ICI Global Innovation Award Simulands Special Acknowledgment

December 9, 2019

Innovate in Education: from PlayStation to Certification!

The experience of Prof. Francesco Maisano – unlocking the potential for cardiovascular simulation with Simulands. Exciting new ideas that can impact worldwide clinical practice.


Thank you. I think I have a real problem here because usually when you talk about Simulators and education, etc., it is very boring, absolutely not innovative. I tell you where I came from. So, last year I was awarded this ICI award. It is a kind of award for the recognition of lifetime achievements in research in Interventional Cardiology, which is not too bad, right?

I got this prize, this silver medal for innovation and so on and I think I am still pretty young to get all these medals … You know you usually get these medals when you are old. So, the question is: “What is the next big thing?”. I am very honest; I will be naked in front of you what I really believe is the next big thing.

The next big thing is here. We’ve been working a lot in this last 20 years to build a new device and we use this new device in everyday practice. We use model imaging, amazing. You know, almost the sky is the limit. And we work in new operating rooms which are amazing. Everything is new, everything has been renovated.

And we still teach the same way as 200 years ago. I mean the same approach as 200 years ago, exactly the same. No difference. It’s almost impossible to change the academy.

So, what is the next big thing? And this is really on my own practice, because I am a Director of the Clinic and I am an academic guy. I think you know we have been in way in diagnostics therapies we are innovating our facilities and also our structures, but education is always the last. Imagine about education, you know, to build the new cardiac surgery it takes 12 years. So, we need to start now. So, we need to put the priority of education, move it more forward.

And yes, I think we can use all that we have learned in these years in innovation for education. We stuck with the concept that “See one, do one, teach one”. This is still happening. I mean how do I teach my people? Look at me, what I do.

This was good many years ago, but the end there has been also some evolution. You do not see introduce in cardiovascular medicine life pages that was necessary because it was impossible to bring everybody in the CathLab and recently we talk a lot about hands-on training. Even ICI we discussed in next year maybe we want to organize hands-on training, which is very important.

And this is all based on these famous simulators. Now what, I hate simulators, I hate them, because you bring simulators in the room and everybody is using them as a PlayStation. And I think that we need to move from there and we need to learn from the past.

Because Grüntzig was doing this kind of procedures on people and giving the certification. Without this certificate we won’t be able to get the balloon. So, we need to move from PlayStation to Certification.

And I start from my personal experience. This is me (you know this picture is pretty impressive), me 20 years ago. First time I see a catheter, first time I see and think a surgery is dead. When I looked at this I don’t understand how it works and actually what is was, there it was, a simulator.

In 20 years I became somebody different. I think you know me. I am very happy that you need no introduction later who I am. I am happy because I work with a lot of giants. But also in these 20 years I have been working with hundreds of different simulators. And I’ve been using simulators to build new devices, to test devices and then to teach these devices to somebody else, and finally to train people to be safe and effective in using these devices. So, that’s why I thought that we should get an advantage of this experience and say: “Ok, let’s do something which is useful for the next generations”. Let’s make a serious step forward in simulation, based on 20 years of R&D and education on simulators. Simulators which are designed by a physician for physicians. Which are purpose-oriented, not just PlayStations. Scalable, portable, etc. Designed to test, educate but also to certify skills and competence.

Obviously the idea is to have different partners, is not only doctors also in industry are different objectives. Let me understand. So, simulators, you know very often we use a simulator to simulate the human being, that doesn’t make any sense. Simulation is needed to build a process, which goes from basic skills, teach people how to move with this new procedures or new devices, understand imaging and understand the devices, known yet the end simulate the real procedure. This is probably only needed in very end of the process and only for certification. To achieve the goal of each of these facts, you need different setup. At the beginning you need for instance just dry simulators, just to understand manuality, the tactile feedbacks. You go forward and you can build a simulators, which are more sophisticated to understand the imaging, the details of the device and understand how the device works and then at the latest stage you build a simulator which really reproducing the procedure, which is been used to test whether the physician is ready to go for humans.

There is a lot of technology behind it. Again, there is 20 years of experience. It’s nothing that you’ll learn in one day. And again, it’s not only just a technology, it’s also the overall process – process which at the end has to go in the direction of good simulator practice. This what we have to build, because at the end simulation has to be use to certify people to understand if the physicians of the future can treat patients safely and effectively.

We use a lot of technology around this. This is not only Simulands is working also on ideas to certify skills and behavior by looking at our motions. So, this is you can … This is me working on a real a patient, but we are working on this behavior analysis and guides and eye-tracking to understand skills and competence.

And this is because we have to go in the direction of work airplanes in the airplanes industry, where they also use this kind of things. To understand how an experienced operator behaves in front of the complication. In front of this complication. And this is the problem, you know, you have here a coronary occlusion. How often you see that? Once in a year. How do you train people to get rid of these problems? I see a lot of this. In the future it will be less. So, we need simulators to prepare the next generation.

So, this are some of the products, which are being already produced by this very early startup, which I think is going to be fundamental for the future, because again – I’ve been working 20 years to heal surgery, because I was there, to bring the surgery to the next level, all the way around… so we have new diagnostic tools, we have better therapies, we have better imaging, we have new facilities, but still we need to prioritize now the education, because this is the future. Thank you.

Prof. Francesco Maisano

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