On a recent visit to Bogota, Colombia we were invited to check out the CLEMI center (Centro Latinoamericano de Entrenamiento en Cirugía Mínima Invasión) just outside the city where surgeons from around Latin America and beyond come to advance their minimally invasive skills. It’s a rather unconventional place that’s unique in its purpsose, methods, organization, and even location. Unlike most surgical training centers around the world, CLEMI is not part of a hospital, medical school, or some other larger facility. It’s a standalone place situated within an hour of Bogota, close to the city of Chia, surrounded by lush mountain sides while minutes away from popular restaurants and an entertainment area.
Driving up to CLEMI you may be surprised by its exterior, a one story brick building that seemingly cloaks itself within the rural area of farms and ranches. It certainly doesn’t advertise what goes on inside while providing an environment for surgeons to do clinical training without the associated stress that often pervades larger inner-city facilities.
Founded in 2007 by the Colombian Society of Orthopedic Surgery and Traumatology (Sociedad Colombiana de Cirugía Ortopédica y Traumatología), CLEMI has been hosting practical classes on minimally invasive techniques since 2008. Over three thousand clinicians have gone through almost 500 training courses there already, with most students coming from outside of Colombia. Its creation was motivated by the fact that many advanced professionals were leaving Colombia to train and work in minimally invasive surgery elsewhere, while traditional surgical techniques remained as standard of care in the country.
In order to increase the quality of local surgeons while keeping them in the country, CLEMI took on the challenge of training advanced techniques and soon was hosting dozens of surgeons from many Spanish speaking countries. Moreover, since student physicians in Latin America typically trail already trained professionals within the clinic while learning new techniques, the center aims to reduce that dependence and focus learning by using a more direct approach that involves cadavers, animals, or computer simulators before doing the same with human patients. The Colombian ortho society established relationships with similar groups around the world, even from different fields, in order to mimic many of the tried and true training methods already in use.
The facility doesn’t have any commercial interests and does not promote any specific products and services, instead providing a space for a variety of competing technologies to be used as needed. Nevertheless, CLEMI is available for rent to medical technology firms that are looking to train physicians in the use of their equipment, something that smaller firms in particular without dedicated in-country training facilities have a hard time accomplishing on their own.
There are a number of training methods that are used, including utilizing human cadavers, live animals, as well as computer and plastic simulators. As an interesting side note, because of the peculiarity of recently introduced Colombian laws, entire cadavers, rather than individual body parts being worked on, have to be used during training.
Although there aren’t any real patients, training is done as though real surgeries are being performed, including scrub ups, covering C-arms in plastic sheeting, and using real X-rays during the procedures. There are even anesthesia machines that are employed during the simulations. All in all there are ten endoscopic towers, a number of Simbionix simulators, six microsurgery microscopes, 21 mechanical simulators of various types, and five C-arms that are on-hand at the facility.
Classes are usually conducted on the weekends, while the weekdays are used for research and course preparation. To reach a greater audience, many of the training courses are live streamed over the Internet to other clinical institutions from where participants can see how things are conducted and ask their own questions from the teaching staff.
In addition to training and professional development, CLEMI is now getting into product development to help its alumni improve existing surgical techniques and even develop new ones. With this in mind they’re moving toward using the center as a test bed for verifying and validating new devices and for helping inventive surgeons obtain patents for their ideas.
The facility was designed by hospital architects, so while inside you may think you’re in a real clinical environment with elevated power outlets, floor drains, safety showers, and many other little details that together create a true clinical simulation. The various rooms are modular and are outfitted to match the needs of the courses running at any given time. The equipment is rolled in and out as necessary, as well as the cadavers or animals.
While we weren’t invited into the morgue, we did see where the animals are prepared for surgery. It’s essentially a pen for about a dozen animals, who are brought there only a day before the training session directly from the free roaming area just outside the facility. They’re cleaned and inspected, sedated, and placed on carts before being brought into the surgical area. The process was designed to be quick and to minimize the stress on the animals.
We were quite surprised by CLEMI, including the organization’s mission and approach to surgical training, as well as by its location and design. While we didn’t have a chance to go through a training session offered at the facility, the staff we spoke with were proud and passionate about the work that they do. They were also very interested being a model for other societies and organizations to copy what they learned about conducting surgical training. Perhaps we’ll see a growth of independent medical training facilities around the world that are designed from the ground up for their core task, focused on education, and run in a realistic way that promotes cohesive practical learning.
Here’s a Spanish language video about CLEMI in which you can get an idea what it’s like inside, what equipment is used, and how training is conducted:
Note: This tour was organized by the Invest in Bogota economic promotion agency.