experienced memberCase volume, fellowship length and reputation are social proof, not evidence of competence11. A jumbo jet a day: the human cost | 44:43Deaths from surgical skills deficits estimated as equivalent to a full jumbo jet crashing every day, consistent with evidence that around 4.2 million people die within 30 days of surgery each year (Nepogodiev et al., The Lancet, 2019)Why one death at a time never makes headlines the way one crash doesThe Bristol Royal Infirmary case: peers knew for a decade before the front pages forced action (The ...
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