The document discusses plans for the Benghazi Medical Training Center (BMTC) in Libya. It outlines the history and evolution of surgical training, reasons for changes in current training methods, and the BMTC's proposed use of virtual simulation, motion capture, and other technologies to improve training efficiency and standardization. The BMTC aims to create a national, regional, and international surgical training center that reduces training times and optimizes teaching through new technologies and competency-based modules spanning basic, advanced, and expert levels.

1. Benghazi Medical Training Center “BMTC”
“Looking Forward”
Concept, Methodology & Organization
JEROME CAU

2. Benghazi Medical Training Center “BMTC”

3. Before the development of ‘Modern Medicine”:
q Surgeons were Barbers or Experts & their followers,
they consider knowledge as a “trade-secrete”
q surgery was limited to the external problems
( with no anesthesia or antiseptic techniques):
simple #s, dislocations, amputations, abscesses,
hernias , heroic attempts to excise huge tumors.
q In 19th century starting of scientific schools in
Britain, Germany ………etc
Evolution of Surgical education:
“History is always important to define the future”

4. q 1889 William Halsted at Johns Hopkins
(USA) built up Structural Residency for
surgical training. Training under capable surgeon
q 1904 Allen introduced: concentrated training
experience and yearly examinations.
q 1928 American fellowships.
q 1937 American Board of Surgery.
Evolution of Surgical education:
“History is always important to define the future”

5. Development of technology:
ANDREW SAVULICH/NEW YORK DAILY NEWS
TRANSISTORS 1956
TRAINING OFFERS SAFE & EFFICIENT USE OF THE DEVICES

6. Training & Knowledge:
q Technology is growing rapidly to minimize risk.
q Surgeons must follow the advances in technology for patient safety.
Past:
Fighter Pilots
Until 2002
At present
Predator 2003
Future:
Fighter Pilots

7. Current surgical training: Reasons for change:
q Training is at present largely unregulatedand not standardized.
q Decreased interest among medical students regarding general surgery as
a career choice.
q Increased patients interest of medico-legal concerns.
q Advances of science, systems, and information technology.
q Shortages in critical care.
q Complexity associated with new procedures and devices.
(e.g catheter-based therapies, image guided procedures).
q Introduction of Laparoscopic surgery in 1990s.
Current Training is
longer and insecure

9. New Concept “One size no longer fits all.”
q Well trained surgeons are more beneficial for patient safety.
q Defined curriculum for surgical skills should be considered for
training outside the operating room before beginning real
operations.
q Evaluation and certification of trainees are essential.
q “a virtual surgical environment” is needed to fit the propose of
training, (shorten the time of training and gives more efficiency).

10. Virtual surgical environment
New teaching technologies :
q Simulators.(patient, surgical, imaging)
q virtual reality.
q Practical operating-theater conditions.
The BCHSP
“Let’s Play First”

11. Skilled Surgeon = Safer Surgery
The best nominee in laparoscopic and conventional surgery should:
q Ensure the highest standard of training and treatment.
q "Hands On“ training of all essential and advanced laparoscopic procedures.
q Learn Minimal Access Surgery.
q The fellowship in Minimal Access Surgery:
International BMC Hands---On Course

12. Teaching Fundamentals:
1. COGNITIVE STAGE:
Gaining of basic skills.
2. CONTEXTUAL STAGE:
Gaining of basic and advanced skills in real life situations.
3. OPERATIONAL STAGE
Gaining of operating strategies / Learning by error.
4. RETROACTIVE STAGE:
Transmission and updating of knowledge with experts.

13. Training Methods:
q Theoretical courses
q Educational video workshops
q Real life situations in the operating theater
q Role play
q Practical exercises
q Operating simulation
q Use and manipulation of instruments / equipment

14. Example of Basic Techniques:
Basic suture training:
q Skills.
q One-handed reef knot technique.
q Instrument tie.
q Surgeon's knot.
q Slip knot.
q Tying in a small opening.
q Tying at depth vertically in a large opening.
q Tying at depth at an angle in a large opening.

15. Motion Capture:
A system measures movement of the Head, Arm
and Hand during training.
To evaluate surgeon’s performance during training =
Training Feedback
Why ??????????

16. Motion Capture:
q Motion capture system is the recording
of objects or people movement. not
his or her visual appearance.
q Specific Hardware & Software collect
images from multiple cameras and
calculate 3D positions. (data)
q This animation data is often mapped
to a 3D model so that the model
performs the same actions.

17. Motion Capture:
q Marks to be applied to the trainee wears near
each joint to identify the motion by the
positions or angles between the marks.
q Marks attach to Sensors track the movement
to computer system in wireless mode. (special
suits are available to provide input)

18. Motion Capture:
q The process can be generated online.
q Information can be used to provide context-
specific information or movement enhancement
to the trainee.

19. Motion Capture:
q The whole training procedure can be
recorded and replayed as a movie to
review it on a monitor.

20. Motion Capture:

21. Motion Capture:
Training Center
France

22. Simulators:
1. Patient simulators: Models
provided by peripheral
equipment attached to a
computer system with clinical
scenarios for training. Allow
hands-on practice + improve
clinical sense.
Different Models: eg. ICU patient, child patient, parts for specific procedure.
From: Tellyes Scientific CO., LTD (Tianjin, China)

23. Simulators:
2. Surgical simulators: Laparoscopic Simulator:
q Laparoscopy skills exercises, multi-screen
synchronized monitoring.
q Video error mark & storage real-time audio
guidance.
q Trainees can learn from the standard videos
which are set from server unit.
q Improve skills by learning from mistakes.
q System generate electronic report of remarks
and scores.

24. SIMULATORS
Interventional specialist

25. Simulators:
Laparoscopic Simulator:

26. Simulators:
3. Laparoscopic Simulator:
q Skills of Vascular anastomosis.

27. Simulators:
3. Anastomotic Score:
I Suture Quality
Regular & thickness = 1
Regular = 2
Others = 4
II Leaks
None = 1
2 – 4 = 2
> 2 = 4
III Duration
< 10 = 0 , < 15 = 1
15 – 30 = 2 , 30 -60 = 4
> 60 = 6
Score
A+ = 2 A = 3 – 4
B = 5 – 6 C = 7 – 8
D = 9 - 12

28. General Objectives of the BMTC
q To create a National, Regional
and Internationaltraining center.
q To share in the BMCs
credentialing and privileging the
policy.
“BMC on the World Map.”

29. Projected Objectives of the BMTC
q To reduce the learning curve by streaming and
optimizing the teaching process in surgical
movement .
q To address demands of surgeons who request
continuous practical learning.
q To teach and develop new cutting edge surgical techniques

30. General Training Diagram:
Basic:
(Registrar & SHO)
Module I: Operating Theater
Module II: Basic Procedures
OT access allowed certificate
Module III: Basic general skills
Module IV: Advanced general skills
Module V: Expert general skills
Second Aid Diploma
Module VI: Basic Laparoscopic skills
Module VII: Advanced Laparoscopic skills.
Module VIII: Expert Laparoscopic skills.
First Aid Diploma
Advanced:
(Senior Registrar, Specialist)
Module I: Vascular
Module II: Visceral
Module III: Urology
Module IV: Gynecology
Module V: Thoracic
Module VI: Cardiac
Module VII: Orthopedics
Module VIII: Neurosurgery
Diploma of general surgery
Experts:
(Consultants)
Workshops:
Morbid Obesity Surgery
Laparoscopic Aortic Surgery
Adrenal Gland Surgery.
Post University Diploma
Local
Opening
International
Opening
Regional
Opening

31. Enjoy Training