Medical Simulation: Another Scientific Revolution
ROGER SMITH Chief Technology Officer US Army PEO STRI http://www.peostri.army.mil/CTO
Approved for Public Release. Security and OPSEC Review Completed: No Issues. Scientific Evolution (Normal Phase)
“If I have seen further it is only by standing on the shoulders of giants.” – Isaac Newton
Newton, 1687 Newtonian Mechanics Kepler, 1630 Planetary Motion Galileo, 1632 Dynamics 2 Kuhn’s Scientific Revolution
Revolutionary New Paradigms Science Created
Weaknesses Revealed
Normal Science (Evolutionary)
Pre- Paradigm Paradigms Created Scientific Revolution
4 Scientific Smackdown
Copernicus
Ptol emy Do Many in Sim
Einstein Newton See One, Do One, Teach One
5 Evolutionary Change
6 Evolutionary Change
7 Revolutionary Change
8 Revolutionary Change
9 U.S. Army Military Occupational Specialties
Enlisted MOS Armor Branch Military Intelligence Branch CMF 63 - Mechanical Maintenance Ordnance Branch Infantry Branch 19D Cavalry Scout 33W (35T) MI Systems Maintainer/Integrator 44B Metal Worker 89B Ammunition Specialist 11B Infantryman 19K Armor Crewmember 96B (35F) Intelligence Analyst 44E Machinist 89D Explosive Ordnance Disposal Specialist 11C Indirect Fire Infantryman 19Z Armor Senior Sergeant 96D (35G) Imagery Analyst 45B Small Arms/Artillery Repairer Quartermaster Corps Branch 11X Infantryman (ambiguous; turns into 11B,11C, or Corps of Engineers Branch 96H (35H) Imagery Ground Station Operator 45G Fire Control Repairer 92A Automated Logistical Specialist 11M) 21B Combat Engineer (Formally 12B) 96R (35H) Ground Surveillance Systems Operator 45K Armament Repairer 92F Petroleum Supply Specialist 11Z Infantry Senior Sergeant 21C Bridge Crewmember 96U (35K) Unmanned Aerial Vehicle Operator 52C Utilities Equipment Repairer 92G Food Service Specialist 11H Infantry Anti-Armor Specialist 21D Diver 96Z (35X) Intelligence Senior Sergeant 52D Power Generation Equipment Repairer 92L Petroleum Laboratory Specialist 11M Mechanized Infantryman 21E Heavy Construction Equipment Operator 97B (35L) Counterintelligence Agent 62B Construction Equipment Repairer 92M Mortuary Affairs Specialist Field Artillery Branch 21G Quarrying Specialist 97E (35M) Human Intelligence Collector 63A M1 Abrams Tank Turret Mechanic/M1 Abrams Tank 92R Parachute Rigger 13B Cannon Crewmember 21H Construction Engineer 97L (35Q) Translator/Interpreter System Mechanic 92S Shower/Laundry and Clothing Repair Specialist 13C TAC Fire Operations Specialist 21J General Construction Equipment Operator 97Z (35Y) Counterintelligence/Human Intelligence Senior 63B Light-Wheel Vehicle Mechanic/Heavy Wheel Vehicle 92W Water Treatment Specialist 13D Field Artillery Tactical Data Systems Specialist 21K Plumber Sergeant Mechanic/Wheel Vehicle Repairer 92Y Unit Supply Specialist 13E Cannon Fire Direction Specialist 21L Lithographer 98C (35N) Signal Intelligence Analyst (Linguist) 63D Artillery Mechanic 92Z Senior Noncommissioned Logistician 13F Fire Support Specialist 21M Firefighter 98G (35P) Cryptologic Linguist 63H Fuel and Electrical Repairer/Track Vehicle Mechanic CMF 94 - Electronic Maintenance 13M Multiple Launch Rocket System Crewmember 21N Construction Equipment Supervisor 98P (35U) Multi-Sensor Operator 63J Quartermaster and Chemical Equipment Repairer 94A Land Combat Electronic Missile System Repairer 13P MLRS/LANCE Operations Fire Directions Specialist 21P Prime Power Production Specialist 98Y (35S) Signals Collector/Analyst 63M M2-3 Bradley Fighting Vehicle System 94D Air Traffic Control Equipment Repairer 13R Field Artillery Firefinder Radar Operator 21Q Transmission and Distribution Specialist 98Z (35Z) Signals Intelligence Senior Sergeant Mechanic/Bradley Fighting Vehicle Systems Turret 94E Radio and Communications Security Repairer 13S Field Artilleryyy Surveyor 21R Interior Electrician 09L (()35V) Translator Aide Mechanic 94F Spppecial Electronics Devices Repairer 13W Field Artillery Meteorological Crewmember 21S Topographic Surveyor 05h EW/SIGINT Morse Intercept Operator 63X Track Vehicle Repairer 94H Test, Measurement & Diagnostic Equipment Supp 13X Field Artillery Enlistment Option 21T Technical Engineering Specialist Psychological Operations Corps Branch 63W All Wheel Vehicle Repairer Specialist 13Z Field Artillery Senior Sergeant 21U Topographic Analyst 37F Psychological363 Operations Specialist 63Z Mechanical Maintenance Supervisor 94K Automatic Test Equipment Operator/Maintainer Air Defense Artillery Branch 21V Concrete and Asphalt Equipment Operator Civil Affairs Branch Medical Department Branches 94L Avionics Communications Equipment Repairer 14E Patriot Fire Control Enhanced Operator/Maintainer 21W Carpentry and Masonry Specialist 38B Civil Affairs Specialist 68A Medical Equipment Repairer 94M Radar Repairer 14J Early Warning System Operator 21X General Engineering Supervisor Adjutant General Branch 68D Operating Room Specialist 94P Multiple Launch Rocket System Repairer 14M Man Portable Air Defense System Crewmember 21Y Topographic Engineering Supervisor 42A Human Resource Specialist 68E Dental Specialist 94R Avionics System Repairer 14R Bradley Linebacker Crewmember 21Z Combat Engineering Senior Sergeant 42F Human Resource Systems Information Specialist 68G Patient Administration Specialist 94S Patriot System Repairer 14S Avenger Crewmember Signal Corps Branch 42L Administration Specialist (to be deleted) 68H Optical Laboratory Specialist 94T Avenger System Repairer 14T PATRIOT Launching Station Enhanced 25B Information Systems Operator Analyst (to be 42R9B Trumpet Player 68J Medical Logistic Specialist 94W Electronic Maintenance Chief Operator/Maintainer renamed Information Technology Specialist in Oct'07) 42R9C Baritone or Euphonium Player 68K Medical Laboratory Specialist 94Y Integrated Family of Test Equipment 14Z Air Defense Artillery (ADA) Senior Sergeant 25C Radio Operator Maintainer 42R9D French Horn Player 68M Hospital Food Specialist 94Z Senior Electronic Maintenance Chief Aviation Branch 25D Telecommunications Operator/Maintainer (to be 42R9E Trombone Player 68P Radiology Specialist Branch Immaterial (not oriented to a branch) 15B Aircraft Powerplant Repairer deleted in Oct'07) 42R9F Tuba Player 68Q Pharmacy Specialist 00Z Command Sergeant Major 15D Aircraft Powertrain Repairer 25F Network Switching Systems Operator/Maintainer 42R9G Flute or Piccolo Player 68R Veterinary Food Inspection Specialist Commissioned Officer & Warrant Officer MOS 15F Aircraft Electrician 25L Wire Systems Installer 42R9H Oboe Player 68S Preventive Medicine Specialist Officer MOS's are usually two numerical digits plus a 15G Aircraft Structural Repairer 25M Multimedia Illustrator 42R9J Clarinet Player 68T Animal Care Specialist letter (most of the time "alpha"). Letterless MOS's are 15H Aircraft Pneudraulica Repairer 25N Nodal Network Systems Operator/Maintainer 42R9K Bassoon Player 68V Respiratory Specialist ambiguous and have several specific MOS's within the 15J OH-58D Armament/Electrical/Avionics Systems 25P Microwave Systems Operator/Maintainer 42R9L Saxophone Player 68W Health Care Specialist (aka Combat Medic) E.g. 62 contains 62A (Emergency Physician) and 62B Repairer 25Q Multichannel Transmission Systems Operator 42R9M Percussion Player 68X Mental Health Specialist (Field Surgeon). 15K Aircraft Components Repair Supervisor 25R Visual Information/Audio Equipment Repairer 42R9N Piano Player 68Z Chief Medical NCO Warrant Officer MOS's (known as WOMOS) are three 15M UH-1H1 He licopter R epai rer 25S S atelli te C ommuni cati on S ystems 42R9T G ui tar Pl ayer Chem ica l B ranch numerical di gi ts pl us a l etter, except 09W wh o i s not ye 15N Avionics Mechanic Operator/Maintainer 42R9U Electric Bass Guitar Player 74D Chemical Operations Specialist (formerly 54B) WO. 15P Aviation Operations Specialist 25T Satellite/Microwave Systems Chief 42S Special Band member CMF 79 - Recruiting and Retention Officer Candidates 15Q Air Traffic Control Operator 25U Signal Support Systems Specialist Finance Branch 79R Recruiter Noncommissioned Officer 09R Cadet 15R AH-64 Attack Helicopter Repairer 25V Combat Documentation & Production Specialist 44C Finance Specialist/Accounting Specialist 79S Career Counselor 09S Officer Candidate 15S OH-58D Helicopter Repairer 25W Telecommunications Operations Chief Public Affairs Branch 79T Recruiting and Retention NCO 09W Warrant Officer Candidate 15T UH-60 Helicopter Repairer 25X Senior Signal Sergeant 46Q Public Affairs Specialist 79V Retention and Transition Noncommissioned Officer Infantry Branch 15U Medium Helicopter Repairer 25Y Information Systems Chief (to be deleted in Oct'07) 46R Broadcast Journalist Transportation Branch 11A Infantry Officer 15V Observation/Scout Helicopter Repairer 25Z Visual Information Operations Chief 46Z Public Affairs Chief 88H Cargo Specialist Field Artillery Branch 15X AH-64 Armament/Electrical Systems Repairer Judge Advocate General Branch Chaplain Branch 88K Watercraft Operator 13A Field Artillery Officer 15Y AH-64D Armament/ Electrical Systems Repairer 27D Paralegal Specialist 56M Chaplain Assistant 88L Watercraft Engineer 131A Field Artillery Targeting Technician 15Z Aircraft Maintenance Senior Sergeant Military Police Corps Branch 88M Motor Transport Operator Air Defense Artillery Branch Special Forces Branch 31B Military Police 88N Traffic Management Coordinator 14 Air Defense Artillery Officer 18B Special Forces Weapons Sergeant 31D CID Special Agent 88P Railway Equipment Repairer 140A Command and Control Systems Technician 18C Special Forces Engineer Sergeant 31E Internment/Resettlement Specialist 88T Railway Section Repairer 140E Air and Missile Defense (AMD) 18D Special Forces Medical Sergeant 88U Railway Operations Crewmember Tactician/Technician (Patriot Systems Technician) 18E Special Forces Communications Sergeant 88Z Transportation Senior Sergeant 140X Air Defense Artillery (ADA) Immaterial 18F Special Forces Assistant Operations & Intelligence Sergeant 10 18X Special Forces Candidate 18Z Special Forces Operations Sergeant (Page 1) U.S. Army Military Occupational Specialties
Aviation Branch Military Intelligence Branch 61A NEPHROLOGIST 67 Medical Service Corps Officer 15 Aviation Officer 35D Military Intelligence Officer 61B MEDICAL ONCOLOGIST/HEMATOLOGIST 67A Health Services 150A Air Traffic and Air Space Management Technician 350F All Source Intelligence Technician 61C ENDOCRINOLOGIST 67B Laboratory Sciences 150U Tactical Unmanned Aerial Vehicle (TUAV) 350G Imagery Intelligence Technician 61D RHEUMATOLOGIST 67C Preventive Medicine Sciences Operations Technician (still classified at 350K until 350Z Attaché Technician 61E CLINICAL PHARMACOLOGIST 67D Behavioral Sciences official transfer to Aviation Branch) 350K (150U) Tactical Unmanned Aerial Vehicle 61F INTERNIST 67E Pharmacy 151A Aviation Maintenance Technician Operations (transferring to Aviation Branch in Summer 61G INFECTIOUS DISEASE OFFICER 67F Optometry 152C OH-6 Pilot 07) 61H FAMILY MEDICINE 67G Podiatry 152B OH-58A/C Pilot 351L Counterintelligence Technician 61J GENERAL SURGEON 67J Aeromedical Evacuation 152D OH-58D Pilot 351M Human Intelligence Collection Technician 61K THORACIC SURGEON 670A Health Services Maintenance Technician 152F AH-64A Pilot 351Y Area Intelligence Technician 61L PLASTIC SURGEON 70A Healthcare Administrator 152H AH-64D Pilot 352N Traffic Analysis Technician 61M ORTHOPEDIC SURGEON 70B Health Services Officer 153A Rotary Wing Aviator (Aircraft Nonspecific) 352P Voice Intercept Technician 61N FLIGHT SURGEON 70C Comptroller 153B UH-1 Pilot 352Q Morse Intercept Technician 61P PHYSIATRIST 70D Information Systems Manager 153D UH-60 Pilot 352R Emanations Analysis Technician 61Q RADIATION ONCOLOGIST 70E Patient Administrator 153DD UH-60 MEDEVAC Pilot 352S Non Morse Intercept Technician 61R DIAGNOSTIC RADIOLOGIST 70F Human Resources Manager 153E MH-60 Pilot 353T Intelligence and Electronic Warfare Technician 61U PATHOLOGIST 70H Plans, Operations, Intelligence Training, and Security 154C CH-47D Pilot Psychological Operations Corps Branch 61W PERIPHERAL VASCULAR SURGEON 70K Medical Logistics 154E MH-47 Pilot 37A Psyygchological Op erations Officer 61Z NEUROSURGEON 70K9I Health Facilities Management 155A Fixed Wing Aviator (Aircraft Nonspecific) 37X Psychological Operations Officer, Designated 62 Medical Corps Officer Chemical Branch 155E C-12 Pilot Civil Affairs Branch 62A Emergency Physician 74A Chemical, General 155F Jet Aircraft Pilot 38A Civil Affairs Officer 62B Field Surgeon 74B Chemical Operations and Training 155G O-5A/EO-5B/RC-7 Pilot 38X Civil Affairs Officer, Designated 63 Dental Corps Officer 74C Chemical Munitions and Materiel Management Special Forces Branch Adjutant General Branch 63A General Dentist Transportation Branch 18A Special Forces Officer 42B Personnel Systems Management Officer 63B Comprehensive Dentist 88A Transportation Officer 180A Special Forces Warrant Officer 42C Band Officer 63D Periodontist 88D Transportation Officer - Motor/Rail Armor Branch 420A Military Personnel Technician 63E Endodontist 880A Marine Deck Officer 19A Armor, General 420C Bandmaster 63F Prosthodontist 881A Marine Engineering Officer 19B Armor Finance Branch 63H Public Health Dentist 882A Mobility Officer 19C Cavalry 44A Finance Officer 63K Pediatric Dentist Ordnance Branch Corps of Engineers Branch Chaplain Branch 63M Orthodontist 91A Ordnance Officer 21A Engineer Officer 56 Chaplain 63N Oral and Maxillofacial Surgeon 890A Ammunition Technician 210A Utilities Operation and Maintenance Technician 56A Command and Unit Chaplain 63P Oral Pathologist 913A Armament Systems Maintenance Technician 215D Geospatial Information Technician (Old - Terrain 56D Clinical Pastoral Educator 63R Executive Dentist 914A Allied Trades Technician Analysis Technician) Medical Department Branches 64A Veterinary Corps Officer 915A Automotive Maintenance Technician Signal Corps Branch 60A OPERATIONAL MEDICINE 640A Veterinary Services Food Safety Technician 915E Senior Automotive Maintenance/Senior Ordnance 25A Signal Officer 60B NUCLEAR MEDICINE OFFICER 65 Medical Specialist Corps Officer Logistics Officer 250N Network Management Technician 60C PREVENTIVE MEDICINE OFFICER 65A Occupational Therapy 919A Engineer Equipment Maintenance Technician 251A Information Systems Technician 60D OCCUPATIONAL MEDICINE OFFICER 65B Physical Therapy Quartermaster Corps Branch 254A Signal Systems Support Technician 60F PULMONARY DISEASE/CRITICAL CARE 65C Dietitian 92A Quartermaster Officer 255Z S eni or Si gnal S ystems T ech ni ci an OFFICER 65D Ph ysi ci an A ssi stant 920A Property Account ing Tec hn ici an Judge Advocate General Branch 60G GASTROENTEROLOGIST 65X Specialist Allied Operations 920B Supply Systems Technician 27A JAG Corps Attorney 60H CARDIOLOGIST 66 Nurse Corps Officer 921A Airdrop Systems Technician 27B Military Judge 60J OBSTETRICIAN AND GYNECOLOGIST 66B Community Health Nurse 922A Food Service Technician 270A Legal Administrator 60K UROLOGIST 66C Psychiatric/Mental Health Nurse 923A Petroleum Systems Technician Military Police Corps Branch 60L DERMATOLOGIST 66E Perioperative Nurse CMF 94 - Electronic Maintenance 31A Military Police Officer 60M ALLERGIST, CLINICAL IMMUNOLOGIST 66F Nurse Anesthetist 948B Electronic Systems Maintenance Technician 311A CID Special Agent 60N ANESTHESIOLOGIST 66G Obstetrics and Gyneco 948D Electronic Missile Systems Maintenance Technician 60P PEDIATRICIAN 66H Medical-Surgical Nurse 948E Senior Electronics Maintenance Technician 60Q PEDIATRIC SUB-SPECIALIST 66N Generalist Nurse 60R CHILD NEUROLOGIST 66P Family Nurse Practitioner 60S OPHTHALMOLOGIST 60T OTOLARYNGOLOGIST 60U CHILD PSYCHIATRIST 60V NEUROLOGIST 60W PSYCHIATRIST 11 (Page 2) Surgical Procedures
Abdominal surgery Fistulotomy Orchidectomy Abdominoplasty Frenectomy Pancreaticoduodenectomy Acromioplasty Frontalis lift Parathyroidectomy Adenoidectomy Fundectomy Penectomy (also known as peotomy) Amputation Gastrectomy Phalloplasty Angioplasty Grafting Pleurodesis Appendicectomy Heart transplantation Pneumotomy Arthrodesis Hemicorporectomy Pneumonectomy Arthroplasty Hemilaminectomy Prostatectomy Arthroscopy Hemorrhoidectomy Psychosurgery Bilateral cingulotomy Hepatectomy Radiosurgery Biopsy Hernia repair Ritidoplasty Brain surgery (Neurosurgery) Hypnosurgery Rotationplasty Breast biopsy 101 Hysterectomy Sigmoidostomy Brostrom prodedure Kidney transplantation Sphincterotomy Cauterization Khyphoplasty Splenectomy Cesarean section Laminectomy Stapedectomy Cholecystectomy Laparoscopy Thoracotomy Circumcision Laparotomy Thrombectomy Clitoridectomy Laryngectomy Thymectomy Colon resection Lithotripsy Thyroidectomy Colostomy Lobotomy Tonsillectomy Colporrhaphy Lumpectomy Tracheotomy Commissurotomy Lung transplantation Tracheostomy Cordotomy Mammectomy Tubal ligation Corneal transplantation Mammoplasty Tubal reversal (Tubal Anastomosis) Cricothoracotomy Mastectomy Ulnar Collateral Ligament Reconstruction Discectomy Mastoidectomy Ureterosigmoidostomy Diverticulectomy Mentoplasty Vaginectomy Episiotomy Myotomy Vasectomy Endarterectomy Mryingotomy Vivisection Endoscopic thoracic sympathectomy Nephrectomy Vulvectomy Foreskin restoration Nissen fundoplication Nuss procedure Oophorectomy 12 Total Integration of Surgical Care
Minimally Invasive Remote Surgery & Open Surgery
Pre-opppgerative planning Simulation & Training Surgical Rehearsal Pre-operative Warmup Intra-operative navigation Courtesy of Joel Jensen, SRI International, Menlo Park, CA The New Paradigm Struggle
Rick Satava: What is the REVOLUTION in surgical education? Simulation Augmented Learning & Treatment
Denson JS, Abrahamson S. A computer-controlled patient simulator. Journal of the American Medical Association 1969; 208:504–8. What Really Matters
¾ Lower Cost
¾ Better Access to Symptoms/Cases
¾ Reduced Time to Competence
¾ Reduced Errors
If si mul ati on can d eli ver one or more o f these, then it may be valuable enough to trigger a scientific smackdown. Scientific Smackdown
Einstein NtNewton Do Many in Sim Copernicus
See One, Do One, PtolemyTeach One
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