0:00:17.301,0:00:21.176
What if I told you[br]there was a new technology

0:00:21.200,0:00:25.768
that, when placed in the hands[br]of doctors and nurses,

0:00:25.792,0:00:30.935
improved outcomes for children[br]and adults, patients of all ages;

0:00:31.991,0:00:34.534
reduced pain and suffering,

0:00:34.558,0:00:37.747
reduced time in the operating rooms,

0:00:37.771,0:00:40.624
reduced anesthetic times,

0:00:40.648,0:00:42.546
had the ultimate dose-response curve

0:00:42.570,0:00:44.316
that the more you did it,

0:00:44.340,0:00:46.662
the better it benefitted patients?

0:00:47.840,0:00:50.242
Here's a kicker: it has no side effects,

0:00:51.666,0:00:54.683
and it's available no matter[br]where care is delivered.

0:00:55.835,0:00:59.277
I can tell you as an ICU doctor[br]at Boston Children's Hospital,

0:00:59.301,0:01:01.608
this would be a game changer for me.

0:01:02.865,0:01:06.467
And the good news is that I'm here[br]to tell you about this technology

0:01:06.491,0:01:10.855
and that we're finding, as we apply[br]this technology in health care,

0:01:10.879,0:01:13.974
we are having these exact outcomes[br]I've just described to you.

0:01:15.132,0:01:19.765
That technology is lifelike rehearsal.

0:01:20.632,0:01:23.171
Just in the times that matter most,

0:01:23.195,0:01:26.566
and in the places that matter most,[br]and for the teams that matter most,

0:01:26.590,0:01:29.757
and ultimately, for the patients[br]that matter most.

0:01:29.781,0:01:31.279
And this technology,

0:01:31.303,0:01:32.661
this lifelike rehearsal,

0:01:32.685,0:01:35.873
is being delivered[br]through medical simulation.

0:01:37.421,0:01:41.422
I thought I would start with a case,

0:01:41.446,0:01:44.156
just to really describe[br]the challenge ahead,

0:01:44.180,0:01:47.551
and why this technology is not just[br]going to improve health care

0:01:47.575,0:01:50.265
but why it's critical to health care.

0:01:51.098,0:01:53.971
This is a child that's born, young girl.

0:01:53.995,0:01:55.755
"Day of life zero," we call it,

0:01:55.779,0:01:58.078
the first day of life,[br]just born into the world.

0:01:58.102,0:01:59.493
And just as she's being born,

0:01:59.517,0:02:01.949
we notice very quickly[br]that she is deteriorating.

0:02:02.469,0:02:05.382
Her heart rate is going up,[br]her blood pressure is going down,

0:02:05.406,0:02:07.048
she's breathing very, very fast.

0:02:07.807,0:02:12.275
And the reason for this[br]is displayed in this chest X-ray.

0:02:15.942,0:02:19.037
You can see here,[br]it's a quick study in radiology.

0:02:19.061,0:02:21.609
As you see here, the upper portion[br]of this child's --

0:02:21.633,0:02:22.944
That's called a babygram,

0:02:22.968,0:02:26.242
a full X-ray of a child's body,[br]a little infant's body.

0:02:26.266,0:02:28.172
As you look on the top side of this,

0:02:28.196,0:02:30.679
that's where the heart and lungs[br]are supposed to be.

0:02:30.703,0:02:33.480
As you look at the bottom end,[br]that's where the abdomen is,

0:02:33.504,0:02:35.926
and that's where the intestines[br]are supposed to be.

0:02:35.950,0:02:38.679
And you can see how[br]there's sort of that translucent area

0:02:38.703,0:02:41.874
that made its way up into the right side[br]of this child's chest.

0:02:41.898,0:02:45.906
And those are the intestines --[br]in the wrong place.

0:02:45.930,0:02:48.100
As a result, they're pushing on the lungs

0:02:48.124,0:02:51.095
and making it very difficult[br]for this poor baby to breathe.

0:02:51.648,0:02:53.141
The fix for this problem

0:02:53.165,0:02:55.819
is to take this child immediately[br]to the operating room,

0:02:55.843,0:02:57.974
bring those intestines[br]back into the abdomen,

0:02:57.998,0:02:59.413
let the lungs expand

0:02:59.437,0:03:01.318
and allow this child to breathe again.

0:03:01.917,0:03:03.976
But before she can go[br]to the operating room,

0:03:04.000,0:03:07.292
she must get whisked away[br]to the ICU, where I work.

0:03:07.316,0:03:09.184
I work with surgical teams.

0:03:09.208,0:03:10.510
We gather around her,

0:03:10.534,0:03:14.635
and we place this child[br]on heart-lung bypass.

0:03:16.026,0:03:17.647
We put her to sleep,

0:03:17.671,0:03:20.267
we make a tiny[br]little incision in the neck,

0:03:20.291,0:03:23.429
we place catheters into the major[br]vessels of the neck --

0:03:23.453,0:03:27.147
and I can tell you that these vessels[br]are about the size of a pen,

0:03:27.171,0:03:29.076
the tip of a pen --

0:03:29.100,0:03:31.184
and then we have blood[br]drawn from the body,

0:03:31.208,0:03:33.616
we bring it through a machine,[br]it gets oxygenated,

0:03:33.640,0:03:35.492
and it goes back into the body.

0:03:35.516,0:03:37.092
We save her life,

0:03:37.116,0:03:39.640
and get her safely to the operating room.

0:03:41.480,0:03:42.758
Here's the problem:

0:03:44.302,0:03:45.875
these disorders --

0:03:45.899,0:03:49.188
what is known is congenital[br]diaphragmatic hernia --

0:03:49.212,0:03:52.808
this hole in the diaphragm that has[br]allowed these intestines to sneak up --

0:03:52.832,0:03:54.798
these disorders are rare.

0:03:55.723,0:03:59.548
Even in the best hands in the world,

0:03:59.572,0:04:03.082
there is still a challenge[br]to get the volume --

0:04:03.106,0:04:05.004
the natural volume of these patients --

0:04:05.028,0:04:07.550
in order to get our expertise[br]curve at 100 percent.

0:04:07.574,0:04:09.674
They just don't present that often.

0:04:11.059,0:04:13.965
So how do you make the rare common?

0:04:16.431,0:04:17.728
Here's the other problem:

0:04:18.689,0:04:23.290
in the health care system[br]that I trained for over 20 years,

0:04:23.314,0:04:24.499
what currently exists,

0:04:24.523,0:04:27.467
the model of training is called[br]the apprenticeship model.

0:04:27.491,0:04:29.406
It's been around for centuries.

0:04:29.430,0:04:33.378
It's based on this idea that you see[br]a surgery maybe once,

0:04:33.402,0:04:34.930
maybe several times,

0:04:34.954,0:04:37.744
you then go do that surgery,

0:04:37.768,0:04:41.326
and then ultimately you teach[br]that surgery to the next generation.

0:04:42.772,0:04:45.522
And implicit in this model --

0:04:45.546,0:04:47.720
I don't need to tell you this --

0:04:47.744,0:04:52.701
is that we practice on the very patients[br]that we are delivering care to.

0:04:54.633,0:04:56.312
That's a problem.

0:04:59.606,0:05:01.803
I think there's a better approach.

0:05:01.827,0:05:06.192
Medicine may very well be the last[br]high-stakes industry

0:05:06.216,0:05:08.938
that does not practice prior to game time.

0:05:10.638,0:05:14.820
I want to describe to you a better[br]approach through medical simulation.

0:05:16.649,0:05:20.026
Well, the first thing we did is we went[br]to other high-stakes industries

0:05:20.050,0:05:22.920
that had been using this type[br]of methodology for decades.

0:05:22.944,0:05:24.609
This is nuclear power.

0:05:24.633,0:05:28.674
Nuclear power runs scenarios[br]on a regular basis

0:05:28.698,0:05:31.915
in order to practice[br]what they hope will never occur.

0:05:32.442,0:05:36.290
And as we're all very familiar,[br]the airline industry --

0:05:36.314,0:05:39.611
we all get on planes now,[br]comforted by the idea

0:05:39.635,0:05:45.431
that pilots and crews have trained[br]on simulators much like these,

0:05:45.455,0:05:48.016
training on scenarios[br]that we hope will never occur,

0:05:48.040,0:05:50.120
but we know if they did,

0:05:50.144,0:05:52.657
they would be prepared for the worst.

0:05:53.160,0:05:57.565
In fact, the airline industry has gone[br]as far as to create fuselages

0:05:57.589,0:05:59.132
of simulation environments,

0:05:59.156,0:06:02.397
because of the importance[br]of the team coming together.

0:06:03.043,0:06:05.307
This is an evacuation drill simulator.

0:06:05.936,0:06:09.803
So again, if that ever were to happen,[br]these rare, rare events,

0:06:09.827,0:06:13.117
they're ready to act[br]on the drop of a dime.

0:06:15.116,0:06:20.434
I guess the most compelling for me[br]in some ways is the sports industry --

0:06:20.458,0:06:22.090
arguably high stakes.

0:06:22.703,0:06:25.964
You think about a baseball team:[br]baseball players practice.

0:06:25.988,0:06:28.659
I think it's a beautiful example[br]of progressive training.

0:06:28.683,0:06:31.443
The first thing they do[br]is go out to spring training.

0:06:31.467,0:06:33.731
They go to a spring training camp,

0:06:33.755,0:06:36.274
perhaps a simulator in baseball.

0:06:36.802,0:06:39.844
They're not on the real field,[br]but they're on a simulated field,

0:06:39.868,0:06:41.901
and they're playing in the pregame season.

0:06:41.925,0:06:45.422
Then they make their way to the field[br]during the season games,

0:06:45.446,0:06:48.544
and what's the first thing they do[br]before they start the game?

0:06:48.568,0:06:52.999
They go into the batting cage[br]and do batting practice for hours,

0:06:53.023,0:06:56.354
having different types of pitches[br]being thrown at them,

0:06:56.378,0:07:00.710
hitting ball after ball[br]as they limber their muscles,

0:07:00.734,0:07:02.707
getting ready for the game itself.

0:07:02.731,0:07:05.581
And here's the most[br]phenomenal part of this,

0:07:06.755,0:07:09.255
and for all of you who watch[br]any sport event,

0:07:09.279,0:07:11.194
you will see this phenomenon happen.

0:07:12.071,0:07:14.759
The batter gets into the batter's box,

0:07:14.783,0:07:16.904
the pitcher gets ready to pitch.

0:07:16.928,0:07:20.034
Right before the pitch is thrown,

0:07:20.058,0:07:21.267
what does that batter do?

0:07:21.291,0:07:23.195
The batter steps out of the box

0:07:24.507,0:07:25.975
and takes a practice swing.

0:07:28.644,0:07:30.469
He wouldn't do it any other way.

0:07:33.112,0:07:36.527
I want to talk to you about how[br]we're building practice swings like this

0:07:36.551,0:07:37.706
in medicine.

0:07:37.730,0:07:41.912
We are building batting cages[br]for the patients that we care about

0:07:41.936,0:07:43.164
at Boston Children's.

0:07:43.188,0:07:45.681
I want to use this case[br]that we recently built.

0:07:46.204,0:07:50.475
It's the case of a four-year-old[br]who had a progressively enlarging head,

0:07:50.499,0:07:51.776
and as a result,

0:07:51.800,0:07:54.932
had loss of developmental milestones,[br]neurologic milestones,

0:07:54.956,0:07:57.973
and the reason for this problem is here --

0:07:58.297,0:08:00.321
it's called hydrocephalus.

0:08:01.172,0:08:04.043
So, a quick study in neurosurgery.

0:08:04.067,0:08:05.232
There's the brain,

0:08:05.256,0:08:07.804
and you can see the cranium[br]surrounding the brain.

0:08:08.269,0:08:11.613
What surrounds the brain,[br]between the brain and cranium,

0:08:11.637,0:08:14.855
is something called[br]cerebrospinal fluid or fluid,

0:08:14.879,0:08:16.613
which acts as a shock absorber.

0:08:17.206,0:08:18.528
In your heads right now,

0:08:18.552,0:08:21.809
there is cerebrospinal fluid[br]just bathing your brains

0:08:21.833,0:08:23.659
and making its way around.

0:08:23.683,0:08:26.309
It's produced in one area[br]and flows through,

0:08:26.333,0:08:27.624
and then is re-exchanged.

0:08:27.648,0:08:30.545
And this beautiful flow pattern[br]occurs for all of us.

0:08:31.125,0:08:33.170
But unfortunately in some children,

0:08:33.194,0:08:35.697
there's a blockage of this flow pattern,

0:08:35.721,0:08:37.273
much like a traffic jam.

0:08:37.745,0:08:40.568
As a result, the fluid accumulates,

0:08:40.592,0:08:43.108
and the brain is pushed aside.

0:08:43.807,0:08:45.644
It has difficulty growing.

0:08:46.281,0:08:49.623
As a result, the child loses[br]neurologic milestones.

0:08:49.647,0:08:52.058
This is a devastating disease in children.

0:08:52.373,0:08:55.447
The cure for this is surgery.

0:08:55.571,0:08:58.481
The traditional surgery is to take[br]a bit of the cranium off,

0:08:58.505,0:08:59.663
a bit of the skull,

0:08:59.687,0:09:02.630
drain this fluid out,[br]stick a drain in place,

0:09:02.654,0:09:05.382
and then eventually bring[br]this drain internal to the body.

0:09:05.406,0:09:06.622
Big operation.

0:09:07.596,0:09:11.913
But some great news is that advances[br]in neurosurgical care

0:09:11.937,0:09:15.646
have allowed us to develop[br]minimally invasive approaches

0:09:15.670,0:09:16.830
to this surgery.

0:09:16.854,0:09:21.179
Through a small pinhole,[br]a camera can be inserted,

0:09:22.432,0:09:25.160
led into the deep brain structure,

0:09:25.184,0:09:29.137
and cause a little hole in a membrane[br]that allows all that fluid to drain,

0:09:29.161,0:09:31.209
much like it would in a sink.

0:09:31.233,0:09:34.348
All of a sudden, the brain[br]is no longer under pressure,

0:09:34.372,0:09:35.829
can re-expand

0:09:35.853,0:09:38.732
and we cure the child[br]through a single-hole incision.

0:09:40.158,0:09:41.573
But here's the problem:

0:09:41.597,0:09:43.741
hydrocephalus is relatively rare.

0:09:44.410,0:09:46.820
And there are no good training methods

0:09:46.844,0:09:50.468
to get really good at getting[br]this scope to the right place.

0:09:50.492,0:09:54.806
But surgeons have been quite creative[br]about this, even our own.

0:09:54.830,0:09:56.838
And they've come up with training models.

0:09:56.862,0:09:58.587
Here's the current training model.

0:09:58.611,0:10:00.569
(Laughter)

0:10:00.593,0:10:02.250
I kid you not.

0:10:02.274,0:10:03.497
This is a red pepper,

0:10:05.022,0:10:06.213
not made in Hollywood;

0:10:06.237,0:10:07.565
it's a real red pepper.

0:10:08.000,0:10:10.947
And what surgeons do is they stick[br]a scope into the pepper,

0:10:10.971,0:10:14.069
and they do what is called a "seedectomy."

0:10:14.093,0:10:15.860
(Laughter)

0:10:15.884,0:10:21.984
They use this scope to remove seeds[br]using a little tweezer.

0:10:22.652,0:10:25.280
And that is a way to get under their belts

0:10:25.304,0:10:28.300
the rudimentary components[br]of doing this surgery.

0:10:28.956,0:10:31.392
Then they head right into[br]the apprenticeship model,

0:10:31.416,0:10:34.288
seeing many of them[br]as they present themselves,

0:10:34.312,0:10:36.305
then doing it, and then teaching it --

0:10:36.329,0:10:38.346
waiting for these patients to arrive.

0:10:39.437,0:10:40.976
We can do a lot better.

0:10:41.429,0:10:45.873
And I want to take you now into[br]what is veritably the Willy Wonka shop

0:10:45.897,0:10:48.176
at Boston Children's Hospital,

0:10:48.200,0:10:52.927
where we are manufacturing[br]reproductions of children

0:10:53.191,0:10:57.097
in order for surgeons and surgical[br]teams to rehearse

0:10:57.121,0:10:59.501
in the most relevant possible ways.

0:10:59.525,0:11:00.900
Let me show you this.

0:11:03.296,0:11:05.204
Here's my team

0:11:05.228,0:11:09.133
in what's called the SIM Engineering[br]Division of the Simulator Program.

0:11:09.940,0:11:12.783
This is an amazing team of individuals.

0:11:12.807,0:11:15.082
They are mechanical engineers;

0:11:15.106,0:11:17.531
you're seeing here, illustrators.

0:11:17.555,0:11:22.127
They take primary data[br]from CT scans and MRIs,

0:11:22.151,0:11:25.481
translate it into digital information,

0:11:25.505,0:11:26.811
animate it,

0:11:26.835,0:11:31.626
put it together into the components[br]of the child itself,

0:11:31.650,0:11:35.444
surface-scan elements of the child[br]that have been casted as needed,

0:11:35.468,0:11:38.053
depending on the surgery itself,

0:11:38.077,0:11:41.968
and then take this digital data[br]and be able to output it

0:11:41.992,0:11:45.740
on state-of-the-art,[br]three-dimensional printing devices

0:11:45.764,0:11:48.034
that allow us to print the components

0:11:48.058,0:11:53.726
exactly to the micron detail of what[br]the child's anatomy will look like.

0:11:53.750,0:11:55.054
You can see here,

0:11:55.078,0:11:57.512
the skull of this child being printed

0:11:57.536,0:12:00.022
in the hours before[br]we performed this surgery.

0:12:01.238,0:12:03.814
But we could not do this work

0:12:03.838,0:12:08.225
without our dear friends on the West Coast[br]in Hollywood, California.

0:12:09.400,0:12:12.630
These are individuals[br]that are incredibly talented

0:12:12.654,0:12:15.078
at being able to recreate reality.

0:12:15.102,0:12:19.526
It was not a long leap for us.

0:12:19.550,0:12:21.126
The more we got into this field,

0:12:21.150,0:12:24.910
the more it became clear to us[br]that we are doing cinematography.

0:12:25.610,0:12:27.487
We're doing filmmaking,

0:12:27.511,0:12:29.735
it's just that the actors are not actors.

0:12:30.529,0:12:33.025
They're real doctors and nurses.

0:12:33.810,0:12:37.189
So these are some photos[br]of our dear friends at Fractured FX

0:12:37.213,0:12:38.682
in Hollywood California,

0:12:38.706,0:12:42.280
an Emmy-Award-winning[br]special effects firm.

0:12:42.304,0:12:45.474
This is Justin Raleigh and his group --

0:12:45.498,0:12:47.146
this is not one of our patients --

0:12:47.170,0:12:48.528
(Laughter)

0:12:48.552,0:12:51.620
but kind of the exquisite work[br]that these individuals do.

0:12:51.644,0:12:55.248
We have now collaborated[br]and fused our experience,

0:12:55.272,0:12:57.678
bringing their group[br]to Boston Children's Hospital,

0:12:57.702,0:13:00.358
sending our group[br]out to Hollywood, California

0:13:00.382,0:13:01.751
and exchanging around this

0:13:01.775,0:13:04.778
to be able to develop[br]these type of simulators.

0:13:04.802,0:13:08.984
What I'm about to show you[br]is a reproduction of this child.

0:13:09.008,0:13:11.016
This is not a real child.

0:13:19.792,0:13:24.920
You'll notice here that every hair[br]on the child's head is reproduced.

0:13:24.944,0:13:28.647
And in fact, this is also[br]that reproduced child --

0:13:28.671,0:13:31.864
and I apologize for any queasy stomachs,

0:13:31.888,0:13:34.748
but that is a reproduction and simulation

0:13:34.772,0:13:36.866
of the child they're about to operate on.

0:13:39.113,0:13:41.551
Here's that membrane we had talked about,

0:13:41.575,0:13:43.734
the inside of this child's brain.

0:13:44.158,0:13:49.126
What you're going to be seeing here[br]is, on one side, the actual patient,

0:13:49.150,0:13:51.429
and on the other side, the simulator.

0:13:51.453,0:13:55.803
As I mentioned, a scope, a little camera,[br]needs to make its way down,

0:13:55.827,0:13:57.228
and you're seeing that here.

0:13:57.252,0:13:59.576
It needs to make a small hole[br]in this membrane

0:13:59.600,0:14:02.309
and allow this fluid to seep out.

0:14:03.775,0:14:08.416
I won't do a quiz show to see[br]who thinks which side is which,

0:14:09.582,0:14:11.886
but on the right is the simulator.

0:14:13.303,0:14:17.101
So surgeons can now produce[br]training opportunities,

0:14:17.125,0:14:20.678
do these surgeries[br]as many times as they want,

0:14:20.702,0:14:23.544
to their heart's content,[br]until they feel comfortable.

0:14:23.668,0:14:27.263
And then, and only then,[br]bring the child into the operating room.

0:14:27.287,0:14:28.456
But we don't stop here.

0:14:28.480,0:14:32.790
We know that a key step to this[br]is not just the skill itself,

0:14:32.814,0:14:37.345
but combining that skill with a team[br]who's going to deliver that care.

0:14:37.369,0:14:39.711
Now we turn to Formula One.

0:14:40.275,0:14:43.525
And here is an example[br]of a technician putting on a tire

0:14:43.549,0:14:46.758
and doing that time and time[br]again on this car.

0:14:46.782,0:14:49.767
But that is very quickly[br]going to be incorporated

0:14:49.791,0:14:51.722
within team-training experiences,

0:14:51.746,0:14:55.955
now as a full team orchestrating[br]the exchange of tires

0:14:55.979,0:14:59.476
and getting this car back on the speedway.

0:15:00.424,0:15:03.701
We've done that step in health care,

0:15:03.725,0:15:09.756
so now what you're about to see[br]is a simulated operation.

0:15:11.010,0:15:13.397
We've taken the simulator[br]I just described to you,

0:15:13.421,0:15:16.822
we've brought it into the operating room[br]at Boston Children's Hospital,

0:15:16.846,0:15:20.501
and these individuals --[br]these native teams, operative teams --

0:15:20.525,0:15:24.048
are doing the surgery before the surgery.

0:15:24.072,0:15:25.809
Operate twice;

0:15:25.833,0:15:27.039
cut once.

0:15:27.369,0:15:28.765
Let me show that to you.

0:15:31.837,0:15:34.950
(Video) Surgical team member 1:[br]You want the head down or head up?

0:15:34.974,0:15:36.678
STM 2: Can you lower it down to 10?

0:15:36.702,0:15:39.351
STM 3: And then lower[br]the whole table down a little bit?

0:15:39.375,0:15:40.629
STM 4: Table coming down.

0:15:43.276,0:15:45.981
STM 3: All right, this[br]is behaving like a vessel.

0:15:46.005,0:15:48.092
Could we have the scissors back, please?

0:15:48.116,0:15:51.417
STM 5: I'm taking my gloves,[br]8 to 8 1/2, all right? I'll be right in.

0:15:51.441,0:15:53.842
STM 6: Great! Thank you.

0:15:54.856,0:15:56.689
Peter Weinstock: It's really amazing.

0:15:57.113,0:15:59.205
The second step to this,[br]which is critical,

0:15:59.229,0:16:02.328
is we take these teams out[br]immediately and debrief them.

0:16:02.802,0:16:04.266
We use the same technologies

0:16:04.290,0:16:08.978
that are used in Lean[br]and Six Sigma in the military,

0:16:09.002,0:16:12.087
and we bring them out[br]and talk about what went right,

0:16:12.111,0:16:13.563
but more importantly,

0:16:13.587,0:16:16.247
we talk about what didn't go well,

0:16:16.271,0:16:18.206
and how we're going to fix it.

0:16:18.230,0:16:20.984
Then we bring them right back in[br]and do it again.

0:16:21.008,0:16:26.199
Deliberative batting practice[br]in the moments when it matters most.

0:16:27.808,0:16:29.830
Let's go back to this case now.

0:16:30.453,0:16:31.830
Same child,

0:16:31.854,0:16:34.244
but now let me describe[br]how we care for this child

0:16:34.268,0:16:35.731
at Boston Children's Hospital.

0:16:35.755,0:16:38.241
This child was born[br]at three o'clock in the morning.

0:16:38.265,0:16:40.272
At two o'clock in the morning,

0:16:40.296,0:16:42.422
we assembled the team,

0:16:42.446,0:16:44.247
and took the reproduced anatomy

0:16:44.271,0:16:48.057
that we would gain[br]out of scans and images,

0:16:48.600,0:16:51.366
and brought that team[br]to the virtual bedside,

0:16:51.390,0:16:52.977
to a simulated bedside --

0:16:53.001,0:16:56.542
the same team that's going to operate[br]on this child in the hours ahead --

0:16:56.566,0:16:58.949
and we have them do the procedure.

0:16:59.616,0:17:01.296
Let me show you a moment of this.

0:17:06.151,0:17:08.311
This is not a real incision.

0:17:09.621,0:17:11.821
And the baby has not yet been born.

0:17:13.283,0:17:14.651
Imagine this.

0:17:21.203,0:17:25.091
So now the conversations[br]that I have with families

0:17:25.115,0:17:27.815
in the intensive care unit[br]at Boston Children's Hospital

0:17:27.839,0:17:29.227
are totally different.

0:17:29.832,0:17:31.568
Imagine this conversation:

0:17:32.719,0:17:37.570
"Not only do we take care of this disorder[br]frequently in our ICU,

0:17:37.594,0:17:39.772
and not only have we done surgeries

0:17:39.796,0:17:42.231
like the surgery we're going[br]to do on your child,

0:17:42.255,0:17:45.969
but we have done your child's surgery.

0:17:47.026,0:17:49.556
And we did it two hours ago.

0:17:49.580,0:17:52.312
And we did it 10 times.

0:17:52.336,0:17:56.157
And now we're prepared to take them[br]back to the operating room."

0:17:57.801,0:18:00.131
So a new technology in health care:

0:18:01.237,0:18:04.105
lifelike rehearsal.

0:18:04.129,0:18:07.683
Practicing prior to game time.

0:18:08.702,0:18:09.882
Thank you.

0:18:09.906,0:18:16.906
(Applause)