An interview with MITIE’s Dr. Brian Dunkin

This is the third, and final, part of our three-part series on MITIE, the Houston Methodist Institute for Technology, Innovation and Education. To recap, MITIE is one of the largest and most comprehensive surgical education and research facilities in the world. Our first blog was a photo tour of MITIE. In our last blog, we talked about how MITIE provides physicians with a comprehensive training facility to learn new surgical techniques.

To finish our time together, I sat down with Dr. Brian Dunkin, the medical director of MITIE, to ask him why MITIE and the work done there is so important. When Dr. Dunkin isn’t at MITIE, he is an endoscopic surgeon, which means he performs surgery through small incisions or natural body openings to make surgery safer and recovery faster.

Me: Why is MITIE so important and why are you so passionate about MITIE that you’d move your family and practice to Texas to build it?

Dr. Dunkin: Passion is the right word to describe MITIE for me. In medicine, we have a pressing need to support the ongoing training of practicing health care professionals. With how quickly things are changing and constant advancements in technology, it’s become a real crisis. You could be in practice after your training for a relatively short period of time and you’re not up to date anymore and you have nowhere to go.

Dr. Brian Dunkin headshot
Dr. Brian Dunkin is MITIE’s medical director and an endoscopic surgeon.

I’ve developed training programs at several institutions, but nowhere did I see the opportunity to develop an educational facility of the scope and scale available at Houston Methodist. That’s what convinced me to move to Texas and become a part of this. I don’t think anyone else on the planet, and certainly in the U.S., could have done what we did with MITIE. No one else had the resources, the space, the commitment from hospital leadership, the people – it took a lot of things coming together for MITIE to be what it is. For example, I recently had the opportunity to give my mentor, a worldwide leader in surgical education, a tour of MITIE, and he was completely blown away by the facility, the scope of programs available, and the timeline in which we accomplished this. Even with our initial success, we still have a lot of things we want to do in MITIE, so we aren’t done yet.

Also, some practicing surgeons don’t understand the importance of or the value of educating other clinicians. I’ve been taught that you teach others what you know. I’ve found that in the process of educating others, you learn, too.

Me: You have a lot of ongoing projects, but what are some of the bigger projects you are working on right now?

Dr. Dunkin: The educational project I’m most excited right now is the MITIE Lapco program, which teaches laparoscopic colon surgery. Learners spend four days in MITIE doing hands-on training with experts from around the world. In most courses, that’s where the learning stops, leaving an educational hole where the surgeon goes back to his or her home institution and is alone in the operating room when trying to start doing this new procedure. I’ve always thought technology was the way to fill this gap.

We added telementoring, or the practice of using a videoconferencing system in the operating room to allow an expert surgeon to virtually mentor another surgeon, to the MITIE Lapco program. Learners have an expert with them virtually for their first 10 cases at their home hospitals. We believe that telementoring will help the learning surgeons perform better, safer surgeries and will help increase the U.S. adoption rate of laparoscopic colon surgery.

Microsurgery training at MITIE
Microsurgery is commonly used to reattach severed nerves and blood vessels. Microscopes are needed for these procedures to ensure that the cells in the nerve ending or blood vessel are lined up properly.

Telementoring is doable and every bit as powerful as in-person mentoring. I have hospital CEOs asking for us to offer telementoring for more courses because they’ve seen the outcomes. They know their surgeons will be able to do these advanced procedures safely and effectively and will have happier patients. I think five years from now, we’ll look back on this conversation and laugh because telementoring will be so common.

Me: What’s your favorite MITIE class or research project so far?

Dr. Dunkin: I think the clear favorite is MITIE Lapco. It wasn’t just the course we put on for the learners, but it was the thoughtfulness, time and effort we put in to designing the program from developing the curriculum and organizing telementoring opportunities after the course. And the feedback we got from learners during the course was unlike anything we’d heard before. Almost everyone in our first MITIE Lapco course had been to a previous course on laparoscopic colon surgery at another institution, and they were just blown away with the difference in their confidence level in performing this surgery at the end of our course compared to the others.

Me: What are some upcoming MITIE classes or research projects that you’re most excited about?

Dr. Dunkin: I’m most excited about the next stage of growth for MITIE because we’re right at the threshold of it.

The first stage was designing and building a physical structure. The next stage was building an infrastructure that could support volume and a variety of programs. In the seven years that we’ve been open we’ve had more than 28,000 learners here.

Now, we are at the point where I want to create more programs like MITIE Lapco that address the full spectrum of surgical education. I can’t tell you how many people have told me that no other place is doing what MITIE is doing. What’s really great is that where we want to go with MITIE fits with Houston Methodist’s goal of leading medicine rather than just practicing it. There are a lot of great courses and research projects in MITIE’s future, but it’s the whole MITIE package that I’m most excited about.

The more I see MITIE evolve, the more confident I am that we are going to change the medical world by creating better educational tools and providing them to colleagues from around the world.

MITIE cool: An inside look

 admit it. I’m a huge nerd. I love learning about how things work and playing with new gadgets. That’s probably why I’m obsessed with MITIE – the Houston Methodist Institute for Technology, Innovation and Education. Officially, MITIE (the acronym is pronounced mighty) is described as one of the largest and most comprehensive education and research facilities in the world. Unofficially, it’s a playground for nerds like me and practicing medical professionals who want to learn new surgical techniques and research new ideas.

Because I can’t fit all of my love for MITIE into one blog, this is the first of a three-part series on MITIE. We’re kicking it off with a photo tour, followed by a review of a recent MITIE class and how it affects average people like you and me, and wrapping up with a Q&A with Dr. Brian Dunkin, the medical director of MITIE (one of the smartest people I know).

Here we go! Please keep arms and legs inside at all times! 

1 - Lobby #1

MITIE spans the entire fifth floor of the Houston Methodist Research Institute. Obviously, the lobby is the first stop. You feel smarter as soon as walk in, and there’s a reason why. The designers wanted MITIE learners to feel like they were entering a professional, modern environment as soon as they stepped off the elevators. The entire floor gives you the smart people vibe with the floor to ceiling windows overlooking the Texas Medical Center and the bright wall colors.

2 - Lobby #2From the lobby, we go to the Med Presence Suite. It has three, 72-inch flat screens at the front of the room and three rows of seating for lectures. Monitors come up out of the desks if you need a closer look at what’s on the big screen. Most often the screens are used to observe a live surgery happening in an operating room at Houston Methodist Hospital or a training surgery in a simulated operating room in MITIE. The Med Presence Suite would also be a good place to watch the game. I’ll bring the chips and salsa. #GoTexans 3 - Med Pres

Next stop is MITIE’s newest addition: the hybrid operating room. It contains a robotically guided rotational fluoroscopy machine and an MRI machine. Having both imaging capabilities in a single operating room provides surgeons with better visualization inside the body to help them perform more complex procedures. The majority of the surgeries practiced in this room are to treat vascular issues. 4 - Hybrid OR #1

Other days, the hybrid room is home to one of NASA’s space suits. After an Italian astronaut almost drowned in July 2013 due to a leak in his helmet during a spacewalk, NASA set out to find innovative solutions to prevent future space suit malfunctions. They asked researchers at the Houston Methodist DeBakey Heart & Vascular Center to perform a fluoroscopic CT scan to better see the components inside the suit and help identify areas of concern. For more about the NASA and Houston Methodist collaboration, you can read this story or watch this video.

 6 - Hybrid OR #3

Next up, the Procedural Skills Lab, or PSL if you’re in the know. Think of the PSL as a massive room with multiple mini operating rooms inside. Each of the stations has a monitor connected to a camera at a teaching station. This allows a learner to stand across the room at another practice station and still observe what the teaching surgeon is doing. The PSL is used for surgeons to practice performing an operation, mastering a new surgical technique, and learning how to use new equipment safely on various types of anatomical and inanimate models. To simulate an actual operating room, the students will wear protective equipment, such as hairnets, masks, gowns and gloves. The PSL is one of the most important rooms in MITIE. Why? Because you want your surgeon to know the latest and greatest techniques, but you don’t want them to practice on you. At least, I don’t. Mitie8

From the PSL, we walk down the hall to the private operating rooms. The first one is a CT operating room. It’s based on the same concept as the hybrid operating room, but this imaging type is ideal for orthopedic surgeries because bones show up better on CT scans.Mitie10

Did you notice that several training rooms in MITIE have imaging capabilities? We have several imaging modalities available in MITIE because many Houston Methodist researchers are focused on improving visualizations inside the body to make surgeries safer and less invasive.

A few of these private operating rooms do not have imaging capabilities so that MITIE can have more flexibility in the type of work done in these rooms. For example, researchers can test a new product or surgical technique here in preparation for sending it to the FDA or other organizations for approval.

We can also set up the Da Vinci robot system in one of these private operating rooms. In this picture, the Da Vinci is set up for a physician to learn how to safely operate with it. We have three Da Vinci robot systems, and they’re super cool (if you can pretend that you’re not being operated on by a huge spider robot). Mitie11

Across the hall from these operating rooms are microsurgery training rooms. Microsurgery is commonly used to reattach severed nerves and blood vessels. Microscopes are needed for these procedures to ensure that the cells in the nerve ending or blood vessel are lined up properly.

13 - Microsurgery Room

Our next stop is a set of rooms that serve as a virtual hospital. Much like a flight simulator for training pilots, the virtual hospital is designed to put learners in a real environment to help them learn. The simulation rooms include typical equipment seen in a hospital or triage room. For training here, we have two SimMan patient simulators named Oscar and Mayer. A tech in a connecting room can control Oscar and Mayer to make them breathe, talk, laugh, cry, go into cardiac arrest, etc. The boys will even react when a trainee gives them medicine based on the scenario they have been programmed to run.Mitie14

At the end of the hall are our partial task rooms. This long room can be divided into several rooms for smaller courses. In this picture, we have airway models set up for a course on intubation.

Mitie16

Last stop – the conference rooms. Not super exciting because of everything we’ve just seen, but they are used for meetings and as staging areas for courses. Most of the walls in these rooms are covered with whiteboard for drawing illustrations or other creative things during meetings. In case you didn’t know, you can also use dry-erase markers on the floor-to-ceiling windows in these rooms. The marks will wipe off with an eraser for a whiteboard. In case you’re wondering, yes, I’ve drawn on almost every window in my house since learning this.    Mitie17

 

That’s it! Thanks for joining us on this tour of the Houston Methodist Institute for Technology, Innovation & Education. MITIE is a great place to learn and discover new things.