Students practice medicine remotely on Stan, the simulated human

Trying out clinical procedures on the Human Patient Simulator
Trying out clinical procedures on the Human Patient Simulator
28 May 2003

The scene on screen could be a TV hospital drama: unproven medical trainees trying ambitious medical procedures on a prone patient nick-named 'Stan the Man'. But the people watching are also trainees - observing from distant hospital sites thanks to an ESA-backed satellite system which also provided the option to remotely take part in the action.

Stan makes the perfect patient; he never complains about being used as a test-subject. His heartbeat, pulse and breathing are normal, and if trainees cut him, he will bleed, but no-one ever has to worry about doing him real harm.

Stan is really a sophisticated mannequin, his life-like responses controlled by a nearby computer called the Human Patient Simulator (HPS). The HPS is the centrepiece of the UK-based Bristol Medical Simulator Centre, used to familiarise students, physicians and medical support staff with real-life clinical scenarios.

Training sessions using the HPS were broadcast via DirecPC satellites to more than a dozen sites across the UK as well as Bosnia, as part of a project called MultiMED first initiated by ESA five years ago. The now-concluded pilot scheme was aimed at providing cost-effective Continuing Medical Education (CME) to healthcare professionals.

In advance of a simulation MultiMED staff could download teaching modules via DirecPC into local terminal data caches. Remote users could then use the terminal for offline coursework and reference, then real-time passive observations once the simulation starts, and ultimately active intervention via a return internet link to influence the outcome of the HPS scenario in play.

"Some remote functional control was available on a single user basis, and our work with pilot users indicated they saw this as a useful future capability," said MultiMED project manager Andrew Davies. "The users initially wanted to explore what could be achieved with audio/visual and discussion capability, supplemented by offline coursework.

"This was the concept of MultiMED as part of an integrated teaching environment. With new funding becoming available for the greater exploitation of technology in healthcare, work is expected to continue in the near future."

'Tele-education' represents one of the most promising applications of satellite telemedicine. Satellites can multicast video lectures and associated data to widely-dispersed sites. Another ESA-funded project called Mayflower has successfully demonstrated using satellites to deliver university courses in medicine to students and nurses in Norway and Italy.

Live presentation layout used in mrcsTV
mrcsTV lets students interact with surgical tutors in live lectures

An ESA-backed pilot scheme called SANTTSUR (Satellite network – Telematics Training for Surgeons) has led to a service called mrcsTV. Operating from the University of Plymouth, mrcsTV delivers 30 live TV lectures a year via satellite to student surgeons across the country. Audience interaction is possible during lectures via telephone, internet, or text message.

Since 1996 the Agency has backed more than 20 telemedicine projects and on 23 and 24 May ESA hosted a symposium in Frascati, Italy called 'Telemedicine via Satellite in the Information Society'. It included a working group on Telemedicine in Education and Clinical Research.

"Medical education represents a very attractive opportunity for satellite services," said Francesco Feliciani of ESA Telecom. "However the market is still in its early phase. There currently is a lack of a clear process of certification of distance learning systems to validate the certificates required by the Continuing Medical Education programmes, which are becoming mandatory in many countries."

"But it is only a matter of time before such factors will be sorted out, by which time the mechanism, the technologies and the services for Telemedicine must be in place. And this is why ESA's role is crucial in providing opportunities for such ventures."

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