IT-oriented clinical education, which enables clinicians to reconfirm their clinical knoweldge under psudo-clinical experience via simulators, is key issue to establish clinical safety. Well-orchestrated development harmonizing teaching materials (simulators), teaching environments (education centers) and and teaching programs (curriculums) is essential to mazimize effect of IT-based education. Initiative, finantial support, and systemtic reform by public sector to setablish central organization for development and authorization of the materials, environmtns, and programs is also important

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This paper presents a survey of the work done in a medical education based on information technology (IT) and a simulation technology. We researched some medical center in Japan, Europe, and USA. Special emphasis is placed on two types of simulator. One is a human patient simulator for a education of students and intern, the other is a VR based surgical simulator for a surgeons.

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Teaching technical skills using simulators for undergraduate and graduate medical education has emerged in recent years. The objective of this study was to examine the status of simulator-based education in hospitals including the university hospitals for these medical educations in Japan. Simulators have already been diffused in many hospitals. The objectives of simulators were different in undergraduate and graduate medical education, respectively. The main objective was acquisition of competency for physical examination for undergraduate medical education and technical skills for graduate medical education. It is needed for us to plan efficient programs (curriculum) using simulators to attain these objectives.

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Virtual Reality (VR) based training systems are becoming popular in medicine. Successful asynchronous teaching of psychomotor skills by recording expert's actions and replaying them to novices would boost the speed of training process. These record-and-replay teaching methods have been demonstrated only in less complex domains, typically in handwriting. This study evaluates a so called record-annotate-replay approach for teaching Digital Rectal Examination (DRE) skill in a simulated Virtual Environment (VE). Experienced urologists' performances were recorded on a physics-based DRE simulator, after which they encapsulated their insight on the skill by making VR annotations to the VE's physical parameters which should be taught. Priority of physical parameters with three-dimensional features and reificative features are pointed out on the recorded performances. In a training experiment, medical students were able to “read” the VR annotations by proactive mainpulation in the VE, which enhanced learning of the skill in comparison to a control group who trained by following visually replayed urologists' movements. This study acts as a proof-of-concept of record-annotate-replay approach which has potential to reduce the restrictions of time, space, language and number of people involved when in VR based teaching of psychomotor skills.

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Objective : This study aimed to evaluate the impact of virtual reality (VR) surgical simulator training on improvement of individual skills for endoscopic surgery and to consider its role in the training system. Methods : (1) Forty-one subjects were assigned to one of the three groups : experienced surgeons experiencing >50 endoscopic procedures (n=12), inexperienced surgeons (1～30 endoscopic procedures, n=9), and medical students with no prior experience (n=20). The participants were trained with LapSim® simulator, and their skills were evaluated with LapSim® “Cutting” task before and after the training. (2) Twenty subjects received training for endoscopic suturing using two types of VR simulator and a training box. After the training, they were asked to select the best training modality. Results : (1) Significant improvements in laparoscopic skills were observed in all three groups after the training. The significant differences in surgical skills observed between each group diminished following the training. (2) Most (15/20) subjects chose the box training as the best training method due to its authenticity. Conclusions : VR simulator is useful in the acquisition of psychomotor skills, but not sufficient for training the suturing technique. The role of VR simulator, currently limited in the training of endoscopic surgery, is expected to expand pending　future progress of VR technology.

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The authors have been developing a practical surgical simulator since 2004 under the contract of National Institute of Information and Communications Technology (NICT). Unlike already commercialized laparoscopic surgical simulators, our surgical simulator is capable for training to improve operation skill and preoperative trainings using particular patients' data. We have completed engineering related development of the simulation-platform, and are now carrying out implementation of urinary organ related laparoscopic operation procedure on the platform with Yokohama City University graduate school of medicine course which is a collaborative research organization.

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