Creative Course Finder: Let the Blood, Urine and Bile Flow

Institution: University of Rochester, Rochester, N.Y.

Course: EDU581 Clinical Teaching in Health Care Professions Education: Teaching and Instructional Method

Target audience: Medical professionals completing a master’s degree in the university’s Health Professionals Education program who want to be able to teach clinical skills to other health care practitioners. The students include physicians, nurses, dentists, chiropractors, physician assistants and physical therapists.

Curriculum: This three-credit class focuses on traditional and innovative methods used in clinical teaching to enhance the students’ knowledge and skills, and examines the theories behind teaching methodologies. It also discusses current and potential future uses of technology in active learning strategies.

As part of the class, students participate in a surgical simulation that uses 3D-printed artificial organs to experience a highly realistic medical situation. The approach could change the way that future surgeons and other medical personnel learn their craft, said Ahmed Ghazi, professor at the University of Rochester’s Medical Center Department of Urology, who began creating the lifelike models with neurosurgery resident Jonathan Stone three years ago.

In the past, surgical residents could only watch as doctors performed procedures or had to practice on cadavers. This left many students wondering if they had the skills to be successful surgeons, Ghazi said. “This exposure helps medical students to reach a decision that ‘Yes I can do this for my career’ or ‘No I don’t think this is for me,’” he added.

Technology: Ghazi and Stone fabricate the realistic-looking body parts by converting images from medical scans into computer-generated designs. Made of hydrogel and polymer, the lifelike models can be prodded, dissected and cut just like living samples.

“We wanted something that would react to the student if they cut it in the wrong place, where it would bleed more than it should or leak liquid or urine,” Ghazi said.

Stone, Ghazi and a lab technician assemble entire segments of the body, complete with artificial muscle tissue, skin, fat and organs such as the liver, intestines, spleen and kidney. Artificial blood vessels are connected to bags of red dye that  “bleed” when cut, and organs leak other bodily fluids such as fake urine or bile.

The assembled body unit is brought into the operating room where it is hooked up to a robotic surgical system that simulates the entire procedure from the first insertion of instruments to completion. 

The realistic model sometimes fools trained professionals, said Ghazi. “We have had times when we are doing these simulations in the OR when nurses or other physicians have looked in the window and thought we were doing the real thing, and have even gone so far as to scrub and put their masks on before coming in thinking there was a patient on the table,” he said. 

Why it’s important: Realistic training for medical professionals is a critical part of their education, said Sarah Peyre, assistant dean for interprofessional education and director of Rochester’s Center for Experiential Learning. Peyre, who co-teaches the course, has seen hands-on training evolve over the years from plastic rescue dummies to robotic tools and virtual reality (VR) programs.

The new organs are a game changer, she said, because they so closely mimic a real human body. “They give students the feedback and the tactile response they would get in a real surgical situation,” she added.

Another advantage is that they are relatively affordable to create compared with other teaching tools such as VR or augmented reality programs, which can cost $100,000 or more. Ghazi and his team can create the 3D models for a few hundred dollars each, and several students can learn from one simulation, Peyre said.

They also offer educators a no-risk way to test whether medical students are completing the procedures correctly, she said.

Ghazi, who is a candidate in the health care master’s program, said that courses like EDU581 are crucial to keep medical educators updated on the latest training technology. “In order for people to learn about how to teach with simulation they must engage in simulation,” he said. “A lot of people in the course weren’t aware of how far we can go with simulation.”

Funding for the project is mainly coming from the university’s urology department, a small grant and individual donors. The simulations have been recognized during annual meetings of the American Urological Association, the nation’s largest organization of urologists, which awarded video presentations of the program with top honors in 2015 and 2016. 

Challenges/Lessons Learned: One of the biggest challenges facing the program is finding the funding to expand it, said Ghazi. Although the materials used to create the models are not expensive, the amount of expert time needed to create each one is extensive. “We make each of these like an artist would,” he said.

Another hurdle is getting the medical community to embrace a new way of thinking about training. Changes in the health care field often happen very slowly, the urology professor said. “I remember when robotic surgery started about a decade ago, its creators were practically laughed out of the room.”

Collaboration with educators and medical professionals like those in the EDU581 class will help to transform perceptions, he said.

Final thoughts: Future uses for the simulated organs extend beyond the classroom, said Ghazi, who foresees using them in real-life medical situations. In the near future, they will enable surgeons to rehearse complex cases before a patient is brought into the operating room. Organs modeled after a patient’s medical scans can accurately replicate the conditions that will occur during the live operation.

“We’re talking about making a model that’s specific to the patient,” said Ghazi. “That will mean it’s not merely a simulation anymore, it’s a rehearsal for the real thing.”