CMAJ: Memorial and Western are leaders in incorporating technology in med schools

[nosuperman]

http://www.cmaj.ca/cgi/content/full/182/7/E289

 

 

"Two universities, for instance, have become leaders in incorporating electronic medical records into their undergraduate medical curriculum: Memorial University of Newfoundland in St. John’s and the University of Western Ontario in London. To encourage other medical schools to catch-up, the Canadian Medical Association (CMA) and its subsidiary, MD Physician Services Inc., are offering the CMA’s electronic medical record to all faculties of medicine in the country, along with free training for faculty and staff."

 

As a premed I can't really comment on the importance of EMRs in undergrad or whether they actually do put UWO & Memorial at any sort of technological advantage, but I'd be interested to hear what you guys think.

[runningdoc]

I think in general that most people are in favour of the EMR in general. I can't speak from the perspective of a physician, but I do work with them pretty consistently in the research I currently do. Any exposure to the systems would be an advantage but I really don't think it would be a big one. Probably no more advantageous than just having young MDs exposed to it before it becomes the status quo in the health care system. The sooner you are used to it, the more receptive to it you are going to become over time.

 

If you are used to handling them, you might have a bit of a leg up in terms of being part of a committee bringing about changes at a new hospital I guess?

[Lactic Folly]

Any hospital system that has an EMR (e.g. Netcare in Alberta) will offer such exposure to its medical students when they rotate through in clerkship, unless the article is referring to something else.

[maodiddymao]

We're pretty big on technology here at Schulich, and as a first year student who's seen the EMR setup through some observerships, the program here is pretty great. As is the network they have set up for sharing imaging. It's not just the radiology department either, I was in the OR one day and a patient's MRI was being used as reference on a large HD monitor in the OR while he was having a procedure done.

 

On top of that, all of the crazy minimally invasive surgery simulators and simulated OR's we have access to at CSTAR is impressive as well. Everywhere you go people tell you that it's the future of surgical residency training, and it's pretty impressive.

 

http://www.lhsc.on.ca/Research_Training/CSTAR/Training.htm

 

That's part of what I've seen so far in my first year, but I imagine there are other schools across the country that have some pretty awesome toys as well

[rmorelan]

We're pretty big on technology here at Schulich, and as a first year student who's seen the EMR setup through some observerships, the program here is pretty great. As is the network they have set up for sharing imaging. It's not just the radiology department either, I was in the OR one day and a patient's MRI was being used as reference on a large HD monitor in the OR while he was having a procedure done.

 

On top of that, all of the crazy minimally invasive surgery simulators and simulated OR's we have access to at CSTAR is impressive as well. Everywhere you go people tell you that it's the future of surgical residency training, and it's pretty impressive.

 

http://www.lhsc.on.ca/Research_Training/CSTAR/Training.htm

 

That's part of what I've seen so far in my first year, but I imagine there are other schools across the country that have some pretty awesome toys as well

 

Those technologies are the major reason I went to Western actually

 

I just have to have the toys!

[nosuperman]

You guys are giving me a medgasm.

[future_doc]

I just have to have the toys!

 

Robot 'the future of surgery'

At St. Michael's, four-armed da Vinci is rapidly proving its capabilities at operating table

Published On Fri Mar 28 2008

 

· Video: Robotic Surgery

 

Video: Robotic Surgery

 

 

 

By Megan Ogilvie Health Reporter

 

Hospital surgeon Ken Pace now has four arms, instead of two, helping him patch up his patients.

 

Even more startlingly, his new assistant's limbs are made of sleek, grey plastic and belong to a $4.5 million robot with the brand name da Vinci that crouches over the operating table like a giant crab.

 

The robot, the first advanced surgical system of its kind in the GTA, will help surgeons at St. Michael's Hospital perform minimally invasive surgery more quickly and safely. And they hope patients who get robot-assisted surgery will recover faster and have less post-op pain and chance of infection.

 

"Everybody recognizes this is the present, or the future, of surgery," says Pace, a urologist. "There is no question we can do better surgery with this than we can with the traditional laparoscopic approaches and even open surgery. It's going to push us to the next level, allow us to do better surgery for our patients, and have a better outcome."

 

Urologists are the first to use the robot, primarily for prostate cancer surgeries but also for kidney blockages. The robot will also be called on by gynecologists doing hysterectomies, as well as general surgeons. Cardiac specialists intend to use the robot to replace some types of heart valves.

 

The robot was designed to push the boundaries of laparoscopic surgery, in which a surgeon operates on a patient using long instruments inserted through "keyhole" incisions in the skin.

 

The robot's main advantage is that its arms act like a surgeon's hand, beyond the scope of a simple tool, says Pace, holding out a traditional laparoscopic instrument to make his point.

 

"These are long sticks that kind of just open and close," he says, making the pincers on the end of the instrument snap shut. "They can't bend, they can't twist, so they can't do this" – Pace swivels his wrist in rapid circles – "like the hand can."

 

The robot's full range of motion helps surgeons manoeuvre the curved suture needles at tricky angles and gives them more precision during delicate procedures. The robotic instruments are electromechanically enhanced and have what are called "endo-wrists" attached to curved pincers that are roughly one centimetre in size.

 

Pace says they can do everything a human hand can, surgically speaking.

 

"It's almost like you shrunk yourself, dropped inside the patient and are doing the surgery from the inside."

 

Technically, the da Vinci, a creation of California-based Intuitive Surgical, Inc., is more a remote-control system than a robot, says Pace. The surgeon sits at a console, away from the operating table, and manipulates the four robotic arms using joystick controls. The system replicates the surgeon's movements in real time.

 

"It's completely under the surgeon's control, does nothing on its own," says Pace.

 

Three of the robotic arms do surgery while the fourth acts as camera operator and light source. The camera projects a view of the surgical site – in high-definition – onto flat-screen TVs arrayed in the OR to guide the surgeon at the console.

 

Pace says the magnified 3-D vision gives him a better view of fine-detailed surgery than if he was at the patient's side, especially since the robot filters out tremors and translates a surgeon's real-time movements into a smaller scale.

 

London Health Sciences Centre was the first Canadian purchaser of a da Vinci system, in 2003. There are now eight up and running in this country, including two in London.

 

Dr. Christopher Schlachta, medical director of London Health Sciences Centre's CSTAR (Canadian Surgical Technologies & Advanced Robotics) program, says prostrate patients, in particular, prefer to have robot-assisted surgery, owing to preliminary evidence that its precision better preserves urine control and erectile function, two potential side effects.

 

The St. Mike's robot was put into use for the second time yesterday when Pace and his team performed prostate cancer surgery on a 70-year-old. The first operation, also to remove a cancerous prostate, was done March 20.

 

As Pace sat working the console controls as head surgeon, the robot's four arms slowly twisted and turned inside the patient's inflated abdomen. For four hours, Pace patiently worked the pincers to nip at fat and muscle and get at the walnut-sized prostate.

 

John Honey, head of urology at St. Mike's, is sold on the system.

 

"It makes the operation half as long, with a quicker recovery time – it gets patients home quicker and back to work," he says.

 

"It's so easy to use. You could sit (at the controls) and I could give you a suture and you could tie a knot, the first time ...

 

"If you can tie your laces, you can use this machine."

[A-Stark]

We're pretty big on technology here at Schulich, and as a first year student who's seen the EMR setup through some observerships, the program here is pretty great. As is the network they have set up for sharing imaging. It's not just the radiology department either, I was in the OR one day and a patient's MRI was being used as reference on a large HD monitor in the OR while he was having a procedure done.

 

Okay, being able to access imaging via a centralized database is pretty standard. In Halifax we have an intra-operative MRI unit too used by neurosurgery. We do have an EMR of sorts, though it's more of a database for scanned items, labs, etc.

[KennethToronto]

Didn't read the article, but EMR to me doesn't have any relevance to undergraduate medical education. Especially pre-clerkship.

 

If you need that much experience and exposure to use the EMR, then it probably sucks and should be re-designed for better user-friendliness.

[maodiddymao]

Didn't read the article, but EMR to me doesn't have any relevance to undergraduate medical education. Especially pre-clerkship.

 

If you need that much experience and exposure to use the EMR, then it probably sucks and should be re-designed for better user-friendliness.

 

It has less to do with needing experience and exposure than it does offering it to anyone that's interested. It's like offering business classes for people that want to learn how important it is to manage the business side of practice and what billing is like. Those in pre-clerkship get early exposure to the idea to understand its relevance, and then they can go back in clerkship to get more hands on time with the idea. It makes tons of sense to me.

[Lactic Folly]

I'm unclear if students are simply being shown and taught to use the EMR (in which case I would be inclined to agree that there aren't that many concepts to grasp).. or if they are actually being taught medical informatics and the theory behind EMR, which would be much more interesting.

[rogerroger]

Every other hospital or clinic uses a different type of EMR. Being taught how to use one program is pretty damn pointless. In Toronto you can walk up up the road and you will be using an entirely different program...

 

These lessons best be more theoretical, if not you are seriously wasting your time in my opinion.

[rmorelan]

Every other hospital or clinic uses a different type of EMR. Being taught how to use one program is pretty damn pointless. In Toronto you can walk up up the road and you will be using an entirely different program...

 

These lessons best be more theoretical, if not you are seriously wasting your time in my opinion.

 

Western has that SWOMEN focus, and the EMR we use is the same one the general area around here uses (I believe). Not perfect but at least broader than just the local hospital

[rogerroger]

Western has that SWOMEN focus, and the EMR we use is the same one the general area around here uses (I believe). Not perfect but at least broader than just the local hospital

 

Maybe they got UH and Vic etc. synced up, you know the LHSC. But that's basically like the UHN is in Toronto. Of course they would share EMR’s.

 

EMR's are politically hot topics at many hospitals. Making everyone agree on one program is quite a feat. The problem with program specific EMR teaching is the moment you do a non-UWO/LHSC elective you will need to "re-learn" how the EMR program works from scratch. Apparently, all this general admin stuff can occupy a good chunk of one's time during the first week on some electives. Just goes to show how inefficient things can be...

 

As to the comments that an EMR program should be intuitive and not need training... I agree it should. But from my limited experiencing working with EMR's in a research capacity, they can be horrendously designed. Even some of the most basic things can be a serious pain in the ass requiring more clicks etc. then it should... For the amount of money that goes into developing these programs it is obscene that they are not all slick and user friendly...