[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:17.30,0:00:21.18,Default,,0000,0000,0000,,What if I told you\Nthere was a new technology
Dialogue: 0,0:00:21.20,0:00:25.77,Default,,0000,0000,0000,,that, when placed in the hands\Nof doctors and nurses,
Dialogue: 0,0:00:25.79,0:00:30.94,Default,,0000,0000,0000,,improved outcomes for children\Nand adults, patients of all ages;
Dialogue: 0,0:00:31.99,0:00:34.53,Default,,0000,0000,0000,,reduced pain and suffering,
Dialogue: 0,0:00:34.56,0:00:37.75,Default,,0000,0000,0000,,reduced time in the operating rooms,
Dialogue: 0,0:00:37.77,0:00:40.62,Default,,0000,0000,0000,,reduced anesthetic times,
Dialogue: 0,0:00:40.65,0:00:42.55,Default,,0000,0000,0000,,had the ultimate dose-response curve
Dialogue: 0,0:00:42.57,0:00:44.32,Default,,0000,0000,0000,,that the more you did it,
Dialogue: 0,0:00:44.34,0:00:46.66,Default,,0000,0000,0000,,the better it benefitted patients?
Dialogue: 0,0:00:47.84,0:00:50.24,Default,,0000,0000,0000,,Here's a kicker: it has no side effects,
Dialogue: 0,0:00:51.67,0:00:54.68,Default,,0000,0000,0000,,and it's available no matter\Nwhere care is delivered.
Dialogue: 0,0:00:55.84,0:00:59.28,Default,,0000,0000,0000,,I can tell you as an ICU doctor\Nat Boston Children's Hospital,
Dialogue: 0,0:00:59.30,0:01:01.61,Default,,0000,0000,0000,,this would be a game changer for me.
Dialogue: 0,0:01:02.86,0:01:06.47,Default,,0000,0000,0000,,And the good news is that I'm here\Nto tell you about this technology
Dialogue: 0,0:01:06.49,0:01:10.86,Default,,0000,0000,0000,,and that we're finding, as we apply\Nthis technology in health care,
Dialogue: 0,0:01:10.88,0:01:13.97,Default,,0000,0000,0000,,we are having these exact outcomes\NI've just described to you.
Dialogue: 0,0:01:15.13,0:01:19.76,Default,,0000,0000,0000,,That technology is lifelike rehearsal.
Dialogue: 0,0:01:20.63,0:01:23.17,Default,,0000,0000,0000,,Just in the times that matter most,
Dialogue: 0,0:01:23.20,0:01:26.57,Default,,0000,0000,0000,,and in the places that matter most,\Nand for the teams that matter most,
Dialogue: 0,0:01:26.59,0:01:29.76,Default,,0000,0000,0000,,and ultimately, for the patients\Nthat matter most.
Dialogue: 0,0:01:29.78,0:01:31.28,Default,,0000,0000,0000,,And this technology,
Dialogue: 0,0:01:31.30,0:01:32.66,Default,,0000,0000,0000,,this lifelike rehearsal,
Dialogue: 0,0:01:32.68,0:01:35.87,Default,,0000,0000,0000,,is being delivered\Nthrough medical simulation.
Dialogue: 0,0:01:37.42,0:01:41.42,Default,,0000,0000,0000,,I thought I would start with a case,
Dialogue: 0,0:01:41.45,0:01:44.16,Default,,0000,0000,0000,,just to really describe\Nthe challenge ahead,
Dialogue: 0,0:01:44.18,0:01:47.55,Default,,0000,0000,0000,,and why this technology is not just\Ngoing to improve health care
Dialogue: 0,0:01:47.58,0:01:50.26,Default,,0000,0000,0000,,but why it's critical to health care.
Dialogue: 0,0:01:51.10,0:01:53.97,Default,,0000,0000,0000,,This is a child that's born, young girl.
Dialogue: 0,0:01:53.100,0:01:55.76,Default,,0000,0000,0000,,"Day of life zero," we call it,
Dialogue: 0,0:01:55.78,0:01:58.08,Default,,0000,0000,0000,,the first day of life,\Njust born into the world.
Dialogue: 0,0:01:58.10,0:01:59.49,Default,,0000,0000,0000,,And just as she's being born,
Dialogue: 0,0:01:59.52,0:02:01.95,Default,,0000,0000,0000,,we notice very quickly\Nthat she is deteriorating.
Dialogue: 0,0:02:02.47,0:02:05.38,Default,,0000,0000,0000,,Her heart rate is going up,\Nher blood pressure is going down,
Dialogue: 0,0:02:05.41,0:02:07.05,Default,,0000,0000,0000,,she's breathing very, very fast.
Dialogue: 0,0:02:07.81,0:02:12.28,Default,,0000,0000,0000,,And the reason for this\Nis displayed in this chest X-ray.
Dialogue: 0,0:02:15.94,0:02:19.04,Default,,0000,0000,0000,,You can see here,\Nit's a quick study in radiology.
Dialogue: 0,0:02:19.06,0:02:21.61,Default,,0000,0000,0000,,As you see here, the upper portion\Nof this child's --
Dialogue: 0,0:02:21.63,0:02:22.94,Default,,0000,0000,0000,,That's called a babygram,
Dialogue: 0,0:02:22.97,0:02:26.24,Default,,0000,0000,0000,,a full X-ray of a child's body,\Na little infant's body.
Dialogue: 0,0:02:26.27,0:02:28.17,Default,,0000,0000,0000,,As you look on the top side of this,
Dialogue: 0,0:02:28.20,0:02:30.68,Default,,0000,0000,0000,,that's where the heart and lungs\Nare supposed to be.
Dialogue: 0,0:02:30.70,0:02:33.48,Default,,0000,0000,0000,,As you look at the bottom end,\Nthat's where the abdomen is,
Dialogue: 0,0:02:33.50,0:02:35.93,Default,,0000,0000,0000,,and that's where the intestines\Nare supposed to be.
Dialogue: 0,0:02:35.95,0:02:38.68,Default,,0000,0000,0000,,And you can see how\Nthere's sort of that translucent area
Dialogue: 0,0:02:38.70,0:02:41.87,Default,,0000,0000,0000,,that made its way up into the right side\Nof this child's chest.
Dialogue: 0,0:02:41.90,0:02:45.91,Default,,0000,0000,0000,,And those are the intestines --\Nin the wrong place.
Dialogue: 0,0:02:45.93,0:02:48.10,Default,,0000,0000,0000,,As a result, they're pushing on the lungs
Dialogue: 0,0:02:48.12,0:02:51.10,Default,,0000,0000,0000,,and making it very difficult\Nfor this poor baby to breathe.
Dialogue: 0,0:02:51.65,0:02:53.14,Default,,0000,0000,0000,,The fix for this problem
Dialogue: 0,0:02:53.16,0:02:55.82,Default,,0000,0000,0000,,is to take this child immediately\Nto the operating room,
Dialogue: 0,0:02:55.84,0:02:57.97,Default,,0000,0000,0000,,bring those intestines\Nback into the abdomen,
Dialogue: 0,0:02:57.100,0:02:59.41,Default,,0000,0000,0000,,let the lungs expand
Dialogue: 0,0:02:59.44,0:03:01.32,Default,,0000,0000,0000,,and allow this child to breathe again.
Dialogue: 0,0:03:01.92,0:03:03.98,Default,,0000,0000,0000,,But before she can go\Nto the operating room,
Dialogue: 0,0:03:04.00,0:03:07.29,Default,,0000,0000,0000,,she must get whisked away\Nto the ICU, where I work.
Dialogue: 0,0:03:07.32,0:03:09.18,Default,,0000,0000,0000,,I work with surgical teams.
Dialogue: 0,0:03:09.21,0:03:10.51,Default,,0000,0000,0000,,We gather around her,
Dialogue: 0,0:03:10.53,0:03:14.64,Default,,0000,0000,0000,,and we place this child\Non heart-lung bypass.
Dialogue: 0,0:03:16.03,0:03:17.65,Default,,0000,0000,0000,,We put her to sleep,
Dialogue: 0,0:03:17.67,0:03:20.27,Default,,0000,0000,0000,,we make a tiny\Nlittle incision in the neck,
Dialogue: 0,0:03:20.29,0:03:23.43,Default,,0000,0000,0000,,we place catheters into the major\Nvessels of the neck --
Dialogue: 0,0:03:23.45,0:03:27.15,Default,,0000,0000,0000,,and I can tell you that these vessels\Nare about the size of a pen,
Dialogue: 0,0:03:27.17,0:03:29.08,Default,,0000,0000,0000,,the tip of a pen --
Dialogue: 0,0:03:29.10,0:03:31.18,Default,,0000,0000,0000,,and then we have blood\Ndrawn from the body,
Dialogue: 0,0:03:31.21,0:03:33.62,Default,,0000,0000,0000,,we bring it through a machine,\Nit gets oxygenated,
Dialogue: 0,0:03:33.64,0:03:35.49,Default,,0000,0000,0000,,and it goes back into the body.
Dialogue: 0,0:03:35.52,0:03:37.09,Default,,0000,0000,0000,,We save her life,
Dialogue: 0,0:03:37.12,0:03:39.64,Default,,0000,0000,0000,,and get her safely to the operating room.
Dialogue: 0,0:03:41.48,0:03:42.76,Default,,0000,0000,0000,,Here's the problem:
Dialogue: 0,0:03:44.30,0:03:45.88,Default,,0000,0000,0000,,these disorders --
Dialogue: 0,0:03:45.90,0:03:49.19,Default,,0000,0000,0000,,what is known is congenital\Ndiaphragmatic hernia --
Dialogue: 0,0:03:49.21,0:03:52.81,Default,,0000,0000,0000,,this hole in the diaphragm that has\Nallowed these intestines to sneak up --
Dialogue: 0,0:03:52.83,0:03:54.80,Default,,0000,0000,0000,,these disorders are rare.
Dialogue: 0,0:03:55.72,0:03:59.55,Default,,0000,0000,0000,,Even in the best hands in the world,
Dialogue: 0,0:03:59.57,0:04:03.08,Default,,0000,0000,0000,,there is still a challenge\Nto get the volume --
Dialogue: 0,0:04:03.11,0:04:05.00,Default,,0000,0000,0000,,the natural volume of these patients --
Dialogue: 0,0:04:05.03,0:04:07.55,Default,,0000,0000,0000,,in order to get our expertise\Ncurve at 100 percent.
Dialogue: 0,0:04:07.57,0:04:09.67,Default,,0000,0000,0000,,They just don't present that often.
Dialogue: 0,0:04:11.06,0:04:13.96,Default,,0000,0000,0000,,So how do you make the rare common?
Dialogue: 0,0:04:16.43,0:04:17.73,Default,,0000,0000,0000,,Here's the other problem:
Dialogue: 0,0:04:18.69,0:04:23.29,Default,,0000,0000,0000,,in the health care system\Nthat I trained for over 20 years,
Dialogue: 0,0:04:23.31,0:04:24.50,Default,,0000,0000,0000,,what currently exists,
Dialogue: 0,0:04:24.52,0:04:27.47,Default,,0000,0000,0000,,the model of training is called\Nthe apprenticeship model.
Dialogue: 0,0:04:27.49,0:04:29.41,Default,,0000,0000,0000,,It's been around for centuries.
Dialogue: 0,0:04:29.43,0:04:33.38,Default,,0000,0000,0000,,It's based on this idea that you see\Na surgery maybe once,
Dialogue: 0,0:04:33.40,0:04:34.93,Default,,0000,0000,0000,,maybe several times,
Dialogue: 0,0:04:34.95,0:04:37.74,Default,,0000,0000,0000,,you then go do that surgery,
Dialogue: 0,0:04:37.77,0:04:41.33,Default,,0000,0000,0000,,and then ultimately you teach\Nthat surgery to the next generation.
Dialogue: 0,0:04:42.77,0:04:45.52,Default,,0000,0000,0000,,And implicit in this model --
Dialogue: 0,0:04:45.55,0:04:47.72,Default,,0000,0000,0000,,I don't need to tell you this --
Dialogue: 0,0:04:47.74,0:04:52.70,Default,,0000,0000,0000,,is that we practice on the very patients\Nthat we are delivering care to.
Dialogue: 0,0:04:54.63,0:04:56.31,Default,,0000,0000,0000,,That's a problem.
Dialogue: 0,0:04:59.61,0:05:01.80,Default,,0000,0000,0000,,I think there's a better approach.
Dialogue: 0,0:05:01.83,0:05:06.19,Default,,0000,0000,0000,,Medicine may very well be the last\Nhigh-stakes industry
Dialogue: 0,0:05:06.22,0:05:08.94,Default,,0000,0000,0000,,that does not practice prior to game time.
Dialogue: 0,0:05:10.64,0:05:14.82,Default,,0000,0000,0000,,I want to describe to you a better\Napproach through medical simulation.
Dialogue: 0,0:05:16.65,0:05:20.03,Default,,0000,0000,0000,,Well, the first thing we did is we went\Nto other high-stakes industries
Dialogue: 0,0:05:20.05,0:05:22.92,Default,,0000,0000,0000,,that had been using this type\Nof methodology for decades.
Dialogue: 0,0:05:22.94,0:05:24.61,Default,,0000,0000,0000,,This is nuclear power.
Dialogue: 0,0:05:24.63,0:05:28.67,Default,,0000,0000,0000,,Nuclear power runs scenarios\Non a regular basis
Dialogue: 0,0:05:28.70,0:05:31.92,Default,,0000,0000,0000,,in order to practice\Nwhat they hope will never occur.
Dialogue: 0,0:05:32.44,0:05:36.29,Default,,0000,0000,0000,,And as we're all very familiar,\Nthe airline industry --
Dialogue: 0,0:05:36.31,0:05:39.61,Default,,0000,0000,0000,,we all get on planes now,\Ncomforted by the idea
Dialogue: 0,0:05:39.64,0:05:45.43,Default,,0000,0000,0000,,that pilots and crews have trained\Non simulators much like these,
Dialogue: 0,0:05:45.46,0:05:48.02,Default,,0000,0000,0000,,training on scenarios\Nthat we hope will never occur,
Dialogue: 0,0:05:48.04,0:05:50.12,Default,,0000,0000,0000,,but we know if they did,
Dialogue: 0,0:05:50.14,0:05:52.66,Default,,0000,0000,0000,,they would be prepared for the worst.
Dialogue: 0,0:05:53.16,0:05:57.56,Default,,0000,0000,0000,,In fact, the airline industry has gone\Nas far as to create fuselages
Dialogue: 0,0:05:57.59,0:05:59.13,Default,,0000,0000,0000,,of simulation environments,
Dialogue: 0,0:05:59.16,0:06:02.40,Default,,0000,0000,0000,,because of the importance\Nof the team coming together.
Dialogue: 0,0:06:03.04,0:06:05.31,Default,,0000,0000,0000,,This is an evacuation drill simulator.
Dialogue: 0,0:06:05.94,0:06:09.80,Default,,0000,0000,0000,,So again, if that ever were to happen,\Nthese rare, rare events,
Dialogue: 0,0:06:09.83,0:06:13.12,Default,,0000,0000,0000,,they're ready to act\Non the drop of a dime.
Dialogue: 0,0:06:15.12,0:06:20.43,Default,,0000,0000,0000,,I guess the most compelling for me\Nin some ways is the sports industry --
Dialogue: 0,0:06:20.46,0:06:22.09,Default,,0000,0000,0000,,arguably high stakes.
Dialogue: 0,0:06:22.70,0:06:25.96,Default,,0000,0000,0000,,You think about a baseball team:\Nbaseball players practice.
Dialogue: 0,0:06:25.99,0:06:28.66,Default,,0000,0000,0000,,I think it's a beautiful example\Nof progressive training.
Dialogue: 0,0:06:28.68,0:06:31.44,Default,,0000,0000,0000,,The first thing they do\Nis go out to spring training.
Dialogue: 0,0:06:31.47,0:06:33.73,Default,,0000,0000,0000,,They go to a spring training camp,
Dialogue: 0,0:06:33.76,0:06:36.27,Default,,0000,0000,0000,,perhaps a simulator in baseball.
Dialogue: 0,0:06:36.80,0:06:39.84,Default,,0000,0000,0000,,They're not on the real field,\Nbut they're on a simulated field,
Dialogue: 0,0:06:39.87,0:06:41.90,Default,,0000,0000,0000,,and they're playing in the pregame season.
Dialogue: 0,0:06:41.92,0:06:45.42,Default,,0000,0000,0000,,Then they make their way to the field\Nduring the season games,
Dialogue: 0,0:06:45.45,0:06:48.54,Default,,0000,0000,0000,,and what's the first thing they do\Nbefore they start the game?
Dialogue: 0,0:06:48.57,0:06:52.100,Default,,0000,0000,0000,,They go into the batting cage\Nand do batting practice for hours,
Dialogue: 0,0:06:53.02,0:06:56.35,Default,,0000,0000,0000,,having different types of pitches\Nbeing thrown at them,
Dialogue: 0,0:06:56.38,0:07:00.71,Default,,0000,0000,0000,,hitting ball after ball\Nas they limber their muscles,
Dialogue: 0,0:07:00.73,0:07:02.71,Default,,0000,0000,0000,,getting ready for the game itself.
Dialogue: 0,0:07:02.73,0:07:05.58,Default,,0000,0000,0000,,And here's the most\Nphenomenal part of this,
Dialogue: 0,0:07:06.76,0:07:09.26,Default,,0000,0000,0000,,and for all of you who watch\Nany sport event,
Dialogue: 0,0:07:09.28,0:07:11.19,Default,,0000,0000,0000,,you will see this phenomenon happen.
Dialogue: 0,0:07:12.07,0:07:14.76,Default,,0000,0000,0000,,The batter gets into the batter's box,
Dialogue: 0,0:07:14.78,0:07:16.90,Default,,0000,0000,0000,,the pitcher gets ready to pitch.
Dialogue: 0,0:07:16.93,0:07:20.03,Default,,0000,0000,0000,,Right before the pitch is thrown,
Dialogue: 0,0:07:20.06,0:07:21.27,Default,,0000,0000,0000,,what does that batter do?
Dialogue: 0,0:07:21.29,0:07:23.20,Default,,0000,0000,0000,,The batter steps out of the box
Dialogue: 0,0:07:24.51,0:07:25.98,Default,,0000,0000,0000,,and takes a practice swing.
Dialogue: 0,0:07:28.64,0:07:30.47,Default,,0000,0000,0000,,He wouldn't do it any other way.
Dialogue: 0,0:07:33.11,0:07:36.53,Default,,0000,0000,0000,,I want to talk to you about how\Nwe're building practice swings like this
Dialogue: 0,0:07:36.55,0:07:37.71,Default,,0000,0000,0000,,in medicine.
Dialogue: 0,0:07:37.73,0:07:41.91,Default,,0000,0000,0000,,We are building batting cages\Nfor the patients that we care about
Dialogue: 0,0:07:41.94,0:07:43.16,Default,,0000,0000,0000,,at Boston Children's.
Dialogue: 0,0:07:43.19,0:07:45.68,Default,,0000,0000,0000,,I want to use this case\Nthat we recently built.
Dialogue: 0,0:07:46.20,0:07:50.48,Default,,0000,0000,0000,,It's the case of a four-year-old\Nwho had a progressively enlarging head,
Dialogue: 0,0:07:50.50,0:07:51.78,Default,,0000,0000,0000,,and as a result,
Dialogue: 0,0:07:51.80,0:07:54.93,Default,,0000,0000,0000,,had loss of developmental milestones,\Nneurologic milestones,
Dialogue: 0,0:07:54.96,0:07:57.97,Default,,0000,0000,0000,,and the reason for this problem is here --
Dialogue: 0,0:07:58.30,0:08:00.32,Default,,0000,0000,0000,,it's called hydrocephalus.
Dialogue: 0,0:08:01.17,0:08:04.04,Default,,0000,0000,0000,,So, a quick study in neurosurgery.
Dialogue: 0,0:08:04.07,0:08:05.23,Default,,0000,0000,0000,,There's the brain,
Dialogue: 0,0:08:05.26,0:08:07.80,Default,,0000,0000,0000,,and you can see the cranium\Nsurrounding the brain.
Dialogue: 0,0:08:08.27,0:08:11.61,Default,,0000,0000,0000,,What surrounds the brain,\Nbetween the brain and cranium,
Dialogue: 0,0:08:11.64,0:08:14.86,Default,,0000,0000,0000,,is something called\Ncerebrospinal fluid or fluid,
Dialogue: 0,0:08:14.88,0:08:16.61,Default,,0000,0000,0000,,which acts as a shock absorber.
Dialogue: 0,0:08:17.21,0:08:18.53,Default,,0000,0000,0000,,In your heads right now,
Dialogue: 0,0:08:18.55,0:08:21.81,Default,,0000,0000,0000,,there is cerebrospinal fluid\Njust bathing your brains
Dialogue: 0,0:08:21.83,0:08:23.66,Default,,0000,0000,0000,,and making its way around.
Dialogue: 0,0:08:23.68,0:08:26.31,Default,,0000,0000,0000,,It's produced in one area\Nand flows through,
Dialogue: 0,0:08:26.33,0:08:27.62,Default,,0000,0000,0000,,and then is re-exchanged.
Dialogue: 0,0:08:27.65,0:08:30.54,Default,,0000,0000,0000,,And this beautiful flow pattern\Noccurs for all of us.
Dialogue: 0,0:08:31.12,0:08:33.17,Default,,0000,0000,0000,,But unfortunately in some children,
Dialogue: 0,0:08:33.19,0:08:35.70,Default,,0000,0000,0000,,there's a blockage of this flow pattern,
Dialogue: 0,0:08:35.72,0:08:37.27,Default,,0000,0000,0000,,much like a traffic jam.
Dialogue: 0,0:08:37.74,0:08:40.57,Default,,0000,0000,0000,,As a result, the fluid accumulates,
Dialogue: 0,0:08:40.59,0:08:43.11,Default,,0000,0000,0000,,and the brain is pushed aside.
Dialogue: 0,0:08:43.81,0:08:45.64,Default,,0000,0000,0000,,It has difficulty growing.
Dialogue: 0,0:08:46.28,0:08:49.62,Default,,0000,0000,0000,,As a result, the child loses\Nneurologic milestones.
Dialogue: 0,0:08:49.65,0:08:52.06,Default,,0000,0000,0000,,This is a devastating disease in children.
Dialogue: 0,0:08:52.37,0:08:55.45,Default,,0000,0000,0000,,The cure for this is surgery.
Dialogue: 0,0:08:55.57,0:08:58.48,Default,,0000,0000,0000,,The traditional surgery is to take\Na bit of the cranium off,
Dialogue: 0,0:08:58.50,0:08:59.66,Default,,0000,0000,0000,,a bit of the skull,
Dialogue: 0,0:08:59.69,0:09:02.63,Default,,0000,0000,0000,,drain this fluid out,\Nstick a drain in place,
Dialogue: 0,0:09:02.65,0:09:05.38,Default,,0000,0000,0000,,and then eventually bring\Nthis drain internal to the body.
Dialogue: 0,0:09:05.41,0:09:06.62,Default,,0000,0000,0000,,Big operation.
Dialogue: 0,0:09:07.60,0:09:11.91,Default,,0000,0000,0000,,But some great news is that advances\Nin neurosurgical care
Dialogue: 0,0:09:11.94,0:09:15.65,Default,,0000,0000,0000,,have allowed us to develop\Nminimally invasive approaches
Dialogue: 0,0:09:15.67,0:09:16.83,Default,,0000,0000,0000,,to this surgery.
Dialogue: 0,0:09:16.85,0:09:21.18,Default,,0000,0000,0000,,Through a small pinhole,\Na camera can be inserted,
Dialogue: 0,0:09:22.43,0:09:25.16,Default,,0000,0000,0000,,led into the deep brain structure,
Dialogue: 0,0:09:25.18,0:09:29.14,Default,,0000,0000,0000,,and cause a little hole in a membrane\Nthat allows all that fluid to drain,
Dialogue: 0,0:09:29.16,0:09:31.21,Default,,0000,0000,0000,,much like it would in a sink.
Dialogue: 0,0:09:31.23,0:09:34.35,Default,,0000,0000,0000,,All of a sudden, the brain\Nis no longer under pressure,
Dialogue: 0,0:09:34.37,0:09:35.83,Default,,0000,0000,0000,,can re-expand
Dialogue: 0,0:09:35.85,0:09:38.73,Default,,0000,0000,0000,,and we cure the child\Nthrough a single-hole incision.
Dialogue: 0,0:09:40.16,0:09:41.57,Default,,0000,0000,0000,,But here's the problem:
Dialogue: 0,0:09:41.60,0:09:43.74,Default,,0000,0000,0000,,hydrocephalus is relatively rare.
Dialogue: 0,0:09:44.41,0:09:46.82,Default,,0000,0000,0000,,And there are no good training methods
Dialogue: 0,0:09:46.84,0:09:50.47,Default,,0000,0000,0000,,to get really good at getting\Nthis scope to the right place.
Dialogue: 0,0:09:50.49,0:09:54.81,Default,,0000,0000,0000,,But surgeons have been quite creative\Nabout this, even our own.
Dialogue: 0,0:09:54.83,0:09:56.84,Default,,0000,0000,0000,,And they've come up with training models.
Dialogue: 0,0:09:56.86,0:09:58.59,Default,,0000,0000,0000,,Here's the current training model.
Dialogue: 0,0:09:58.61,0:10:00.57,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:10:00.59,0:10:02.25,Default,,0000,0000,0000,,I kid you not.
Dialogue: 0,0:10:02.27,0:10:03.50,Default,,0000,0000,0000,,This is a red pepper,
Dialogue: 0,0:10:05.02,0:10:06.21,Default,,0000,0000,0000,,not made in Hollywood;
Dialogue: 0,0:10:06.24,0:10:07.56,Default,,0000,0000,0000,,it's a real red pepper.
Dialogue: 0,0:10:08.00,0:10:10.95,Default,,0000,0000,0000,,And what surgeons do is they stick\Na scope into the pepper,
Dialogue: 0,0:10:10.97,0:10:14.07,Default,,0000,0000,0000,,and they do what is called a "seedectomy."
Dialogue: 0,0:10:14.09,0:10:15.86,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:10:15.88,0:10:21.98,Default,,0000,0000,0000,,They use this scope to remove seeds\Nusing a little tweezer.
Dialogue: 0,0:10:22.65,0:10:25.28,Default,,0000,0000,0000,,And that is a way to get under their belts
Dialogue: 0,0:10:25.30,0:10:28.30,Default,,0000,0000,0000,,the rudimentary components\Nof doing this surgery.
Dialogue: 0,0:10:28.96,0:10:31.39,Default,,0000,0000,0000,,Then they head right into\Nthe apprenticeship model,
Dialogue: 0,0:10:31.42,0:10:34.29,Default,,0000,0000,0000,,seeing many of them\Nas they present themselves,
Dialogue: 0,0:10:34.31,0:10:36.30,Default,,0000,0000,0000,,then doing it, and then teaching it --
Dialogue: 0,0:10:36.33,0:10:38.35,Default,,0000,0000,0000,,waiting for these patients to arrive.
Dialogue: 0,0:10:39.44,0:10:40.98,Default,,0000,0000,0000,,We can do a lot better.
Dialogue: 0,0:10:41.43,0:10:45.87,Default,,0000,0000,0000,,And I want to take you now into\Nwhat is veritably the Willy Wonka shop
Dialogue: 0,0:10:45.90,0:10:48.18,Default,,0000,0000,0000,,at Boston Children's Hospital,
Dialogue: 0,0:10:48.20,0:10:52.93,Default,,0000,0000,0000,,where we are manufacturing\Nreproductions of children
Dialogue: 0,0:10:53.19,0:10:57.10,Default,,0000,0000,0000,,in order for surgeons and surgical\Nteams to rehearse
Dialogue: 0,0:10:57.12,0:10:59.50,Default,,0000,0000,0000,,in the most relevant possible ways.
Dialogue: 0,0:10:59.52,0:11:00.90,Default,,0000,0000,0000,,Let me show you this.
Dialogue: 0,0:11:03.30,0:11:05.20,Default,,0000,0000,0000,,Here's my team
Dialogue: 0,0:11:05.23,0:11:09.13,Default,,0000,0000,0000,,in what's called the SIM Engineering\NDivision of the Simulator Program.
Dialogue: 0,0:11:09.94,0:11:12.78,Default,,0000,0000,0000,,This is an amazing team of individuals.
Dialogue: 0,0:11:12.81,0:11:15.08,Default,,0000,0000,0000,,They are mechanical engineers;
Dialogue: 0,0:11:15.11,0:11:17.53,Default,,0000,0000,0000,,you're seeing here, illustrators.
Dialogue: 0,0:11:17.56,0:11:22.13,Default,,0000,0000,0000,,They take primary data\Nfrom CT scans and MRIs,
Dialogue: 0,0:11:22.15,0:11:25.48,Default,,0000,0000,0000,,translate it into digital information,
Dialogue: 0,0:11:25.50,0:11:26.81,Default,,0000,0000,0000,,animate it,
Dialogue: 0,0:11:26.84,0:11:31.63,Default,,0000,0000,0000,,put it together into the components\Nof the child itself,
Dialogue: 0,0:11:31.65,0:11:35.44,Default,,0000,0000,0000,,surface-scan elements of the child\Nthat have been casted as needed,
Dialogue: 0,0:11:35.47,0:11:38.05,Default,,0000,0000,0000,,depending on the surgery itself,
Dialogue: 0,0:11:38.08,0:11:41.97,Default,,0000,0000,0000,,and then take this digital data\Nand be able to output it
Dialogue: 0,0:11:41.99,0:11:45.74,Default,,0000,0000,0000,,on state-of-the-art,\Nthree-dimensional printing devices
Dialogue: 0,0:11:45.76,0:11:48.03,Default,,0000,0000,0000,,that allow us to print the components
Dialogue: 0,0:11:48.06,0:11:53.73,Default,,0000,0000,0000,,exactly to the micron detail of what\Nthe child's anatomy will look like.
Dialogue: 0,0:11:53.75,0:11:55.05,Default,,0000,0000,0000,,You can see here,
Dialogue: 0,0:11:55.08,0:11:57.51,Default,,0000,0000,0000,,the skull of this child being printed
Dialogue: 0,0:11:57.54,0:12:00.02,Default,,0000,0000,0000,,in the hours before\Nwe performed this surgery.
Dialogue: 0,0:12:01.24,0:12:03.81,Default,,0000,0000,0000,,But we could not do this work
Dialogue: 0,0:12:03.84,0:12:08.22,Default,,0000,0000,0000,,without our dear friends on the West Coast\Nin Hollywood, California.
Dialogue: 0,0:12:09.40,0:12:12.63,Default,,0000,0000,0000,,These are individuals\Nthat are incredibly talented
Dialogue: 0,0:12:12.65,0:12:15.08,Default,,0000,0000,0000,,at being able to recreate reality.
Dialogue: 0,0:12:15.10,0:12:19.53,Default,,0000,0000,0000,,It was not a long leap for us.
Dialogue: 0,0:12:19.55,0:12:21.13,Default,,0000,0000,0000,,The more we got into this field,
Dialogue: 0,0:12:21.15,0:12:24.91,Default,,0000,0000,0000,,the more it became clear to us\Nthat we are doing cinematography.
Dialogue: 0,0:12:25.61,0:12:27.49,Default,,0000,0000,0000,,We're doing filmmaking,
Dialogue: 0,0:12:27.51,0:12:29.74,Default,,0000,0000,0000,,it's just that the actors are not actors.
Dialogue: 0,0:12:30.53,0:12:33.02,Default,,0000,0000,0000,,They're real doctors and nurses.
Dialogue: 0,0:12:33.81,0:12:37.19,Default,,0000,0000,0000,,So these are some photos\Nof our dear friends at Fractured FX
Dialogue: 0,0:12:37.21,0:12:38.68,Default,,0000,0000,0000,,in Hollywood California,
Dialogue: 0,0:12:38.71,0:12:42.28,Default,,0000,0000,0000,,an Emmy-Award-winning\Nspecial effects firm.
Dialogue: 0,0:12:42.30,0:12:45.47,Default,,0000,0000,0000,,This is Justin Raleigh and his group --
Dialogue: 0,0:12:45.50,0:12:47.15,Default,,0000,0000,0000,,this is not one of our patients --
Dialogue: 0,0:12:47.17,0:12:48.53,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:12:48.55,0:12:51.62,Default,,0000,0000,0000,,but kind of the exquisite work\Nthat these individuals do.
Dialogue: 0,0:12:51.64,0:12:55.25,Default,,0000,0000,0000,,We have now collaborated\Nand fused our experience,
Dialogue: 0,0:12:55.27,0:12:57.68,Default,,0000,0000,0000,,bringing their group\Nto Boston Children's Hospital,
Dialogue: 0,0:12:57.70,0:13:00.36,Default,,0000,0000,0000,,sending our group\Nout to Hollywood, California
Dialogue: 0,0:13:00.38,0:13:01.75,Default,,0000,0000,0000,,and exchanging around this
Dialogue: 0,0:13:01.78,0:13:04.78,Default,,0000,0000,0000,,to be able to develop\Nthese type of simulators.
Dialogue: 0,0:13:04.80,0:13:08.98,Default,,0000,0000,0000,,What I'm about to show you\Nis a reproduction of this child.
Dialogue: 0,0:13:09.01,0:13:11.02,Default,,0000,0000,0000,,This is not a real child.
Dialogue: 0,0:13:19.79,0:13:24.92,Default,,0000,0000,0000,,You'll notice here that every hair\Non the child's head is reproduced.
Dialogue: 0,0:13:24.94,0:13:28.65,Default,,0000,0000,0000,,And in fact, this is also\Nthat reproduced child --
Dialogue: 0,0:13:28.67,0:13:31.86,Default,,0000,0000,0000,,and I apologize for any queasy stomachs,
Dialogue: 0,0:13:31.89,0:13:34.75,Default,,0000,0000,0000,,but that is a reproduction and simulation
Dialogue: 0,0:13:34.77,0:13:36.87,Default,,0000,0000,0000,,of the child they're about to operate on.
Dialogue: 0,0:13:39.11,0:13:41.55,Default,,0000,0000,0000,,Here's that membrane we had talked about,
Dialogue: 0,0:13:41.58,0:13:43.73,Default,,0000,0000,0000,,the inside of this child's brain.
Dialogue: 0,0:13:44.16,0:13:49.13,Default,,0000,0000,0000,,What you're going to be seeing here\Nis, on one side, the actual patient,
Dialogue: 0,0:13:49.15,0:13:51.43,Default,,0000,0000,0000,,and on the other side, the simulator.
Dialogue: 0,0:13:51.45,0:13:55.80,Default,,0000,0000,0000,,As I mentioned, a scope, a little camera,\Nneeds to make its way down,
Dialogue: 0,0:13:55.83,0:13:57.23,Default,,0000,0000,0000,,and you're seeing that here.
Dialogue: 0,0:13:57.25,0:13:59.58,Default,,0000,0000,0000,,It needs to make a small hole\Nin this membrane
Dialogue: 0,0:13:59.60,0:14:02.31,Default,,0000,0000,0000,,and allow this fluid to seep out.
Dialogue: 0,0:14:03.78,0:14:08.42,Default,,0000,0000,0000,,I won't do a quiz show to see\Nwho thinks which side is which,
Dialogue: 0,0:14:09.58,0:14:11.89,Default,,0000,0000,0000,,but on the right is the simulator.
Dialogue: 0,0:14:13.30,0:14:17.10,Default,,0000,0000,0000,,So surgeons can now produce\Ntraining opportunities,
Dialogue: 0,0:14:17.12,0:14:20.68,Default,,0000,0000,0000,,do these surgeries\Nas many times as they want,
Dialogue: 0,0:14:20.70,0:14:23.54,Default,,0000,0000,0000,,to their heart's content,\Nuntil they feel comfortable.
Dialogue: 0,0:14:23.67,0:14:27.26,Default,,0000,0000,0000,,And then, and only then,\Nbring the child into the operating room.
Dialogue: 0,0:14:27.29,0:14:28.46,Default,,0000,0000,0000,,But we don't stop here.
Dialogue: 0,0:14:28.48,0:14:32.79,Default,,0000,0000,0000,,We know that a key step to this\Nis not just the skill itself,
Dialogue: 0,0:14:32.81,0:14:37.34,Default,,0000,0000,0000,,but combining that skill with a team\Nwho's going to deliver that care.
Dialogue: 0,0:14:37.37,0:14:39.71,Default,,0000,0000,0000,,Now we turn to Formula One.
Dialogue: 0,0:14:40.28,0:14:43.52,Default,,0000,0000,0000,,And here is an example\Nof a technician putting on a tire
Dialogue: 0,0:14:43.55,0:14:46.76,Default,,0000,0000,0000,,and doing that time and time\Nagain on this car.
Dialogue: 0,0:14:46.78,0:14:49.77,Default,,0000,0000,0000,,But that is very quickly\Ngoing to be incorporated
Dialogue: 0,0:14:49.79,0:14:51.72,Default,,0000,0000,0000,,within team-training experiences,
Dialogue: 0,0:14:51.75,0:14:55.96,Default,,0000,0000,0000,,now as a full team orchestrating\Nthe exchange of tires
Dialogue: 0,0:14:55.98,0:14:59.48,Default,,0000,0000,0000,,and getting this car back on the speedway.
Dialogue: 0,0:15:00.42,0:15:03.70,Default,,0000,0000,0000,,We've done that step in health care,
Dialogue: 0,0:15:03.72,0:15:09.76,Default,,0000,0000,0000,,so now what you're about to see\Nis a simulated operation.
Dialogue: 0,0:15:11.01,0:15:13.40,Default,,0000,0000,0000,,We've taken the simulator\NI just described to you,
Dialogue: 0,0:15:13.42,0:15:16.82,Default,,0000,0000,0000,,we've brought it into the operating room\Nat Boston Children's Hospital,
Dialogue: 0,0:15:16.85,0:15:20.50,Default,,0000,0000,0000,,and these individuals --\Nthese native teams, operative teams --
Dialogue: 0,0:15:20.52,0:15:24.05,Default,,0000,0000,0000,,are doing the surgery before the surgery.
Dialogue: 0,0:15:24.07,0:15:25.81,Default,,0000,0000,0000,,Operate twice;
Dialogue: 0,0:15:25.83,0:15:27.04,Default,,0000,0000,0000,,cut once.
Dialogue: 0,0:15:27.37,0:15:28.76,Default,,0000,0000,0000,,Let me show that to you.
Dialogue: 0,0:15:31.84,0:15:34.95,Default,,0000,0000,0000,,(Video) Surgical team member 1:\NYou want the head down or head up?
Dialogue: 0,0:15:34.97,0:15:36.68,Default,,0000,0000,0000,,STM 2: Can you lower it down to 10?
Dialogue: 0,0:15:36.70,0:15:39.35,Default,,0000,0000,0000,,STM 3: And then lower\Nthe whole table down a little bit?
Dialogue: 0,0:15:39.38,0:15:40.63,Default,,0000,0000,0000,,STM 4: Table coming down.
Dialogue: 0,0:15:43.28,0:15:45.98,Default,,0000,0000,0000,,STM 3: All right, this\Nis behaving like a vessel.
Dialogue: 0,0:15:46.00,0:15:48.09,Default,,0000,0000,0000,,Could we have the scissors back, please?
Dialogue: 0,0:15:48.12,0:15:51.42,Default,,0000,0000,0000,,STM 5: I'm taking my gloves,\N8 to 8 1/2, all right? I'll be right in.
Dialogue: 0,0:15:51.44,0:15:53.84,Default,,0000,0000,0000,,STM 6: Great! Thank you.
Dialogue: 0,0:15:54.86,0:15:56.69,Default,,0000,0000,0000,,Peter Weinstock: It's really amazing.
Dialogue: 0,0:15:57.11,0:15:59.20,Default,,0000,0000,0000,,The second step to this,\Nwhich is critical,
Dialogue: 0,0:15:59.23,0:16:02.33,Default,,0000,0000,0000,,is we take these teams out\Nimmediately and debrief them.
Dialogue: 0,0:16:02.80,0:16:04.27,Default,,0000,0000,0000,,We use the same technologies
Dialogue: 0,0:16:04.29,0:16:08.98,Default,,0000,0000,0000,,that are used in Lean\Nand Six Sigma in the military,
Dialogue: 0,0:16:09.00,0:16:12.09,Default,,0000,0000,0000,,and we bring them out\Nand talk about what went right,
Dialogue: 0,0:16:12.11,0:16:13.56,Default,,0000,0000,0000,,but more importantly,
Dialogue: 0,0:16:13.59,0:16:16.25,Default,,0000,0000,0000,,we talk about what didn't go well,
Dialogue: 0,0:16:16.27,0:16:18.21,Default,,0000,0000,0000,,and how we're going to fix it.
Dialogue: 0,0:16:18.23,0:16:20.98,Default,,0000,0000,0000,,Then we bring them right back in\Nand do it again.
Dialogue: 0,0:16:21.01,0:16:26.20,Default,,0000,0000,0000,,Deliberative batting practice\Nin the moments when it matters most.
Dialogue: 0,0:16:27.81,0:16:29.83,Default,,0000,0000,0000,,Let's go back to this case now.
Dialogue: 0,0:16:30.45,0:16:31.83,Default,,0000,0000,0000,,Same child,
Dialogue: 0,0:16:31.85,0:16:34.24,Default,,0000,0000,0000,,but now let me describe\Nhow we care for this child
Dialogue: 0,0:16:34.27,0:16:35.73,Default,,0000,0000,0000,,at Boston Children's Hospital.
Dialogue: 0,0:16:35.76,0:16:38.24,Default,,0000,0000,0000,,This child was born\Nat three o'clock in the morning.
Dialogue: 0,0:16:38.26,0:16:40.27,Default,,0000,0000,0000,,At two o'clock in the morning,
Dialogue: 0,0:16:40.30,0:16:42.42,Default,,0000,0000,0000,,we assembled the team,
Dialogue: 0,0:16:42.45,0:16:44.25,Default,,0000,0000,0000,,and took the reproduced anatomy
Dialogue: 0,0:16:44.27,0:16:48.06,Default,,0000,0000,0000,,that we would gain\Nout of scans and images,
Dialogue: 0,0:16:48.60,0:16:51.37,Default,,0000,0000,0000,,and brought that team\Nto the virtual bedside,
Dialogue: 0,0:16:51.39,0:16:52.98,Default,,0000,0000,0000,,to a simulated bedside --
Dialogue: 0,0:16:53.00,0:16:56.54,Default,,0000,0000,0000,,the same team that's going to operate\Non this child in the hours ahead --
Dialogue: 0,0:16:56.57,0:16:58.95,Default,,0000,0000,0000,,and we have them do the procedure.
Dialogue: 0,0:16:59.62,0:17:01.30,Default,,0000,0000,0000,,Let me show you a moment of this.
Dialogue: 0,0:17:06.15,0:17:08.31,Default,,0000,0000,0000,,This is not a real incision.
Dialogue: 0,0:17:09.62,0:17:11.82,Default,,0000,0000,0000,,And the baby has not yet been born.
Dialogue: 0,0:17:13.28,0:17:14.65,Default,,0000,0000,0000,,Imagine this.
Dialogue: 0,0:17:21.20,0:17:25.09,Default,,0000,0000,0000,,So now the conversations\Nthat I have with families
Dialogue: 0,0:17:25.12,0:17:27.82,Default,,0000,0000,0000,,in the intensive care unit\Nat Boston Children's Hospital
Dialogue: 0,0:17:27.84,0:17:29.23,Default,,0000,0000,0000,,are totally different.
Dialogue: 0,0:17:29.83,0:17:31.57,Default,,0000,0000,0000,,Imagine this conversation:
Dialogue: 0,0:17:32.72,0:17:37.57,Default,,0000,0000,0000,,"Not only do we take care of this disorder\Nfrequently in our ICU,
Dialogue: 0,0:17:37.59,0:17:39.77,Default,,0000,0000,0000,,and not only have we done surgeries
Dialogue: 0,0:17:39.80,0:17:42.23,Default,,0000,0000,0000,,like the surgery we're going\Nto do on your child,
Dialogue: 0,0:17:42.26,0:17:45.97,Default,,0000,0000,0000,,but we have done your child's surgery.
Dialogue: 0,0:17:47.03,0:17:49.56,Default,,0000,0000,0000,,And we did it two hours ago.
Dialogue: 0,0:17:49.58,0:17:52.31,Default,,0000,0000,0000,,And we did it 10 times.
Dialogue: 0,0:17:52.34,0:17:56.16,Default,,0000,0000,0000,,And now we're prepared to take them\Nback to the operating room."
Dialogue: 0,0:17:57.80,0:18:00.13,Default,,0000,0000,0000,,So a new technology in health care:
Dialogue: 0,0:18:01.24,0:18:04.10,Default,,0000,0000,0000,,lifelike rehearsal.
Dialogue: 0,0:18:04.13,0:18:07.68,Default,,0000,0000,0000,,Practicing prior to game time.
Dialogue: 0,0:18:08.70,0:18:09.88,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:18:09.91,0:18:16.91,Default,,0000,0000,0000,,(Applause)