Virtual surgeries, actual lifesaving: how Pécs trains the doctors of the future

10 August 2023

Covering the whole field of medicine, the University of Pécs Medical School Medical Skills Education and Innovation Centre provides world-class simulation tools to help future doctors develop critical skills. We visited the centre, which is unique in Hungary.

It is like we are in the middle of an ER episode. A team of doctors is working with a patient in visibly bad condition, conducting tests, and vividly discussing the next steps in therapy. A few oddities can be observed at a second glance though. First, many of the 'doctors' are unabashedly young, second, the equipment appears much more modern than those seen in the legendary series, and third, the 'patient' is in fact a disturbingly realistic, breathing, and blinking dummy.

We are in the Medical School’s Medical Skills Education and Innovation Centre in Pécs, where new generations of doctors learn and practice the skills of their profession with the help of world-class equipment, and where new surgical procedures and therapeutic methods can be developed through high-fidelity simulation solutions.

The cases are simulated, the knowledge acquired is real

We have probably received simulation training at one time or another, for example during a medical course for obtaining a driver’s license, where we practiced first aid and CPR on a dummy. This is the basic level of simulation training, but to train doctors and medical staff, much more complex solutions are needed.

"In healthcare, having the right practice and routine can literally be a matter of life and death, but a lot of things are very difficult to learn under standardized and controlled conditions, with a sufficient number of cases and real patients. This is where simulation training comes into play, which has come a long way thanks to advances in technology and methods, and modern medical education would be unimaginable without it," says Dr. Szilárd Rendeki, Director of the Medical Skills Education and Innovation Centre, starting from the basics.

The predecessor of the centre, Mediskills Lab (the name comes from the English word skill, the meaning of which includes expertise, ability, and dexterity in Hungarian) was established in 2012, and since then it has undergone several large-scale developments and now has a multi-billion HUF equipment park and an area of more than 1,500 square metres for the doctors and nurses of the future.

From suture pads to virtual reality surgeries

Simulation training methods range from simple to almost fully realistic, complex solutions, and from medical interventions consisting of a few steps to even simulating the work of a complete healthcare team.

"On one side of the spectrum there are the CPR manikins and suture pads that may be familiar from medical courses – the latter are used to practice and perfect the right stitches - and on the other side is the operating theatre, where entire surgeries can be performed on cadavers, i.e., simulators using virtual or augmented reality. For example, the laparoscopic cholecystectomy simulator, where not only can the student or resident doctor follow the surgery on large displays, but also feel the tissue resistance with the help of so-called haptic feedback, and we also have a complete VR room with virtual reality goggles and haptic gloves, as well as a treadmill for walking in space for a more realistic experience," says the head of the centre, giving some tangible examples.

Complex procedures include the abovementioned "ER scenario", where an entire emergency procedure takes place: the patient arrives, a staff of students collects the medical history, performs tests, establishes the diagnosis, and decides on treatment.

Such realistic exercises, involving entire teams of doctors, demonstrate that although skills labs were initially used to practice the manual skills of medical specialties (such as various types of surgery), simulation training can be used in a much wider range. It is to exploit this potential that the Medical Skills Education and Innovation Centre has been established at the Medical School in Pécs, through the merger of the Department of Surgical Research and Techniques (SOKI), the Mediskills Lab, and the Department of Operational Medicine.

"We are thinking of an interdisciplinary centre in a unique way in Hungary where the tools of all specialties can be found and practiced, from surgery to internal medicine to the manual part of dentistry", summarises Dr. Szilárd Rendeki. With this in mind, the centre has, for example, a doctor's office, a dental operatory, and a fully equipped hospital room, just like in a functional hospital. In addition, they pay significant attention to a fundamental but often under-emphasised area of medicine, namely doctor-patient communication.

"We place a strong emphasis on live patient scenarios, during which we practice situations with the help of actors where it is vital to communicate properly, whether it is to ask patients about their complaints or to deliver bad news. We have dedicated two rooms for this purpose."

Comprehensive simulation training is only the first step in practising medicine and in professional development, and it is very important to accompany it with continuous feedback. A sophisticated audiovisual system at the centre allows all practices to be recorded (and VR training contents to be produced as well) and analysed in detail, and the Division of Medical Education Development and Communication provides ongoing support to teachers regarding teaching methodology.

From simulated surgeries to real life-saving procedures

Continuous feedback is also very important because, in addition to developing medical skills, another important task of the centre is innovation, i.e., testing and developing new ideas and, if all goes well, developing completely new procedures.

"The great advantage of high-fidelity simulation is that we can safely and cost-effectively test ideas and new concepts that would otherwise not be possible. If it stands the test, further development and hopefully practical application can be the next steps, in collaboration with the Preclinical Research Centre, recently handed over at the UP Medical School, and the clinics involved. Imagine an arc: if there is a promising idea, it will be tested under simulated conditions on plastic dummies. If this is successful, then the cadaver phase can follow in our operating theatre. This is followed by animal experiments in the Preclinical Research Centre, and if these are also successful, the procedure or new methodology can be perfected in clinical settings." - explains Dr. Péter Maróti, Deputy Director of the centre, who was a student when the original Mediskills Lab was established almost a decade ago.

The collaboration with the UP 3D Printing and Visualisation Centre is a great help, where the centre's engineer-physician teams model interventions in three-dimensional space and make prototypes for certain interventions.

Inter- and multi-disciplinary research teams are currently working on several progressive projects. One of their developments is the automated, objective assessment of basic surgical skills using artificial intelligence (SurgAI™), while another one is exploring the potentials of applying virtual and augmented reality in the education of medical students.

There is also an active collaboration regarding the "Military Medicine Centre of Excellence (TKP2021-NVA-06)", a tender won by the UPMS Medical Skills Education and Innovation Centre, where the aim is to support patient care in a theatre of war with robotic devices, exoskeletons. Among the projects already completed are the 3D Centre's paediatric bone models, which not only allow medical students to practice the treatment of fractures common in children but also improve the quality of paediatric trauma care.

Not just a classroom

Simulation training can, of course, never fully replace the practice involving real patients and the practice that can only be gained through direct patient care, but it is a great help for students.

"The skills lab was one of the most influential parts of my university years," says Rita, for example, who spent four years as a student in the lab and is now starting her surgical specialty training. "During the training, we have the opportunity to practice procedures and interventions that are often stressful, and for which we do not necessarily have the time, facilities, or staff at the clinics, but are still important to learn. Examples of such procedures include venepuncture, catheterization, wound closure, hemostasis, advanced resuscitation, solving acute situations, and trauma care. This will help us act more confident when we find ourselves in such situations in real life," says Rita, who believes that institutions providing such services should play a much bigger role in medical training.

Bence, who has chosen the anesthesia-intensive therapy field, agrees with her, having participated in the Centre as a student technician in addition to his compulsory practices, and having gained a lot both personally and professionally from the supportive atmosphere here. "Undergraduate Research Society essays, theses, presentations, and notes were written during the afternoons and evenings spent together with learning. More importantly, the Lab is not just a workplace or a classroom for us, but an origo, a home, a place on campus. Because there is always good company, a good conversation partner, an encouraging word or look."

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