Advancements in medical devices, diagnostic methods, treatment procedures, and medications contribute to better patient outcomes and healthier lives. But the training system has not advanced neck to neck when compared to the innovations in the medical field. Teaching surgeons poorly or not teaching them enough about these complex procedures and technologies will prove to be damaging for those who go under their knife. Complications would arise from those very innovations that were intended to bring benefits. A picture is worth 1000 words.
Virtual Reality-based training targets these deep-rooted deficiencies transforms bookish learning into something that is practical and can be visualized. It essentially improves the skills and the confidence of the surgeons in a myriad of ways. A decade or two back, surgeons had to practice a new procedure about 10 to 20 times to gain proficiency but now, due to the complications involved, the number has gone up to 50–100 cases. That is exactly why Virtual Reality-based training is an absolute necessity.
Existing weak links in surgical training and evaluation mechanisms
Precise and objective evaluations are often an Achilles’ heel for surgical residency programs as they do not have a quantitative measure to assess surgical skills. So what constitutes a “good surgeon”? Apart from these, the other challenges during residency include, lack of adequate opportunities to perform procedures and to continuously practice medical skills with cutting-edge devices. The best that most surgeons get is a one or two-day training workshop. Such training mostly does not offer any scope for the surgeons to reinforce their skills.
But when the surgeon has to perform a procedure in real life on a patient with that same medical device several months or years later, that training workshop would be of no experiential consequence, thus forcing them to refresh their almost non-existent practical knowledge while they are on the job. These shortcomings in the mode of training and evaluation are creating increasing levels of risk for both the patient and the surgeon, both of who face serious consequences.
Stats that would send shivers down a patient’s spine
The simple fact is that surgical training isn’t up to the mark. Below are some solid data that prove this statement and vouch for the current surgical training methods to undergo some serious facelift.
- The University of Michigan in a recent study reports that almost 30% of surgeons are not able to operate independently after completing their residency programs.
- According to the data released in a recent publication by the New England Journal of Medicine, less-skilled bariatric surgeons record mortality rates that are five times higher when compared to their high-skilled counterparts.
- Around 7 million patients all over the world experience surgical complications each year.
- Medical errors are third in the list of leading causes of death in the US.
Taking a leaf out of the aviation industry’s training manual
The medical field often looks up to the aviation industry for inspiration. Aviation training has included simulation components and other related technologies for vast improvements in training methods and has thus raised the bar for aviation safety by several notches in the last decade. In the last 20 years, flight hours around the world have doubled, but aviation accidents have fallen by 45%.
The arrival of VR to revolutionize surgical training
Recent advancements in Virtual and Augmented Reality hope to achieve for surgical training what simulation-based training has done for Aviation. Simulators are better for surgeons to practice procedures but they are expensive and most of them typically simulate just a single procedure. VR has revolutionized simulations of medical procedures by making them more effective, accessible, and affordable.
For example, laparoscopic VR trainers measure metrics such as time taken for the completion of the procedure, the economy of movement, a tool to tool contact, loss of tool to tissue contact, instrument path length, and procedure-specific errors. The software allows the user to customize their own training programs which can be viewed and evaluated by an administrator in real-time. Recent improvements, such as Oculus Rift in the VR technology have made the virtual reality experience much more immersive than the earlier VR headsets.
VR technology is portable, easily accessible, and is capable of providing on-demand training anywhere, anytime, making them ideal for surgeons who can practice their skills whenever they want to. VR surgical training technology has an easy checklist style of assessment, which provides objective evaluation of the surgical proficiency, taking the element of human subjectivity out of the equation. They provide reliable evaluations because they look granularly into what the surgeon does right and wrong and by clearly identifying areas of improvement.
Proof of Effectiveness:
Although hospitals and universities have employed VR technology for training purposes for a few years now, there is limited material when it comes to documenting its effectiveness and the improvement it brings to the domain. Researchers at UCLA’s David Geffen School of Medicine had validated a VR-based surgical training technology named Osso VR, for a bone fracture repair procedure. Measured by the Global Five-Point rating scale, surgeons who were VR trained received significantly higher ratings in every category when compared to those who were traditionally trained. Results show that students who were trained using VR were able to complete the procedure 20% faster and performed 38% more steps correctly than those who were trained using the traditional processes.
Based on this study, the overall surgical performance improvement due to the involvement of VR training is quoted at 230% when compared to traditional training. Although there is a long way to go for VR technology to be adopted by healthcare universities all over the world, there is no denying the fact that it is certainly ushering in a new era in surgical training and evaluation procedures.
Limitations of Virtual Reality Surgical Trainers:
Virtual reality is, without a doubt, a path-breaking idea that makes surgical learning more accessible and experience-oriented. Still, there are several challenges to be conquered. Graphics can simulate anatomical structures and present an excellent visual representation however modeling the physical properties of its real-life counterparts in order to manipulate them in a realistic fashion is still an area where research is in progress. The biggest limitation of virtual reality simulation-based learning is the lack of haptic feedback. VR simulators, in their current state of advancement, are not capable of providing any tactile feedback.
It is not just the technical challenges, but the financial challenges such as the cost involved in developing the software and the budgets that hospitals have to procure such trainers. The procedure-based simulation will be the core focus area in the coming years. Developing software at a lower cost will increase the chances of adoption by healthcare universities and hospitals around the world. Another challenge will be to make these VR trainers more accessible. The simulators need to be a lot more integrated into surgical training programs and should be available on premise in teaching hospitals.
VR Trainers have limitations in mimicking the real-time surgical environment as they lack tactile feedback. In a way to tackle this shortcoming, hybrid trainers which consolidate computerized components with ex vivo synthetic parts to deliver tactile feedback have come into the picture. Haptics experienced when using these hybrid trainers are real as the trainee would be interacting with real objects and instruments.
The limitation of such physical models is that their cost is much higher when compared to ordinary VR trainers. Also, complex human anatomy and physiology cannot be replicated accurately, for example bleeding vessels, leaking structures caused by trauma. Virtual reality surpasses physical models in this realm.
Conglomerate approach to solving limitations quicker
A few decades back video game companies followed an in-house approach to create every component of the video game themselves. But later they realized that by delegating different components to other companies, the chances of solving complexities and achieving more are not just higher but are a lot faster. Surgical VR simulation companies are currently working independently. VR trainers can benefit greatly by having different companies work on the different parts of the instrument to make it more precise and to replicate the software as close as possible to the actual procedure. There could also be a standardized platform on which this simulation software runs, bringing down the cost due to the mass production involved.
In this modern era of increasing awareness about patient safety, virtual reality assisted learning has certainly paved a new path by providing a safe environment for the surgeons to practice and perfect their skills, to be able to deliver their best in critical real-life situations. The new ethos of proficiency-based evaluation for surgeons means that there are bound to be lesser chances of medical errors and hence lesser surgical complications. So it is a fact that virtual reality assisted learning has helped advance patient safety in a great way by overwhelming the steepest part of learning in a surgeon’s journey.
Author: Mohan Bharathi Srinivasan