New medical simulation center gives students and physicians fresh perspectives on the human body

BUFFALO, N.Y. — The study of the human body is undergoing a major change at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

The concerted effort to transform the way students and others study and explore human structure was made possible by the Jacobs School’s new building, which opened late last year in downtown Buffalo and returned the 171-year-old school to its historic roots.

Deliberately sited just steps from Buffalo’s major hospitals and medical research facilities, the new building was designed to promote collaboration among faculty and students, regardless of discipline. Inside, offices and conference rooms on each floor open onto a vast glass-enclosed atrium punctuated with open staircases and plenty of wired “collision spaces.”

The new vision for studying the human body is taking shape on the building’s seventh floor, in UB RIS²E (Research, Innovation, Surgical Simulation, Education), where collaborations take place between researchers and educators in fields that don’t often interact.

Connections by design

“This facility was purpose built – not happenstance -- to make these conversations flow,” said John Tomaszewski, MD, SUNY Distinguished Professor, Peter A. Nickerson, PhD, Chair of Pathology and Anatomical Sciences at the Jacobs School and president of UBMD Pathology. “It was planned out and driven from concept to construction.”

In some ways, the center’s focus on pathology and anatomy puts UB at odds with some trends in medical education. Tomaszewski said there are medical schools that have been dismantling and deemphasizing entire anatomy departments, focusing almost exclusively on digital approaches.

“We think that’s absolutely wrong,” he said. “There’s tremendous and important meaning in human structure.”

To develop and execute the concept, Tomaszewski was recruited in 2011 from the University of Pennsylvania, and Steven Schwaitzberg, MD, professor and chair of surgery and president of UBMD Surgery, was recruited in 2015 from Harvard University.

Tomaszewski has been in the forefront of advances in digital pathology and computational modeling, using the data these techniques generate to push the fields of integrated diagnostics and personalized predictive medicine. Schwaitzberg ran an innovation center at the Tufts University School of Medicine/New England Medical Center for nearly two decades; he pioneered minimally invasive and robotic surgical techniques and developed a microwave blood warming technology approved by the Food and Drug Administration and now in routine use.

Together, they see UB RIS²E as a multidisciplinary center that educates learners at every level — from medical students to practicing physicians and surgeons — about the human body in the most comprehensive way possible. “Our facility has this integration of people: surgeons working with anatomists working with computational people and engineers,” Tomaszewski said. “It’s a whole team approach.”

Under Tomaszewski, pathologists and computational anatomists use experimental methods and digital technologies to generate and analyze biological data. Schwaitzberg and his colleagues apply those data to the innovation of new procedures, surgical techniques and instruments to improve those procedures.

The approach takes advantage of both hands-on and virtual techniques from advanced imaging and computational methods and phantoms, which are organs generated by 3-D printers and biological materials. UB’s robust anatomical gifts program, the state’s largest, plays a key role, not just in educating medical students but in providing simulation opportunities for researchers and industrial partners.

Integrating the virtual with the physical

“This is what the future of medicine is all about: integrating anatomy and imaging from the cellular level to the whole body,” said Schwaitzberg.

That integration is already happening in ANA 500, the school’s Gross Human Anatomy course. In addition to the cadaver that every first-year medical student works on, each group also now receives high-resolution computational tomography (CT) scans of their cadaver.

“It’s all about learning how to use those data,” Tomaszewski explained. “It’s integrating the virtual representation of the body — the CT scans — with the physical representation of the body from human gifts in a very robust and formalized way. To be able to understand something in full 360 degrees, you have to go from visual learning and simulation to phantoms, biological materials and human gifts. The separation of these has been artificial and not good for the person who’s learning.”

It’s not only students who benefit. In the center, clinicians and surgeons are learning new procedures and techniques through simulations with virtual or 3-D printed models generated by computational anatomists who study how musculoskeletal structure affects function.

For example, a partnership with the School of Dental Medicine is yielding answers about how the shape of the jaw affects issues related to temporomandibular joint disorders (TMJ). And orthopaedists and bioengineers at UB are exploring how computational models of how humans bear weight can improve implantable hips and knees in an aging population.

Simulating the future

Schwaitzberg pointed out that the integration of so many approaches gives the UB center major advantages over other facilities striving to do similar things, especially for industries seeking to innovate.

“Simulation is an absolute requirement for the future,” he said. “We will be creating anatomical models of the liver and gall bladder so that surgeons can practice their skills, do flexible endoscopy training and become more proficient at screening for colon cancer.”

The goal is simple: “When your doctors are better trained, you have better outcomes,” he said.

And industry needs facilities like this, he added. “Surgeons use tools. Tool users have to be trained on new tools in safe environments before they use them on people. There has to be a feedback loop between the tool user and the toolmaker. That iterative feedback loop has to exist in order to continue innovation. UB RIS²E can deliver it, allowing all the components—research, innovation, simulation and education -- to work in synchrony for mutual benefit.”

UB RIS²E features four simulated operating rooms designed to support surgical procedure simulations; 17 surgical tables for prosection (cadaver dissection) and method development; 21 computer workstations in the surgical skills area for research, teaching and simulations; a 3-D printing facility; a facility for engineering and structural scientists to collaborate; and a fully equipped structural science visualization room that includes a 12 ft, high-resolution touchscreen monitor, full videoconferencing equipment and software for working with human structural data.

The UB RIS²E spaces are adjacent to the facilities devoted to the teaching of gross anatomy and the anatomical gifts program. 

Funding has been provided by a $1 million grant from Empire State Development and $1 million from the Cummings Foundation. Additional opportunities for philanthropic donations, especially from industry, are being pursued.

The center consists of four collaborating facilities:

·         The Structural Sciences Learning Center, directed by Tomaszewski.

·         The Surgical Skills Simulation Center, which includes the Robotics and Advanced Surgery Suite, directed by Schwaitzberg and John Marzo, MD, professor in the Department of Orthopaedics.

·         The Behling Simulation Center on the sixth floor, where students learn and are tested on new skills using realistic mannequins.

·         The Clinical Competency Center, also on the sixth floor, where students learn from working with “standardized patient volunteers.” Karen Zinnerstrom, PhD, coordinator for training and evaluation, directs both of these.

UB RIS²E has also developed partnerships with the university’s Buffalo Institute for Genomics and Data Analysis (BIG), the Jacobs Institute and the Atlas Lab of Roswell Park Comprehensive Cancer Center.