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  1. The patient doesn't have a name or, for that matter, hair. For the moment, he is a 61-year-old Caucasian, but that could change. This is the Simulation Lab at the University of Houston's College of Optometry, where students learn diagnostic techniques on a state-of-the-art, first-in-the-nation set of networked computers that mimic, as closely as possible, the experience of examining real patients' eyes. The patient even blinks, and when the light is too strong, the avatar blinks more. The virtual patient at the first station resembles a disconcerting mannequin head tied into a computer screen. The student uses a genuine-looking wand (instead of a light, it's a camera) to look into the patient's eye. What that student sees is displayed on the computer screen. Heather Anderson, assistant professor of optometry, points out that the image being shown is the optic nerve. Up on the screen pops information about the nerve. The program will also, Anderson says, randomly select sample cases and ask treatment questions. That's just for starters. The next computer is hooked up to a rectangle with a face in relief, as if it were emerging from water. "It's a more complex, 3D experience," Anderson says. This time, the patient simulates dilated pupils, and the student must wear a headband-mounted light. Some 200 pathology cases have been built in, Anderson says. The object is to teach pattern recognition, so students will be familiar with what they are seeing. In addition to diagnostic practice, the simulator allows students to practice aligning the equipment exactly with the patient's eyes. The experience is lifelike, but not entirely so. "All the avatars are bald," she says, "because hair takes a lot of memory." The system is called Eyesi, made by VR Magic. One is being used in Australia, but this is the first in the U.S. It cost about $400,000 and was paid for by the College of Optometry, with some funds from the main campus. VR Magic began by making surgery simulations but swiftly discovered how useful the system could be in diagnostic training. The turn toward simulation reflects a broader trend in health education, Anderson says, in which simulation, rather than live patients, can act as a useful, ever-ready teaching tool. The lab is open all day and night, every day. In some ways, the system is structured like a video game: you have to complete Level 1 before you can move on to Level 2. It also provides data on each student. If Student X isn't doing a thorough enough job of examining a retina, the computer will know. So far, the 100 second-year students are the first to use the simulation. It seems like a success. "I didn't expect it to be so real," says Amanda Wheeler. "It translates so directly to the real person. Learning the mechanics and getting things in the right place is so helpful." Or, as Betty Zhang puts it, "crazy-cool." More specifically, she says, "You have the opportunity to make mistakes that don't have consequences to real patients." Brian Stanley swiftly adapted to the whole video-game aspect. In fact, he came in on a Saturday, waited an hour for access to a simulator, and then hunkered down for eight hours until he had completed his first round of training. That's not uncommon, Anderson says. The deadline for students is the end of the semester. "But by the end of the first weekend, 10 students were done," she says.
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