COMMENTARY

Virtual Reality Surgery Simulators Could Help Train Future Surgeons

November 18, 2016
Thomas Morrow MD

Having had a few surgical procedures during my long life, I can truly say that surgery is one of the most personal of all medical experiences. Somehow having another person purposefully cut into a body seems more personal than having a primary care provider prescribe a medication. Because of this, we would like to think that the surgeon making that cut is more than adequately trained to do the procedure needed. But, that may not actually be the case.  A study published in 2009 looked at this exact issue.

The study, performed by the American Board of Surgery in conjunction with the Association of Program Directors asked 254 general surgery residency program directors to complete a survey ranking, in their opinion, the importance of the need for competence at the end of residency of 300 various types of surgery. Of these 300, the program directors listed 121 procedures that residents should be “competent” to perform by the end of their residency, termed an A category procedure. They also ranked the other 179 as either B or C, with C meaning that the surgeon needed not to be familiar nor competent to perform at the end of their residency.

The study then went on to look at the actual experience of the graduating surgeons with these procedures. It is worth noting that surgical residents are required to log their surgical experience for each and every procedure they had experience with during residency into a web-based program managed by the Accreditation Council for Graduate Medical Education. 

The findings were rather startling. All residents in the nation had enough experience to be competent on only one procedure—laparoscopic cholecystectomy. Of the rest, many of the residents fell short on the number of procedures they assisted with or performed. There were 83 different procedures that were performed fewer than 5 times. Of great interest to me was that, on average, residents only performed 15 open abdominal operations during their 5 years of training.

Residents have demonstrated their feelings of inadequacy by extending their training voluntarily.  In fact, nearly 4 out of 5 extend their training beyond 5 years! 

Reasons behind this lack of experience include reduced work hours mandated by training programs over the past several decades, increased number of actual procedures, and increased complexity of the procedures in surgery. These are real problems. But, increasing the number of years of training is not really very attractive to many… especially given the looming physician shortage.

But, there may be a better way, and one that is already in use in a variety of professions, particularly flying airplanes; simulators in the form of virtual reality (VR).

A San Francisco Bay start-up, Osso VR, founded by a recently graduated orthopedic surgeon, Justin Barad MD, feels that the current state of VR may significantly change how surgeons are trained and at the same time improve competency for older surgeons interested in learning new procedures or learning to use new devices.

Osso VR is a venture-capital-backed surgical training platform with a focus on hands-on learning. Osso VR training modules are highly interactive, allowing for a more active educational experience with realistic actions modelled after the real world equivalent.  They liken their approach to fishing. There are many ways to teach someone to fish. You can have them read about fishing, you can have them watch someone else fish, or you can just let them fish. That is the philosophy behind Osso VR.

Dr Barad was interested in software long before he went to medical school having served as the captain of his computer science team in high school and a stint at Activision., a video game development company. He subsequently received a bioengineering degree from UC Berkeley before completing his MD and orthopedic residency at UCLA (as well as a fellowship in pediatric orthopedics at Harvard). He has teamed up with Matt Newport and Brady Evans, MD, MBA.  Matt is the CTO of Osso VR. Matt was a psychology major before becoming a veteran game developer with over 15 years professional game development experience. Dr Evans has spent half a lifetime at Harvard completing his MD, MBA and is currently in his 4th year of orthopedic surgery training.

Their award-winning platform is currently in its alpha development phase and is in the midst of a validation study at UCLA.  Their study will compare surgical residents’ real world performance of actual procedures before and after training in VR. Their plan to offer Osso VR to surgeons in the second or third quarter of next year, and are currently helping training programs obtain compatible VR systems. 

They are exploring a variety of business models. They hope to provide the software to surgeons at an affordable cost by partnering with medical device manufacturers to create training content for cutting edge surgical systems.

While VR will never exactly reproduce an emergency experience, it will no doubt provide valuable supplemental training for surgeons as well as other physicians, and is a welcomed addition to the health care technology landscape.