Imagine having a missionary as your father. Or moving to a foreign country as a small child and going to school in a remote rural area. Or learning about medicine from the age of 9, standing on a box by your father’s operating table. Any one of those life experiences would probably give you a very different perspective on the world, but for Professor John Windsor, the co-founder of SIMTICS, they were all fundamental parts of his life until he was fifteen years old!
“I grew up in northern India and did all of my primary and secondary schooling there,“ says Professor Windsor. “My father went out in 1963 to set up a heart unit in a post-graduate institute, and thus helped establish that specialty in India. He went on to work as a general surgeon in mission hospitals for twenty years.”
It’s no wonder John has such an interesting worldview, and such a passion for making education accessible and available to all, regardless of geographic location or economic circumstances.
As well as the wonderful climate and the spectacular Himalayas, he also remembers the principles he learned. “Under my dad’s influence I grew up understanding the importance of healthcare and community development, and that educational opportunities were precious. It was a wonderful upbringing, to be honest.”
When he finished secondary school John returned to New Zealand, completed a double major in physiology and biochemistry and then enrolled in preclinical medical school at the University of Otago. He later transferred to the University of Auckland and qualified as a medical doctor before training as a general surgeon. He then completed a two-year fellowship in hepato-biliary and pancreatic surgery in Edinburgh, working under Sir David Carter.
Windsor seems tireless; on top of all his surgical, academic and research work, over the last 5 years he has published 112 of 235 manuscripts, raised $6m in grants and given over 100 invited talks, including Visiting Professorships to Harvard, Oxford, Karolinska, Singapore, Capetown, Johannesburg and Delhi.
Back in New Zealand, he was encouraged to pursue an academic career. In 1992 he founded the Pancreas Research Group, which has been at the centre of his research endeavor, and in 1994 he was appointed as Senior Lecturer of Surgery at the University of Auckland and as a Consultant Surgeon at the Auckland Hospital.
Around this time, the advent of the laparoscopic revolution was putting significant pressure on traditional approaches to surgical training. John set up the first Surgical Skills Centre in New Zealand to address this need. Later, in 2007, he raised $2 million and, in partnership with the Mercy Ascot Integrated Hospitals Ltd, he designed a purpose-built facility: the Advanced Clinical Skills Centre. This has become a world-class environment for skills research and training.
So how did a surgeon come to develop an online simulation technology like SIMTICS?
The lessons learnt during his early life in rural India, the years of skills training, and experience with using physical simulators have all played a significant role in John’s thinking. From this the approach to ‘integrated cognitive simulation’ was developed, in partnership with two other doctors.
John’s interest in virtual learning began back in 2003 when he met George Oosthuizen, an experienced surgeon who had recently moved from South Africa to New Zealand. Oosthuizen had to become a student again and retake his fellowship exam, before he could practice in his newly adopted country.
“George found studying inefficient and exasperating. He had to pull books and journals from libraries, videos off the internet, advice from colleagues, diagrams from elsewhere… while trying to build 3D pictures in his mind and pull all this information together to become proficient at different procedures. He shared his frustrations and this led us to ask: could we use technology to bring together all of the necessary materials in one place to promote more efficient learning?” John explains. “As we explored this idea further, we realized that there was an opportunity to incorporate modern educational theory and practice with appealing media like computer graphics and video to make the learning experience more interactive, effective, and enjoyable.
With the help of some programmers, they mocked up a basic product framework, then got to work on their first procedure prototype: a laparoscopic appendectomy. As the lead subject expert, John had a starring role, performing and narrating the steps for the video portion.
The company gained support from an Auckland based business incubator and gradually attracted investors. To ensure commercial viability, the growing team branched out from surgical procedures into the wider healthcare market with a range of medical procedure simulations. Later they developed three suites of simulations for ultrasonography and radiography, and eventually more clinical procedures for medical assistants and entry-level nursing students. Dental Assisting modules are the latest addition to the catalog.
Cognitive learning is valuable and needs greater emphasis.
In developing the content, the SIMTICS team focused on the cognitive learning required for procedures, since this is a layer of knowledge that can be easily addressed by technology, outside of the clinical setting. It is also thought that cognitive knowledge represents up to 75% of the skills required for the safe performance of procedures. Cognitive knowledge doesn’t replace hands-on, psychomotor skills learning, but it is a critical part of the required learning that can be addressed separately, even while the learner is working alone, and without equipment.
The idea that cognitive learning is highly valuable and needs to be given greater emphasis originally came from the world of sport. Not only do high-performing athletes practice to achieve excellent physical performance, they also mentally rehearse their event or activity, running every single aspect through their minds beforehand. The movie, Rush, about Formula One drivers brings this to life with a scene where driver James Hunt lies on the floor with his eyes closed and ‘mentally’ drives his car around the course, steering and pressing pedals in his mind, before his next race.
The SIMTICS product also achieves Oosthuizen’s dream of having everything in one place for learning a medical procedure. It allows learners to read, watch, explore in 3D, practice, and test their skills, all from the same interface.
At the heart of SIMTICS is a virtual reality simulator. This is what allows the learner to do their mental rehearsal of each new skill or procedure. Each module covers one type of healthcare procedure, from lumbar puncture or administering an intradermal injection, to ultrasound assessment of the aorta or performing radiography of the chest. The simulations require the learner to cognitively learn and understand the steps of that procedure, then perform it online just as if they were doing it in real-life. For instance, in a SIMTICS simulation, the learner has to prepare, position the patient, select and move instruments and consumables, place them correctly, and in some cases operate a virtual machine. For people studying sonography or radiography, SIMTICS is a bit like having a real imaging machine at home or in the classroom – at a tiny fraction of the cost.
As well as interactive simulations, each SIMTICS module also contains a step-by-step video demonstration, a text description of the procedure, explorable 3D anatomy, and quizzes to test theoretical knowledge. The product does not dictate a pre-set ‘one-size-fits-all’ sequence of learning, so these components can be accessed in any order. “We home-schooled our five children,” says Professor Windsor, “and through that I came to appreciate the value of individualized learning, and providing choices in order to match learning opportunities with learning styles. And everyone gains by being able to experience and absorb the same information in different formats.”
The built-in SIMTICS logbook continually tracks your study hours, simulation completion times, and scores. It even records the errors made in the simulations, so you know what to work on next time. When SIMTICS is used in education institutions and work-teams, the logbook data can also be accessed by instructors and supervisors.
Making education available anywhere, anytime.
The desire to find the most cost-effective and accessible education solutions has been a strong driver for someone who grew up in one of the poorest parts of the world. “Coming from a missionary background in rural India, I know how important it is to find a generalizable and sustainable approach to education, that can be accessed regardless of geographical location. SIMTICS is one of my contributions to achieving that mission.”
SIMTICS currently has a catalogue of over 130 modules, covering ultrasound scanning protocols, radiographic positioning, dental assisting, medical assisting and common medical procedures.