A lot of negative news is coming out of Las Vegas these days. Suffering from one of the highest foreclosure rates in the country, the financial impact on the state has been severe. With state revenues down, one of the areas that suffered cuts is healthcare services. A high profile budget cut involved the closure of the University Medical Center (UMC) outpatient cancer center due to state Medicaid cuts. With all the bad news, it is easy to miss a healthcare bright spot at UMC. The Virtual Skills Laboratory, currently the largest facility of its kind in the Western U.S., has been a part of training future surgeons from the University of Nevada's School of Medicine since December 2008. Sixty-five third year residents are currently training at the facility. The simulators allow residents to get hands-on training before operating on humans.

Much of surgical training has been through textbook and observation training. Occasionally, students were able to practice on cadavers and animals. Virtual training allows students to train in an environment with realistic graphics and feedback through haptics technology.

Dr. James N. Lau (left) and Dr. Adnan Mohsin (right) of UMC's Virtual Skills LabDr. Adnan Mohsin, the Surgical Skills Lab Coordinator at UMC's Virtual Skills Lab, explained that virtual skills training is becoming more important with the Accreditation Council for Graduate Medical Education (ACGME) limiting residents to 80-hour weeks. With typical surgical residents previously spending up to 110 hours a week training, the Lab provides an important function. "It provides a safe, controlled environment for residents to practice procedures such as chest tube insertions."

"There is a lot of art involved," says Dr. James N. Lau, who is a Minimally Invasive Surgery Assistant Professor as well as the Chief of Bariatric Surgery. He believes in the role of technology in training future surgeons. "We are a skills-based field, so surgeons need to be trained in a skills lab."

Along with virtual training on surgical procedures, the lab also conducts communication training for residents, including how to communicate bad news to patients.

Virtual training of surgeons is still relatively new. The American College of Surgeons has had a voluntary accreditation program for virtual training labs since 2005. There are currently 33 facilities participating in the program in the U.S. Dr. Mohsin, who is training to be a surgeon himself, said the University of Nevada School of Medicine currently does not mandate a minimum number of virtual training for residents. That may change once the ACS introduces a recommended curriculum and training modules.Dr. Mohsin demonstrating a Stryker simulator

With this generation of residents being weaned on video games, it's not surprising that advanced simulators is finally making its way into medical training programs. "There are numerous studies that indicate increased hand-eye coordination with gamers. This translates to better laparoscopic skills," says Dr. Lau.

Despite UMC's embrace of virtual training, the school currently does not train surgeons via the web through Twitter or Second Life. Dr. Lau cites patient privacy concerns, although he concedes that there is some value to these types of training because it exposes the general public to the intricacies of surgery in general.

Given the remote training needs and the number of smaller medical schools in the country that are experiencing budgetary constraints, it may be a good idea for medical simulation companies to consider delivering web-based simulation training. The experience may not be as high fidelity as as the full simulators offered by UMC (the haptic feedback is helpful) but the higher engagement for students and the lack of any training facilities at all in some areas may be worth the trade-off.

Despite recent funding setbacks, UMC is scheduled to open a 37,000 square foot simulation center, the University of Nevada School of Medicine Simulation Center, September 1, 2009. The larger facility will also provide training opportunities for non-surgical students, such as nurses and anesthesiologists.