Advancements in medical devices and surgical techniques hold promise for saving and improving lives. But our current system of training and assessing surgeons has lagged behind the pace of innovation - leaving some doctors unprepared to perform complex surgeries and putting some patients at risk. Using virtual reality technology in training may play an important role in addressing these deficiencies and improving skills. A limited study at UCLA's David Geffen School of Medicine had promising results.
Advancements in medical devices and surgical techniques hold promise for saving and improving lives. But our current system of training and assessing surgeons has lagged behind the pace of innovation - leaving some doctors unprepared to perform complex surgeries and putting some patients at risk. Using virtual reality technology in training may play an important role in addressing these deficiencies and improving skills.
While the skills-deficiency problem takes many forms, we see a particular disparity in surgeon preparedness between their residencies and fellowships. This leads us to the questions: Are some residents innately better surgeons? Or do these differences point toward discrepancies in the clinical scenarios and the level of autonomy that each surgeon experienced in training? For example, while one surgeon might have performed dozens of hip arthroscopies during their training, another might have done it once or never at all.
More to the point, how can we deliver the right kind of training in a standardized way? Furthermore, how can we objectively assess whether surgeons can perform proficiently prior to entering independent practice?
Indeed, accurate and objective assessment is an Achilles heel among many surgical residency programs. These programs don't traditionally provide standardized assessments with quantitative benchmarks or "scores" for surgical skill, which can leave them subject to bias when it comes to gauging residents' performance. When defining a "good surgeon," it can be difficult to separate bedside manner and work ethic from technical ability and surgical mastery.
In addition to challenges with assessment, surgeons often lack adequate opportunities to consistently practice skills they're learning - especially skills related to new medical technologies. When training on a new device, surgeons often travel to a one- to two-day training workshop with the medical device company. This one-time training generally doesn't offer avenues for surgeons to continue reinforcing their skills. It could be four to six months from the time surgeons train on a procedure to when they perform it on a patient, forcing them to refresh their knowledge "on the fly" in the operating room.
These shortfalls in training and assessment are creating increasing levels of risk, with serious consequences for patients and the surgeons that care for them. Consider these statistics:
Though these data points are alarming, the situation may continue to worsen due to the looming impact of the aging baby-boomer population and projected surgeon shortage, which will further exacerbate the issue of access to trained and qualified surgeons.
Virtual-reality-based training systems offer an intriguing solution to several aspects of these challenges. By definition, VR is the use of computer technology to create a simulated environment, placing the user inside an experience. These platforms directly address the skills gap by providing immersive, hands-on training that closely simulates an operating room environment. VR platforms offer portable, on-demand training that can be used anytime, anywhere.
What is more, VR-based tools incorporate "checklist-style" assessment measures to objectively gauge surgical proficiency, taking the process outside the realm of human subjectivity. These tools offer a highly granular picture of what surgeons are doing correctly and identify areas for improvement.
Hospitals and universities around the world have successfully embraced VR-based training for years, but until now, we've had limited research on VR's effectiveness. We set out to fill that gap through our recent clinical validation study at UCLA's David Geffen School of Medicine. The key finding: VR training on the Osso VR platform improved participants' overall surgical performance by 230% compared with traditional training methods.
In the study, which was performed over two weeks, 20 participants were randomized between a traditionally trained group and a group that underwent VR training on the Osso VR platform to a specified level of proficiency. Then, each participant performed a tibial intramedullary nailing, a procedure to repair a fractured tibia, one of the bones running between the knee and ankle. They operated on an artificial "sawbones" model, graded by a blinded observer.
As measured by the Global Assessment Five-Point Rating Scale, participants in the VR group received significantly higher ratings in all categories compared to the traditionally-trained group, with an overall improvement of 230% in the total score. VR-trained participants completed the procedure an average of 20% faster than the traditionally-trained group. They also completed 38% more steps correctly in the procedure-specific checklist. Both findings were statistically significant.
We presented the results of the yet-unpublished study, "Randomized, Controlled Trial of a Virtual Reality Tool to Teach Surgical Technique for Tibial Shaft Fracture Intramedullary Nailing," at the 2019 Annual Meeting of the Western Orthopedic Association. Long-term longitudinal studies are needed to further explore how VR impacts patient outcomes and decreases costs by improving surgical efficiency.
Today's rapidly evolving surgical landscape requires new ways to provide access to experiential surgical education. In addition, we must formalize our approach to technical assessment in order to more objectively measure surgeons' capabilities to ensure a consistent level of quality and standardized skill set of our surgical workforce.
With a strained surgical-education system, rapid medical innovation and a pending surgeon shortage, VR may offer an important educational tool to augment surgeon training and continue to offer patients the very best care.
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