AUGUSTA, GA - Next time a physician wants to invade your private parts with his or her fingers, ask yourself this: How do doctors learn what it feels like to probe an enlarged prostate or feel for a lump in your breast? And how does some cold-fingered MD have a clue how you feel about it?

After all, not only are patients reluctant to be prodded in the anus or vagina, doctors and medical students face the same taboos we all do. They’re uncomfortable talking about sexual issues. They’re squeamish about feeling for prostates or scraping a cervix.

Enter tall and jocular Dr. D. Scott Lind, who realized that modern medical instruction need not be limited to the real world. He married game technology with medical mannequins to develop an alternate reality for medical instruction. World of Warcraft it’s not. Think Sims Med School — a place where real medical students get to poke and prod human looking (and feeling) avatars before they poke and prod you.

Lind grew up in the great white north of Minnesota and Canada, son of a prominent surgeon and medical educator, Jim Lind.

“Jim Lind is at once a brilliant and esteemed academic surgeon and a no-nonsense guy,” wrote Barbara Saltman Berci in a newsletter of the Society of American Gastroinestinal Endoscopic Surgeons. “Many in surgery consider him one of Canada’s most enduring gifts to the U.S.”

Jim Lind became heavily involved in surgical education and helped develop problem-based learning. “That’s where they give you a problem related to what you’re trying to study,” Scott Lind said. “You talk about the problem. You have to research it. There’s some data that you may develop better critical thinkers in that environment.”

Jim Lind passed along more than an interest in medical education. His sons (Scott’s brother is also a doctor — and a middle-aged rock musician) also picked up some impressive physical and mental talents from their father.

Born in Rochester, Minn., Lind remembers growing up in the shadow of the statue of 40-foot-tall Husky the Muskie in Kenora, Ontario, where his family had a cottage. He never grew as tall as Husky, but he grew tall enough to be a force on the high school court. “I scored 17 in one quarter one time,” he recalled. “It’s the highlight of my life.”

He’s a joker.

Lind played college hoops at McMaster University in Hamilton, Ontario — “End of the bench,” he quips — quitting in his final year to focus on getting into medical school.

At that point, he followed father to Norfolk, Va., where Jim Lind had taken a chair at the Eastern Virginia Medical School. As Lind tells it, Eastern Virginia is famous for two people, Harold Ramis and Rick Moranis, neither of whom graduated. And for Lind, Virginia was for lovers. He met his wife at the library at Old Dominion University.

“I taught her how to use an endoscope and looked in her eyes,” he said. “That was in ’83. We got married in ’84.”

They spent their honeymoon driving his old Cutlass and towing a trailer to his surgical residency in San Antonio. “My wife cried all the way to the Alabama border,” he remembers.

However, his medical career went much better than his basketball career. He won a fellowship in surgical oncology at the Medical College of Virginia. When he completed that in 1992, he landed a teaching job at the University of Florida College of Medicine.

That’s where Scott Lind met Benjamin Lok, a PhD in computer science. Lok had created a number of computerized avatars. Scott Lind had an idea for using those avatars in medical education.

What Lind wanted to do was re-create the interaction between patient and doctor in a virtual world. But it’s much harder to simulate the complex feedback system of a patient interview than it is to build an alien shoot-‘em-up scenario.

In Lind’s virtual clinic, medical students wear goggles that allow them to see the avatars.

The avatars respond to questions based on what illness they’ve been programmed to simulate.

The computer uses voice-recognition software to understand the questions. Actors have recorded a wide variety of answers.

“Part of my left breast has been painful for a while,” the avatar says in one recorded session with student.

“When did it start?” the student asks. There’s a slight delay because the voice recognition software doesn’t pick it up right away.

“I guess the pain started a couple of months ago,” the avatar says. “My mother has breast cancer.” The avatar wonders whether breast cancer may run in the family. In the body language, she’s wringing her hands.

And so begins an interaction that not only covers the facts of breast cancer, but requires the student to respond with empathy and understanding.

Then the students can move on to a breast examination to look for lumps in the breast. That’s possible because of the work of Dr. Carla Pugh, a surgeon at Northwestern University.

Pugh builds simulators for breasts and other body parts, including penises and pelvises. Her simulated breasts not only come in all shapes and sizes, they also have sensors to tell students whether they’re actually touching the right area and using correct pressure.

When the exam is completed, Lind can provide feedback about the interview and the physical exam. If the students failed to examine the entire breast, the portions they missed show up on a computerized chart.

“A lot of people miss parts,” Lind said. If they do, he can retrain people to cover the entire breast.

The avatar simulation also proves significant in training doctors about empathy and their own inhibitions. “When you’re taking a sexual history, you wouldn’t believe the questions you have to ask,” Lind said. “I get embarrassed.”

But when the students were asked to take the history from an avatar first, the doctor found a dramatic reduction in heart rate and blood pressure when they next handled a similar survey with a real person.

Some studies have also shown that when the skin color of the avatar is changed, racial biases show up. Now Lind is trying to use the avatars to help students learn lessons about other cultures before they face them in the real world.

Working with Kyle Johnson, an assistant professor of computer science at the University of Georgia, Lind is trying to expand the capabilities of the avatars. For instance, they’re working to create accents to help simulate patients who may talk in a different dialect. That may have very practical applications for foreign medical graduates now studying here, because they haven’t been exposed to the wide variety of English speech patterns.

Lind’s studies show that the avatars can help train students to take an empathetic approach. The fact that the avatars look life-size and that the students are immersed in the alternate environment with goggles and headphones makes the situation more real than it would be if they were looking at a computer screen.

“What we’re trying to do here is simulate a real interaction to the best of our ability,” Lind said.

The avatar system creates important feedback loops. Not only can a trainer provide feedback after the session, the students themselves can see how they handled difficult questions and make adjustments. And they can practice.

Lind presented the avatar training system to doctors at the Association of American Medical Colleges Research in Medical Education meeting. “The coolest thing was they all responded that they could have done better,” he said. “We redid it, and they did do better.”

This year, all the second-year students at MCG will receive the breast exam interaction training with an avatar. A similar program is in use at the University of Florida. Keele University in England is using it. When MCG expands to UGA, Lind expects that virtual training will be available from the beginning.

So far, the technology has been relatively inexpensive. “We build this with off-the-shelf technology for $8,000,” Lind said. There’s even possibility of creating virtual medical instruments, in much the same way a Wii creates a virtual tennis racket.

Lind sees potential for using avatars to train doctors to how to do many exams that would be uncomfortable for both doctor and patient — prostate exams, testicular exams, pelvic exams. They’d learn how to better communicate with patients about private issues — the bedside manner part of the business of medicine.

“All these things are important to patients,” Lind said. “All the facts related to disease, you can pick those up by a push of a button. But how to interrelate with patients, you can’t learn that from the Internet. You have to actually do it, and have someone observe you.”

And even now, Lind is dreaming of another level — an avatar instructor in the simulated examination room, telling medical students what they’re doing right and wrong even as they’re doing it.