In medicine, there isn't a lot of opportunity for practice or room for error. But computerized virtual-reality systems are starting to let doctors and nurses learn by doing - without doing it to a live patient.
Nursing students at the State University of New York at Plattsburgh, for example, practice inserting an IV into an arm that feels no pain because it is attached to a simulated human body on a computer screen.At other hospitals so-called rehearsal stations will let surgeons try out difficult and costly procedures without putting scalpel to flesh.
A combination of electronic surgical tools and specialized software simulates the resistance of a patient's skin giving way as a scalpel makes its incision. A three-dimensional organ can be removed and then replaced. A needle biopsy can be performed on an on-screen brain.
Virtual reality, which harnesses computers to create highly realistic simulations, is gradually becoming a serious medical tool.
"The usual practice of `see one, do one, teach one' is being questioned as on-the-job training," said Walter Greenleaf, a medical researcher in Palo Alto, Calif., referring to the medical tradition of a doctor's learning a surgical technique by observing it once and being expected to fly solo the next time.
Simulators have long been used as a training device for airplane pilots, but they only recently have been applied to medicine. And researchers say it could be years before these devices are common-place.
But continual refinement and adaptation of computers and software to the medical field could hasten that evolution, said Dr. Shaun Jones, a program manager at the Defense Department's Advanced Research Projects Agency, or ARPA, which has provided grant money to this effort.
One company that has received several million dollars from ARPA is High Techsplanations, a privately held company in Rockville, Md., that has worked with SUNY Plattsburgh and Duke University on projects and has emerged as a leading developer of virtual-reality software for the medical field.
With the grant from ARPA, High Techsplanations is creating simulations of treating the kinds of injuries that soldiers suffer in battle.
"The first time a doctor performs a procedure is usually on a person," said Dr. Jonathan Merril, the company's chief technology officer, an internist turned software developer.
High Techsplanations is also developing a surgical-simulation software program, called Teleos, which is to run on high-powered workstations from Silicon Graphics and provide doctors and researchers with a software library of simulated human organs.
The program is expected to reach the market next year and sell for about $20,000.
To perform these practice procedures, surgeons might use products like the Phantom, a system that's under development by Sensable Devices Inc. of Cambridge, Mass. The device resembles a desk lamp, with a PC attached on one end and a thimble on the other. By placing the forefinger in the thimble the physician can "feel" the sensation of operating on the virtual patient.
Eventually, virtual-reality techniques might enable surgeons to perform operations by long distance using a robotic surgeon.