More Related Content Similar to The Value of Robotics for Surgery Training (20) More from SeriousGamesAssoc (20) The Value of Robotics for Surgery Training 1. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com© 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
The Value of Robotics Simulation for
Surgical Training
Jeff Berkley, PhD
CEO, President & Founder
Mimic Technologies Inc SKIP INTRO
© 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
2. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
According to the federal Agency for Healthcare Research and Quality (AHRQ),
patient safety has been declining leading to over 250,000 deaths a year at a cost of
approximately $30 billion*
As a result of the Affordable Care Act, medicine is transforming from a “Pay per Service” to a “Pay for
Performance” industry
Our Medical System is Broken!
• “To Err is Human – To Delay is Deadly…Ten years later, a million lives lost, billions of dollars
wasted”, Consumers Union, SafePatientProject.org, May 2009
• BMJ 2016; 353 doi: http://dx.doi.org/10.1136/bmj.i2139 (Published 03 May 2016)
Equivalent
to seven
jumbo jets
crashing
every
week
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Epidemiology of Surgical Errors
Primitive Causes of Surgical Errors
8.85
10.27
11.58
2010 2014 2018
Incidence of Surgical Errors
(Million Cases)
Procedural
Incompetence
41.81%
Lack of Adequate
Preoperative
Planning
19.56%
Indecorous Work
Process
13.45%
Poor Peer
Communication
12.18% Meager
Negligence
9.24%
Fatigue
2.23%
Usage of Alcohol
during Procedure
1.53%
CAGR:
3.19%
Surgical Errors
BIS Research, “Robotics Simulators: An Emerging Frontier in the Era of Healthcare Robotics”, July 2019
Addressable
with training
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Why Robotics?
Robot assisted surgery increases the applied dexterity and accuracy of the surgeon
because of the following advantages:
• The surgeon’s hand motion is scaled so large movements results in small instrument motion
• Hand tremor can be filtered out
• The surgeon controls his or her own camera
• The surgeon can switch control between multiple instruments
• High definition 3D visualization enables better depth perception
• The da Vinci robot has been clinically shown to be equivalent or superior to open or laparoscopic surgery in
Urology, Gynecology and is developing in General Surgery
Conducting surgery through a robot is analogous to shrinking the surgeon and placing them inside the body
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Challenges for Healthcare Systems
Multiple Hospitals
Many Robots
Central Robotics Committee but Decentralized Local Committees
Need for improved Risk Management
Need for improved Efficiency in the OR
Comprehensive Credentialing & Privileging
SOLUTION
Comprehensive Robotics Program built on
Proficiency, Data & Simulation
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New Concerns with Credentialing
Surgeons are being sued for lack of
informed consent regarding their skill
and experience level
Medicolegal Review of Liability Risks for Gynecologists
Stemming from Lack of Training in Robot-Assisted Surgery
Yu L. Lee, Gokhan S. Kilic, MD, John Y. Phelps, MD, JD, LLM.
JMIG, 2011; 18(4), 512-515.
Hospitals are now being sued for negligence
regarding credentialing policies
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Recent Landmark Robotic Case
Bremerton WA
Taylor v. Intuitive
“…responsibility for training, credentialing,
and privileging surgeons to use new
technologies belongs to physicians and
the hospitals where they work.”
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Traditional Surgical Credentialing
Take a course
Get proctored
Good until you retire
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9. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Traditional Surgical Credentialing
Problems with Traditional Credentialing
One Time Event
doesn’t address skills degradation with no ongoing
maintenance of certification or proficiency
Doesn’t Anticipate Changes in technology
Review of privileges usually
Only Triggered by Traditional
Morbid Events, not by deviations from normal
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IMPACT OF
TECHNOLOGY
on Aviation Safety
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Impact of Technology on Aviation Safety
A Statistical Analysis of Commercial Aviation Accidents 1958-2016, Airbus
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What the Aviation Industry Can Teach Us
Aviation Industry
Initial Pilots License
Upgrade Certification
Demonstrate Competency
Annual Currency Required
Annual Recertification
Medical Industry
Initial Surgical Privilege
New Procedure Training
None
None
None
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Who Would Benefit From Better Training?
Uniquely positioned to
set the standard for
robotic surgery
simulation across
most robotic platforms
Surgeons
Hospitals
Med Device Industry
Nearly every surgeon who
uses the da Vinci robot
has trained with Mimic’s
virtual reality platform
Mimic’s advanced
analytics help executives
assess surgeon risk &
efficiency before they
enter the OR Medical device companies
use Mimic’s simulation to
optimize robot design and
deliver exceptional
training
With +1M robotic
surgeries conducted
last year, there is a
tremendous opportunity
to reduce costs through
simulation training and
evaluation
Partnered to deliver
simulation with nearly
every company
launching a minimally
invasive surgical (“MIS”)
robot
Mimic is ready to expand
its product and services
offering as new surgical
robot companies enter
the market
Robotic surgery will
replace most manual
surgery and Mimic has
significantly enabled
adoption
Extensive data
collection and analytics
allow surgeons to
compare themselves to
surgeons in “rest-of-
world”
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It Takes A Team
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Laparoscopic skills development
for the surgical assist
Mimic Simulation Platforms
S U R G E O N T R A I N I N G T E A M T R A I N I N G
Innovation, through leadership in robotic simulation
On demand, stand-alone simulation
training for da Vinci Xi®, da Vinci Si®,
and da Vinci S®
Portable simulation training
for da Vinci Xi®, da Vinci Si®,
and da Vinci S®
www.MimicSimulation.com
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Mimic Simulation Software
High fidelity virtual reality training
for learning robot control, advanced surgical
skills, first assistant skills and team collaboration.
Procedure-specific augmented reality training
where expert surgeons lead you through
interactive video of real surgical cases.
17. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Mimic Simulation Software
120+ laparoscopic and team
training exercises included with
Mimic’s dV-Trainer® and FlexVR™
(compared to 35+ on the ISI
‘backpack’)
Over 4.3 million training sessions
since 2007 launch of dV-Trainer®
Regular software updates continue
to deliver new and novel content to
keep trainees engaged and
entertained
High fidelity simulation engine
that runs dV-Trainer®, FlexVR™, and
XTT™
BAC K
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Mimic Simulation Software
Features world-class surgeons and
educators and live surgery footage
to mentor trainees in VR and AR
through procedure specific learning
Features real 3D video footage with
embedded virtual content to enable
an interactive experience
Develop decision-making skills and
procedure knowledge
Scoring system, sophisticated
admin tools and cloud back up for
proficiency assessment and
curriculum customization.
BAC K
19. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Immersive VR Training for the Entire Team
Operating room setup
Patient positioning
Robot draping and prep
Trocar placement
Robot positioning and docking
Emergency procedures
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Internal Video Review
Optimize follow-up curriculum training based on video review of initial surgeries
Customize Curriculum
(Leverage Machine Learning)
Conduct Internal
GEARS Review
Record Video
of Surgery
21. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Robot vs. Simulator
0
50
100
150
200
250
300
350
DVSS dVT Hopsital Flex VR
TIME TO COMPLETE COMPARISON
75% 25% Median
+60%
+33%
0
50
100
150
200
250
300
350
DVSS dVT Hospital Flex VR
TIME TO COMPLETE COMPARISON
75% 25% Median
+ 2%
-6%
When no feet involved in the exercise
difference in performance noticeable
When feet involved in the exercise
difference in performance variable decreases
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Utilization Comparison
Mimic Team Trainer Total Sessions (Dec 2016 – Jan 2017) : 1351
XTT Team Training Sessions (Dec 2016- Jan 2017) : 450
ISI Skills Simulator Total Sessions (2014-2016): 209
23. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Benefits of Stand-alone
Access to training anytime
Training does not sacrifice valuable
OR and robot time
Allows for independent training
without supervision and observation
Surgeons and teams are trained to
proficiency before robot even installed
Better program management with data
access and cloud-based analytics
Utilizes low cost capital for training
Greater efficiency in multi robot
systems through a common
training platform
24. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com© 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Distributed Simulation Hospital Program
Unify training, testing, and monitoring across ALL
system hospitals utilizing the Mimic MScore Portal™
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TRAINING HUB
dV-Trainer® XTT™
Distributed Simulation Hospital Program
TRAINING & PRIVILEGING
Training Hub sets standards and
provides premium training.
Leverages Mimic’s simulation
platforms such as dV-Trainer®,
XTT™ and the real robot.
26. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com© 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
TRAINING HUB
dV-Trainer® XTT™
SATELLITE SATELLITE SATELLITE SATELLITE
MOBILITY OF FlexVR™
Transfer FlexVR between
satellite locations as needed
Distributed Simulation Hospital Program
TRAINING & TESTING
Satellite hospitals train and test surgeons
with portable FlexVR™ Systems.
TRAINING & PRIVILEGING
Training Hub sets standards and
provides premium training.
Leverages Mimic’s simulation
platforms such as dV-Trainer®,
XTT™ and the real robot.
27. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com© 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
TRAINING HUB
dV-Trainer® XTT™
SATELLITE SATELLITE SATELLITE SATELLITE
MOBILITY OF FlexVR™
Transfer FlexVR between
satellite locations as needed
Distributed Simulation Hospital Program
TRAINING & TESTING
Satellite hospitals train and test surgeons
with portable FlexVR™ Systems.
TRAINING & PRIVILEGING
Training Hub sets standards and
provides premium training.
Leverages Mimic’s simulation
platforms such as dV-Trainer®,
XTT™ and the real robot.
28. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com© 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
TRAINING HUB
dV-Trainer® XTT™
Surgeons seeking advanced training
or in need of remediation are sent to
the Training Hub
SATELLITE SATELLITE SATELLITE SATELLITE
Distributed Simulation Hospital Program
TRAINING & TESTING
Satellite hospitals train and test surgeons
with portable FlexVR™ Systems.
TRAINING & PRIVILEGING
Training Hub sets standards and
provides premium training.
Leverages Mimic’s simulation
platforms such as dV-Trainer®,
XTT™ and the real robot.
29. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Visibility into your data
anytime, anywhere
Superior analysis tailored
specifically to your needs
Simulation Assessment Platforms
Custom Reporting
Proficiency-based scoring is the
core of our simulation platform
30. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Performance Analytics and Reports
Easy admin tools to setup and manage users
and curricula
Proficiency-based scoring that is derived from
experienced surgeon data
Data backed up in the cloud with MScore Portal™
for managing users, implementing programs,
generating reports, etc.
Advanced analytics and comparisons to rest-of-world
Scoring system and sophisticated admin tools
for dV-Trainer®, FlexVR™, and XTT™
31. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Custom Reporting and Program Management
Mimic builds customized training curriculums and
helps hospital systems manage their programs.
Focus is on training, privileging and credentialing
through objective simulation data.
Mimic distills data down to dashboards that can
be absorbed by stakeholders at a glance.
Mimic facilitates the continuance of robotics
simulation programs despite the turnover over
program managers and stakeholders.
Mimic brings 18 years of experience in robotics
training to help customers understand best
practices for utilizing simulation.
32. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Quality and Efficiency Example
Example data from Beaumont Hospital
-5 -4 -3 -2 -1 0 1 2 3 4 5 -5 -4 -3 -2 -1 0 1 2 3 4 5
Includes time to complete task, economy of motion, and master workspace range
MORE EFFICIENT
use of the device
SHORTER
OR time
MEASURES
commitment to
learning process
METRICS
for surgical
case privilege
METRICS
for skill
degradation
=
Increased
Quality &
Efficiency
Established
Benchmark
Training Based on Dreyfus Model
33. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
-5 -4 -3 -2 -1 0 1 2 3 4 5-5 -4 -3 -2 -1 0 1 2 3 4 5
LEADS TO
fewer mistakes
& complications
MEASURES
commitment
to program
METRICS
for surgical
case privilege
METRICS
for skill
degradation
Risk and Safety Example
Example data from Beaumont Hospital
Includes instrument collisions, dropped objects, moving instruments when out of view, excessive force, and missed targets
=
Increased
Safety &
Decreased
Risk
Training
Standards
S T A R T
F I N I S H
Training Based on Dreyfus Model
34. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Predictive Analytics
Mimic uses machine learning and advanced statistic to identify top performers and anticipate curriculum durations
Distribution of hypothetical hours to competency in all exercises of curriculums at STAN (Nancy, France)
and the Nicholson Center (Florida)
22% competent
in
over 20 hours
22% competent in
over 20 hours
“Distribution of Innate
Psychomotor Skills
Recognized as Important
for Surgical
Specialization in
Unconditioned Medical
Undergraduates”, Moglia,
et al., Surgical
Endoscopy, 2018
Innate Ability Curve
37% competent in
under 10 hours STAN Curricula
Nicholson Center Curricula
BAC K
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Hysterectomy Cost Models
Activity Cost
Top
25%
Cost
per case
Bottom
25%
Cost
per case
Delta
per case
OR Times $50/minute 90 mins $4,500 140 mins $7,000 $2,500
Complications
$20,000/
complication
1% $200 4% $800 $600
LOS $500/day 1 day $500 1.8 days $900 $400
Re-
Admissions
$20,000/
re-admission
1% $200 3% $600 $400
Total $5,400 $9,300 $3,900
Delta = $3,900 per case
Data/study from CAVA Robotics, Dr. Rick Low et al, 2015.
Data from 250 surgeons, 200,000 robotic cases, 36
institutions
A hospital group doing 4,500
cases per year using 20 robots,
with the lowest performing 50
surgeons doing approximately
225 cases a year:
Potential Savings
from training bottom performing
50 surgeons and teams:
Data/study from Loftus Health Healthcare
Consulting, 2015)
INCREASED HOSPITAL EFFICIENCY =
REDUCED CASE TIME IN THE OR
$926K/year
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Culligan Study – Morristown Protocol
Culligan, et al, FPMRS, Jan/Feb 2014
EXPERT SURGEONS STUDY GROUP CONTROL
Number 5 14 4
Demographics N/A Same (49.1) Same (53.5)
Average simulation hours Some 20 (9.7 to 38.2) 0
No of cases Average 142/year 0 Enough to be
granted privileges
Mean Hyst operative times 20.2 minutes 21.7 minutes 30.9 minutes
EBL 25ml 25.4ml 31.25ml
Goals score 50 34.7 31.1
Completing this protocol IN THE STUDY GROUP of robotic
simulator skills translated to EXPERT-LEVEL SURGICAL TIMES
during live human surgery. As such, we have established
predictive validity of this protocol.”
BAC K
37. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Skills Degradation Prevention
Mimic develops a plan for a
SKILLS MAINTENANCE CURRICULUM
Required integration of surgical specialty benchmarks
Skills Maintenance and Remediation
Core robotic psychomotor skills begin to
degrade significantly in 2–4 weeks
Particularly true for surgeons new to robotics
Efficiency – Accuracy – Safety
FOCUS ON
Guseila LM, Saranathan A, Jenison EL, Gil KM, Elias JJ (2013) Training to maintain surgical skills during periods of robotic surgery inactivity. Int J Med Robot; doi:10.1002/rcs.1562.
Jenison EL, Gil KM, Lendvay TS, Guy MS (2012) Robotic surgical skills; Acquisition, maintenance, and degradation. J Soc Laparoendoscopic Surgeons 16:218-228.
38. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Pre and Post Exercises were performed
Both Surgeons 1 & 2 attended MIS/Mimic Courses
Skills Degradation Study
0
200
400
600
800
1000
1200
1400
Energy Switching 1 Peg Board 1 Ring & Rail 1 Energy Switching 1 Peg Board 1 Ring & Rail 1
Aug-15 15-Oct
Skills Degradation
Surgeon 1
Performance remained consistent
• Performed 5 Robotic Procedures
• Practiced on a simulator
Surgeon 2
Performance declined significantly
• Performed 0 Robotic Procedures
• Did not practice on a simulator
39. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
What we did in Tacoma
2005: Acquired robot
2007: Decision to form Robotics Committee
2008: Formal robotics committee for system
Multi-disciplinary
Independent
Medical Director position
‒ Under COO
‒ Peer Review Authority
Gives advice to other Medical Staff Departments
40. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Annual Recertification: ALL
Pass 2 Consecutive
Peg Board 2 90%
Energy Dissection 2 90%
Ring Walk 2 90%
Suture Sponge 2 90%
Simulator
41. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
C&P at MultiCare Health Systems
Robotic Credentialing: Basic,
Advanced simulation requirements
(pass 5 with 2 consecutive passes)
Annual Certification: Minimum 12
cases per year, all surgeons pass 2
consecutive Sim exercises
Program adopted in 2008
All robotics surgeons required to pass annual
simulation test to prove proficiency
Failure to complete at least 12 cases per year
results required simulation training and testing
62 surgeons credentialed (all specialties),
35 currently have privileges at all 4 hospitals
5 surgeons have relinquished privileges
‒ Could not pass simulation due to physical
conditions not otherwise apparent
5 low volume surgeons have maintained
privileges by passing simulation training and
testing requirements
Multi-Care:
Only Health Care System in the
Pacific Northwest that has NOT
had a robotic surgery lawsuit.
42. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
The Evolving Role of Simulation
Training
‒ Basic: Psychomotor skills
‒ Advanced: Procedures
‒ Team: Bedside assist
Current Uses of Simulation
Credentialing, privileging
and remediation
Surgical Warm-up
Gaining Momentum
43. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Complication-Simulation Training
Basic Management
Vascular injuries
Bowel and urinary tract injuries
Advanced Management
Worsening complication
scenario
Procedure-specific
Complications
Major vessel injury and repair
with pelvic lymph node
dissection
44. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
The Evolving Role of Simulation
MScore™ portal cloud links simulators to
central admin for review
‒ Data Analytics available to all program
directors as well as surgeons/students
‒ Link to simulation performance
to clinical outcomes
‒ Compare performance and outcomes on
different robotic systems
‒ Reduce insurance rates for high utilization
and proven simulation performance
Remote surgical planning
Virtual Reality for OR setup and docking
Connected, Smart Simulation
45. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
The Evolving Role of Simulation
Surgical Planning
‒ Practice complex procedures on
actual patients based on imaging
input into simulator
‒ Practice simulated procedures new to
surgeon with Augmented Reality
Practice on different robots prior to
actual surgeries if you use more
than one system
Machine learning: Identify skills
necessary to improve clinical
outcomes, then practice
2019 and Beyond!
46. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Conclusions
Robots will take over the operating room!
Over 1 million robot assisted surgeries
Procedures growing at 17%
Simulation enables surgeons to learn, improve and maintain skills,
especially during periods of robotic inactivity, without training on
patients
Need to establish a credentialing and privileging system (high stakes
testing) that relies on simulation
Simulation will eventually enter the operating room
Pre-operative planning
Tele-collaboration
Assisted surgery through augmented reality and machine learning
47. © 2019 Mimic Technologies, Inc. All rights reserved. www.MimicSimulation.com
Join the Contest! Join our Team!
Thank you! jeff@mimicsimulation.com
Editor's Notes Mimic Technologies can help to standardize and improve your robotics training and credentialing programs. Representative of the Estate of FRED E. TAYLOR, deceased; and on behalf of the Estateof FRED E. TAYLOR; and JOSETTE
TAYLOR, Individually,
V.
IMPACT: The responsibility for insuring adequate surgeon training and competence falls on the Hospital/Medical System. Here's a breakdown of all of our exercises:dVT / FlexVR:-- Si: 68 exercises-- Xi: 67 exercises-- FRS Si: 6 exercises-- FRS Xi: 6 exercises-- RTN Si: 12 exercises-- RTN Xi: 12 exercises-- Top Gun: 4 exercisesXTT:-- Team: 13 exercises-- Lap-only: 11 exercises-- Haptic Demo: 1 exercise Credentialing and residency program for faculty surgeons, customized to meet training needs of different target groups
Simplify oversight responsibilities of educators and program coordinators
Credentialing and residency program for faculty surgeons, customized to meet training needs of different target groups
Simplify oversight responsibilities of educators and program coordinators
Credentialing and residency program for faculty surgeons, customized to meet training needs of different target groups
Simplify oversight responsibilities of educators and program coordinators
Credentialing and residency program for faculty surgeons, customized to meet training needs of different target groups
Simplify oversight responsibilities of educators and program coordinators
Credentialing and residency program for faculty surgeons, customized to meet training needs of different target groups
Simplify oversight responsibilities of educators and program coordinators
35