Medical Simulation: Another Scientific RevolutionAnother Scientific .

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Medical Simulation:Another Scientific RevolutionROGER SMITHChief Technology OfficerUS Army PEO STRIhttp://www.peostri.army.mil/CTOApproved for Public Release.Security and OPSEC Review Completed: No Issues.

Scientific Evolution (Normal Phase)“If I have seen further it is only by standing on the shoulders of giants.”– Isaac NewtonNewton, 1687NewtonNewtonian MechanicsKepler, 1630Planetary MotionGalileo, 1632Dynamics2

Kuhn’s Scientific edNew ParadigmsCreated

Scientific Revolution4

Scientific SmackdownCopernicuspPt lPtolemyDo Many in SimEinsteinNewtonSee One, Do One,Teach One5

Evolutionary Change6

Evolutionary Change7

Revolutionary Change8

Revolutionary Change9

U.S. ArmyMilitary Occupational SpecialtiesEnlisted MOSInfantry Branch11B Infantryman11C Indirect Fire Infantryman11X Infantryman (ambiguous; turns into 11B,11C, or11M)11Z Infantry Senior Sergeant11H Infantry Anti-Armor Specialist11M Mechanized InfantrymanField Artillery Branch13B Cannon Crewmember13C TAC Fire Operations Specialist13D Field Artillery Tactical Data Systems Specialist13E Cannon Fire Direction Specialist13F Fire Support Specialist13M Multiple Launch Rocket System Crewmember13P MLRS/LANCE Operations Fire Directions Specialist13R Field Artillery Firefinder Radar Operator13S Field Artilleryy Surveyory13W Field Artillery Meteorological Crewmember13X Field Artillery Enlistment Option13Z Field Artillery Senior SergeantAir Defense Artillery Branch14E Patriot Fire Control Enhanced Operator/Maintainer14J Early Warning System Operator14M Man Portable Air Defense System Crewmember14R Bradley Linebacker Crewmember14S Avenger Crewmember14T PATRIOT Launching Station EnhancedOperator/Maintainer14Z Air Defense Artillery (ADA) Senior SergeantAviation Branch15B Aircraft Powerplant Repairer15D Aircraft Powertrain Repairer15F Aircraft Electrician15G Aircraft Structural Repairer15H Aircraft Pneudraulica Repairer15J OH-58D Armament/Electrical/Avionics SystemsRepairer15K Aircraft Components Repair Supervisor15M UHUH-11 HelicopterH liRepairerR i15N Avionics Mechanic15P Aviation Operations Specialist15Q Air Traffic Control Operator15R AH-64 Attack Helicopter Repairer15S OH-58D Helicopter Repairer15T UH-60 Helicopter Repairer15U Medium Helicopter Repairer15V Observation/Scout Helicopter Repairer15X AH-64 Armament/Electrical Systems Repairer15Y AH-64D Armament/ Electrical Systems Repairer15Z Aircraft Maintenance Senior SergeantSpecial Forces Branch18B Special Forces Weapons Sergeant18C Special Forces Engineer Sergeant18D Special Forces Medical Sergeant18E Special Forces Communications Sergeant18F Special Forces Assistant Operations & IntelligenceSergeant18X Special Forces Candidate18Z Special Forces Operations SergeantArmor Branch19D Cavalry Scout19K Armor Crewmember19Z Armor Senior SergeantCorps of Engineers Branch21B Combat Engineer (Formally 12B)21C Bridge Crewmember21D Diver21E Heavy Construction Equipment Operator21G Quarrying Specialist21H Construction Engineer21J General Construction Equipment Operator21K Plumber21L Lithographer21M Firefighter21N Construction Equipment Supervisor21P Prime Power Production Specialist21Q Transmission and Distribution Specialist21R Interior Electrician21S Topographic Surveyor21T Technical Engineering Specialist21U Topographic Analyst21V Concrete and Asphalt Equipment Operator21W Carpentry and Masonry Specialist21X General Engineering Supervisor21Y Topographic Engineering Supervisor21Z Combat Engineering Senior SergeantSignal Corps Branch25B Information Systems Operator Analyst (to berenamed Information Technology Specialist in Oct'07)Oct 07)25C Radio Operator Maintainer25D Telecommunications Operator/Maintainer (to bedeleted in Oct'07)25F Network Switching Systems Operator/Maintainer25L Wire Systems Installer25M Multimedia Illustrator25N Nodal Network Systems Operator/Maintainer25P Microwave Systems Operator/Maintainer25Q Multichannel Transmission Systems Operator25R Visual Information/Audio Equipment Repairer25S SatelliteS lli CommunicationCi i SystemsSOperator/Maintainer25T Satellite/Microwave Systems Chief25U Signal Support Systems Specialist25V Combat Documentation & Production Specialist25W Telecommunications Operations Chief25X Senior Signal Sergeant25Y Information Systems Chief (to be deleted in Oct'07)25Z Visual Information Operations ChiefJudge Advocate General Branch27D Paralegal SpecialistMilitary Police Corps Branch31B Military Police31D CID Special Agent31E Internment/Resettlement SpecialistMilitary Intelligence Branch33W (35T) MI Systems Maintainer/Integrator96B (35F) Intelligence Analyst96D (35G) Imagery Analyst96H (35H) Imagery Ground Station Operator96R (35H) Ground Surveillance Systems Operator96U (35K) Unmanned Aerial Vehicle Operator96Z (35X) Intelligence Senior Sergeant97B (35L) Counterintelligence Agent97E (35M) Human Intelligence Collector97L (35Q) Translator/Interpreter97Z (35Y) Counterintelligence/Human Intelligence SeniorSergeant98C (35N) Signal Intelligence Analyst (Linguist)98G (35P) Cryptologic Linguist98P (35U) Multi-Sensor Operator98Y (35S) Signals Collector/Analyst98Z (35Z) Signals Intelligence Senior Sergeant09L ((35V)) Translator Aide05h EW/SIGINT Morse Intercept OperatorPsychological Operations Corps Branch37F Psychological Operations SpecialistCivil Affairs Branch38B Civil Affairs SpecialistAdjutant General Branch42A Human Resource Specialist42F Human Resource Systems Information Specialist42L Administration Specialist (to be deleted)42R9B Trumpet Player42R9C Baritone or Euphonium Player42R9D French Horn Player42R9E Trombone Player42R9F Tuba Player42R9G Flute or Piccolo Player42R9H Oboe Player42R9J Clarinet Player42R9K Bassoon Player42R9L Saxophone Player42R9M Percussion Player42R9N Piano Player42R9T GuitarG i PlayerPl42R9U Electric Bass Guitar Player42S Special Band memberFinance Branch44C Finance Specialist/Accounting SpecialistPublic Affairs Branch46Q Public Affairs Specialist46R Broadcast Journalist46Z Public Affairs ChiefChaplain Branch56M Chaplain Assistant363CMF 63 - Mechanical Maintenance44B Metal Worker44E Machinist45B Small Arms/Artillery Repairer45G Fire Control Repairer45K Armament Repairer52C Utilities Equipment Repairer52D Power Generation Equipment Repairer62B Construction Equipment Repairer63A M1 Abrams Tank Turret Mechanic/M1 Abrams TankSystem Mechanic63B Light-Wheel Vehicle Mechanic/Heavy Wheel VehicleMechanic/Wheel Vehicle Repairer63D Artillery Mechanic63H Fuel and Electrical Repairer/Track Vehicle Mechanic63J Quartermaster and Chemical Equipment Repairer63M M2-3 Bradley Fighting Vehicle SystemMechanic/Bradley Fighting Vehicle Systems TurretMechanic63X Track Vehicle Repairer63W All Wheel Vehicle Repairer63Z Mechanical Maintenance SupervisorMedical Department Branches68A Medical Equipment Repairer68D Operating Room Specialist68E Dental Specialist68G Patient Administration Specialist68H Optical Laboratory Specialist68J Medical Logistic Specialist68K Medical Laboratory Specialist68M Hospital Food Specialist68P Radiology Specialist68Q Pharmacy Specialist68R Veterinary Food Inspection Specialist68S Preventive Medicine Specialist68T Animal Care Specialist68V Respiratory Specialist68W Health Care Specialist (aka Combat Medic)68X Mental Health Specialist68Z Chief Medical NCOCh i l BranchChemicalBh74D Chemical Operations Specialist (formerly 54B)CMF 79 - Recruiting and Retention79R Recruiter Noncommissioned Officer79S Career Counselor79T Recruiting and Retention NCO79V Retention and Transition Noncommissioned OfficerTransportation Branch88H Cargo Specialist88K Watercraft Operator88L Watercraft Engineer88M Motor Transport Operator88N Traffic Management Coordinator88P Railway Equipment Repairer88T Railway Section Repairer88U Railway Operations Crewmember88Z Transportation Senior SergeantOrdnance Branch89B Ammunition Specialist89D Explosive Ordnance Disposal SpecialistQuartermaster Corps Branch92A Automated Logistical Specialist92F Petroleum Supply Specialist92G Food Service Specialist92L Petroleum Laboratory Specialist92M Mortuary Affairs Specialist92R Parachute Rigger92S Shower/Laundry and Clothing Repair Specialist92W Water Treatment Specialist92Y Unit Supply Specialist92Z Senior Noncommissioned LogisticianCMF 94 - Electronic Maintenance94A Land Combat Electronic Missile System Repairer94D Air Traffic Control Equipment Repairer94E Radio and Communications Security Repairer94F SpecialpElectronics Devices Repairerp94H Test, Measurement & Diagnostic Equipment SuppSpecialist94K Automatic Test Equipment Operator/Maintainer94L Avionics Communications Equipment Repairer94M Radar Repairer94P Multiple Launch Rocket System Repairer94R Avionics System Repairer94S Patriot System Repairer94T Avenger System Repairer94W Electronic Maintenance Chief94Y Integrated Family of Test Equipment94Z Senior Electronic Maintenance ChiefBranch Immaterial (not oriented to a branch)00Z Command Sergeant MajorCommissioned Officer & Warrant Officer MOSOfficer MOS's are usually two numerical digits plus aletter (most of the time "alpha"). Letterless MOS's areambiguous and have several specific MOS's within theE.g. 62 contains 62A (Emergency Physician) and 62B(Field Surgeon).Warrant Officer MOS's (known as WOMOS) are threenumericali l digitsdi i plusl a letter,lexcept 09W whoh isi not yeWO.Officer Candidates09R Cadet09S Officer Candidate09W Warrant Officer CandidateInfantry Branch11A Infantry OfficerField Artillery Branch13A Field Artillery Officer131A Field Artillery Targeting TechnicianAir Defense Artillery Branch14 Air Defense Artillery Officer140A Command and Control Systems Technician140E Air and Missile Defense (AMD)Tactician/Technician (Patriot Systems Technician)140X Air Defense Artillery (ADA) Immaterial10(Page 1)

U.S. ArmyMilitary Occupational SpecialtiesAviation Branch15 Aviation Officer150A Air Traffic and Air Space Management Technician150U Tactical Unmanned Aerial Vehicle (TUAV)Operations Technician (still classified at 350K untilofficial transfer to Aviation Branch)151A Aviation Maintenance Technician152C OH-6 Pilot152B OH-58A/C Pilot152D OH-58D Pilot152F AH-64A Pilot152H AH-64D Pilot153A Rotary Wing Aviator (Aircraft Nonspecific)153B UH-1 Pilot153D UH-60 Pilot153DD UH-60 MEDEVAC Pilot153E MH-60 Pilot154C CH-47D Pilot154E MH-47 Pilot155A Fixed Wing Aviator (Aircraft Nonspecific)155E C-12 Pilot155F Jet Aircraft Pilot155G O-5A/EO-5B/RC-7 PilotSpecial Forces Branch18A Special Forces Officer180A Special Forces Warrant OfficerArmor Branch19A Armor, General19B Armor19C CavalryCorps of Engineers Branch21A Engineer Officer210A Utilities Operation and Maintenance Technician215D Geospatial Information Technician (Old - TerrainAnalysis Technician)Signal Corps Branch25A Signal Officer250N Network Management Technician251A Information Systems Technician254A Signal Systems Support Technician255Z SeniorS i SignalSi l SystemsSTechnicianT h i iJudge Advocate General Branch27A JAG Corps Attorney27B Military Judge270A Legal AdministratorMilitary Police Corps Branch31A Military Police Officer311A CID Special AgentMilitary Intelligence Branch35D Military Intelligence Officer350F All Source Intelligence Technician350G Imagery Intelligence Technician350Z Attaché Technician350K (150U) Tactical Unmanned Aerial VehicleOperations (transferring to Aviation Branch in Summer07)351L Counterintelligence Technician351M Human Intelligence Collection Technician351Y Area Intelligence Technician352N Traffic Analysis Technician352P Voice Intercept Technician352Q Morse Intercept Technician352R Emanations Analysis Technician352S Non Morse Intercept Technician353T Intelligence and Electronic Warfare TechnicianPsychological Operations Corps Branch37A PsychologicalygOperationspOfficer37X Psychological Operations Officer, DesignatedCivil Affairs Branch38A Civil Affairs Officer38X Civil Affairs Officer, DesignatedAdjutant General Branch42B Personnel Systems Management Officer42C Band Officer420A Military Personnel Technician420C BandmasterFinance Branch44A Finance OfficerChaplain Branch56 Chaplain56A Command and Unit Chaplain56D Clinical Pastoral EducatorMedical Department Branches60A OPERATIONAL MEDICINE60B NUCLEAR MEDICINE OFFICER60C PREVENTIVE MEDICINE OFFICER60D OCCUPATIONAL MEDICINE OFFICER60F PULMONARY DISEASE/CRITICAL CAREOFFICER60G GASTROENTEROLOGIST60H CARDIOLOGIST60J OBSTETRICIAN AND GYNECOLOGIST60K UROLOGIST60L DERMATOLOGIST60M ALLERGIST, CLINICAL IMMUNOLOGIST60N ANESTHESIOLOGIST60P PEDIATRICIAN60Q PEDIATRIC SUB-SPECIALIST60R CHILD NEUROLOGIST60S OPHTHALMOLOGIST60T OTOLARYNGOLOGIST60U CHILD PSYCHIATRIST60V NEUROLOGIST60W PSYCHIATRIST61A NEPHROLOGIST61B MEDICAL ONCOLOGIST/HEMATOLOGIST61C ENDOCRINOLOGIST61D RHEUMATOLOGIST61E CLINICAL PHARMACOLOGIST61F INTERNIST61G INFECTIOUS DISEASE OFFICER61H FAMILY MEDICINE61J GENERAL SURGEON61K THORACIC SURGEON61L PLASTIC SURGEON61M ORTHOPEDIC SURGEON61N FLIGHT SURGEON61P PHYSIATRIST61Q RADIATION ONCOLOGIST61R DIAGNOSTIC RADIOLOGIST61U PATHOLOGIST61W PERIPHERAL VASCULAR SURGEON61Z NEUROSURGEON62 Medical Corps Officer62A Emergency Physician62B Field Surgeon63 Dental Corps Officer63A General Dentist63B Comprehensive Dentist63D Periodontist63E Endodontist63F Prosthodontist63H Public Health Dentist63K Pediatric Dentist63M Orthodontist63N Oral and Maxillofacial Surgeon63P Oral Pathologist63R Executive Dentist64A Veterinary Corps Officer640A Veterinary Services Food Safety Technician65 Medical Specialist Corps Officer65A Occupational Therapy65B Physical Therapy65C Dietitian65D PhysicianPh i i AssistantA i65X Specialist Allied Operations66 Nurse Corps Officer66B Community Health Nurse66C Psychiatric/Mental Health Nurse66E Perioperative Nurse66F Nurse Anesthetist66G Obstetrics and Gyneco66H Medical-Surgical Nurse66N Generalist Nurse66P Family Nurse Practitioner67 Medical Service Corps Officer67A Health Services67B Laboratory Sciences67C Preventive Medicine Sciences67D Behavioral Sciences67E Pharmacy67F Optometry67G Podiatry67J Aeromedical Evacuation670A Health Services Maintenance Technician70A Healthcare Administrator70B Health Services Officer70C Comptroller70D Information Systems Manager70E Patient Administrator70F Human Resources Manager70H Plans, Operations, Intelligence Training, and Security70K Medical Logistics70K9I Health Facilities ManagementgChemical Branch74A Chemical, General74B Chemical Operations and Training74C Chemical Munitions and Materiel ManagementTransportation Branch88A Transportation Officer88D Transportation Officer - Motor/Rail880A Marine Deck Officer881A Marine Engineering Officer882A Mobility OfficerOrdnance Branch91A Ordnance Officer890A Ammunition Technician913A Armament Systems Maintenance Technician914A Allied Trades Technician915A Automotive Maintenance Technician915E Senior Automotive Maintenance/Senior OrdnanceLogistics Officer919A Engineer Equipment Maintenance TechnicianQuartermaster Corps Branch92A Quartermaster Officer920A PProperty AAccountingi TTechnicianh i i920B Supply Systems Technician921A Airdrop Systems Technician922A Food Service Technician923A Petroleum Systems TechnicianCMF 94 - Electronic Maintenance948B Electronic Systems Maintenance Technician948D Electronic Missile Systems Maintenance Technician948E Senior Electronics Maintenance Technician11(Page 2)

Surgical ProceduresAbdominal lastyArthroscopyBilateral cingulotomyBiopsyBrain surgery (Neurosurgery)Breast biopsyBrostrom prodedureCauterizationCesarean lon omyCorneal lectomyEpisiotomyEndarterectomyEndoscopic thoracic sympathectomyForeskin restoration101FistulotomyFrenectomyFrontalis liftFundectomyGastrectomyGraftingHeart rrhoidectomyHepatectomyHernia repairHypnosurgeryHysterectomyKidney Lung issen fundoplicationNuss ectomyParathyroidectomyPenectomy (also known as Tubal ligationTubal reversal (Tubal Anastomosis)Ulnar Collateral Ligament tomyVivisectionVulvectomy12

Total Integration of Surgical CareMinimallyy Invasive& Open SurgeryRemote SurgeryPre-operativeppplanninggSurgical RehearsalSimulationSimlation & TrainingPre-operative WarmupIntra-operative navigationCourtesy of Joel Jensen, SRI International, Menlo Park, CA

The New Paradigm StruggleRick Satava: What is the REVOLUTION in surgical education?

Simulation AugmentedLearning & TreatmentDenson JS, Abrahamson S. A computer-controlled patient simulator. Journal of the American Medical Association 1969; 208:504–8.

What Really Matters¾Lower Cost¾Better Access to Symptoms/Cases¾Reduced Time to Competence¾Reduced ErrorsIf simulationi l ti can deliverd lione or more off ththese, ththen it maybe valuable enough to trigger a scientific smackdown.

Scientific SmackdownEinsteinN DoNewtont Many in SimCopernicusSee One, Do One,PtolemyTeachTeach One17

U.S. Army Military Occupational Specialties Enlisted MOS Infantry Branch 11B Infantryman 11C Indirect Fire Infantryman 11X Infantryman (ambiguous; turns into 11B,11C, or 11M) 11Z Infantry Senior Sergeant 11H Infantry Anti-Armor Specialist Armor Branch 19D Cavalry Scout 19K Armor Crewmember 19Z Armor Senior Sergeant Corps of Engineers Branch