Immersion Medical. Immersion Corporation Overview Based in San Jose, 3 locations, including Immersion Medical and Canada. Based in San Jose, 3 locations,

Immersion MedicalImmersion Medical

Immersion Corporation OverviewImmersion Corporation Overview

Based in San Jose, 3 locations, including Immersion Based in San Jose, 3 locations, including Immersion Medical and Canada.Medical and Canada.

Develops and licenses hardware and software related to Develops and licenses hardware and software related to sense of touch.sense of touch.

Leader in Medical simulation with approximately 800 Leader in Medical simulation with approximately 800 systems in the field worldwidesystems in the field worldwide

Many awards for technology and product including:Many awards for technology and product including: 2001 Gold IDEA for industrial design of device2001 Gold IDEA for industrial design of device 2002 Dr. Frank H. Netter Award for Special Contributions to 2002 Dr. Frank H. Netter Award for Special Contributions to

Medical EducationMedical Education 2002 National Tibbetts Award Recognition award for Outstanding 2002 National Tibbetts Award Recognition award for Outstanding

Contributions to the SBIR ProgramContributions to the SBIR Program

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Anatomy of a SimulatorAnatomy of a Simulator

Computer GraphicsComputer Graphics

3-D Anatomic Models3-D Anatomic Models

HapticsHaptics

Content - DidacticsContent - Didactics

Auditory ResponsesAuditory Responses

Virtual Attending Virtual Attending FeedbackFeedback

MetricsMetrics

DatabaseDatabase

General Features of Immersion General Features of Immersion SimulatorsSimulators

Anatomic or pathologic variationsAnatomic or pathologic variations Various degrees of difficulty allows for users to be assessed for improvementVarious degrees of difficulty allows for users to be assessed for improvement

Realistic physiology and complicationsRealistic physiology and complications Users have to respond to the consequences of their actionsUsers have to respond to the consequences of their actions

Built-in feedback (virtual attending/professor)Built-in feedback (virtual attending/professor) Provides independent learningProvides independent learning

Realistic haptics and graphicsRealistic haptics and graphics Mimics real environment for enhanced learningMimics real environment for enhanced learning

Didactic contentDidactic content Provides independent learningProvides independent learning

Quantitative assessment Quantitative assessment Objective data for skills assessment and monitoringObjective data for skills assessment and monitoring

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AccuTouchAccuTouch Endoscopy Simulator Endoscopy Simulator

BronchoscopyBronchoscopy

Flexible SigmoidoscopyFlexible Sigmoidoscopy

ColonoscopyColonoscopy

ERCPERCP

PipelinePipeline

EGDEGD

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AccuTouchAccuTouch Endovascular Simulator Endovascular Simulator

Cardiac PacingCardiac Pacing• Right sideRight side

• Left sideLeft side

AngiographyAngiography AngioplastyAngioplasty StentingStenting

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CathSimCathSim

Peripheral IV - Adult, Peripheral IV - Adult, Pediatric, GeriatricPediatric, Geriatric

PhlebotomyPhlebotomy PICCPICC

PipelinePipeline CVCCVC ThoracentesisThoracentesis PericardiocentesisPericardiocentesis

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OtherOther

Hysteroscopy – Hysteroscopy – MyomectomyMyomectomy

UreteroscopyUreteroscopy Physical DiagnosisPhysical Diagnosis

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Validation StudiesValidation Studies

Expert Expert ComparisonComparison

Skills Skills TransferenceTransference

RequirementRequirement AccreditationAccreditation

EndoscopyEndoscopy

(10 studies)(10 studies)

Mehta AC, Ost D, Mehta AC, Ost D, Salinas SG, Sanchez Salinas SG, Sanchez DE, DeRosiers A, DE, DeRosiers A, Tasto JL, Britt E. Tasto JL, Britt E.

Datta VK, Mandalia Datta VK, Mandalia M, Mackay SD, Darzi M, Mackay SD, Darzi AW. AW.

Britt EJ, Tasto JL, Britt EJ, Tasto JL, Merrill GLMerrill GL

Ost D, DeRosiers Ost D, DeRosiers A, Britt E, Fein A, Britt E, Fein AM, Lesser ML, AM, Lesser ML, Mehta AC. Mehta AC.

Rowe, R. & Rowe, R. & Cohen, R.Cohen, R.

Rowe, R. & Rowe, R. & Cohen, R.Cohen, R.

Rowe, R.Rowe, R.

Colt HG, Crawford Colt HG, Crawford SW, Galbraith O. SW, Galbraith O.

Sedlack RE, Sedlack RE, Kolars JC. Kolars JC.

Garuda, S., Garuda, S., Kesharvarzian, Kesharvarzian, A., Losurdo, A., Losurdo, J.,Brown, M.D. J.,Brown, M.D.

EndovascularEndovascular

(1 study)(1 study)

Wong T, Darzi A, Wong T, Darzi A, Foale R & Schilling Foale R & Schilling RJRJ

Cath SimCath Sim

(1 study)(1 study)

Rawn CL, Reznek Rawn CL, Reznek MA, Heinrichs WL, MA, Heinrichs WL, Srivastava S, Dev P, Srivastava S, Dev P, Drummel TMDrummel TM

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Studies – RequirementStudies – Requirement

Colt HG, Crawford SW, Galbraith O. Colt HG, Crawford SW, Galbraith O. Virtual Virtual reality bronchoscopy simulation: A revolution reality bronchoscopy simulation: A revolution in procedural training. in procedural training. CHESTCHEST 2001;120:1333- 2001;120:1333-1339.1339.

Outcome: Outcome: Novices significantly improved their Novices significantly improved their dexterity and accuracy with both the simulator dexterity and accuracy with both the simulator and the model following simulator training, to and the model following simulator training, to the extent that their performance on the the extent that their performance on the simulator after training equaled or surpassed simulator after training equaled or surpassed that of the experienced physicians who had that of the experienced physicians who had received no simulator training.received no simulator training.

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Studies - RequirementStudies - Requirement

Sedlack RE, Kolars JC.Sedlack RE, Kolars JC. Colonoscopy curriculum Colonoscopy curriculum development and performance-based assessment development and performance-based assessment criteria on a computer-based endoscopy simulator. criteria on a computer-based endoscopy simulator. Academic MedicineAcademic Medicine 2002;77(7):750-751 2002;77(7):750-751

Outcome: Outcome: The authors concluded that simulator-The authors concluded that simulator-based training would be most beneficial in the early based training would be most beneficial in the early stages of colonoscopy training. Trainees at the Mayo stages of colonoscopy training. Trainees at the Mayo Clinic must now complete 9 hours of simulator training Clinic must now complete 9 hours of simulator training involving approximately 25 virtual procedures, then involving approximately 25 virtual procedures, then demonstrate certain performance standards on the demonstrate certain performance standards on the simulator before advancing to live-patient simulator before advancing to live-patient colonoscopies.colonoscopies.

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Studies - RequirementStudies - Requirement

Garuda, S., Kesharvarzian, A., Losurdo, J.,Brown, Garuda, S., Kesharvarzian, A., Losurdo, J.,Brown, M.D. M.D. Efficacy of a Computer-Assisted Endoscopic Efficacy of a Computer-Assisted Endoscopic Simulator in Training Residents in Flexible Simulator in Training Residents in Flexible Sigmoidoscopy. Presented at American College of Sigmoidoscopy. Presented at American College of Gastroenterology Seattle, WA; October 18-23, 2002Gastroenterology Seattle, WA; October 18-23, 2002

OutcomeOutcome: : Use of a simulator reduced the number of Use of a simulator reduced the number of procedures required to reach competence in both procedures required to reach competence in both genders. This study would appear to validate the use genders. This study would appear to validate the use of the AccuTouch simulator in reducing the number of of the AccuTouch simulator in reducing the number of patient based procedures required to to achieve skill in patient based procedures required to to achieve skill in performing flexible sigmoidoscopyperforming flexible sigmoidoscopy

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Studies – Skill TransferenceStudies – Skill Transference

Rowe, R. & Cohen, R. Rowe, R. & Cohen, R. Virtual reality Virtual reality bronchoscopy simulator (abstract). bronchoscopy simulator (abstract). Anesthesiology.Anesthesiology. 2000;93(3A):A-1219 2000;93(3A):A-1219

Outcome: Outcome: Following training on the simulator, Following training on the simulator, subjects showed significant improvement subjects showed significant improvement when performing a live bronchoscopy (shorter when performing a live bronchoscopy (shorter duration measures, less times lost, fewer duration measures, less times lost, fewer collisions, less help from attending) compared collisions, less help from attending) compared with their performance prior to training.with their performance prior to training.

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Rowe, R. Rowe, R. Time evaluation of a virtual reality Time evaluation of a virtual reality bronchoscopy simulator (abstract). bronchoscopy simulator (abstract). Anesthesiology. Anesthesiology. 2000;93(3A):A-1220.2000;93(3A):A-1220.

Outcome:Outcome: The simulator proved effective in The simulator proved effective in fostering procedural efficiency, as all residents fostering procedural efficiency, as all residents performed the live bronchoscopic intubation in performed the live bronchoscopic intubation in less than 90 seconds following training on the less than 90 seconds following training on the simulator (untrained novices typically take simulator (untrained novices typically take more than 5 minutes).more than 5 minutes).

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Rowe, R., Cohen, R. Rowe, R., Cohen, R. An evaluation of a Virtual Reality An evaluation of a Virtual Reality Airway Simulator. Airway Simulator. Anesthesia & AnalgesiaAnesthesia & Analgesia 2002: 95:62-6 2002: 95:62-6

Outcome: Outcome: Performance was markedly improved after the Performance was markedly improved after the Simulator. Time to completion of successful intubation Simulator. Time to completion of successful intubation with a bronchoscope was reduced from 5.15 to 0.88 min with a bronchoscope was reduced from 5.15 to 0.88 min (P< 0.001). The number of times that the tip of the (P< 0.001). The number of times that the tip of the bronchoscope hit the mucosa was reduced from 21.4 to bronchoscope hit the mucosa was reduced from 21.4 to 3.0 (P<0.001). The amount of time that the resident spent 3.0 (P<0.001). The amount of time that the resident spent viewing the mucosa decreased from 2.24 to 0.19 min viewing the mucosa decreased from 2.24 to 0.19 min (P<0.001). The percent of time viewing the channel of the (P<0.001). The percent of time viewing the channel of the airway increased from 58.5% to 80.4% (P=0.004). This airway increased from 58.5% to 80.4% (P=0.004). This bronchoscopy simulator was very effective in teaching bronchoscopy simulator was very effective in teaching residents the psychomotor skills necessary for fiberoptic residents the psychomotor skills necessary for fiberoptic intubation. intubation.

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Ost D, DeRosiers A, Britt E, Fein AM, Lesser ML, Ost D, DeRosiers A, Britt E, Fein AM, Lesser ML, Mehta AC. Mehta AC. Assessment of a bronchoscopy simulator. Assessment of a bronchoscopy simulator. American Journal of Respiratory and Critical Care American Journal of Respiratory and Critical Care MedicineMedicine 2001;164:2248-2265. 2001;164:2248-2265.

OutcomeOutcome: Construct validity was demonstrated for the : Construct validity was demonstrated for the simulator, with intermediates/ experts performing simulator, with intermediates/ experts performing significantly better than novices for procedure time, significantly better than novices for procedure time, collisions, and percentages of segments entered, and collisions, and percentages of segments entered, and experts generating significantly less red-out than experts generating significantly less red-out than novices. Fellows who trained on the simulator novices. Fellows who trained on the simulator performed significantly better in live bronchoscopies performed significantly better in live bronchoscopies (duration, quality score, bronchoscopy nurse score, and (duration, quality score, bronchoscopy nurse score, and amount of meperidine used) than did fellows who amount of meperidine used) than did fellows who underwent conventional training.underwent conventional training.

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Studies – Expert ComparisonStudies – Expert Comparison

Britt EJ, Tasto JL, Merril GL. Britt EJ, Tasto JL, Merril GL. Assessing Assessing competence in bronchoscopy by use of a virtual competence in bronchoscopy by use of a virtual reality simulator [abstract]. In: reality simulator [abstract]. In: Program and Program and Abstracts of the Jubilee 10th World Congress for Abstracts of the Jubilee 10th World Congress for Bronchology & 10th World Congress for Bronchology & 10th World Congress for BronchoesophagologyBronchoesophagology; June 14-17, 1998; ; June 14-17, 1998; Budapest, Hungary. Abstract 0-10. Budapest, Hungary. Abstract 0-10.

Outcome:Outcome: Construct validity was demonstrated for the Construct validity was demonstrated for the simulator, which differentiated the three groups of simulator, which differentiated the three groups of users: beginners had the longest performance times, users: beginners had the longest performance times, experts had the shortest times, and intermediates had experts had the shortest times, and intermediates had intermediary times.intermediary times.

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Datta VK, Mandalia M, Mackay SD, Darzi Datta VK, Mandalia M, Mackay SD, Darzi AW.AW. Evaluation and validation of a virtual Evaluation and validation of a virtual reality based flexible sigmoidoscopy trainer. reality based flexible sigmoidoscopy trainer. Gut (Supplement)Gut (Supplement) 2001;48:A97-A98. 2001;48:A97-A98.

OutcomeOutcome: Construct validity was : Construct validity was demonstrated for the simulator, which demonstrated for the simulator, which differentiated procedural performance differentiated procedural performance (procedure time, % mucosa visualized, and (procedure time, % mucosa visualized, and efficiency ratio [% mucosa/time]) among the efficiency ratio [% mucosa/time]) among the three cohorts according to their experience three cohorts according to their experience level.level.

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Mehta AC, Ost D, Salinas SG, Sanchez DE, Mehta AC, Ost D, Salinas SG, Sanchez DE, DeRosiers A, Tasto JL, Britt E. DeRosiers A, Tasto JL, Britt E. Objective Objective assessment of bronchoscopy skills by a bronchoscopy assessment of bronchoscopy skills by a bronchoscopy training simulator. training simulator. American Journal of Respiratory American Journal of Respiratory and Critical Care Medicineand Critical Care Medicine 2000;161:A234. 2000;161:A234.

OutcomeOutcome: Construct validity was demonstrated for the : Construct validity was demonstrated for the simulator, which differentiated procedural performancesimulator, which differentiated procedural performance (duration, time in red-out, and scope collisions with (duration, time in red-out, and scope collisions with airway walls) among the three cohorts according to airway walls) among the three cohorts according to their experience level.their experience level.

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Wong T, Darzi A, Foale R & Schilling RJ.Wong T, Darzi A, Foale R & Schilling RJ. Virtual Virtual reality permanent pacing: Validation of a novel reality permanent pacing: Validation of a novel computerized permanent pacemaker implantation computerized permanent pacemaker implantation simulator. simulator. Journal of the American College of Journal of the American College of Cardiology (Supplement) Cardiology (Supplement) 2001;37(2):493A-494A.2001;37(2):493A-494A.

Outcome:Outcome: Construct validity was demonstrated for the Construct validity was demonstrated for the simulator, which differentiated procedural efficiency simulator, which differentiated procedural efficiency (less time in procedure and in fluoroscopy, and better (less time in procedure and in fluoroscopy, and better visualization of tissues by x-ray) among the three visualization of tissues by x-ray) among the three cohorts according to their experience level.cohorts according to their experience level.

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Rawn CL, Reznek MA, Heinrichs WL, Srivastava S, Dev P, Rawn CL, Reznek MA, Heinrichs WL, Srivastava S, Dev P, Drummel TM. Drummel TM. Validation of an IV Insertion Simulator: Validation of an IV Insertion Simulator: Establishing a Standard Simulator Evaluation Protocol. Establishing a Standard Simulator Evaluation Protocol. Conference Proceedings: Medicine Meets Virtual RealityConference Proceedings: Medicine Meets Virtual Reality 2002:pp-pp.2002:pp-pp.

Outcome: Outcome: Part I: While statistical significance was absent, the CathSim Part I: While statistical significance was absent, the CathSim trained student group received higher scores than the mannequin group in all trained student group received higher scores than the mannequin group in all steps of the procedure.steps of the procedure.

Part II: The expert physicians performed significantly better than the Part II: The expert physicians performed significantly better than the intermediates and novices on five of ten simulator metrics. No other intermediates and novices on five of ten simulator metrics. No other measures showed significance.measures showed significance.

Part III: The expert nurses performed significantly better than the Part III: The expert nurses performed significantly better than the intermediates and novices on two simulator metrics. No other measures intermediates and novices on two simulator metrics. No other measures showed significance.showed significance.

Expert physicians and nurses rated CathSim as realistic, useful, immersive, Expert physicians and nurses rated CathSim as realistic, useful, immersive, beneficial for training students, and easily implemented.beneficial for training students, and easily implemented.

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Perfecting the Practice through Perfecting the Practice through Medical SimulationMedical Simulation

Enhanced Multi-dimensional Learning ExperienceEnhanced Multi-dimensional Learning Experience

Skill AcquisitionSkill AcquisitionSkill AcquisitionSkill Acquisition

Skill DevelopmentSkill DevelopmentSkill DevelopmentSkill Development

Skill ValidationSkill ValidationSkill ValidationSkill Validation

Skill MaintenanceSkill MaintenanceSkill MaintenanceSkill Maintenance

Increased CompetencyIncreased CompetencyIncreased CompetencyIncreased Competency

Improved Patient CareImproved Patient CareImproved Patient CareImproved Patient Care

Decreased CostsDecreased CostsDecreased CostsDecreased Costs

Documents

Immersion Medical. Immersion Corporation Overview Based in San Jose, 3 locations, including Immersion Medical and Canada. Based in San Jose, 3 locations,