Richard G. Epstein

[left.htm]

PHYSICIANS TRAINED WITH

VIRTUAL PATIENTS LACK

COMMUNICATIONS SKILLS

---

New Breed of Doctor is

Less Compassionate, More

Eager to Operate, Study Finds

---

Professor Recommends More

Use of Human Patients During

Physician Training

---

Special to the Sentinel-Observer

by

Uriah Hoskins

Science and Medicine Reporter

An entire generation of physicians and surgeons has been trained using virtual reality simulations. Now, a study from Silicon Valley University indicates that physicians and surgeons who have been trained in this manner have certain deficiencies relative to previous generations of physicians and surgeons.

The study was conducted by Professor Janet Lowery of the School of Medicine. She conducted numerous interviews with physicians and their patients in order to ascertain whether the use of virtual realities for medical training has had an impact upon the quality of health care delivery. Dr. Lowery discovered significant differences in the way that patients viewed doctors who were trained using virtual reality simulations as opposed to doctors who were trained using actual patients.

"We found that patients much preferred doctors who were trained using actual patients," Dr. Lowery explained in a teleview interview. "Doctors who were trained using actual patients were described as being more compassionate and more caring than doctors who were trained using virtual reality simulations."

Of course, no doctor leaves medical school without some practice with actual patients, but more and more, physicians and surgeons are being trained using virtual reality simulations, both in medical school and even during residency.

Thomas Krosley, M. D., age 58, graduated from medical school back in 1996 when virtual reality simulations were just emerging as a viable technology for teaching future medical practitioners. "Everything I learned in medical school I learned with real cadavers and real people. Today, they don't use cadavers at all. The problem I see with the way doctors are trained today is that when I am operating on a real person, it is a life and death situation, I am like God. That is a real, living person down there. I knew this before I became board certified because of the clinical training that I had received. The thing is that when you work with a real person you become aware of your gut feelings, your intuitions. Sometimes these spell the difference between life and death. When you practice with a virtual reality simulation, your gut feelings mean nothing. It's only a game. The gut feelings are a part of the reality of performing surgery."

Dr. Lowery's research showed marked differences between the surgeons of Dr. Krosley's generation and the new surgeons that are being trained today. "In informal interviews we found that the new surgeons never talk about intuition and gut feelings. Everything is mechanical. A virtual reality simulation just does not bring out this intuitive aspect of the work of a surgeon.

"Our formal questionnaires and surveys found that surgeons trained using virtual reality were less able to handle unusual circumstances that might arise during surgery, circumstances that were not covered in the virtual reality simulations. We documented dozens of cases where a new surgeon who was trained using virtual reality simulations froze in the middle of surgery and had to be replaced when the operation took an unexpected turn. The older doctors were more flexible and, using their gut feelings, they could handle just about any scenario."

Dr. Lowery also discovered that physicians and surgeons who were trained primarily using virtual reality simulations were more likely to recommend operations than the physicians and surgeons of an earlier generation. "It's almost as if the younger physicians and surgeons have lost touch with the patient's perception of surgery, which is that some stranger is going to be poking around inside my body. These younger physicians and surgeons seem to be divorced from the emotional reality of surgery."

Dr. Lowery recommends reducing the dependency upon virtual reality simulations in medical education. "We need to de-emphasize the technology and we need to reintroduce the living, breathing patient. I recorded the words of one young surgeon that just about says it all."

Dr. Lowery then played the video. It showed a surgeon whose face was in shadow. He explained that he had been trained primarily with virtual reality simulations. He had this to say about his profession and about his job. "The way you are trained and educated is going to mold your perception of things. I must confess that I see my patients as virtual realities and not as living realities. I need to be careful with my choice of words here. I see my patients as embodying principles that I learned from studying hundreds, if not thousands, of medical problems using virtual reality simulations. I look at the symptoms and I try to see the virtual reality behind the actual reality. I think this is backwards. I think I should be seeing the human reality with the virtual reality in the background, but it's almost impossible for me to do that now."