Can you imagine thousands of cadaveric specimens in a convention hall? Of course not, and neither could the American Urological Association (AUA). Instead of using specimens, urologists at the 1994 meeting in San Francisco practiced in virtual reality (VR). Of the nearly 6,000 professional attendees, 3,500 got to practice a laparoscopic lymph node dissection procedure in VR while at the conference.

Still only a crowd-drawing exhibit at medical trade shows as far as most surgeons and medical meeting planners are concerned, VR is gradually becoming a serious medical tool. And the implications for continuing medical education (CME) providers and medical meeting planners are enormous:

With outcomes-based CME likely to be a reality by the end of 1997 (see related story, page 30), a training method that easily records physician performance could be a real help for CME providers intent on measuring learner outcomes.

For meeting planners, practice procedures using VR eliminate the costs, logistical hassles, and ethical concerns associated with using cadaveric specimens or live animals.

Coming soon: Patient-specific VR programs built from CAT scans and MRI data. Physicians will be able to rehearse specific procedures for specific patients. For CME providers, this could lead to the Holy Grail of demonstrating improved outcomes for patients, not just physicians.

How VR Systems Work High Techsplanations (HT), Inc., a Rockville, MD software developer, has created Teleos, a medical simulation software. Martin McGurn, HT's director of business development, explains that the company developed surgical simulations by extending the idea of flight simulators used to train pilots.

"We needed to travel through an anatomical environment like a plane flies through an atmospheric environment, but our tools needed to interact with organic structures. Someone manipulating the clamps and on the screen has to see them cut, feel them snap, see blood vessels bleed," McGurn says.

Over the next several years, McGurn anticipates that computer-based surgical simulation will become a standard tool for medical procedures training, much the way flight simulators are used in the airline industry today.

MusculoGraphics, Inc., based in Evanston, IL, another medical software developer, specializes in visualization and simulation technology for analyzing the dynamics of musculoskeletal systems. According to its president, Peter Loan, "MusculoGraphics software models of the human elbow, wrist, and jaw allow users to learn techniques to deal with surgical alterations and joint implants." Movement, such as walking, can then be quantitatively assessed and compared to normal action of the limb in teaching kinesiologists and physical therapists to diagnose and treat movement disorders.

Cine-Med, a medical education company based in Woodbury, CT, offers a library of medical training videos along with interactive multimedia medical training on CD-ROM, interactive latex models, and its "Virtual Clinic," which simulates endoscopic skills and procedures that provide sensory feedback through VR techniques. Cine-Med's system uses a combination of physical models comprised of latex organs for volumetric work in a fiberglass body, together with CD-ROM-based instruction. A physician operating on a latex model will see that deformation on the computer screen.

Measuring Learner Outcomes For CME providers looking for ways to reliably measure learner outcomes (e.g., Did the physician learn anything by attending our meeting?), perhaps the greatest thing about VR systems is their ability to automatically track and evaluate the performance of physicians being trained. Kevin McGovern, president and CEO of Cine-Med, envisions credentialing authorities and hospitals being able to award certification or grant hospital privileges according to a physician's skill, without putting patients at risk.

How Good Is It? Is VR, then, the answer to a CME provider's prayers? "Not so fast," says McGovern. "Nothing that I've seen yet is good enough to compare the outcomes of training on VR medical simulators with outcomes from training on real patients. I do not think the computer will ever be able to simulate live tissue."

Developers' opinions aside, the bottom line is whether CME course directors think the technology is legitimate. "The laparoscopic surgery simulation programs are still a little crude for surgical training, but the endoscopic flexible ureteroscopy simulator is well on its way to being an excellent training tool,' says Glenn Preminger, MD, professor of urologic surgery, Duke University and senior educator with the AUA

In short, VR is being held to high standards and is delivering on some of them. Costs are coming down. In 1996, the hardware and software is available for under $50,000-down from $200,000 in 1994. If costs keep falling, and the difficulties of dealing with specimens continue to increase, VR may become a real bargain sooner than anyone thinks.