Improving Surgical Performance and Physician Proficiency With AR/VR Simulations
Improving Surgical Performance and Physician Proficiency With AR/VR Simulations
Here is ReadWrite Q&A with FundamentalVR.
*Many thanks to Richard Vincent, CEO, and co-founder of FundamentalVR, for his time, responses and answers in this interview.
Can you give an overview of the Fundamental Surgery platform and the problem it solves?
Multiple studies have shown surgical simulations can improve physicians’ cognitive, psychomotor, and technical performance. However, less than 0.5% of the world’s surgeons currently have access to surgical simulations; not surprising when they can exceed $ 100K to purchase and cost over $ 25K a year for medical institutions to maintain.
What is Fundamental Surgery?
Fundamental Surgery is the world’s first SaaS-based education platform using HapticVRTM technology that combines high fidelity virtual reality with the sense-of-touch. The platform allows surgeons to experience the same sights, sounds, and feelings they would result in an actual procedure in a controlled, safe, and measurable way.
Fundamental Surgery was created to democratize access to immersive education, putting this tech within arms reach of every surgeon in the world through off-the-shelf equipment that can be bought and operated anywhere.
The SaaS-based platform offers a flight simulator type experience for trainees and qualified surgeons at a fraction of the costs of traditional education tools and for less than the price of a single cadaver.
Fundamental Surgery is a multimodal solution and is also available on standalone VR headsets, such as Oculus Quest and HTC Vive Focus, through its @HomeVR modality.
Both @HomeVR and HapticVR modalities provide educational simulations accredited by professional surgical bodies in the US and UK (American Academy of Orthopaedic Surgeons and the Royal College of Surgeons in London), and this multimodal approach is specifically designed to be for the different stages of the learning process.
What about traditional surgeon training?
The training of surgeons hasn’t changed much over the past 150 years with classroom-based theory, operating room observation, and theater-style viewing of cadaver-based still primary ways students are taught.
While these methods certainly have their benefits and place in curriculums, they don’t allow trainees to continuously practice their skills and develop muscle memory. These methods also don’t offer instructors with in-depth insights into how their students are progressing.
Our platform allows students and surgeons to practice procedures an unlimited amount of times, and develop muscle memory due to our haptic technology. Additionally, we can offer an unparalleled amount of data on how users are performing and progressing in an objective way.
How does the platform differ from other VR simulations solutions?
While VR has been used in hospitals to help trainees acquire technical knowledge, Fundamental Surgery takes it to a different level using HapticVR that mimics the physical cues of surgical actions, medical tools and tissue variations.
Practicing in this way goes beyond knowledge acquisition of talent and competence, and allows students also to develop the muscle memory that develops the skills necessary for surgical proficiency.
We are able to mimic real-life sensations of numerous medical tools and tissue variants within a submillimeter accuracy of resistance. That allows surgeons and medical students to develop muscle memory and get real-time feedback on what they are doing.
How and when is this platform used?
Between our HapticVR modality and our @HomeVR offering that allows users to practice from anywhere with a standalone VR headset, we offer users multiple options to practice their skills. A single user login ensures a seamless experience with the same high-fidelity graphics, content, and data tracking capabilities across each modality.
We recently rolled out a multiuser feature that allows users to practice and learn alongside their peers and instructors. Our multiuser capability has really become critical during COVID as instructors and professionals have been working to find ways to meet with their students and peers from multiple locations.
Our platform is also hardware agnostic, which makes it more accessible and affordable to medical institutions.
Can your solution and procedures be scaled?
Ultimately, we’ve created a solution that can be scaled rapidly to help many groups within the medical community train, meet, and learn anywhere in the world and at any time.
Additionally, our simulations are created, validated, and refined by experts in their respective fields. We have partnerships with the likes of Mayo Clinic and UCLA, along with our Global Medical Panel to make sure our solution is as realistic and helpful to the medical community as possible.
One last point is that our orthopedic simulations are accredited by the American Academy of Orthopaedic Surgeons (AAOS) and the Royal College of Surgeons in London. This means that by using our platform, surgeons can earn credits to use towards their maintenance of certification.
Why is haptics important for surgical training? What studies or evidence are there to show their usefulness?
Haptics technology is important because it helps surgeons develop muscle memory that is critical for performing surgery. Using haptics allows the user to have a fully immersive training experience where they can experience the same sounds, important visuals they would during a real procedure.
Tell me about your validation studies.
We’ve conducted validation studies with the British Orthopaedic Training Association and The Royal London Hospital with surgeons at various levels of training and found that overwhelmingly participants found the simulation and its haptics technology useful.
Our simulations have also been accredited by the Royal College of Surgeons and AAOS, allowing the use of Fundamental Surgery to count towards a surgeon’s ongoing professional development. These accreditations validate our technology from an industry standpoint and show Fundamental Surgery’s training benefits.
Can you explain what the new @HomeVR modality is, how it helps residents and surgeons, as well as the difference between it and the HapticVR modality?
@HomeVR is an extension of our HapticVR platform. The HapticVR allows users to access our accredited educational simulations on standalone VR headsets such as Oculus Quest and HTC Vive Focus.
The difference between @HomeVR and our HapticVR platforms is the level of haptics used. With the HapticVR modality, users can gain muscle memory and really experience the feelings they would during surgery.
With this modality, people use haptic arms, which provide them with the force feedback and position, also known as Kinesthetics, they would encounter during a procedure.
The @HomeVR modality complements HapticVR well by bringing our VR simulations to standalone VR headsets so they can continue their practice anywhere and hone or master any skills needed.
Together, the modalities fuse Cutaneous (tactile vibration) and Kinesthetics (force feedback & position) haptic technologies in a single system to provide a more powerful, flexible, and cost-effective education platform.
Fundamental Surgery also expanded with a multiuser function. What is that and how does it work?
Our multiuser feature allows an unlimited amount of users to step inside a virtual OR and participate in lessons alongside their supervisors and team members. The majority of experience and knowledge among surgeons and students is gained via face to face encounters, which isn’t always possible.
The multi-user capability of Fundamental Surgery allows for the same hands-on, collaborative experience people would have during an in-person training session. Additionally, it lets supervisors monitor work, provide feedback, and answer questions in real-time anywhere in the world.
In addition to being used for lectures or one on one learning, it’s also great for team-based learning, as surgical teams can practice together and build team chemistry.
What type of data are you able to collect while residents and surgeons are using the platform?
We are able to measure and record every user interaction, such as surgical gaze, respect for tissue, and efficiency of movement, which are widely connected with surgical proficiency.
All measurements and recordings are provided in real-time, all within a single display that can be accessed anywhere by any device. The data collected is also compliant with CME (AAOS) and CPD (RCS) specifications allowing the use of either modality to count towards a surgeon’s ongoing professional development.
What equipment is needed to use the Fundamental Surgery platform?
We made our platform hardware agnostic to ensure that it is accessible and affordable. It also allows the user to pick the equipment they are more comfortable with or already use.
To use the HapticVR system, there are three elements needed; a laptop or desktop, two haptic arms, and a VR headset such as the Oculus Rift or the Dell Visor.
For @HomeVR, all that’s needed is an untethered VR headset like Oculus Quest or an HTC Vive Focus Plus.
Who benefits from VR training tools? Educators? Residents? Students?
We find that immersive training and education technologies, like Fundamental Surgery, benefit many groups in the medical community.
In reality, medical professionals at any level can benefit from VR training tools.
For educators, immersive VR training tools not only allow instructors to provide their students with more training options, but the level of data they can access from tools like Fundamental Surgery provides them with unparalleled insights into their students’ capabilities.
For residents, simulations allow them to hone skills and maintain proficiency at their convenience. Finally, for students, surgical VR training tools allow them to practice skills that they observe during lessons, perfect a move they learned during cadaver training as well as gain muscle memory by repeating a simulation.
Medical Device and Pharma companies are finding great value in the platform and often for a much more advanced user. Their use cases include for remote proctoring and education as well as bridging the physical divide by allowing them to conduct demos and meetings via our virtual multiuser capability.
Who currently uses Fundamental Surgery?
We are proud to say that Fundamental Surgery is being used worldwide. To name a few places, the Mayo Clinic and UCLA in the U.S., Sana in Germany, and the UCLH in the U.K. are a few medical institutions using our platform.
NYU Langone is also trialing @HomeVR with its residents as they work to navigate self-isolation restrictions.
Furthermore, a number of leading medical device companies and Pharma companies have adopted the platform to aid education.
Please comment on how COVID-19 has impacted medical training and how Fundamental Surgery can help?
The pandemic has caused medical institutions, hospitals, and universities to quickly adjust how they train and teach students and residents.
In-person training is severely limited, with universities moving to virtual teaching, elective surgeries are rescheduled, and doctors are turning to telemedicine visits. These changes have taken place quickly in this pandemic and have required organizations to find new ways for their students and residents to get the vital hands-on experience they need to practice and learn skills.
Fundamental Surgery is a beneficial tool for the medical community. With our platform, residents and trainees can practice their skills in a safer environment, and their supervisors can monitor their capabilities and growth remotely through their dashboard.
What are examples of ways Fundamental Surgery is currently working with institutions during COVID to continue their surgical training efforts?
Currently, we are working with NYU Langone and St George’s Hospital London to give their residents and students access to @HomeVR so they can continue their training remotely.
We are also speaking with new universities and programs regularly on how Fundamental Surgery can help them and look forward to helping as many students and residents during this trying time.
What feedback have you received from trainees and educators who are using Fundamental Surgery to train now?
Very positive! Both from trainees and their supervisors as well as experienced surgeons learning new techniques. Trainees primarily enjoy the flexibility of being able to practice on their own time or repeating a simulation as many times as they want.
From educators, we are hearing that the data they receive from Fundamental Surgery is helping them better understand the abilities of their trainees, where they can use improvement and how they are progressing.
Additionally, we’ve received helpful insights into new features users would like to see us add to Fundamental Surgery. We are always working to expand and enhance Fundamental Surgery so we always enjoy hearing directly from our users on how we can continue to grow the platform.
Moving forward, what do you think curriculums and resident programs will look like for the remainder of the year and beyond the pandemic? Will programs rely more on immersive training tools?
I think we will see several changes implemented now that will last beyond the pandemic. In a webinar series we facilitated with faculty and surgeons from around the world, we had this discussion and a few great points were brought up.
First, the use of immersive training tools will allow programs to move towards competency-based curriculums instead of chronological. The change will mean that residents will be able to move forward in their studies once they prove they have competent skills in what they are studying instead of completing their studies based on time studying.
For example, if a student was scheduled to learn a certain skill set in five months but learns to perform that skill proficiently in three months, they will be allowed to move forward in their studies instead of having to wait for the end of the classes. We are already seeing this transition take place in Australia and the UK.
Additionally, this move to remote learning and incorporating technologies into curriculums has started discussions around organizations and professionals pooling resources to allow trainees to learn from leaders and experts worldwide no matter their location.
In theory, if a program is using immersive tools to teach trainees, they can easily have experts in their field host virtual lessons and guide simulation training — even if they live in a different country.
Why do you think immersive technology is being accepted now in the medical field and why do you think it has staying power?
Right now, the medical field is looking for answers to the problems the pandemic has caused. One of the most effective solutions they’ve turned to during this time is immersive technology.
Before the pandemic, organizations were starting to adopt immersive training tools, but the current need for resources that allow students to continue their education remotely has amplified the need and acceptance of solutions like Fundamental Surgery.
I think immersive technologies definitely have staying power beyond the pandemic. Although the pandemic has sped up the adoption rate for these technologies, organizations and trainees alike are seeing their lasting benefits as they use simulation tools.
What are hurdles that need to be overcome for immersive training tools to be widely adopted?
I believe it’s simple — decision-makers need to be put in front of the technology and experience it for themselves. The decision-makers, also need to see their students and residents use this technology. Once they watch the process, it’s an uncomplicated course to sell them on the benefits and usefulness of immersive training tools — because they have witnessed it for themselves.
Though, because of the pandemic, we are seeing immersive training tools being accepted on wider bases as medical institutions need new ways of delivering ongoing education and bringing remote individuals together quickly. Immersive technology is perfect to accomplish this needed training.
Now that they’ve experienced it, we think it’s going to lead to a fundamental change in how medical institutions teach surgery going forward. It will be similar to the way the aviation industry has embraced using simulations.
Ultimately, the more organizations utilize immersive training tools the more we will see better-prepared surgeons, a better understanding of a surgeon’s capabilities and better patient outcomes.
What are the next evolutions of AR/VR in healthcare in your opinion?
I believe the use of haptics will be more widely used in healthcare training as the industry more widely understands the benefits of incorporating the sense of touch into immersive solutions.
Paradoxically, this could cause an issue for the industry if every procedure or medical tool requires a hospital to sign up for a different VR solution.
How will the healthcare industry find the information they need about the AR/VR?
We believe a channel delivery system for medical education will begin to immerge that will provide a single interface and access point for hospitals and medical students — a veritable “Netflix” of medical education if you like!
What about robots?
We also believe in the near feature we will see increased use of robotic, remote surgery using immersive and haptic feedback interfaces.
Isn’t everyone or every “body” different?
One of the things we are interested in looking at further with our partners is the development of patient-specific modeling through AR/VR.
Using the patient-specific model will allow a virtual model of an individual to be created, and surgeons will be able to practice virtually on that person and carry out the procedure multiple times before they attempt to do so for real in the operating theater.
What about the GPU and why is it important?
Developments in the area of improving the Graphics Processing Unit (GPU) are ongoing. GPU handles the graphics operations and uses 1/10 the processing power of traditional CPU. The capabilities of GPUs will be utilized to visualize real-time procedures even on smaller devices. These are expected and will also enhance experiences.
Image Credit: ????? ???????; Pexels
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