TEDxNatick
Peter Weinstock: Lifelike simulations that make real-life surgery safer
彼得·萬斯托克: 栩栩如生的模擬演練使得實際的手術更為安全
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治療重症的醫師彼得·萬斯托克展示如何結合醫療團隊、好萊塢特效以及 3D 列印，模擬出幾可亂真的病人模型，以供練習高危險性的手術。「練習兩次，動刀一次。」一窺前瞻手術的究竟。
Peter Weinstock - Pediatric ICU doctor
Dr. Peter Weinstock is an Intensive Care Unit physician and Director of the Pediatric Simulator Program at Boston Children's Hospital/Harvard Medical School. Peter and his team fuse medicine with state of the art special effects, puppeteering and 3D printing technologies to create lifelike simulations of complex surgeries. Full bio
Dr. Peter Weinstock is an Intensive Care Unit physician and Director of the Pediatric Simulator Program at Boston Children's Hospital/Harvard Medical School. Peter and his team fuse medicine with state of the art special effects, puppeteering and 3D printing technologies to create lifelike simulations of complex surgeries. Full bio
Double-click the English transcript below to play the video.
00:12
What if I told you
there was a new technology
there was a new technology
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想像這會怎樣──
把一種新科技
00:16
that, when placed in the hands
of doctors and nurses,
of doctors and nurses,
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交給醫生和護士使用，
00:21
improved outcomes for children
and adults, patients of all ages;
and adults, patients of all ages;
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它能改善兒童、成人，
所有年齡患者的治療效果；
00:27
reduced pain and suffering,
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它能降低病人的痛苦，
00:30
reduced time in the operating rooms,
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縮短手術的時間，
00:33
reduced anesthetic times,
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減少麻醉的次數，
00:36
had the ultimate dose-response curve
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獲得最佳的劑量反應曲線；
00:38
that the more you did it,
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這技術被用得越多，
00:39
the better it benefitted patients?
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患者的獲益就越大。
00:43
Here's a kicker: it has no side effects,
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意料之外的是：它不但沒有副作用，
00:45
and it's available no matter
where care is delivered.
where care is delivered.
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且可用於任何治療。
00:49
I can tell you as an ICU doctor
at Boston Children's Hospital,
at Boston Children's Hospital,
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身為波士頓兒童醫院
加護病房的醫生，
加護病房的醫生，
00:52
this would be a game changer for me.
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我認為局面會全然改觀。
00:55
That technology is lifelike rehearsal.
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我說的科技是
仿真的醫學模擬和練習，
01:00
This lifelike rehearsal is being delivered
through medical simulation.
through medical simulation.
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用逼真的醫學模擬來練習。
01:05
I thought I would start with a case,
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我先舉個實例
01:09
just to really describe
the challenge ahead,
the challenge ahead,
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來確切說明醫學所面臨的挑戰，
01:12
and why this technology is not just
going to improve health care
going to improve health care
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為何這技術不但會改善醫療，
01:16
but why it's critical to health care.
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並且是不可或缺的。
01:19
This is a child that's born, young girl.
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這是一個剛出生的小女孩。
01:22
"Day of life zero," we call it,
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我們稱為「生命的首日」，
01:24
the first day of life,
just born into the world.
just born into the world.
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她降生到這世界的第一天。
她一出生，
01:26
And just as she's being born,
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我們立刻發現她的健康狀況
01:27
we notice very quickly
that she is deteriorating.
that she is deteriorating.
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正急遽惡化。
01:30
Her heart rate is going up,
her blood pressure is going down,
her blood pressure is going down,
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她的心跳加速，
血壓下降，
01:33
she's breathing very, very fast.
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呼吸非常急促。
01:36
And the reason for this
is displayed in this chest X-ray.
is displayed in this chest X-ray.
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這張 X 光片顯示病因。
01:41
That's called a babygram,
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我們稱之為嬰兒圖像 (babygram)，
01:42
a full X-ray of a child's body,
a little infant's body.
a little infant's body.
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是嬰兒全身的 X 光片。
01:45
As you look on the top side of this,
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圖片的上半
01:47
that's where the heart and lungs
are supposed to be.
are supposed to be.
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是心臟和肺臟應該在的位置；
01:50
As you look at the bottom end,
that's where the abdomen is,
that's where the abdomen is,
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下半是腹部和小腸應該在的位置。
01:53
and that's where the intestines
are supposed to be.
are supposed to be.
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看這塊半透明的區域，
01:55
And you can see how
there's sort of that translucent area
there's sort of that translucent area
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01:58
that made its way up into the right side
of this child's chest.
of this child's chest.
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一直延伸到右上方嬰兒的胸腔，
02:01
And those are the intestines --
in the wrong place.
in the wrong place.
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那是錯位的小腸。
02:05
As a result, they're pushing on the lungs
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小腸推擠肺部，
02:07
and making it very difficult
for this poor baby to breathe.
for this poor baby to breathe.
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使得這可憐的嬰兒難以呼吸。
02:11
The fix for this problem
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解決之道是馬上為她動手術，
02:12
is to take this child immediately
to the operating room,
to the operating room,
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把小腸移回腹部，
02:15
bring those intestines
back into the abdomen,
back into the abdomen,
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讓她肺的空間擴大，
02:17
let the lungs expand
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02:19
and allow this child to breathe again.
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能夠恢復呼吸。
02:21
But before she can go
to the operating room,
to the operating room,
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但在手術之前，
02:23
she must get whisked away
to the ICU, where I work.
to the ICU, where I work.
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必須先火速送她進我的加護病房。
02:26
I work with surgical teams.
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我和手術團隊圍繞著她，
02:28
We gather around her,
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02:30
and we place this child
on heart-lung bypass.
on heart-lung bypass.
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為她接上體外心肺循環機 ，
02:35
We put her to sleep,
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上麻醉藥，
02:37
we make a tiny
little incision in the neck,
little incision in the neck,
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在脖子上切個小口，
02:39
we place catheters into the major
vessels of the neck --
vessels of the neck --
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把導管伸入脖子的主動脈內。
02:43
and I can tell you that these vessels
are about the size of a pen,
are about the size of a pen,
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這些血管的尺寸只有筆尖那麼細。
02:46
the tip of a pen --
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02:48
and then we have blood
drawn from the body,
drawn from the body,
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我們抽出她的血液，
02:50
we bring it through a machine,
it gets oxygenated,
it gets oxygenated,
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導入一台機器，充氧，
02:53
and it goes back into the body.
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再送回體內。
02:55
We save her life,
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我們挽救她的性命，
02:56
and get her safely to the operating room.
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把她安全送進開刀房。
03:01
Here's the problem:
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問題在此：
03:03
these disorders --
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她罹患的病
03:05
what is known is congenital
diaphragmatic hernia --
diaphragmatic hernia --
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被稱為「先天性橫膈疝氣」，
03:08
this hole in the diaphragm that has
allowed these intestines to sneak up --
allowed these intestines to sneak up --
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隔膜上有個洞使腸子得以向上移位，
03:12
these disorders are rare.
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是種罕見的疾病。
03:15
Even in the best hands in the world,
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即使是世上最優秀的外科醫生
03:19
there is still a challenge
to get the volume --
to get the volume --
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也難以累積足夠的經驗，
03:22
the natural volume of these patients --
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因為患者的數目太少，
03:24
in order to get our expertise
curve at 100 percent.
curve at 100 percent.
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醫師難以練到百分之百的技術曲線。
03:27
They just don't present that often.
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很難遇到這種病例。
03:30
So how do you make the rare common?
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那麼，怎樣變罕見為常見呢？
03:36
Here's the other problem:
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另外還有一個問題：
03:38
in the health care system
that I trained for over 20 years,
that I trained for over 20 years,
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我服務了二十多年的醫療系統，
03:42
what currently exists,
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現行的訓練模式稱為「學徒模式」，
03:44
the model of training is called
the apprenticeship model.
the apprenticeship model.
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03:47
It's been around for centuries.
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已有數百年的歷史。
03:49
It's based on this idea that you see
a surgery maybe once,
a surgery maybe once,
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學徒模式的基本概念
是先看別人做一次或數次的手術，
03:53
maybe several times,
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03:54
you then go do that surgery,
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然後自己動手術；
03:57
and then ultimately you teach
that surgery to the next generation.
that surgery to the next generation.
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最終再把這技術傳承給下一代。
04:02
And implicit in this model --
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其實說白了，
04:05
I don't need to tell you this --
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相信大家也能想得到，
04:07
is that we practice on the very patients
that we are delivering care to.
that we are delivering care to.
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學徒模式是一面開刀、一面練習。
04:14
That's a problem.
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這是個大問題。
04:19
I think there's a better approach.
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我認為有更好的方法。
04:21
Medicine may very well be the last
high-stakes industry
high-stakes industry
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醫療很可能是最後一門
不先訓練就實作的高風險行業了。
04:25
that does not practice prior to game time.
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04:30
I want to describe to you a better
approach through medical simulation.
approach through medical simulation.
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讓我闡述醫療模擬這個好辦法。
04:36
Well, the first thing we did is we went
to other high-stakes industries
to other high-stakes industries
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我們先參觀其他已經使用這方法
數十年之久的高風險行業，
04:39
that had been using this type
of methodology for decades.
of methodology for decades.
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04:42
This is nuclear power.
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核電廠。
04:44
Nuclear power runs scenarios
on a regular basis
on a regular basis
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核電廠會定期演習，
練習和防範不樂見的未然；
04:48
in order to practice
what they hope will never occur.
what they hope will never occur.
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04:52
And as we're all very familiar,
the airline industry --
the airline industry --
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還有大家熟悉的航空業。
04:55
we all get on planes now,
comforted by the idea
comforted by the idea
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現今大家搭機都很放心，
因爲機師和機組人員
04:59
that pilots and crews have trained
on simulators much like these,
on simulators much like these,
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已被飛行模擬器訓練過，
像這樣的模擬器，
05:05
training on scenarios
that we hope will never occur,
that we hope will never occur,
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他們知道要如何應對
但願永不發生的緊急狀況；
但願永不發生的緊急狀況；
05:07
but we know if they did,
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萬一不幸發生了，
05:09
they would be prepared for the worst.
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我們有信心他們能應變。
05:12
In fact, the airline industry has gone
as far as to create fuselages
as far as to create fuselages
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事實上，
航空業甚至直接打造機艙模擬情境，
05:17
of simulation environments,
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05:18
because of the importance
of the team coming together.
of the team coming together.
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因為整體團隊的運作至關重要。
05:22
This is an evacuation drill simulator.
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這是模擬的疏散演習。
05:25
So again, if that ever were to happen,
these rare, rare events,
these rare, rare events,
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我重申，一旦發生罕見事故，
05:29
they're ready to act
on the drop of a dime.
on the drop of a dime.
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他們能夠瞬間應變。
05:34
I guess the most compelling for me
in some ways is the sports industry --
in some ways is the sports industry --
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我猜，最吸引我目光的
還是高風險的體育行業。
05:40
arguably high stakes.
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05:42
You think about a baseball team:
baseball players practice.
baseball players practice.
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我認為棒球隊球員練習
05:45
I think it's a beautiful example
of progressive training.
of progressive training.
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是個漸進訓練的好例子。
05:48
The first thing they do
is go out to spring training.
is go out to spring training.
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他們先進行春季訓練。
05:51
They go to a spring training camp,
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春訓用的可能是棒球模擬器，
05:53
perhaps a simulator in baseball.
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05:56
They're not on the real field,
but they're on a simulated field,
but they're on a simulated field,
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不是實體球場，而是模擬的球場。
05:59
and they're playing in the pregame season.
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他們打季前賽，
06:01
Then they make their way to the field
during the season games,
during the season games,
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然後在正規賽季進入棒球比賽場。
06:05
and what's the first thing they do
before they start the game?
before they start the game?
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開賽前他們先做些什麼呢？
06:08
They go into the batting cage
and do batting practice for hours,
and do batting practice for hours,
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先在擊球練習區揮棒幾個小時；
06:12
having different types of pitches
being thrown at them,
being thrown at them,
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面對各式球路
06:16
hitting ball after ball
as they limber their muscles,
as they limber their muscles,
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一次又一次揮棒暖身，
06:20
getting ready for the game itself.
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為真正的比賽做準備。
06:22
And here's the most
phenomenal part of this,
phenomenal part of this,
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最不凡的部分，
06:26
and for all of you who watch
any sport event,
any sport event,
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所有看球賽的人
06:29
you will see this phenomenon happen.
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都會看到這現象：
06:31
The batter gets into the batter's box,
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打者進入打擊區，
06:34
the pitcher gets ready to pitch.
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投手準備投球，
06:36
Right before the pitch is thrown,
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就在球被投出之前，
06:39
what does that batter do?
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打者做什麼動作？
06:41
The batter steps out of the box
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打者離開打擊區
06:44
and takes a practice swing.
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練習揮棒。
06:46
He wouldn't do it any other way.
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打者必定這樣做。
06:49
I want to talk to you about how
we're building practice swings like this
we're building practice swings like this
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告訴你
我們如何為醫療行業建立練習系統，
06:52
in medicine.
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建造打擊練習區，
06:54
We are building batting cages
for the patients that we care about
for the patients that we care about
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為心繫的患者
建在波士頓兒童醫院裡。
06:58
at Boston Children's.
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06:59
I want to use this case
that we recently built.
that we recently built.
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我用最近建的案例說明：
07:02
It's the case of a four-year-old
who had a progressively enlarging head,
who had a progressively enlarging head,
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這個四歲兒童的頭部逐漸漲大，
07:06
and as a result,
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以致發育不如預期，
07:08
had loss of developmental milestones,
neurologic milestones,
neurologic milestones,
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錯失了腦神經發育的里程碑。
07:11
and the reason for this problem is here --
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問題出在這裡：
07:14
it's called hydrocephalus.
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「腦積水」。
07:16
So, a quick study in neurosurgery.
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快速簡介腦神經外科手術的做法。
07:19
There's the brain,
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這是大腦，
07:20
and you can see the cranium
surrounding the brain.
surrounding the brain.
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顱骨包圍著大腦，
07:23
What surrounds the brain,
between the brain and cranium,
between the brain and cranium,
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在大腦和顱骨之間流動的
07:27
is something called
cerebrospinal fluid or fluid,
cerebrospinal fluid or fluid,
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是「腦脊液」，
07:30
which acts as a shock absorber.
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它的作用是緩衝撞擊力。
07:32
In your heads right now,
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此刻你的大腦
07:33
there is cerebrospinal fluid
just bathing your brains
just bathing your brains
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浸泡在頭骨裡的腦脊液裡，
07:37
and making its way around.
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腦脊液繞著大腦流動，
07:39
It's produced in one area
and flows through,
and flows through,
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在一個地方產生腦脊液，
07:41
and then is re-exchanged.
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流動，然後再循環，
07:43
And this beautiful flow pattern
occurs for all of us.
occurs for all of us.
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每個人的腦脊液都美妙地流動著。
07:46
But unfortunately in some children,
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但不幸有些孩子的腦脊液
07:48
there's a blockage of this flow pattern,
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塞住不流動，
07:51
much like a traffic jam.
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就像交通壅塞那樣。
07:53
As a result, the fluid accumulates,
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結果腦脊液積聚，
07:55
and the brain is pushed aside.
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腦被擠到一邊，
07:59
It has difficulty growing.
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難以生長，
08:01
As a result, the child loses
neurologic milestones.
neurologic milestones.
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孩子因此腦神經發育遲緩，
08:05
This is a devastating disease in children.
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這是種毀滅性的兒童病。
08:08
The cure for this is surgery.
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治療方式是動手術。
08:12
The traditional surgery is to take
a bit of the cranium off,
a bit of the cranium off,
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傳統手術是取下一小塊顱骨，
08:15
a bit of the skull,
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一小塊頭骨，
08:16
drain this fluid out,
stick a drain in place,
stick a drain in place,
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安裝一條引流管排出腦脊液，
08:19
and then eventually bring
this drain internal to the body.
this drain internal to the body.
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引流到身體的內部。
08:21
Big operation.
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這是個大手術。
08:24
But some great news is that advances
in neurosurgical care
in neurosurgical care
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好消息是神經外科醫療
已經進步到
08:28
have allowed us to develop
minimally invasive approaches
minimally invasive approaches
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能讓我們施行微創手術。
08:32
to this surgery.
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相機可通過小針孔
08:33
Through a small pinhole,
a camera can be inserted,
a camera can be inserted,
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08:38
led into the deep brain structure,
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進入深層的腦結構，
08:41
and cause a little hole in a membrane
that allows all that fluid to drain,
that allows all that fluid to drain,
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在腦膜上開個小孔引流腦脊液，
08:45
much like it would in a sink.
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就像讓水槽排水一樣。
08:47
All of a sudden, the brain
is no longer under pressure,
is no longer under pressure,
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轉眼間，腦部不再受壓，
08:50
can re-expand
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能夠伸展，
08:52
and we cure the child
through a single-hole incision.
through a single-hole incision.
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開一個小切口就能治療這孩子。
08:56
But here's the problem:
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但問題是：
08:58
hydrocephalus is relatively rare.
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腦積水相當罕見，
09:00
And there are no good training methods
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沒有好的訓練方法能讓我們
09:03
to get really good at getting
this scope to the right place.
this scope to the right place.
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嫻熟地把鏡頭擺放在正確的位置。
09:06
But surgeons have been quite creative
about this, even our own.
about this, even our own.
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對此外科醫生相當有創造力，
我們自己的醫生也是。
09:11
And they've come up with training models.
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他們發明了訓練模型。
09:13
Here's the current training model.
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這是目前的訓練模型。
09:15
(Laughter)
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（笑聲）
09:17
I kid you not.
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我可沒開玩笑。
09:18
This is a red pepper,
not made in Hollywood;
not made in Hollywood;
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這是個紅椒，不是好萊塢做的，
09:21
it's real red pepper.
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而是真正的紅椒。
09:23
And what surgeons do is they stick
a scope into the pepper,
a scope into the pepper,
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外科醫生把鏡頭伸入紅椒，
09:25
and they do what is called a "seedectomy."
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進行所謂「椒籽切除術」。
09:29
(Laughter)
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（笑聲）
09:30
They use this scope to remove seeds
using a little tweezer.
using a little tweezer.
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他們用鏡頭和小鑷子摘除紅椒籽，
09:37
And that is a way to get under their belts
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那是學會基本手術操作的方式。
09:40
the rudimentary components
of doing this surgery.
of doing this surgery.
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09:44
Then they head right into
the apprenticeship model,
the apprenticeship model,
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接著他們直接進入學徒模式，
09:46
seeing many of them
as they present themselves,
as they present themselves,
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觀摩多次臨場的手術，
09:49
then doing it, and then teaching it --
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然後親自動手，接著傳授，
09:51
waiting for these patients to arrive.
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等待著新的患者。
09:54
We can do a lot better.
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我們有更好的方式。
09:56
We are manufacturing
reproductions of children
reproductions of children
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如今我們複製病童，
10:00
in order for surgeons and surgical
teams to rehearse
teams to rehearse
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讓外科醫生和手術團隊
以最接近實況的方式一再練習。
10:04
in the most relevant possible ways.
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10:07
Let me show you this.
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讓我來展示。
10:09
Here's my team
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這是我的團隊，
10:10
in what's called the SIM Engineering
Division of the Simulator Program.
Division of the Simulator Program.
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模擬計劃的模擬工程團隊。
10:15
This is an amazing team of individuals.
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團隊的每個人都很了不起。
10:18
They are mechanical engineers;
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有機械工程師，
10:20
you're seeing here, illustrators.
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和這裡看到的繪圖師。
10:22
They take primary data
from CT scans and MRIs,
from CT scans and MRIs,
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他們把電腦斷層
和核磁共振掃描的原始數據
10:27
translate it into digital information,
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轉成數字資訊，
10:30
animate it,
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做成動畫，
10:32
put it together into the components
of the child itself,
of the child itself,
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整合做成兒童自身的器官。
10:37
surface-scan elements of the child
that have been casted as needed,
that have been casted as needed,
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根據手術本身的需求，
事先已掃描兒童的器官，
10:40
depending on the surgery itself,
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10:43
and then take this digital data
and be able to output it
and be able to output it
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連同數據輸出到
10:47
on state-of-the-art,
three-dimensional printing devices
three-dimensional printing devices
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最先進的三維列印機，
10:51
that allow us to print the components
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把兒童的器官列印出來，
10:53
exactly to the micron detail of what
the child's anatomy will look like.
the child's anatomy will look like.
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細節精確到微米的程度。
10:59
You can see here,
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647130
1304
這裡看到的是
11:00
the skull of this child being printed
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兒童的頭骨
11:02
in the hours before
we performed this surgery.
we performed this surgery.
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在手術前數小時被列印出來。
11:06
But we could not do this work
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如果沒有西岸加州好萊塢的夥伴們
11:09
without our dear friends on the West Coast
in Hollywood, California.
in Hollywood, California.
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我們無法做到。
11:14
These are individuals
that are incredibly talented
that are incredibly talented
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這些是特別擅長重製現實的人。
11:18
at being able to recreate reality.
221
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2424
11:20
It was not a long leap for us.
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這不算是我們的大躍進。
11:24
The more we got into this field,
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在這個領域了解得越多就越清楚，
11:26
the more it became clear to us
that we are doing cinematography.
that we are doing cinematography.
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我們是在拍片，
11:30
We're doing filmmaking,
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1877
在製作電影。
11:32
it's just that the actors are not actors.
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2224
但不由演員演出，
而是如假包換的醫生和護士。
11:35
They're real doctors and nurses.
227
683909
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11:39
So these are some photos
of our dear friends at Fractured FX
of our dear friends at Fractured FX
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687190
3379
這些照片來自
任職於加州好萊塢
Fractured FX 的好朋友們，
Fractured FX 的好朋友們，
11:42
in Hollywood California,
229
690593
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11:44
an Emmy-Award-winning
special effects firm.
special effects firm.
230
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3574
那是個獲得艾美獎的特效公司。
11:47
This is Justin Raleigh and his group --
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3170
這是賈斯汀·羅利和他的隊友，
11:50
this is not one of our patients --
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那可不是我們的病人，
11:52
(Laughter)
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（笑聲）
11:53
but kind of the exquisite work
that these individuals do.
that these individuals do.
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而是他們的精湛作品。
11:57
We have now collaborated
and fused our experience,
and fused our experience,
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3604
我們現已融合雙方的經驗，
12:00
bringing their group
to Boston Children's Hospital,
to Boston Children's Hospital,
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2406
邀請他們團隊到波士頓兒童醫院，
12:03
sending our group
out to Hollywood, California
out to Hollywood, California
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也送我們的人去加州好萊塢，
12:05
and exchanging around this
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交流和開發這類的模擬器。
12:07
to be able to develop
these type of simulators.
these type of simulators.
239
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3003
12:10
What I'm about to show you
is a reproduction of this child.
is a reproduction of this child.
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下面向大家展示這孩子的複製模型。
12:19
You'll notice here that every hair
on the child's head is reproduced.
on the child's head is reproduced.
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可以看到
孩子的每根頭髮都被複製了。
12:24
And in fact, this is also
that reproduced child --
that reproduced child --
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事實上，這也是複製的孩子。
12:28
and I apologize for any queasy stomachs,
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若看了不舒服，我道歉。
12:31
but that is a reproduction and simulation
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那是為他們要動手術的孩子
12:34
of the child they're about to operate on.
245
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所做的模型和模擬。
12:38
Here's that membrane we had talked about,
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這是我們先前說過孩子的腦膜。
12:40
the inside of this child's brain.
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12:43
What you're going to be seeing here
is, on one side, the actual patient,
is, on one side, the actual patient,
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這裡看到的一邊是真實的病患，
12:48
and on the other side, the simulator.
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2279
另一邊是模擬的。
12:50
As I mentioned, a scope, a little camera,
needs to make its way down,
needs to make its way down,
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4350
如我先前說的
要把小相機鏡頭像這樣向下伸，
12:55
and you're seeing that here.
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12:56
It needs to make a small hole
in this membrane
in this membrane
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在腦膜上開個小洞
12:58
and allow this fluid to seep out.
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排出腦脊液。
13:03
I won't do a quiz show to see
who thinks which side is which,
who thinks which side is which,
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4641
我不考你們哪邊真，哪邊模擬。
13:08
but on the right is the simulator.
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2304
右側是模擬的。
13:12
So surgeons can now produce
training opportunities,
training opportunities,
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現在創造了訓練的機會，
13:16
do these surgeries
as many times as they want,
as many times as they want,
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3053
讓醫生可以重複做無數遍的手術，
13:19
to their heart's content,
until they feel comfortable.
until they feel comfortable.
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直到他們滿意、有信心之後，
13:22
And then, and only then,
bring the child into the operating room.
bring the child into the operating room.
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3565
才為孩子動手術。
13:26
But we don't stop here.
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不只這樣，
13:27
We know that a key step to this
is not just the skill itself,
is not just the skill itself,
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4310
我們知道關鍵不侷限於手術的技巧，
13:31
but combining that skill with a team
who's going to deliver that care.
who's going to deliver that care.
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而在結合手術團隊和技巧。
13:36
Now we turn to Formula One.
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2342
現在我們轉看
一級方程式賽車的例子。
一級方程式賽車的例子。
13:39
And here is an example
of a technician putting on a tire
of a technician putting on a tire
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3250
技師安裝輪胎，
13:42
and doing that time and time
again on this car.
again on this car.
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3209
一而再、再而三換車胎。
13:45
But that is very quickly
going to be incorporated
going to be incorporated
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2985
很快納入整個團隊的訓練中，
13:48
within team-training experiences,
267
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1931
13:50
now as a full team orchestrating
the exchange of tires
the exchange of tires
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4209
群策群力換車胎，
13:54
and getting this car back on the speedway.
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2998
把車送回賽道。
13:58
We've done that step in health care,
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3277
在醫療領域我們也這麼做。
14:01
so now what you're about to see
is a simulated operation.
is a simulated operation.
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接下來看模擬手術。
14:06
We've taken the simulator
I just described to you,
I just described to you,
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2387
把我剛才描述的模擬手術訓練
14:09
we've brought it into the operating room
at Boston Children's Hospital,
at Boston Children's Hospital,
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3401
帶進波士頓兒童醫院的手術室裡，
14:12
and these individuals --
these native teams, operative teams --
these native teams, operative teams --
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3655
本地手術團隊的這些人
14:16
are doing the surgery before the surgery.
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3523
正在進行手術前的模擬手術。
14:19
Operate twice;
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1737
練習兩次；
14:21
cut once.
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1206
實切一次。
14:23
Let me show that to you.
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851119
1396
請看。
14:25
(Video) Surgical team member 1:
You want the head down or head up?
You want the head down or head up?
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853417
3113
（影片）手術團隊成員之一：
頭放低還是放高？
頭放低還是放高？
14:28
STM 2: Can you lower it down to 10?
280
856554
1704
團員二：降低到 10 好嗎？
14:30
STM 3: And then lower
the whole table down a little bit?
the whole table down a little bit?
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2649
團員三：把整個手術台
降低點，好嗎？
降低點，好嗎？
14:32
STM 4: Table coming down.
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860955
1254
團員四：正在降低手術台。
14:36
STM 3: All right, this
is behaving like a vessel.
is behaving like a vessel.
283
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2705
團員三：好，這像是條血管。
14:39
Could we have the scissors back, please?
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2087
請把剪刀拿回來好嗎？
14:41
STM 5: I'm taking my gloves,
8 to 8 1/2, all right? I'll be right in.
8 to 8 1/2, all right? I'll be right in.
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3301
團員五：我正脫除手套。
8 到 8 1/2 好嗎？馬上回來。
8 到 8 1/2 好嗎？馬上回來。
14:45
STM 6: Great! Thank you.
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2401
團員六：太好了！謝謝。
14:48
Peter Weinstock: It's really amazing.
287
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1833
（彼得·萬斯托克）真的很棒。
14:50
The second step to this,
which is critical,
which is critical,
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2092
接下來是關鍵的第二步：
14:52
is we take these teams out
immediately and debrief them.
immediately and debrief them.
289
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3099
立刻請團隊出來聽簡報。
14:55
We use the same technologies
290
883432
1464
用和軍方一樣的
14:56
that are used in Lean
and Six Sigma in the military,
and Six Sigma in the military,
291
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4688
「精實六標準差」，
15:01
and we bring them out
and talk about what went right,
and talk about what went right,
292
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3085
討論哪裡做得好，
15:04
but more importantly,
293
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1645
更重要的是知道哪裡做得不好
15:06
we talk about what didn't go well,
294
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2467
15:08
and how we're going to fix it.
295
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1935
以及要如何改正。
15:10
Then we bring them right back in
and do it again.
and do it again.
296
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2754
然後讓他們立刻回手術室再做一次。
15:13
Deliberative batting practice
in the moments when it matters most.
in the moments when it matters most.
297
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5191
是緊要關頭的刻意擊球練習。
15:20
Let's go back to this case now.
298
908438
2022
回到這個病例。
15:23
Same child,
299
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1377
同一個孩子，
15:24
but now let me describe
how we care for this child
how we care for this child
300
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2390
現在描述我們在波士頓兒童醫院
15:26
at Boston Children's Hospital.
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1463
如何護理這個孩子。
15:28
This child was born
at three o'clock in the morning.
at three o'clock in the morning.
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2486
這孩子在凌晨三點出生。
15:30
At two o'clock in the morning,
303
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2007
在凌晨兩點，
15:32
we assembled the team,
304
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2126
我們就集合醫療團隊，
15:35
and took the reproduced anatomy
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1801
把用掃描和影像所複製的解剖結構
15:36
that we would gain
out of scans and images,
out of scans and images,
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3705
15:40
and brought that team
to the virtual bedside,
to the virtual bedside,
307
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2766
及團隊送到虛擬病床，
15:43
to a simulated bedside --
308
931420
1587
也就是模擬的病床。
15:45
the same team that's going to operate
on this child in the hours ahead --
on this child in the hours ahead --
309
933031
3541
幾個小時後同一團隊
要為這孩子動手術，
要為這孩子動手術，
15:48
and we have them do the procedure.
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2383
先讓他們操作模擬一遍。
15:51
Let me show you a moment of this.
311
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1680
請看其中的片段，
15:54
This is not a real incision.
312
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2160
不是真的切口，
15:57
And the baby has not yet been born.
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嬰兒尚未出生。
16:01
Imagine this.
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想像一下，
16:04
So now the conversations
that I have with families
that I have with families
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如今我與孩子的家人
在波士頓兒童醫院加護病房的對話
16:08
in the intensive care unit
at Boston Children's Hospital
at Boston Children's Hospital
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和以往截然不同。
16:10
are totally different.
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想像這對話：
16:12
Imagine this conversation:
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「我們不僅常在加護病房醫這種病，
16:15
"Not only do we take care of this disorder
frequently in our ICU,
frequently in our ICU,
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不僅曾多次做過
將要為令郎／令嬡進行的手術，
將要為令郎／令嬡進行的手術，
16:20
and not only have we done surgeries
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16:22
like the surgery we're going
to do on your child,
to do on your child,
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16:25
but we have done your child's surgery.
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而且，我們已為他／她手術過了，
16:29
And we did it two hours ago.
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兩個小時前做了十回。
16:32
And we did it 10 times.
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16:35
And now we're prepared to take them
back to the operating room."
back to the operating room."
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我們已準備好進行真正的手術。」
16:40
So a new technology in health care:
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新的醫療技術：
16:44
lifelike rehearsal.
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栩栩如生的模擬醫學演練，
16:47
Practicing prior to game time.
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賽前的練習。
16:51
Thank you.
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謝謝。
16:52
(Applause)
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（鼓掌）
ABOUT THE SPEAKER
Peter Weinstock - Pediatric ICU doctorDr. Peter Weinstock is an Intensive Care Unit physician and Director of the Pediatric Simulator Program at Boston Children's Hospital/Harvard Medical School. Peter and his team fuse medicine with state of the art special effects, puppeteering and 3D printing technologies to create lifelike simulations of complex surgeries.
Why you should listen
Dr. Peter Weinstock has merged his lifelong interest in human nature, medicine, theater and puppetry to develop one of the most advanced rehearsal spaces in medicine. Weinstock is a practicing pediatric intensive care unit physician at Boston Children's Hospital, where he serves as Senior Associate in Critical Care Medicine, Associate Professor of Anesthesia at Harvard Medical School, Chair of Pediatric Simulation and Director of the Boston Children's Hospital Simulator Program (SIMPeds). Weinstock works with his team of educators, psychologists, engineers, animators, special effects designers and 3D printers to immerse doctors, nurses, patients and their families in Hollywood-style "life-like" experiences -- all to optimize performance, clinical outcomes, as well as the entire healthcare journey for children and their families.
Weinstock received his PhD from Rockefeller University in molecular and cell biology, followed by clinical training in plastic and general surgery at the University of Pittsburgh and general pediatrics and critical care medicine at the Boston Children’s Hospital. His passion is in developing methods that link highly realistic practice and preparedness training directly to the delivery of high quality, safe care to improve the lives of infants, children and their families. Due to its inherent emotionality, Weinstock's approach to simulation is keenly connected to emotionality and behavioral psychology as essential elements of relationships and decision-making to understand and optimize human-human and human-technology interactions. Weinstock has rapidly grown SIMPeds to thousands of simulations per year, and the SIMPeds method has been adopted among pediatric teaching centers around the globe.
Weinstock frequently lectures internationally on state of art simulation and experiential learning, and he has published sentinel articles in innovative application and approaches to simulation -- from human factors to engineering and testing of next generation of ultra-realistic training devices. He has chaired meetings worldwide and is Founding President of the International Pediatric Simulation Society.
Peter Weinstock | Speaker | TED.com