[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:01.00,0:00:04.90,Default,,0000,0000,0000,,What if I told you there\Nwas a new technology
Dialogue: 0,0:00:04.90,0:00:09.49,Default,,0000,0000,0000,,that when placed in the hands\Nof doctors and nurses,
Dialogue: 0,0:00:09.49,0:00:13.24,Default,,0000,0000,0000,,improved outcomes\Nfor children and adults --
Dialogue: 0,0:00:13.24,0:00:15.74,Default,,0000,0000,0000,,patients of all ages --
Dialogue: 0,0:00:15.74,0:00:18.30,Default,,0000,0000,0000,,reduced pain and suffering,
Dialogue: 0,0:00:18.30,0:00:21.52,Default,,0000,0000,0000,,reduced time in the operating rooms,
Dialogue: 0,0:00:21.52,0:00:24.39,Default,,0000,0000,0000,,reduced anesthetic times,
Dialogue: 0,0:00:24.39,0:00:26.31,Default,,0000,0000,0000,,had the ultimate dose response curve
Dialogue: 0,0:00:26.31,0:00:28.08,Default,,0000,0000,0000,,that the more you did it,
Dialogue: 0,0:00:28.08,0:00:30.40,Default,,0000,0000,0000,,the better it benefitted patients?
Dialogue: 0,0:00:31.41,0:00:32.41,Default,,0000,0000,0000,,Here's a kicker:
Dialogue: 0,0:00:32.41,0:00:34.12,Default,,0000,0000,0000,,it has no side effects,
Dialogue: 0,0:00:34.12,0:00:37.13,Default,,0000,0000,0000,,and it's available no matter\Nwhere care is delivered.
Dialogue: 0,0:00:37.62,0:00:41.08,Default,,0000,0000,0000,,I can tell you as an ICU doctor\Nat Boston Children's Hospital
Dialogue: 0,0:00:41.08,0:00:43.66,Default,,0000,0000,0000,,this would be a game changer for me.
Dialogue: 0,0:00:43.66,0:00:47.93,Default,,0000,0000,0000,,That technology is lifelike rehearsal.
Dialogue: 0,0:00:48.77,0:00:53.32,Default,,0000,0000,0000,,This lifelike rehearsal is being\Ndelivered through medical simulation.
Dialogue: 0,0:00:54.01,0:00:58.20,Default,,0000,0000,0000,,I thought I would start with a case,
Dialogue: 0,0:00:58.20,0:01:00.93,Default,,0000,0000,0000,,just to really describe\Nthe challenge ahead,
Dialogue: 0,0:01:00.93,0:01:04.32,Default,,0000,0000,0000,,and why this technology is not just\Ngoing to improve healthcare,
Dialogue: 0,0:01:04.32,0:01:07.34,Default,,0000,0000,0000,,but why it's critical to healthcare.
Dialogue: 0,0:01:07.71,0:01:09.75,Default,,0000,0000,0000,,This is a child that's born --
Dialogue: 0,0:01:09.75,0:01:10.75,Default,,0000,0000,0000,,young girl --
Dialogue: 0,0:01:10.75,0:01:12.41,Default,,0000,0000,0000,,day of life zero, we call it.
Dialogue: 0,0:01:12.41,0:01:13.46,Default,,0000,0000,0000,,The first day of life,
Dialogue: 0,0:01:13.46,0:01:14.66,Default,,0000,0000,0000,,just born into the world.
Dialogue: 0,0:01:14.66,0:01:16.07,Default,,0000,0000,0000,,And just as she's being born,
Dialogue: 0,0:01:16.07,0:01:18.86,Default,,0000,0000,0000,,we notice very quickly\Nthat she is deteriorating.
Dialogue: 0,0:01:19.08,0:01:20.41,Default,,0000,0000,0000,,Her heart rate is going up,
Dialogue: 0,0:01:20.41,0:01:22.03,Default,,0000,0000,0000,,her blood pressure is going down,
Dialogue: 0,0:01:22.03,0:01:24.04,Default,,0000,0000,0000,,she's breathing very, very fast.
Dialogue: 0,0:01:24.40,0:01:29.22,Default,,0000,0000,0000,,And the reason for this is displayed\Nin this chest X-ray.
Dialogue: 0,0:01:29.32,0:01:30.66,Default,,0000,0000,0000,,That's called a babygram,
Dialogue: 0,0:01:30.66,0:01:32.64,Default,,0000,0000,0000,,and this is full X-ray of a child's body,
Dialogue: 0,0:01:32.64,0:01:34.04,Default,,0000,0000,0000,,a little infant's body.
Dialogue: 0,0:01:34.04,0:01:35.79,Default,,0000,0000,0000,,As you look on the top side of this,
Dialogue: 0,0:01:35.79,0:01:38.22,Default,,0000,0000,0000,,that's where the heart and lungs\Nare supposed to be.
Dialogue: 0,0:01:38.22,0:01:39.68,Default,,0000,0000,0000,,As you look at the bottom end,
Dialogue: 0,0:01:39.68,0:01:41.02,Default,,0000,0000,0000,,that's where the abdomen is,
Dialogue: 0,0:01:41.02,0:01:43.42,Default,,0000,0000,0000,,and that's where the intestines\Nare supposed to be,
Dialogue: 0,0:01:43.42,0:01:46.17,Default,,0000,0000,0000,,and you can see how there's\Nsort of that translucent area
Dialogue: 0,0:01:46.17,0:01:49.27,Default,,0000,0000,0000,,that made its way up and to the right\Nside of this child's chest.
Dialogue: 0,0:01:49.62,0:01:52.10,Default,,0000,0000,0000,,And those are the intestines,
Dialogue: 0,0:01:52.10,0:01:53.85,Default,,0000,0000,0000,,in the wrong place.
Dialogue: 0,0:01:53.85,0:01:56.05,Default,,0000,0000,0000,,As a result, they're pushing on the lungs
Dialogue: 0,0:01:56.05,0:01:58.96,Default,,0000,0000,0000,,and making it very difficult\Nfor this poor baby to breathe.
Dialogue: 0,0:01:59.33,0:02:00.85,Default,,0000,0000,0000,,The fix for this problem
Dialogue: 0,0:02:00.85,0:02:03.50,Default,,0000,0000,0000,,is to take this child immediately\Nto the operating room,
Dialogue: 0,0:02:03.50,0:02:05.65,Default,,0000,0000,0000,,bring those intestines back\Ninto the abdomen,
Dialogue: 0,0:02:05.65,0:02:09.42,Default,,0000,0000,0000,,let the lungs expand and allow\Nthis child to breathe again.
Dialogue: 0,0:02:09.68,0:02:11.76,Default,,0000,0000,0000,,But before she can go\Nto the operating room,
Dialogue: 0,0:02:11.76,0:02:14.21,Default,,0000,0000,0000,,she must get whisked away to the ICU,
Dialogue: 0,0:02:14.21,0:02:15.22,Default,,0000,0000,0000,,where I work,
Dialogue: 0,0:02:15.22,0:02:16.84,Default,,0000,0000,0000,,and I work with surgical teams.
Dialogue: 0,0:02:16.84,0:02:18.42,Default,,0000,0000,0000,,We gather around her,
Dialogue: 0,0:02:18.42,0:02:22.85,Default,,0000,0000,0000,,and we place this child\Non heart-lung bypass.
Dialogue: 0,0:02:23.62,0:02:25.54,Default,,0000,0000,0000,,We put her to sleep,
Dialogue: 0,0:02:25.54,0:02:28.16,Default,,0000,0000,0000,,we make a tiny\Nlittle incision in the neck,
Dialogue: 0,0:02:28.16,0:02:31.29,Default,,0000,0000,0000,,we place catheters into the major\Nvessels of the neck --
Dialogue: 0,0:02:31.29,0:02:34.82,Default,,0000,0000,0000,,and I can tell you that these vessels\Nare about the size of a pen,
Dialogue: 0,0:02:34.82,0:02:36.90,Default,,0000,0000,0000,,the tip of a pen --
Dialogue: 0,0:02:36.90,0:02:39.06,Default,,0000,0000,0000,,and then we have blood\Ndrawn from the body,
Dialogue: 0,0:02:39.06,0:02:40.49,Default,,0000,0000,0000,,we bring it through a machine,
Dialogue: 0,0:02:40.49,0:02:41.57,Default,,0000,0000,0000,,it gets oxygenated,
Dialogue: 0,0:02:41.57,0:02:43.44,Default,,0000,0000,0000,,and it goes back into the body.
Dialogue: 0,0:02:43.44,0:02:45.04,Default,,0000,0000,0000,,We save her life,
Dialogue: 0,0:02:45.04,0:02:47.56,Default,,0000,0000,0000,,and get her safely to the operating room.
Dialogue: 0,0:02:49.37,0:02:51.33,Default,,0000,0000,0000,,Here's the problem.
Dialogue: 0,0:02:52.07,0:02:53.66,Default,,0000,0000,0000,,These disorders --
Dialogue: 0,0:02:53.66,0:02:56.97,Default,,0000,0000,0000,,what is known is Congenital\NDiaphragmatic Hernia --
Dialogue: 0,0:02:56.97,0:03:00.50,Default,,0000,0000,0000,,this hole in the diaphragm that has\Nallowed these intestines to sneak up --
Dialogue: 0,0:03:00.50,0:03:02.47,Default,,0000,0000,0000,,these disorders are rare.
Dialogue: 0,0:03:03.50,0:03:07.34,Default,,0000,0000,0000,,Even in the best hands in the world,
Dialogue: 0,0:03:07.34,0:03:10.78,Default,,0000,0000,0000,,there is still a challenge\Nto get the volume --
Dialogue: 0,0:03:10.78,0:03:12.69,Default,,0000,0000,0000,,the natural volume of these patients
Dialogue: 0,0:03:12.69,0:03:15.38,Default,,0000,0000,0000,,in order to get our\Nexpertise curve at 100 percent.
Dialogue: 0,0:03:15.38,0:03:18.12,Default,,0000,0000,0000,,They just don't present that often.
Dialogue: 0,0:03:18.74,0:03:22.07,Default,,0000,0000,0000,,So how do you make the rare common?
Dialogue: 0,0:03:24.29,0:03:25.86,Default,,0000,0000,0000,,Here's the other problem.
Dialogue: 0,0:03:26.63,0:03:31.13,Default,,0000,0000,0000,,In the healthcare system\Nthat I trained for over 20 years,
Dialogue: 0,0:03:31.13,0:03:32.34,Default,,0000,0000,0000,,what currently exists,
Dialogue: 0,0:03:32.34,0:03:35.31,Default,,0000,0000,0000,,the model of training is called\Nthe apprenticeship model.
Dialogue: 0,0:03:35.31,0:03:37.22,Default,,0000,0000,0000,,It's been around for centuries.
Dialogue: 0,0:03:37.37,0:03:41.34,Default,,0000,0000,0000,,It's based on this idea that you see\Na surgery maybe once,
Dialogue: 0,0:03:41.34,0:03:42.89,Default,,0000,0000,0000,,maybe several times,
Dialogue: 0,0:03:42.89,0:03:45.71,Default,,0000,0000,0000,,you then go do that surgery,
Dialogue: 0,0:03:45.71,0:03:49.75,Default,,0000,0000,0000,,and then ultimately you teach\Nthat surgery to the next generation.
Dialogue: 0,0:03:50.67,0:03:53.44,Default,,0000,0000,0000,,An implicit in this model --
Dialogue: 0,0:03:53.44,0:03:55.64,Default,,0000,0000,0000,,I don't need to tell you this --
Dialogue: 0,0:03:55.64,0:04:00.68,Default,,0000,0000,0000,,is that we practice on the very patients\Nthat we are delivering care to.
Dialogue: 0,0:04:02.44,0:04:04.12,Default,,0000,0000,0000,,That's a problem.
Dialogue: 0,0:04:07.42,0:04:09.80,Default,,0000,0000,0000,,I think there's a better approach.
Dialogue: 0,0:04:09.80,0:04:14.24,Default,,0000,0000,0000,,Medicine may very well be the last\Nhigh-stakes industry
Dialogue: 0,0:04:14.24,0:04:16.96,Default,,0000,0000,0000,,that does not practice prior to game time.
Dialogue: 0,0:04:18.45,0:04:22.77,Default,,0000,0000,0000,,I want to describe to you a better\Napproach through medical simulation.
Dialogue: 0,0:04:24.44,0:04:27.78,Default,,0000,0000,0000,,Well, the first thing we did is we went\Nto other high-stakes industries
Dialogue: 0,0:04:27.78,0:04:30.58,Default,,0000,0000,0000,,that had been using this type\Nof methodology for decades.
Dialogue: 0,0:04:30.84,0:04:32.53,Default,,0000,0000,0000,,This is nuclear power.
Dialogue: 0,0:04:32.53,0:04:36.59,Default,,0000,0000,0000,,Nuclear power runs scenarios\Non regular basis
Dialogue: 0,0:04:36.59,0:04:39.81,Default,,0000,0000,0000,,in order to practice what they\Nhope will never occur.
Dialogue: 0,0:04:40.25,0:04:42.16,Default,,0000,0000,0000,,And as we're all very familiar,
Dialogue: 0,0:04:42.16,0:04:43.97,Default,,0000,0000,0000,,the airline industry.
Dialogue: 0,0:04:44.27,0:04:47.42,Default,,0000,0000,0000,,We all get on planes now\Ncomforted by the idea
Dialogue: 0,0:04:47.42,0:04:53.34,Default,,0000,0000,0000,,that pilots and crews have trained\Non simulators much like these,
Dialogue: 0,0:04:53.34,0:04:55.92,Default,,0000,0000,0000,,training on scenarios\Nthat we hope will never occur,
Dialogue: 0,0:04:55.92,0:04:58.24,Default,,0000,0000,0000,,but we know if they did,
Dialogue: 0,0:04:58.24,0:05:00.65,Default,,0000,0000,0000,,they would be prepared for the worst.
Dialogue: 0,0:05:01.25,0:05:05.68,Default,,0000,0000,0000,,In fact, the airline industry has gone\Nas far as to create fuselages
Dialogue: 0,0:05:05.68,0:05:07.24,Default,,0000,0000,0000,,of simulation environments
Dialogue: 0,0:05:07.24,0:05:10.49,Default,,0000,0000,0000,,because of the importance\Nof the team coming together.
Dialogue: 0,0:05:11.01,0:05:13.28,Default,,0000,0000,0000,,This is an evacuation drill simulator.
Dialogue: 0,0:05:13.78,0:05:14.78,Default,,0000,0000,0000,,So that again,
Dialogue: 0,0:05:14.78,0:05:16.13,Default,,0000,0000,0000,,if that ever were to happen,
Dialogue: 0,0:05:16.13,0:05:17.95,Default,,0000,0000,0000,,these rare, rare events,
Dialogue: 0,0:05:17.95,0:05:21.62,Default,,0000,0000,0000,,they're ready to act\Non the drop of a dime.
Dialogue: 0,0:05:23.06,0:05:26.09,Default,,0000,0000,0000,,I guess the most compelling\Nfor me in some ways,
Dialogue: 0,0:05:26.09,0:05:28.41,Default,,0000,0000,0000,,is the sports industry ...
Dialogue: 0,0:05:28.41,0:05:30.53,Default,,0000,0000,0000,,arguably high stakes.
Dialogue: 0,0:05:30.75,0:05:32.53,Default,,0000,0000,0000,,You think about how a baseball team,
Dialogue: 0,0:05:32.53,0:05:33.100,Default,,0000,0000,0000,,baseball players practice.
Dialogue: 0,0:05:33.100,0:05:36.69,Default,,0000,0000,0000,,I think it's a beautiful example\Nof progressive training.
Dialogue: 0,0:05:36.69,0:05:39.48,Default,,0000,0000,0000,,The first thing they do is they\Ngo out to spring training.
Dialogue: 0,0:05:39.48,0:05:41.89,Default,,0000,0000,0000,,They go to a spring training camp,
Dialogue: 0,0:05:41.89,0:05:44.56,Default,,0000,0000,0000,,perhaps a simulator in baseball.
Dialogue: 0,0:05:44.56,0:05:46.02,Default,,0000,0000,0000,,They're not on the real field,
Dialogue: 0,0:05:46.02,0:05:47.61,Default,,0000,0000,0000,,but they're on a simulated field,
Dialogue: 0,0:05:47.61,0:05:49.81,Default,,0000,0000,0000,,and they're playing\Nin the pre-game season.
Dialogue: 0,0:05:49.81,0:05:53.43,Default,,0000,0000,0000,,Then they make they're way to the field\Nduring the season games,
Dialogue: 0,0:05:53.43,0:05:56.44,Default,,0000,0000,0000,,and what's the first thing they do\Nbefore they start the game?
Dialogue: 0,0:05:56.44,0:05:57.91,Default,,0000,0000,0000,,They go into the batting cage,
Dialogue: 0,0:05:57.91,0:06:01.02,Default,,0000,0000,0000,,and they do batting practice for hours,
Dialogue: 0,0:06:01.02,0:06:04.56,Default,,0000,0000,0000,,having different types of pitches\Nbeing thrown at them,
Dialogue: 0,0:06:04.56,0:06:08.85,Default,,0000,0000,0000,,hitting ball after ball\Nas they limber their muscles,
Dialogue: 0,0:06:08.85,0:06:10.84,Default,,0000,0000,0000,,getting ready for the game itself.
Dialogue: 0,0:06:10.84,0:06:14.64,Default,,0000,0000,0000,,And here's the most\Nphenomenal part of this ...
Dialogue: 0,0:06:14.64,0:06:17.28,Default,,0000,0000,0000,,and for all of you who watch\Nand sport event,
Dialogue: 0,0:06:17.28,0:06:19.48,Default,,0000,0000,0000,,you will see this phenomenon happen.
Dialogue: 0,0:06:19.79,0:06:22.78,Default,,0000,0000,0000,,The batter gets into the batter's box,
Dialogue: 0,0:06:22.78,0:06:24.97,Default,,0000,0000,0000,,the pitcher gets ready to pitch.
Dialogue: 0,0:06:24.97,0:06:28.10,Default,,0000,0000,0000,,Right before the pitch is thrown,
Dialogue: 0,0:06:28.10,0:06:29.33,Default,,0000,0000,0000,,what does that batter do?
Dialogue: 0,0:06:29.33,0:06:32.57,Default,,0000,0000,0000,,The batter steps out of the box,
Dialogue: 0,0:06:32.57,0:06:34.59,Default,,0000,0000,0000,,and takes a practice swing.
Dialogue: 0,0:06:34.59,0:06:36.81,Default,,0000,0000,0000,,He wouldn't do it any other way.
Dialogue: 0,0:06:37.49,0:06:38.52,Default,,0000,0000,0000,,I want to talk to you
Dialogue: 0,0:06:38.52,0:06:41.67,Default,,0000,0000,0000,,about how we're building\Npractice swings like this in medicine.
Dialogue: 0,0:06:41.67,0:06:46.36,Default,,0000,0000,0000,,We are building batting cages\Nfor the patients that we care about
Dialogue: 0,0:06:46.36,0:06:47.80,Default,,0000,0000,0000,,at Boston Children's.
Dialogue: 0,0:06:47.80,0:06:50.48,Default,,0000,0000,0000,,I want to use this case\Nthat we recently built.
Dialogue: 0,0:06:50.78,0:06:54.93,Default,,0000,0000,0000,,It's the case of a four-year-old\Nwho had a progressively enlarging head,
Dialogue: 0,0:06:54.93,0:06:55.93,Default,,0000,0000,0000,,and as a result,
Dialogue: 0,0:06:55.93,0:06:58.16,Default,,0000,0000,0000,,had loss of developmental milestones --
Dialogue: 0,0:06:58.16,0:06:59.34,Default,,0000,0000,0000,,neurologic milestones --
Dialogue: 0,0:06:59.34,0:07:02.53,Default,,0000,0000,0000,,and the reason for this problem is here,
Dialogue: 0,0:07:02.53,0:07:04.67,Default,,0000,0000,0000,,it's called hydrocephalus.
Dialogue: 0,0:07:04.67,0:07:07.42,Default,,0000,0000,0000,,So a quick study in neurosurgery.
Dialogue: 0,0:07:07.63,0:07:08.63,Default,,0000,0000,0000,,There's the brain,
Dialogue: 0,0:07:08.63,0:07:11.24,Default,,0000,0000,0000,,and you can see the cranium\Nsurrounding the brain.
Dialogue: 0,0:07:11.76,0:07:15.34,Default,,0000,0000,0000,,What surrounds the brain actually\Nbetween the brain and cranium
Dialogue: 0,0:07:15.34,0:07:17.35,Default,,0000,0000,0000,,is something called cerebrospinal fluid,
Dialogue: 0,0:07:17.35,0:07:20.45,Default,,0000,0000,0000,,or fluid which acts as a shock absorber.
Dialogue: 0,0:07:20.70,0:07:22.05,Default,,0000,0000,0000,,In your heads right now,
Dialogue: 0,0:07:22.05,0:07:25.40,Default,,0000,0000,0000,,there is cerebrosprinal fluid\Njust bathing your brains
Dialogue: 0,0:07:25.40,0:07:27.18,Default,,0000,0000,0000,,and making its way around.
Dialogue: 0,0:07:27.18,0:07:28.67,Default,,0000,0000,0000,,It's produced in one area,
Dialogue: 0,0:07:28.67,0:07:29.96,Default,,0000,0000,0000,,and flows through
Dialogue: 0,0:07:29.96,0:07:31.30,Default,,0000,0000,0000,,and then is re-exchanged.
Dialogue: 0,0:07:31.30,0:07:34.24,Default,,0000,0000,0000,,And this beautiful flow pattern\Noccurs for all of us.
Dialogue: 0,0:07:34.54,0:07:36.83,Default,,0000,0000,0000,,But unfortunately in some children,
Dialogue: 0,0:07:36.83,0:07:39.27,Default,,0000,0000,0000,,there's a blockage of this flow pattern,
Dialogue: 0,0:07:39.27,0:07:40.82,Default,,0000,0000,0000,,much like a traffic jam.
Dialogue: 0,0:07:41.26,0:07:42.30,Default,,0000,0000,0000,,As a result,
Dialogue: 0,0:07:42.30,0:07:44.27,Default,,0000,0000,0000,,the fluid accumulates,
Dialogue: 0,0:07:44.27,0:07:46.79,Default,,0000,0000,0000,,and the brain is pushed aside.
Dialogue: 0,0:07:47.26,0:07:49.10,Default,,0000,0000,0000,,It has difficulty growing.
Dialogue: 0,0:07:49.80,0:07:51.20,Default,,0000,0000,0000,,As a result,
Dialogue: 0,0:07:51.20,0:07:53.31,Default,,0000,0000,0000,,the child loses neurologic milestones.
Dialogue: 0,0:07:53.31,0:07:55.72,Default,,0000,0000,0000,,This is a devastating disease in children.
Dialogue: 0,0:07:56.99,0:08:00.12,Default,,0000,0000,0000,,So the cure for this is surgery.
Dialogue: 0,0:08:00.31,0:08:03.23,Default,,0000,0000,0000,,The traditional surgery is to take\Na bit of the cranium off --
Dialogue: 0,0:08:03.23,0:08:04.23,Default,,0000,0000,0000,,a bit of the skull --
Dialogue: 0,0:08:04.23,0:08:05.36,Default,,0000,0000,0000,,drain this fluid out,
Dialogue: 0,0:08:05.36,0:08:07.32,Default,,0000,0000,0000,,stick a drain in place,
Dialogue: 0,0:08:07.32,0:08:10.07,Default,,0000,0000,0000,,and then eventually bring\Nthis drain internal to the body.
Dialogue: 0,0:08:10.07,0:08:11.67,Default,,0000,0000,0000,,Big operation.
Dialogue: 0,0:08:12.28,0:08:16.67,Default,,0000,0000,0000,,But some great news is that advances\Nin neurosurgical care
Dialogue: 0,0:08:16.67,0:08:20.20,Default,,0000,0000,0000,,have allowed us to develop\Nminimally invasive approaches
Dialogue: 0,0:08:20.20,0:08:21.25,Default,,0000,0000,0000,,to this surgery.
Dialogue: 0,0:08:21.25,0:08:23.52,Default,,0000,0000,0000,,Through a small pin hole,
Dialogue: 0,0:08:23.52,0:08:27.22,Default,,0000,0000,0000,,a camera can be inserted,
Dialogue: 0,0:08:27.22,0:08:29.97,Default,,0000,0000,0000,,led into the deep brain structure,
Dialogue: 0,0:08:29.97,0:08:33.90,Default,,0000,0000,0000,,and cause a little hole in a membrane\Nthat allows all that fluid to drain,
Dialogue: 0,0:08:33.90,0:08:35.97,Default,,0000,0000,0000,,much like it would in a sink.
Dialogue: 0,0:08:35.97,0:08:37.05,Default,,0000,0000,0000,,All of a sudden,
Dialogue: 0,0:08:37.05,0:08:39.10,Default,,0000,0000,0000,,the brain is no longer under pressure,
Dialogue: 0,0:08:39.10,0:08:40.58,Default,,0000,0000,0000,,can re-expand,
Dialogue: 0,0:08:40.58,0:08:43.83,Default,,0000,0000,0000,,and we cure the child through\Na single hole incision.
Dialogue: 0,0:08:44.68,0:08:46.37,Default,,0000,0000,0000,,But here's the problem.
Dialogue: 0,0:08:46.37,0:08:49.22,Default,,0000,0000,0000,,Hydrocephalus is relatively rare,
Dialogue: 0,0:08:49.22,0:08:51.65,Default,,0000,0000,0000,,and there are no good training methods
Dialogue: 0,0:08:51.65,0:08:55.21,Default,,0000,0000,0000,,to get really good at getting\Nthis scope to the right place.
Dialogue: 0,0:08:55.21,0:08:58.37,Default,,0000,0000,0000,,But surgeons have been\Nquite creative about this,
Dialogue: 0,0:08:58.37,0:08:59.53,Default,,0000,0000,0000,,even our own.
Dialogue: 0,0:08:59.53,0:09:01.49,Default,,0000,0000,0000,,And they've come up with training models.
Dialogue: 0,0:09:01.49,0:09:03.13,Default,,0000,0000,0000,,Here's the current training model.
Dialogue: 0,0:09:03.13,0:09:04.28,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:09:05.24,0:09:06.71,Default,,0000,0000,0000,,I kid you not.
Dialogue: 0,0:09:06.92,0:09:08.35,Default,,0000,0000,0000,,This is a red pepper,
Dialogue: 0,0:09:08.35,0:09:09.54,Default,,0000,0000,0000,,not made in Hollywood,
Dialogue: 0,0:09:09.54,0:09:10.98,Default,,0000,0000,0000,,it's real, red pepper.
Dialogue: 0,0:09:11.26,0:09:14.23,Default,,0000,0000,0000,,And what surgeons do is they\Nstick a scope into the pepper,
Dialogue: 0,0:09:14.23,0:09:17.13,Default,,0000,0000,0000,,and they do what is called\Na seedectomy.
Dialogue: 0,0:09:17.35,0:09:18.73,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:09:18.99,0:09:23.03,Default,,0000,0000,0000,,They use this scope to remove seeds
Dialogue: 0,0:09:23.03,0:09:25.96,Default,,0000,0000,0000,,using a little tweezer,
Dialogue: 0,0:09:25.96,0:09:28.68,Default,,0000,0000,0000,,and that is a way to get under their belts
Dialogue: 0,0:09:28.68,0:09:32.01,Default,,0000,0000,0000,,the rudimentary components\Nof doing this surgery.
Dialogue: 0,0:09:32.29,0:09:34.72,Default,,0000,0000,0000,,Then they head right into\Nthe apprenticeship model,
Dialogue: 0,0:09:34.72,0:09:37.77,Default,,0000,0000,0000,,seeing many of them\Nas they present themselves,
Dialogue: 0,0:09:37.77,0:09:38.89,Default,,0000,0000,0000,,then doing it,
Dialogue: 0,0:09:38.89,0:09:40.06,Default,,0000,0000,0000,,and then teaching it --
Dialogue: 0,0:09:40.06,0:09:42.19,Default,,0000,0000,0000,,waiting for these patients to arrive.
Dialogue: 0,0:09:42.56,0:09:44.18,Default,,0000,0000,0000,,We can do a lot better.
Dialogue: 0,0:09:44.18,0:09:48.93,Default,,0000,0000,0000,,We are manufacturing\Nreproductions of children
Dialogue: 0,0:09:48.93,0:09:53.05,Default,,0000,0000,0000,,in order for surgeons and surgical\Nteams to rehearse
Dialogue: 0,0:09:53.05,0:09:55.24,Default,,0000,0000,0000,,in the most relevant possible ways.
Dialogue: 0,0:09:55.46,0:09:57.06,Default,,0000,0000,0000,,Let me show you this.
Dialogue: 0,0:09:57.35,0:09:59.02,Default,,0000,0000,0000,,Here's my team
Dialogue: 0,0:09:59.02,0:10:02.68,Default,,0000,0000,0000,,in what's called the SIM Engineering\Ndivision of the Simulator Program.
Dialogue: 0,0:10:03.48,0:10:06.06,Default,,0000,0000,0000,,This is an amazing team of individuals.
Dialogue: 0,0:10:06.35,0:10:08.43,Default,,0000,0000,0000,,They are mechanical engineers.
Dialogue: 0,0:10:08.65,0:10:11.28,Default,,0000,0000,0000,,You're seeing here, illustrators.
Dialogue: 0,0:10:11.28,0:10:15.79,Default,,0000,0000,0000,,They take primary data\Nfrom CT scans and MRIs,
Dialogue: 0,0:10:15.79,0:10:19.18,Default,,0000,0000,0000,,translate it into digital information,
Dialogue: 0,0:10:19.18,0:10:20.51,Default,,0000,0000,0000,,animate it,
Dialogue: 0,0:10:20.51,0:10:25.33,Default,,0000,0000,0000,,put it together into the components\Nof the child itself,
Dialogue: 0,0:10:25.33,0:10:29.14,Default,,0000,0000,0000,,surface scan elements of the child\Nthat have been casted as needed,
Dialogue: 0,0:10:29.14,0:10:31.75,Default,,0000,0000,0000,,depending on the surgery itself,
Dialogue: 0,0:10:31.75,0:10:35.73,Default,,0000,0000,0000,,and then take this digital data\Nand be able to output it
Dialogue: 0,0:10:35.73,0:10:39.43,Default,,0000,0000,0000,,on state-of-the-art,\Nthree-dimensional printing devices
Dialogue: 0,0:10:39.43,0:10:44.90,Default,,0000,0000,0000,,that allow us to print the components\Nexactly to the micron detail
Dialogue: 0,0:10:44.90,0:10:47.51,Default,,0000,0000,0000,,of what the child's\Nanatomy will look like.
Dialogue: 0,0:10:47.51,0:10:48.92,Default,,0000,0000,0000,,You can see here,
Dialogue: 0,0:10:48.92,0:10:51.38,Default,,0000,0000,0000,,the skull of this child being printed
Dialogue: 0,0:10:51.38,0:10:54.11,Default,,0000,0000,0000,,in the hours before\Nwe performed this surgery.
Dialogue: 0,0:10:54.68,0:10:59.84,Default,,0000,0000,0000,,But we could not do this work without\Nour dear friends on the West Coast
Dialogue: 0,0:10:59.84,0:11:01.66,Default,,0000,0000,0000,,in Hollywood, California.
Dialogue: 0,0:11:02.90,0:11:06.16,Default,,0000,0000,0000,,These are individuals that are\Nincredibly talented
Dialogue: 0,0:11:06.16,0:11:08.41,Default,,0000,0000,0000,,at being able to recreate reality.
Dialogue: 0,0:11:08.70,0:11:12.93,Default,,0000,0000,0000,,It was not a long leap for us.
Dialogue: 0,0:11:13.06,0:11:14.62,Default,,0000,0000,0000,,The more we got into this field,
Dialogue: 0,0:11:14.62,0:11:18.95,Default,,0000,0000,0000,,the more it became clear to us\Nthat we are doing cinematography.
Dialogue: 0,0:11:19.26,0:11:21.16,Default,,0000,0000,0000,,We're doing filmmaking,
Dialogue: 0,0:11:21.16,0:11:24.09,Default,,0000,0000,0000,,it's just that the actors are not actors,
Dialogue: 0,0:11:24.09,0:11:26.91,Default,,0000,0000,0000,,they're real doctors and nurses.
Dialogue: 0,0:11:27.32,0:11:30.62,Default,,0000,0000,0000,,So these are some photos of our\Ndear friends at Fractured FX
Dialogue: 0,0:11:30.62,0:11:32.42,Default,,0000,0000,0000,,in Hollywood California,
Dialogue: 0,0:11:32.42,0:11:35.68,Default,,0000,0000,0000,,an Emmy-award winning\Nspecial effects firm.
Dialogue: 0,0:11:36.47,0:11:39.24,Default,,0000,0000,0000,,This is Justin Raleigh and his group --
Dialogue: 0,0:11:39.24,0:11:40.91,Default,,0000,0000,0000,,this is not one of our patients --
Dialogue: 0,0:11:40.91,0:11:42.23,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:11:42.23,0:11:45.20,Default,,0000,0000,0000,,but kind of the exquisite work\Nthat these individuals do.
Dialogue: 0,0:11:45.20,0:11:48.81,Default,,0000,0000,0000,,We have now collaborated\Nand fused our experience,
Dialogue: 0,0:11:48.81,0:11:51.22,Default,,0000,0000,0000,,bringing their group to Boston\NChildren's Hospital,
Dialogue: 0,0:11:51.22,0:11:54.12,Default,,0000,0000,0000,,sending our group\Nout to Hollywood, California,
Dialogue: 0,0:11:54.12,0:11:55.59,Default,,0000,0000,0000,,and exchanging around this
Dialogue: 0,0:11:55.59,0:11:58.54,Default,,0000,0000,0000,,to be able to develop these\Ntype of simultors.
Dialogue: 0,0:11:58.54,0:12:02.85,Default,,0000,0000,0000,,What I'm about to show you\Nis a reproduction of this child.
Dialogue: 0,0:12:07.41,0:12:12.56,Default,,0000,0000,0000,,You'll notice here that every hair\Non the child's head is reproduced.
Dialogue: 0,0:12:12.56,0:12:13.86,Default,,0000,0000,0000,,And in fact,
Dialogue: 0,0:12:13.86,0:12:16.32,Default,,0000,0000,0000,,this is also that reproduced child,
Dialogue: 0,0:12:16.32,0:12:19.54,Default,,0000,0000,0000,,and I apologize for any queasy stomachs,
Dialogue: 0,0:12:19.54,0:12:24.49,Default,,0000,0000,0000,,but that is a reproduction in simulation\Nof the child they're about to operate on.
Dialogue: 0,0:12:26.72,0:12:29.18,Default,,0000,0000,0000,,Here's that membrane we had talked about,
Dialogue: 0,0:12:29.18,0:12:31.33,Default,,0000,0000,0000,,the inside of this child's brain.
Dialogue: 0,0:12:31.60,0:12:34.90,Default,,0000,0000,0000,,What you're going to be seeing here\Nis on one side,
Dialogue: 0,0:12:34.90,0:12:36.90,Default,,0000,0000,0000,,the actual patient,
Dialogue: 0,0:12:36.90,0:12:37.97,Default,,0000,0000,0000,,and on the other side,
Dialogue: 0,0:12:37.97,0:12:39.11,Default,,0000,0000,0000,,the simulator.
Dialogue: 0,0:12:39.11,0:12:40.12,Default,,0000,0000,0000,,As I mentioned,
Dialogue: 0,0:12:40.12,0:12:41.52,Default,,0000,0000,0000,,a scope,
Dialogue: 0,0:12:41.52,0:12:43.58,Default,,0000,0000,0000,,a little camera needs\Nto make it's way down,
Dialogue: 0,0:12:43.58,0:12:44.92,Default,,0000,0000,0000,,and you're seeing that here.
Dialogue: 0,0:12:44.92,0:12:47.27,Default,,0000,0000,0000,,It needs to make a small\Nhole in this membrane --
Dialogue: 0,0:12:47.27,0:12:50.43,Default,,0000,0000,0000,,allow this fluid to seep out.
Dialogue: 0,0:12:51.29,0:12:57.17,Default,,0000,0000,0000,,I won't do a quiz show to see\Nwho thinks which side is which ...
Dialogue: 0,0:12:57.17,0:13:00.30,Default,,0000,0000,0000,,but on the right is the simulator.
Dialogue: 0,0:13:00.91,0:13:04.70,Default,,0000,0000,0000,,So surgeons can now produce\Ntraining opportunities,
Dialogue: 0,0:13:04.70,0:13:07.78,Default,,0000,0000,0000,,do these surgeries as many\Ntimes as they want --
Dialogue: 0,0:13:07.78,0:13:09.12,Default,,0000,0000,0000,,until their heart's content,
Dialogue: 0,0:13:09.12,0:13:10.64,Default,,0000,0000,0000,,until they feel comfortable.
Dialogue: 0,0:13:10.64,0:13:11.64,Default,,0000,0000,0000,,And then --
Dialogue: 0,0:13:11.64,0:13:12.64,Default,,0000,0000,0000,,and only then,
Dialogue: 0,0:13:12.64,0:13:14.56,Default,,0000,0000,0000,,bring the child into the operating room.
Dialogue: 0,0:13:14.56,0:13:15.67,Default,,0000,0000,0000,,But we don't stop here.
Dialogue: 0,0:13:15.67,0:13:19.79,Default,,0000,0000,0000,,We know that a key step to this\Nis not just the skill itself,
Dialogue: 0,0:13:19.79,0:13:24.22,Default,,0000,0000,0000,,but combining that skill with a team\Nwho's going to deliver that care.
Dialogue: 0,0:13:24.60,0:13:27.41,Default,,0000,0000,0000,,Now we turn to Formula One.
Dialogue: 0,0:13:27.41,0:13:30.58,Default,,0000,0000,0000,,And here is an example\Nof a technician putting a tire,
Dialogue: 0,0:13:30.58,0:13:33.81,Default,,0000,0000,0000,,and doing that time and time\Nagain on this car,
Dialogue: 0,0:13:33.81,0:13:36.68,Default,,0000,0000,0000,,but that is very quickly\Ngoing to be incorporated
Dialogue: 0,0:13:36.68,0:13:38.76,Default,,0000,0000,0000,,within team training experiences,
Dialogue: 0,0:13:38.76,0:13:42.99,Default,,0000,0000,0000,,now as a full team orchestrating\Nthe exchange of tires
Dialogue: 0,0:13:42.99,0:13:46.26,Default,,0000,0000,0000,,and getting this car back on the speedway.
Dialogue: 0,0:13:46.59,0:13:49.73,Default,,0000,0000,0000,,We've done that step in healthcare,
Dialogue: 0,0:13:49.73,0:13:53.49,Default,,0000,0000,0000,,so now what you're about to see\Nis a simulated operation.
Dialogue: 0,0:13:54.82,0:13:57.17,Default,,0000,0000,0000,,We've taken the simulator\NI just described to you,
Dialogue: 0,0:13:57.17,0:14:00.59,Default,,0000,0000,0000,,we've brought it into the operating room\Nat Boston Children's Hospital,
Dialogue: 0,0:14:00.59,0:14:01.83,Default,,0000,0000,0000,,and these individuals --
Dialogue: 0,0:14:01.83,0:14:04.33,Default,,0000,0000,0000,,these native teams, operative teams --
Dialogue: 0,0:14:04.33,0:14:08.00,Default,,0000,0000,0000,,are doing the surgery before the surgery.
Dialogue: 0,0:14:08.00,0:14:09.76,Default,,0000,0000,0000,,Operate twice;
Dialogue: 0,0:14:09.76,0:14:11.11,Default,,0000,0000,0000,,cut once.
Dialogue: 0,0:14:11.38,0:14:13.10,Default,,0000,0000,0000,,Let me show that to you.
Dialogue: 0,0:14:13.52,0:14:16.36,Default,,0000,0000,0000,,(Video) Surgical team: You want\Nthe head down or head up?
Dialogue: 0,0:14:18.15,0:14:20.18,Default,,0000,0000,0000,,Lower the whole table down a little bit.
Dialogue: 0,0:14:20.18,0:14:21.68,Default,,0000,0000,0000,,Table coming down.
Dialogue: 0,0:14:24.98,0:14:27.71,Default,,0000,0000,0000,,All right, this is behaving like a vessel.
Dialogue: 0,0:14:27.71,0:14:30.21,Default,,0000,0000,0000,,Can I have the scissors back, please?
Dialogue: 0,0:14:36.52,0:14:38.03,Default,,0000,0000,0000,,PW: It's really amazing.
Dialogue: 0,0:14:38.03,0:14:39.95,Default,,0000,0000,0000,,The second step to this which is critical
Dialogue: 0,0:14:39.95,0:14:43.02,Default,,0000,0000,0000,,is we take these teams out\Nimmediately and we debrief them.
Dialogue: 0,0:14:43.44,0:14:45.20,Default,,0000,0000,0000,,We use the same technologies
Dialogue: 0,0:14:45.20,0:14:49.91,Default,,0000,0000,0000,,that are used in Lean\Nand Six Sigma in the military,
Dialogue: 0,0:14:49.91,0:14:52.89,Default,,0000,0000,0000,,and we bring them out and we\Ntalk about what went right,
Dialogue: 0,0:14:52.89,0:14:54.56,Default,,0000,0000,0000,,but more importantly,
Dialogue: 0,0:14:54.56,0:14:57.04,Default,,0000,0000,0000,,we talk about what didn't go well,
Dialogue: 0,0:14:57.04,0:14:59.14,Default,,0000,0000,0000,,and how we're going to fix it.
Dialogue: 0,0:14:59.14,0:15:01.92,Default,,0000,0000,0000,,Then we bring them right back in\Nand we do it again.
Dialogue: 0,0:15:01.92,0:15:06.93,Default,,0000,0000,0000,,Deliberative batting practice\Nin the moments when it matters most.
Dialogue: 0,0:15:08.74,0:15:10.76,Default,,0000,0000,0000,,Let's go back to this case now.
Dialogue: 0,0:15:11.09,0:15:12.56,Default,,0000,0000,0000,,Same child,
Dialogue: 0,0:15:12.56,0:15:13.66,Default,,0000,0000,0000,,but now let me describe
Dialogue: 0,0:15:13.66,0:15:16.34,Default,,0000,0000,0000,,how we care for this child\Nat Boston Children's Hospital.
Dialogue: 0,0:15:16.34,0:15:19.21,Default,,0000,0000,0000,,This child was born\Nat three o'clock in the morning.
Dialogue: 0,0:15:19.21,0:15:21.24,Default,,0000,0000,0000,,At two o'clock in the morning,
Dialogue: 0,0:15:21.24,0:15:23.39,Default,,0000,0000,0000,,we assembled the team,
Dialogue: 0,0:15:23.39,0:15:25.21,Default,,0000,0000,0000,,and took the reproduced anatomy
Dialogue: 0,0:15:25.21,0:15:28.94,Default,,0000,0000,0000,,that we would gain\Nout of scans and images,
Dialogue: 0,0:15:28.94,0:15:31.67,Default,,0000,0000,0000,,and brought that team\Nto the virtual bedside,
Dialogue: 0,0:15:31.67,0:15:33.28,Default,,0000,0000,0000,,to a simulated bedside --
Dialogue: 0,0:15:33.28,0:15:37.02,Default,,0000,0000,0000,,the same team that's going to operate\Non this child in the hours ahead --
Dialogue: 0,0:15:37.02,0:15:39.49,Default,,0000,0000,0000,,and we have them do the procedure.
Dialogue: 0,0:15:39.78,0:15:41.52,Default,,0000,0000,0000,,Let me show you a moment of this.
Dialogue: 0,0:15:42.33,0:15:45.76,Default,,0000,0000,0000,,This is not a real incision,
Dialogue: 0,0:15:45.76,0:15:48.41,Default,,0000,0000,0000,,and the baby has not yet been born.
Dialogue: 0,0:15:49.31,0:15:50.68,Default,,0000,0000,0000,,Imagine this.
Dialogue: 0,0:15:52.29,0:15:56.20,Default,,0000,0000,0000,,So now the conversations\Nthat I have with families
Dialogue: 0,0:15:56.20,0:15:58.84,Default,,0000,0000,0000,,in the intensive care unit\Nat Boston Children's Hospital
Dialogue: 0,0:15:58.84,0:16:00.40,Default,,0000,0000,0000,,are totally different.
Dialogue: 0,0:16:00.87,0:16:02.92,Default,,0000,0000,0000,,Imagine this conversation.
Dialogue: 0,0:16:03.88,0:16:08.66,Default,,0000,0000,0000,,Not only do we take care of this\Ndisorder frequently in our ICU,
Dialogue: 0,0:16:08.66,0:16:10.38,Default,,0000,0000,0000,,and not only have we done surgeries
Dialogue: 0,0:16:10.38,0:16:13.21,Default,,0000,0000,0000,,like the surgery we're going\Nto do on your child,
Dialogue: 0,0:16:13.21,0:16:18.15,Default,,0000,0000,0000,,but we have done your child's surgery,
Dialogue: 0,0:16:18.15,0:16:20.90,Default,,0000,0000,0000,,and we did it two hours ago,
Dialogue: 0,0:16:20.90,0:16:23.59,Default,,0000,0000,0000,,and we did it 10 times,
Dialogue: 0,0:16:23.59,0:16:27.83,Default,,0000,0000,0000,,and now we're prepared to take\Nthem back to the operating room.
Dialogue: 0,0:16:28.79,0:16:32.44,Default,,0000,0000,0000,,So a new technology in healtchare:
Dialogue: 0,0:16:32.44,0:16:35.33,Default,,0000,0000,0000,,lifelike rehearsal.
Dialogue: 0,0:16:35.33,0:16:38.89,Default,,0000,0000,0000,,Practicing prior to game time.
Dialogue: 0,0:16:39.64,0:16:40.79,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:16:41.04,0:16:42.38,Default,,0000,0000,0000,,(Applause)