'Surgeons should train on simulators, like pilots'

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Indy Lifestyle Online

Surgery in Britain's hospitals is unnecessarily risky because doctors are having to hone their skills on real patients instead of practising on plastic dummies, the Government's Chief Medical Officer will say today.

Patients are being exposed to harm because there are too few simulators for doctors to learn on, Sir Liam Donaldson will say. Airline pilots are challenged every six months in simulators on their responses to emergencies but surgeons may spend entire careers without facing an equivalent test.

Airline passengers have a one in 10 million chance of dying in an accident; a hospital patienthas a one in 300 chance of dying or being seriously harmed. Sir Liam will call for greater investment in mannequins, and establishment of a national centre for simulation techniques.

In his annual report, he will say that surgical safety has fallen a long way below airline safety because of lack of regular testing. "Medical training is often caricatured in the phrase, 'See one, do one, teach one'. How much better if, before you do a gall bladder operation, you have already done 100 in a simulator," Sir Liam said. "If I had to have my gall bladder out I would rather it was done by someone who had already done 100 in a simulator." He will highlight the case of Elaine Bromley, who died during a minor operation in 2005, after anaesthetists were unable to place a breathing tube down her throat. Instead of using the emergency procedure of puncturing her throat through the neck in a tracheostomy, the doctors panicked and struggled for 20 minutes to insert the tube; by then, she had suffered irreversible brain damage.

Sir Liam compared her death with the survival of the 155 passengers on US Airways Flight 1549 which was successfully landed on the Hudson river last January after both engines failed, something never achieved before. "The voice recording of the captain [Chesley Sullenberger] is quite remarkable: he is calm and collected because he had rehearsed emergency landings in simulators many, many times before."

Research shows surgeons trained on simulators are twice as fast and twice as accurate as those who have not been. But there are fewer than 20 sophisticated simulators for Britain's 12,000 surgeons and 47,000 doctors in training, compared with 14 simulators used by British Airways to train 3,200 pilots.

Israel leads the world in the science of simulation, and trains 7,000 doctors and other healthcare professionals a year using sophisticated dummies that bleed, breathe, can be anaesthetised and resuscitated and show vital signs that mimic their human counterparts.

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