[Script Info]
Title: 
[Events]
Format: Layer, Start, End, Style, Name, MarginL, MarginR, MarginV, Effect, Text
Dialogue: 0,0:00:00.80,0:00:04.68,Default,,0000,0000,0000,,What if I told you\Nthere was a new technology
Dialogue: 0,0:00:04.70,0:00:09.27,Default,,0000,0000,0000,,that, when placed in the hands\Nof doctors and nurses,
Dialogue: 0,0:00:09.29,0:00:14.44,Default,,0000,0000,0000,,improved outcomes for children\Nand adults, patients of all ages;
Dialogue: 0,0:00:15.49,0:00:18.03,Default,,0000,0000,0000,,reduced pain and suffering,
Dialogue: 0,0:00:18.06,0:00:21.25,Default,,0000,0000,0000,,reduced time in the operating rooms,
Dialogue: 0,0:00:21.27,0:00:24.12,Default,,0000,0000,0000,,reduced anesthetic times,
Dialogue: 0,0:00:24.15,0:00:26.05,Default,,0000,0000,0000,,had the ultimate dose-response curve
Dialogue: 0,0:00:26.07,0:00:27.82,Default,,0000,0000,0000,,that the more you did it,
Dialogue: 0,0:00:27.84,0:00:30.16,Default,,0000,0000,0000,,the better it benefitted patients?
Dialogue: 0,0:00:31.34,0:00:33.74,Default,,0000,0000,0000,,Here's a kicker: it has no side effects,
Dialogue: 0,0:00:33.77,0:00:36.78,Default,,0000,0000,0000,,and it's available no matter\Nwhere care is delivered.
Dialogue: 0,0:00:37.50,0:00:40.95,Default,,0000,0000,0000,,I can tell you as an ICU doctor\Nat Boston Children's Hospital,
Dialogue: 0,0:00:40.97,0:00:43.28,Default,,0000,0000,0000,,this would be a game changer for me.
Dialogue: 0,0:00:43.30,0:00:47.94,Default,,0000,0000,0000,,That technology is lifelike rehearsal.
Dialogue: 0,0:00:48.71,0:00:53.26,Default,,0000,0000,0000,,This lifelike rehearsal is being delivered\Nthrough medical simulation.
Dialogue: 0,0:00:53.89,0:00:57.89,Default,,0000,0000,0000,,I thought I would start with a case,
Dialogue: 0,0:00:57.92,0:01:00.63,Default,,0000,0000,0000,,just to really describe\Nthe challenge ahead,
Dialogue: 0,0:01:00.65,0:01:04.02,Default,,0000,0000,0000,,and why this technology is not just\Ngoing to improve health care
Dialogue: 0,0:01:04.04,0:01:06.74,Default,,0000,0000,0000,,but why it's critical to health care.
Dialogue: 0,0:01:07.57,0:01:10.44,Default,,0000,0000,0000,,This is a child that's born, young girl.
Dialogue: 0,0:01:10.46,0:01:12.22,Default,,0000,0000,0000,,"Day of life zero," we call it,
Dialogue: 0,0:01:12.25,0:01:14.55,Default,,0000,0000,0000,,the first day of life,\Njust born into the world.
Dialogue: 0,0:01:14.57,0:01:15.96,Default,,0000,0000,0000,,And just as she's being born,
Dialogue: 0,0:01:15.99,0:01:18.42,Default,,0000,0000,0000,,we notice very quickly\Nthat she is deteriorating.
Dialogue: 0,0:01:18.94,0:01:21.85,Default,,0000,0000,0000,,Her heart rate is going up,\Nher blood pressure is going down,
Dialogue: 0,0:01:21.88,0:01:23.52,Default,,0000,0000,0000,,she's breathing very, very fast.
Dialogue: 0,0:01:24.28,0:01:29.18,Default,,0000,0000,0000,,And the reason for this\Nis displayed in this chest X-ray.
Dialogue: 0,0:01:29.20,0:01:30.51,Default,,0000,0000,0000,,That's called a babygram,
Dialogue: 0,0:01:30.54,0:01:33.81,Default,,0000,0000,0000,,a full X-ray of a child's body,\Na little infant's body.
Dialogue: 0,0:01:33.84,0:01:35.74,Default,,0000,0000,0000,,As you look on the top side of this,
Dialogue: 0,0:01:35.77,0:01:38.25,Default,,0000,0000,0000,,that's where the heart and lungs\Nare supposed to be.
Dialogue: 0,0:01:38.27,0:01:41.05,Default,,0000,0000,0000,,As you look at the bottom end,\Nthat's where the abdomen is,
Dialogue: 0,0:01:41.07,0:01:43.50,Default,,0000,0000,0000,,and that's where the intestines\Nare supposed to be.
Dialogue: 0,0:01:43.52,0:01:46.25,Default,,0000,0000,0000,,And you can see how\Nthere's sort of that translucent area
Dialogue: 0,0:01:46.27,0:01:49.44,Default,,0000,0000,0000,,that made its way up into the right side\Nof this child's chest.
Dialogue: 0,0:01:49.47,0:01:53.48,Default,,0000,0000,0000,,And those are the intestines --\Nin the wrong place.
Dialogue: 0,0:01:53.50,0:01:55.67,Default,,0000,0000,0000,,As a result, they're pushing on the lungs
Dialogue: 0,0:01:55.69,0:01:58.66,Default,,0000,0000,0000,,and making it very difficult\Nfor this poor baby to breathe.
Dialogue: 0,0:01:59.22,0:02:00.71,Default,,0000,0000,0000,,The fix for this problem
Dialogue: 0,0:02:00.74,0:02:03.39,Default,,0000,0000,0000,,is to take this child immediately\Nto the operating room,
Dialogue: 0,0:02:03.41,0:02:05.54,Default,,0000,0000,0000,,bring those intestines\Nback into the abdomen,
Dialogue: 0,0:02:05.57,0:02:06.98,Default,,0000,0000,0000,,let the lungs expand
Dialogue: 0,0:02:07.01,0:02:08.89,Default,,0000,0000,0000,,and allow this child to breathe again.
Dialogue: 0,0:02:09.49,0:02:11.55,Default,,0000,0000,0000,,But before she can go\Nto the operating room,
Dialogue: 0,0:02:11.57,0:02:14.86,Default,,0000,0000,0000,,she must get whisked away\Nto the ICU, where I work.
Dialogue: 0,0:02:14.89,0:02:16.75,Default,,0000,0000,0000,,I work with surgical teams.
Dialogue: 0,0:02:16.78,0:02:18.08,Default,,0000,0000,0000,,We gather around her,
Dialogue: 0,0:02:18.10,0:02:22.20,Default,,0000,0000,0000,,and we place this child\Non heart-lung bypass.
Dialogue: 0,0:02:23.60,0:02:25.22,Default,,0000,0000,0000,,We put her to sleep,
Dialogue: 0,0:02:25.24,0:02:27.84,Default,,0000,0000,0000,,we make a tiny\Nlittle incision in the neck,
Dialogue: 0,0:02:27.86,0:02:30.100,Default,,0000,0000,0000,,we place catheters into the major\Nvessels of the neck --
Dialogue: 0,0:02:31.02,0:02:34.72,Default,,0000,0000,0000,,and I can tell you that these vessels\Nare about the size of a pen,
Dialogue: 0,0:02:34.74,0:02:36.65,Default,,0000,0000,0000,,the tip of a pen --
Dialogue: 0,0:02:36.67,0:02:38.75,Default,,0000,0000,0000,,and then we have blood\Ndrawn from the body,
Dialogue: 0,0:02:38.78,0:02:41.19,Default,,0000,0000,0000,,we bring it through a machine,\Nit gets oxygenated,
Dialogue: 0,0:02:41.21,0:02:43.06,Default,,0000,0000,0000,,and it goes back into the body.
Dialogue: 0,0:02:43.09,0:02:44.66,Default,,0000,0000,0000,,We save her life,
Dialogue: 0,0:02:44.69,0:02:47.21,Default,,0000,0000,0000,,and get her safely to the operating room.
Dialogue: 0,0:02:49.05,0:02:50.33,Default,,0000,0000,0000,,Here's the problem:
Dialogue: 0,0:02:51.87,0:02:53.44,Default,,0000,0000,0000,,these disorders --
Dialogue: 0,0:02:53.47,0:02:56.76,Default,,0000,0000,0000,,what is known is congenital\Ndiaphragmatic hernia --
Dialogue: 0,0:02:56.78,0:03:00.38,Default,,0000,0000,0000,,this hole in the diaphragm that has\Nallowed these intestines to sneak up --
Dialogue: 0,0:03:00.40,0:03:02.37,Default,,0000,0000,0000,,these disorders are rare.
Dialogue: 0,0:03:03.29,0:03:07.12,Default,,0000,0000,0000,,Even in the best hands in the world,
Dialogue: 0,0:03:07.14,0:03:10.65,Default,,0000,0000,0000,,there is still a challenge\Nto get the volume --
Dialogue: 0,0:03:10.68,0:03:12.57,Default,,0000,0000,0000,,the natural volume of these patients --
Dialogue: 0,0:03:12.60,0:03:15.12,Default,,0000,0000,0000,,in order to get our expertise\Ncurve at 100 percent.
Dialogue: 0,0:03:15.14,0:03:17.24,Default,,0000,0000,0000,,They just don't present that often.
Dialogue: 0,0:03:18.73,0:03:21.64,Default,,0000,0000,0000,,So how do you make the rare common?
Dialogue: 0,0:03:24.10,0:03:25.40,Default,,0000,0000,0000,,Here's the other problem:
Dialogue: 0,0:03:26.36,0:03:30.96,Default,,0000,0000,0000,,in the health care system\Nthat I trained for over 20 years,
Dialogue: 0,0:03:30.98,0:03:32.17,Default,,0000,0000,0000,,what currently exists,
Dialogue: 0,0:03:32.19,0:03:35.14,Default,,0000,0000,0000,,the model of training is called\Nthe apprenticeship model.
Dialogue: 0,0:03:35.16,0:03:37.08,Default,,0000,0000,0000,,It's been around for centuries.
Dialogue: 0,0:03:37.10,0:03:41.05,Default,,0000,0000,0000,,It's based on this idea that you see\Na surgery maybe once,
Dialogue: 0,0:03:41.07,0:03:42.60,Default,,0000,0000,0000,,maybe several times,
Dialogue: 0,0:03:42.62,0:03:45.41,Default,,0000,0000,0000,,you then go do that surgery,
Dialogue: 0,0:03:45.44,0:03:48.100,Default,,0000,0000,0000,,and then ultimately you teach\Nthat surgery to the next generation.
Dialogue: 0,0:03:50.44,0:03:53.19,Default,,0000,0000,0000,,And implicit in this model --
Dialogue: 0,0:03:53.22,0:03:55.39,Default,,0000,0000,0000,,I don't need to tell you this --
Dialogue: 0,0:03:55.41,0:04:00.37,Default,,0000,0000,0000,,is that we practice on the very patients\Nthat we are delivering care to.
Dialogue: 0,0:04:02.30,0:04:03.98,Default,,0000,0000,0000,,That's a problem.
Dialogue: 0,0:04:07.28,0:04:09.47,Default,,0000,0000,0000,,I think there's a better approach.
Dialogue: 0,0:04:09.50,0:04:13.86,Default,,0000,0000,0000,,Medicine may very well be the last\Nhigh-stakes industry
Dialogue: 0,0:04:13.89,0:04:16.61,Default,,0000,0000,0000,,that does not practice prior to game time.
Dialogue: 0,0:04:18.31,0:04:22.49,Default,,0000,0000,0000,,I want to describe to you a better\Napproach through medical simulation.
Dialogue: 0,0:04:24.32,0:04:27.70,Default,,0000,0000,0000,,Well, the first thing we did is we went\Nto other high-stakes industries
Dialogue: 0,0:04:27.72,0:04:30.59,Default,,0000,0000,0000,,that had been using this type\Nof methodology for decades.
Dialogue: 0,0:04:30.61,0:04:32.28,Default,,0000,0000,0000,,This is nuclear power.
Dialogue: 0,0:04:32.30,0:04:36.34,Default,,0000,0000,0000,,Nuclear power runs scenarios\Non a regular basis
Dialogue: 0,0:04:36.37,0:04:39.58,Default,,0000,0000,0000,,in order to practice\Nwhat they hope will never occur.
Dialogue: 0,0:04:40.11,0:04:43.96,Default,,0000,0000,0000,,And as we're all very familiar,\Nthe airline industry --
Dialogue: 0,0:04:43.98,0:04:47.28,Default,,0000,0000,0000,,we all get on planes now,\Ncomforted by the idea
Dialogue: 0,0:04:47.30,0:04:53.10,Default,,0000,0000,0000,,that pilots and crews have trained\Non simulators much like these,
Dialogue: 0,0:04:53.12,0:04:55.69,Default,,0000,0000,0000,,training on scenarios\Nthat we hope will never occur,
Dialogue: 0,0:04:55.71,0:04:57.89,Default,,0000,0000,0000,,but we know if they did,
Dialogue: 0,0:04:57.91,0:05:00.43,Default,,0000,0000,0000,,they would be prepared for the worst.
Dialogue: 0,0:05:00.93,0:05:05.34,Default,,0000,0000,0000,,In fact, the airline industry has gone\Nas far as to create fuselages
Dialogue: 0,0:05:05.36,0:05:06.90,Default,,0000,0000,0000,,of simulation environments,
Dialogue: 0,0:05:06.93,0:05:10.17,Default,,0000,0000,0000,,because of the importance\Nof the team coming together.
Dialogue: 0,0:05:10.81,0:05:13.08,Default,,0000,0000,0000,,This is an evacuation drill simulator.
Dialogue: 0,0:05:13.71,0:05:17.57,Default,,0000,0000,0000,,So again, if that ever were to happen,\Nthese rare, rare events,
Dialogue: 0,0:05:17.60,0:05:20.89,Default,,0000,0000,0000,,they're ready to act\Non the drop of a dime.
Dialogue: 0,0:05:22.89,0:05:28.20,Default,,0000,0000,0000,,I guess the most compelling for me\Nin some ways is the sports industry --
Dialogue: 0,0:05:28.23,0:05:29.86,Default,,0000,0000,0000,,arguably high stakes.
Dialogue: 0,0:05:30.47,0:05:33.73,Default,,0000,0000,0000,,You think about a baseball team:\Nbaseball players practice.
Dialogue: 0,0:05:33.76,0:05:36.43,Default,,0000,0000,0000,,I think it's a beautiful example\Nof progressive training.
Dialogue: 0,0:05:36.45,0:05:39.21,Default,,0000,0000,0000,,The first thing they do\Nis go out to spring training.
Dialogue: 0,0:05:39.24,0:05:41.50,Default,,0000,0000,0000,,They go to a spring training camp,
Dialogue: 0,0:05:41.52,0:05:44.04,Default,,0000,0000,0000,,perhaps a simulator in baseball.
Dialogue: 0,0:05:44.57,0:05:47.61,Default,,0000,0000,0000,,They're not on the real field,\Nbut they're on a simulated field,
Dialogue: 0,0:05:47.64,0:05:49.67,Default,,0000,0000,0000,,and they're playing in the pregame season.
Dialogue: 0,0:05:49.70,0:05:53.19,Default,,0000,0000,0000,,Then they make their way to the field\Nduring the season games,
Dialogue: 0,0:05:53.22,0:05:56.31,Default,,0000,0000,0000,,and what's the first thing they do\Nbefore they start the game?
Dialogue: 0,0:05:56.34,0:06:00.77,Default,,0000,0000,0000,,They go into the batting cage\Nand do batting practice for hours,
Dialogue: 0,0:06:00.79,0:06:04.12,Default,,0000,0000,0000,,having different types of pitches\Nbeing thrown at them,
Dialogue: 0,0:06:04.15,0:06:08.48,Default,,0000,0000,0000,,hitting ball after ball\Nas they limber their muscles,
Dialogue: 0,0:06:08.50,0:06:10.48,Default,,0000,0000,0000,,getting ready for the game itself.
Dialogue: 0,0:06:10.50,0:06:13.35,Default,,0000,0000,0000,,And here's the most\Nphenomenal part of this,
Dialogue: 0,0:06:14.52,0:06:17.02,Default,,0000,0000,0000,,and for all of you who watch\Nany sport event,
Dialogue: 0,0:06:17.05,0:06:18.96,Default,,0000,0000,0000,,you will see this phenomenon happen.
Dialogue: 0,0:06:19.84,0:06:22.53,Default,,0000,0000,0000,,The batter gets into the batter's box,
Dialogue: 0,0:06:22.55,0:06:24.67,Default,,0000,0000,0000,,the pitcher gets ready to pitch.
Dialogue: 0,0:06:24.70,0:06:27.80,Default,,0000,0000,0000,,Right before the pitch is thrown,
Dialogue: 0,0:06:27.83,0:06:29.04,Default,,0000,0000,0000,,what does that batter do?
Dialogue: 0,0:06:29.06,0:06:30.96,Default,,0000,0000,0000,,The batter steps out of the box
Dialogue: 0,0:06:32.28,0:06:34.32,Default,,0000,0000,0000,,and takes a practice swing.
Dialogue: 0,0:06:34.34,0:06:36.17,Default,,0000,0000,0000,,He wouldn't do it any other way.
Dialogue: 0,0:06:37.39,0:06:40.81,Default,,0000,0000,0000,,I want to talk to you about how\Nwe're building practice swings like this
Dialogue: 0,0:06:40.83,0:06:41.99,Default,,0000,0000,0000,,in medicine.
Dialogue: 0,0:06:42.01,0:06:46.19,Default,,0000,0000,0000,,We are building batting cages\Nfor the patients that we care about
Dialogue: 0,0:06:46.22,0:06:47.44,Default,,0000,0000,0000,,at Boston Children's.
Dialogue: 0,0:06:47.47,0:06:49.96,Default,,0000,0000,0000,,I want to use this case\Nthat we recently built.
Dialogue: 0,0:06:50.48,0:06:54.76,Default,,0000,0000,0000,,It's the case of a four-year-old\Nwho had a progressively enlarging head,
Dialogue: 0,0:06:54.78,0:06:56.06,Default,,0000,0000,0000,,and as a result,
Dialogue: 0,0:06:56.08,0:06:59.21,Default,,0000,0000,0000,,had loss of developmental milestones,\Nneurologic milestones,
Dialogue: 0,0:06:59.24,0:07:02.25,Default,,0000,0000,0000,,and the reason for this problem is here --
Dialogue: 0,0:07:02.28,0:07:03.93,Default,,0000,0000,0000,,it's called hydrocephalus.
Dialogue: 0,0:07:04.55,0:07:07.42,Default,,0000,0000,0000,,So, a quick study in neurosurgery.
Dialogue: 0,0:07:07.45,0:07:08.61,Default,,0000,0000,0000,,There's the brain,
Dialogue: 0,0:07:08.64,0:07:11.18,Default,,0000,0000,0000,,and you can see the cranium\Nsurrounding the brain.
Dialogue: 0,0:07:11.65,0:07:14.99,Default,,0000,0000,0000,,What surrounds the brain,\Nbetween the brain and cranium,
Dialogue: 0,0:07:15.02,0:07:18.24,Default,,0000,0000,0000,,is something called\Ncerebrospinal fluid or fluid,
Dialogue: 0,0:07:18.26,0:07:19.99,Default,,0000,0000,0000,,which acts as a shock absorber.
Dialogue: 0,0:07:20.59,0:07:21.91,Default,,0000,0000,0000,,In your heads right now,
Dialogue: 0,0:07:21.93,0:07:25.19,Default,,0000,0000,0000,,there is cerebrospinal fluid\Njust bathing your brains
Dialogue: 0,0:07:25.21,0:07:27.04,Default,,0000,0000,0000,,and making its way around.
Dialogue: 0,0:07:27.06,0:07:29.69,Default,,0000,0000,0000,,It's produced in one area\Nand flows through,
Dialogue: 0,0:07:29.71,0:07:31.00,Default,,0000,0000,0000,,and then is re-exchanged.
Dialogue: 0,0:07:31.03,0:07:33.92,Default,,0000,0000,0000,,And this beautiful flow pattern\Noccurs for all of us.
Dialogue: 0,0:07:34.44,0:07:36.49,Default,,0000,0000,0000,,But unfortunately in some children,
Dialogue: 0,0:07:36.51,0:07:39.02,Default,,0000,0000,0000,,there's a blockage of this flow pattern,
Dialogue: 0,0:07:39.04,0:07:40.59,Default,,0000,0000,0000,,much like a traffic jam.
Dialogue: 0,0:07:41.06,0:07:43.89,Default,,0000,0000,0000,,As a result, the fluid accumulates,
Dialogue: 0,0:07:43.91,0:07:46.43,Default,,0000,0000,0000,,and the brain is pushed aside.
Dialogue: 0,0:07:47.13,0:07:48.96,Default,,0000,0000,0000,,It has difficulty growing.
Dialogue: 0,0:07:49.60,0:07:53.09,Default,,0000,0000,0000,,As a result, the child loses\Nneurologic milestones.
Dialogue: 0,0:07:53.12,0:07:55.53,Default,,0000,0000,0000,,This is a devastating disease in children.
Dialogue: 0,0:07:56.97,0:08:00.05,Default,,0000,0000,0000,,The cure for this is surgery.
Dialogue: 0,0:08:00.07,0:08:02.98,Default,,0000,0000,0000,,The traditional surgery is to take\Na bit of the cranium off,
Dialogue: 0,0:08:03.00,0:08:04.16,Default,,0000,0000,0000,,a bit of the skull,
Dialogue: 0,0:08:04.19,0:08:07.13,Default,,0000,0000,0000,,drain this fluid out,\Nstick a drain in place,
Dialogue: 0,0:08:07.15,0:08:09.88,Default,,0000,0000,0000,,and then eventually bring\Nthis drain internal to the body.
Dialogue: 0,0:08:09.91,0:08:11.12,Default,,0000,0000,0000,,Big operation.
Dialogue: 0,0:08:12.10,0:08:16.41,Default,,0000,0000,0000,,But some great news is that advances\Nin neurosurgical care
Dialogue: 0,0:08:16.44,0:08:20.15,Default,,0000,0000,0000,,have allowed us to develop\Nminimally invasive approaches
Dialogue: 0,0:08:20.17,0:08:21.33,Default,,0000,0000,0000,,to this surgery.
Dialogue: 0,0:08:21.35,0:08:25.68,Default,,0000,0000,0000,,Through a small pinhole,\Na camera can be inserted,
Dialogue: 0,0:08:26.93,0:08:29.66,Default,,0000,0000,0000,,led into the deep brain structure,
Dialogue: 0,0:08:29.68,0:08:33.64,Default,,0000,0000,0000,,and cause a little hole in a membrane\Nthat allows all that fluid to drain,
Dialogue: 0,0:08:33.66,0:08:35.71,Default,,0000,0000,0000,,much like it would in a sink.
Dialogue: 0,0:08:35.73,0:08:38.85,Default,,0000,0000,0000,,All of a sudden, the brain\Nis no longer under pressure,
Dialogue: 0,0:08:38.87,0:08:40.33,Default,,0000,0000,0000,,can re-expand
Dialogue: 0,0:08:40.35,0:08:43.23,Default,,0000,0000,0000,,and we cure the child\Nthrough a single-hole incision.
Dialogue: 0,0:08:44.66,0:08:46.07,Default,,0000,0000,0000,,But here's the problem:
Dialogue: 0,0:08:46.10,0:08:48.24,Default,,0000,0000,0000,,hydrocephalus is relatively rare.
Dialogue: 0,0:08:48.91,0:08:51.32,Default,,0000,0000,0000,,And there are no good training methods
Dialogue: 0,0:08:51.34,0:08:54.97,Default,,0000,0000,0000,,to get really good at getting\Nthis scope to the right place.
Dialogue: 0,0:08:54.99,0:08:59.31,Default,,0000,0000,0000,,But surgeons have been quite creative\Nabout this, even our own.
Dialogue: 0,0:08:59.33,0:09:01.34,Default,,0000,0000,0000,,And they've come up with training models.
Dialogue: 0,0:09:01.36,0:09:03.09,Default,,0000,0000,0000,,Here's the current training model.
Dialogue: 0,0:09:03.11,0:09:05.07,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:09:05.09,0:09:06.75,Default,,0000,0000,0000,,I kid you not.
Dialogue: 0,0:09:06.77,0:09:09.21,Default,,0000,0000,0000,,This is a red pepper,\Nnot made in Hollywood;
Dialogue: 0,0:09:09.24,0:09:10.56,Default,,0000,0000,0000,,it's real red pepper.
Dialogue: 0,0:09:11.00,0:09:13.95,Default,,0000,0000,0000,,And what surgeons do is they stick\Na scope into the pepper,
Dialogue: 0,0:09:13.97,0:09:17.07,Default,,0000,0000,0000,,and they do what is called a "seedectomy."
Dialogue: 0,0:09:17.09,0:09:18.86,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:09:18.88,0:09:24.98,Default,,0000,0000,0000,,They use this scope to remove seeds\Nusing a little tweezer.
Dialogue: 0,0:09:25.81,0:09:28.44,Default,,0000,0000,0000,,And that is a way to get under their belts
Dialogue: 0,0:09:28.46,0:09:31.46,Default,,0000,0000,0000,,the rudimentary components\Nof doing this surgery.
Dialogue: 0,0:09:32.12,0:09:34.55,Default,,0000,0000,0000,,Then they head right into\Nthe apprenticeship model,
Dialogue: 0,0:09:34.58,0:09:37.45,Default,,0000,0000,0000,,seeing many of them\Nas they present themselves,
Dialogue: 0,0:09:37.47,0:09:39.74,Default,,0000,0000,0000,,then doing it, and then teaching it --
Dialogue: 0,0:09:39.76,0:09:41.78,Default,,0000,0000,0000,,waiting for these patients to arrive.
Dialogue: 0,0:09:42.53,0:09:44.07,Default,,0000,0000,0000,,We can do a lot better.
Dialogue: 0,0:09:44.09,0:09:48.82,Default,,0000,0000,0000,,We are manufacturing\Nreproductions of children
Dialogue: 0,0:09:48.84,0:09:52.75,Default,,0000,0000,0000,,in order for surgeons and surgical\Nteams to rehearse
Dialogue: 0,0:09:52.77,0:09:55.15,Default,,0000,0000,0000,,in the most relevant possible ways.
Dialogue: 0,0:09:55.18,0:09:56.55,Default,,0000,0000,0000,,Let me show you this.
Dialogue: 0,0:09:57.15,0:09:58.65,Default,,0000,0000,0000,,Here's my team
Dialogue: 0,0:09:58.68,0:10:02.58,Default,,0000,0000,0000,,in what's called the SIM Engineering\NDivision of the Simulator Program.
Dialogue: 0,0:10:03.32,0:10:06.16,Default,,0000,0000,0000,,This is an amazing team of individuals.
Dialogue: 0,0:10:06.19,0:10:08.46,Default,,0000,0000,0000,,They are mechanical engineers;
Dialogue: 0,0:10:08.49,0:10:10.91,Default,,0000,0000,0000,,you're seeing here, illustrators.
Dialogue: 0,0:10:10.94,0:10:15.51,Default,,0000,0000,0000,,They take primary data\Nfrom CT scans and MRIs,
Dialogue: 0,0:10:15.53,0:10:18.86,Default,,0000,0000,0000,,translate it into digital information,
Dialogue: 0,0:10:18.88,0:10:20.19,Default,,0000,0000,0000,,animate it,
Dialogue: 0,0:10:20.22,0:10:25.01,Default,,0000,0000,0000,,put it together into the components\Nof the child itself,
Dialogue: 0,0:10:25.03,0:10:28.82,Default,,0000,0000,0000,,surface-scan elements of the child\Nthat have been casted as needed,
Dialogue: 0,0:10:28.85,0:10:31.43,Default,,0000,0000,0000,,depending on the surgery itself,
Dialogue: 0,0:10:31.46,0:10:35.35,Default,,0000,0000,0000,,and then take this digital data\Nand be able to output it
Dialogue: 0,0:10:35.37,0:10:39.12,Default,,0000,0000,0000,,on state-of-the-art,\Nthree-dimensional printing devices
Dialogue: 0,0:10:39.14,0:10:41.41,Default,,0000,0000,0000,,that allow us to print the components
Dialogue: 0,0:10:41.44,0:10:47.11,Default,,0000,0000,0000,,exactly to the micron detail of what\Nthe child's anatomy will look like.
Dialogue: 0,0:10:47.13,0:10:48.43,Default,,0000,0000,0000,,You can see here,
Dialogue: 0,0:10:48.46,0:10:50.89,Default,,0000,0000,0000,,the skull of this child being printed
Dialogue: 0,0:10:50.92,0:10:53.40,Default,,0000,0000,0000,,in the hours before\Nwe performed this surgery.
Dialogue: 0,0:10:54.62,0:10:57.19,Default,,0000,0000,0000,,But we could not do this work
Dialogue: 0,0:10:57.22,0:11:01.60,Default,,0000,0000,0000,,without our dear friends on the West Coast\Nin Hollywood, California.
Dialogue: 0,0:11:02.78,0:11:06.01,Default,,0000,0000,0000,,These are individuals\Nthat are incredibly talented
Dialogue: 0,0:11:06.03,0:11:08.46,Default,,0000,0000,0000,,at being able to recreate reality.
Dialogue: 0,0:11:08.48,0:11:12.91,Default,,0000,0000,0000,,It was not a long leap for us.
Dialogue: 0,0:11:12.93,0:11:14.51,Default,,0000,0000,0000,,The more we got into this field,
Dialogue: 0,0:11:14.53,0:11:18.29,Default,,0000,0000,0000,,the more it became clear to us\Nthat we are doing cinematography.
Dialogue: 0,0:11:18.99,0:11:20.87,Default,,0000,0000,0000,,We're doing filmmaking,
Dialogue: 0,0:11:20.89,0:11:23.12,Default,,0000,0000,0000,,it's just that the actors are not actors.
Dialogue: 0,0:11:23.91,0:11:26.40,Default,,0000,0000,0000,,They're real doctors and nurses.
Dialogue: 0,0:11:27.19,0:11:30.57,Default,,0000,0000,0000,,So these are some photos\Nof our dear friends at Fractured FX
Dialogue: 0,0:11:30.59,0:11:32.06,Default,,0000,0000,0000,,in Hollywood California,
Dialogue: 0,0:11:32.09,0:11:35.66,Default,,0000,0000,0000,,an Emmy-Award-winning\Nspecial effects firm.
Dialogue: 0,0:11:35.68,0:11:38.85,Default,,0000,0000,0000,,This is Justin Raleigh and his group --
Dialogue: 0,0:11:38.88,0:11:40.53,Default,,0000,0000,0000,,this is not one of our patients --
Dialogue: 0,0:11:40.55,0:11:41.91,Default,,0000,0000,0000,,(Laughter)
Dialogue: 0,0:11:41.93,0:11:45.00,Default,,0000,0000,0000,,but kind of the exquisite work\Nthat these individuals do.
Dialogue: 0,0:11:45.02,0:11:48.63,Default,,0000,0000,0000,,We have now collaborated\Nand fused our experience,
Dialogue: 0,0:11:48.65,0:11:51.06,Default,,0000,0000,0000,,bringing their group\Nto Boston Children's Hospital,
Dialogue: 0,0:11:51.08,0:11:53.74,Default,,0000,0000,0000,,sending our group\Nout to Hollywood, California
Dialogue: 0,0:11:53.76,0:11:55.13,Default,,0000,0000,0000,,and exchanging around this
Dialogue: 0,0:11:55.16,0:11:58.16,Default,,0000,0000,0000,,to be able to develop\Nthese type of simulators.
Dialogue: 0,0:11:58.18,0:12:02.65,Default,,0000,0000,0000,,What I'm about to show you\Nis a reproduction of this child.
Dialogue: 0,0:12:07.17,0:12:12.30,Default,,0000,0000,0000,,You'll notice here that every hair\Non the child's head is reproduced.
Dialogue: 0,0:12:12.32,0:12:16.03,Default,,0000,0000,0000,,And in fact, this is also\Nthat reproduced child --
Dialogue: 0,0:12:16.05,0:12:19.24,Default,,0000,0000,0000,,and I apologize for any queasy stomachs,
Dialogue: 0,0:12:19.27,0:12:22.13,Default,,0000,0000,0000,,but that is a reproduction and simulation
Dialogue: 0,0:12:22.15,0:12:24.25,Default,,0000,0000,0000,,of the child they're about to operate on.
Dialogue: 0,0:12:26.49,0:12:28.93,Default,,0000,0000,0000,,Here's that membrane we had talked about,
Dialogue: 0,0:12:28.96,0:12:31.11,Default,,0000,0000,0000,,the inside of this child's brain.
Dialogue: 0,0:12:31.54,0:12:36.51,Default,,0000,0000,0000,,What you're going to be seeing here\Nis, on one side, the actual patient,
Dialogue: 0,0:12:36.53,0:12:38.81,Default,,0000,0000,0000,,and on the other side, the simulator.
Dialogue: 0,0:12:38.83,0:12:43.18,Default,,0000,0000,0000,,As I mentioned, a scope, a little camera,\Nneeds to make its way down,
Dialogue: 0,0:12:43.21,0:12:44.61,Default,,0000,0000,0000,,and you're seeing that here.
Dialogue: 0,0:12:44.63,0:12:46.96,Default,,0000,0000,0000,,It needs to make a small hole\Nin this membrane
Dialogue: 0,0:12:46.98,0:12:49.69,Default,,0000,0000,0000,,and allow this fluid to seep out.
Dialogue: 0,0:12:51.16,0:12:55.80,Default,,0000,0000,0000,,I won't do a quiz show to see\Nwho thinks which side is which,
Dialogue: 0,0:12:56.96,0:12:59.27,Default,,0000,0000,0000,,but on the right is the simulator.
Dialogue: 0,0:13:00.68,0:13:04.48,Default,,0000,0000,0000,,So surgeons can now produce\Ntraining opportunities,
Dialogue: 0,0:13:04.50,0:13:07.56,Default,,0000,0000,0000,,do these surgeries\Nas many times as they want,
Dialogue: 0,0:13:07.58,0:13:10.42,Default,,0000,0000,0000,,to their heart's content,\Nuntil they feel comfortable.
Dialogue: 0,0:13:10.45,0:13:14.01,Default,,0000,0000,0000,,And then, and only then,\Nbring the child into the operating room.
Dialogue: 0,0:13:14.04,0:13:15.21,Default,,0000,0000,0000,,But we don't stop here.
Dialogue: 0,0:13:15.23,0:13:19.54,Default,,0000,0000,0000,,We know that a key step to this\Nis not just the skill itself,
Dialogue: 0,0:13:19.56,0:13:24.10,Default,,0000,0000,0000,,but combining that skill with a team\Nwho's going to deliver that care.
Dialogue: 0,0:13:24.12,0:13:26.46,Default,,0000,0000,0000,,Now we turn to Formula One.
Dialogue: 0,0:13:27.02,0:13:30.28,Default,,0000,0000,0000,,And here is an example\Nof a technician putting on a tire
Dialogue: 0,0:13:30.30,0:13:33.51,Default,,0000,0000,0000,,and doing that time and time\Nagain on this car.
Dialogue: 0,0:13:33.53,0:13:36.52,Default,,0000,0000,0000,,But that is very quickly\Ngoing to be incorporated
Dialogue: 0,0:13:36.54,0:13:38.47,Default,,0000,0000,0000,,within team-training experiences,
Dialogue: 0,0:13:38.50,0:13:42.70,Default,,0000,0000,0000,,now as a full team orchestrating\Nthe exchange of tires
Dialogue: 0,0:13:42.73,0:13:45.73,Default,,0000,0000,0000,,and getting this car back on the speedway.
Dialogue: 0,0:13:46.27,0:13:49.55,Default,,0000,0000,0000,,We've done that step in health care,
Dialogue: 0,0:13:49.58,0:13:53.70,Default,,0000,0000,0000,,so now what you're about to see\Nis a simulated operation.
Dialogue: 0,0:13:54.76,0:13:57.15,Default,,0000,0000,0000,,We've taken the simulator\NI just described to you,
Dialogue: 0,0:13:57.17,0:14:00.57,Default,,0000,0000,0000,,we've brought it into the operating room\Nat Boston Children's Hospital,
Dialogue: 0,0:14:00.60,0:14:04.25,Default,,0000,0000,0000,,and these individuals --\Nthese native teams, operative teams --
Dialogue: 0,0:14:04.28,0:14:07.80,Default,,0000,0000,0000,,are doing the surgery before the surgery.
Dialogue: 0,0:14:07.82,0:14:09.56,Default,,0000,0000,0000,,Operate twice;
Dialogue: 0,0:14:09.58,0:14:10.79,Default,,0000,0000,0000,,cut once.
Dialogue: 0,0:14:11.12,0:14:12.52,Default,,0000,0000,0000,,Let me show that to you.
Dialogue: 0,0:14:13.42,0:14:16.53,Default,,0000,0000,0000,,(Video) Surgical team member 1:\NYou want the head down or head up?
Dialogue: 0,0:14:16.55,0:14:18.26,Default,,0000,0000,0000,,STM 2: Can you lower it down to 10?
Dialogue: 0,0:14:18.28,0:14:20.93,Default,,0000,0000,0000,,STM 3: And then lower\Nthe whole table down a little bit?
Dialogue: 0,0:14:20.96,0:14:22.21,Default,,0000,0000,0000,,STM 4: Table coming down.
Dialogue: 0,0:14:24.86,0:14:27.56,Default,,0000,0000,0000,,STM 3: All right, this\Nis behaving like a vessel.
Dialogue: 0,0:14:27.58,0:14:29.67,Default,,0000,0000,0000,,Could we have the scissors back, please?
Dialogue: 0,0:14:29.70,0:14:32.100,Default,,0000,0000,0000,,STM 5: I'm taking my gloves,\N8 to 8 1/2, all right? I'll be right in.
Dialogue: 0,0:14:33.02,0:14:35.42,Default,,0000,0000,0000,,STM 6: Great! Thank you.
Dialogue: 0,0:14:36.34,0:14:38.17,Default,,0000,0000,0000,,Peter Weinstock: It's really amazing.
Dialogue: 0,0:14:38.19,0:14:40.28,Default,,0000,0000,0000,,The second step to this,\Nwhich is critical,
Dialogue: 0,0:14:40.31,0:14:43.41,Default,,0000,0000,0000,,is we take these teams out\Nimmediately and debrief them.
Dialogue: 0,0:14:43.43,0:14:44.90,Default,,0000,0000,0000,,We use the same technologies
Dialogue: 0,0:14:44.92,0:14:49.61,Default,,0000,0000,0000,,that are used in Lean\Nand Six Sigma in the military,
Dialogue: 0,0:14:49.63,0:14:52.72,Default,,0000,0000,0000,,and we bring them out\Nand talk about what went right,
Dialogue: 0,0:14:52.74,0:14:54.39,Default,,0000,0000,0000,,but more importantly,
Dialogue: 0,0:14:54.41,0:14:56.88,Default,,0000,0000,0000,,we talk about what didn't go well,
Dialogue: 0,0:14:56.90,0:14:58.84,Default,,0000,0000,0000,,and how we're going to fix it.
Dialogue: 0,0:14:58.86,0:15:01.61,Default,,0000,0000,0000,,Then we bring them right back in\Nand do it again.
Dialogue: 0,0:15:01.64,0:15:06.83,Default,,0000,0000,0000,,Deliberative batting practice\Nin the moments when it matters most.
Dialogue: 0,0:15:08.44,0:15:10.46,Default,,0000,0000,0000,,Let's go back to this case now.
Dialogue: 0,0:15:11.08,0:15:12.46,Default,,0000,0000,0000,,Same child,
Dialogue: 0,0:15:12.48,0:15:14.87,Default,,0000,0000,0000,,but now let me describe\Nhow we care for this child
Dialogue: 0,0:15:14.90,0:15:16.36,Default,,0000,0000,0000,,at Boston Children's Hospital.
Dialogue: 0,0:15:16.38,0:15:18.87,Default,,0000,0000,0000,,This child was born\Nat three o'clock in the morning.
Dialogue: 0,0:15:18.90,0:15:20.90,Default,,0000,0000,0000,,At two o'clock in the morning,
Dialogue: 0,0:15:20.93,0:15:23.05,Default,,0000,0000,0000,,we assembled the team,
Dialogue: 0,0:15:23.08,0:15:24.88,Default,,0000,0000,0000,,and took the reproduced anatomy
Dialogue: 0,0:15:24.90,0:15:28.61,Default,,0000,0000,0000,,that we would gain\Nout of scans and images,
Dialogue: 0,0:15:28.63,0:15:31.40,Default,,0000,0000,0000,,and brought that team\Nto the virtual bedside,
Dialogue: 0,0:15:31.42,0:15:33.01,Default,,0000,0000,0000,,to a simulated bedside --
Dialogue: 0,0:15:33.03,0:15:36.57,Default,,0000,0000,0000,,the same team that's going to operate\Non this child in the hours ahead --
Dialogue: 0,0:15:36.60,0:15:38.98,Default,,0000,0000,0000,,and we have them do the procedure.
Dialogue: 0,0:15:39.59,0:15:41.27,Default,,0000,0000,0000,,Let me show you a moment of this.
Dialogue: 0,0:15:42.21,0:15:44.37,Default,,0000,0000,0000,,This is not a real incision.
Dialogue: 0,0:15:45.45,0:15:47.65,Default,,0000,0000,0000,,And the baby has not yet been born.
Dialogue: 0,0:15:49.11,0:15:50.48,Default,,0000,0000,0000,,Imagine this.
Dialogue: 0,0:15:52.13,0:15:56.02,Default,,0000,0000,0000,,So now the conversations\Nthat I have with families
Dialogue: 0,0:15:56.04,0:15:58.74,Default,,0000,0000,0000,,in the intensive care unit\Nat Boston Children's Hospital
Dialogue: 0,0:15:58.77,0:16:00.16,Default,,0000,0000,0000,,are totally different.
Dialogue: 0,0:16:00.76,0:16:02.50,Default,,0000,0000,0000,,Imagine this conversation:
Dialogue: 0,0:16:03.65,0:16:08.50,Default,,0000,0000,0000,,"Not only do we take care of this disorder\Nfrequently in our ICU,
Dialogue: 0,0:16:08.52,0:16:10.70,Default,,0000,0000,0000,,and not only have we done surgeries
Dialogue: 0,0:16:10.73,0:16:13.16,Default,,0000,0000,0000,,like the surgery we're going\Nto do on your child,
Dialogue: 0,0:16:13.18,0:16:16.90,Default,,0000,0000,0000,,but we have done your child's surgery.
Dialogue: 0,0:16:17.96,0:16:20.49,Default,,0000,0000,0000,,And we did it two hours ago.
Dialogue: 0,0:16:20.51,0:16:23.24,Default,,0000,0000,0000,,And we did it 10 times.
Dialogue: 0,0:16:23.27,0:16:27.09,Default,,0000,0000,0000,,And now we're prepared to take them\Nback to the operating room."
Dialogue: 0,0:16:28.73,0:16:31.06,Default,,0000,0000,0000,,So a new technology in health care:
Dialogue: 0,0:16:32.17,0:16:35.04,Default,,0000,0000,0000,,lifelike rehearsal.
Dialogue: 0,0:16:35.06,0:16:38.61,Default,,0000,0000,0000,,Practicing prior to game time.
Dialogue: 0,0:16:39.63,0:16:40.81,Default,,0000,0000,0000,,Thank you.
Dialogue: 0,0:16:40.84,0:16:45.50,Default,,0000,0000,0000,,(Applause)