Although injection and aspiration of soft tissues and joints is a mainstay in the therapy of rheumatic diseases, surveys of training programs and practicing physicians have continually shown that medical trainees and active physicians alike are not able to practice these procedures with sufficient repetition and supervision to become technically proficient. Most physicians, therefore, have to learn these important procedures in a very sub- optimal fashion by """"""""practicing"""""""" on their patients in an unsupervised environment once they are in the community. To address this and other lack of training opportunities in medical procedures, Touch of Life Technologies, Inc. (referred to as ToLTech herein) is pioneering the creation of virtual reality based simulators, among which is the Needle Insertion and Palpation Simulator (NISP). The NISP uses a virtual knee and shoulder as well as a syringe integrated with a haptic device; the trainee actively controls the needle and syringe such that he or she can perform any type of injection, correctly or incorrectly, in a monitored environment. A study with the current generation simulator with residents as well as an analysis by leaders in Rheumatology education of the simulator as a teaching tool has revealed a great interest in this technology as well as identified important aspects of the process that should be improved. This Phase I proposal is submitted to further develop this simulator for commercial use and will improve the current generation simulator by addressing the concerns of trainees and educators in five areas: #1: Create a bimanual joint injection and aspiration simulator; #2: Measure the exact forces encountered when traversing the skin, joint and other tissue interfaces so that these can be utilized in the simulations procedure; #3: Develop a hardware controlled shoulder to allow teaching of procedures for that joint; #4: Develop soft tissue diagnosis and procedures for periarticular regions; and #5 Integrate the simulation procedures itself into a HTML-based, real time anatomic educational system. During development, key aspects of the simulator as viewed by the teacher and trainee will undergo a human factors heuristic review and analysis by a group of expert Rheumatology educators. We believe that combining these multiple approaches will allow us in Phase II to then devise a simulated training environment such that trainees will be demonstrably better in performing these musculoskeletal procedures.
