The field of orthopedics is very complex and constantly changing, especially as the fast and furious pace of new surgical devices and technologies accelerates.

THE PROBLEM

The importance of highly effective and accessible tools and resources, in addition to exposure to hands-on surgical training, is essential.

“Amid the digital acceleration of healthcare transformation, we can no longer rely on the age-old mantra, ‘See one, do one, teach one,’ to train the next generation of surgeons,” said Dr. Cory Calendine, head of orthopedics. surgery at Williamson Medical Center and orthopedic surgeon and founder of the Bone and Joint Institute of Tennessee.

“On the contrary, we should implore them to ‘do as much as possible,'” he continued. “In fact, the more practice a resident or attending surgeon can perform, the more proficient they will become.”

With the aggressive pace of new devices, technologies, and techniques, it is becoming increasingly important to track and measure performance metrics. These skills gaps can have real consequences for patients, surgeons and their healthcare institutions.

“Training should never stop for a surgeon, and we need better methods,” Calendine said. “While scholarship programs remain an option for further training, many studies point to an opportunity to develop a better training system.

“Additionally, recent changes made by the ACGME, in the wake of the COVID-19 pandemic, have imposed restricted cleaning hours, significantly limiting resident and co-worker exposure to patients, mentors and procedures. “, he continued.

The correlation between surgical volume and performance for patient outcomes is undeniable. A recent study from the University of Michigan found that 30% of surgeons could not operate independently after residency.

“A 2019 study from UCLA’s David Geffen School of Medicine found that surgical performance using the Osso VR platform improved surgical performance by 230 percent.”

Dr. Cory Calendine, Bone and Joint Institute of Tennessee

“Preventing surgical errors requires the attention of all personnel involved in patient care, including institutions responsible for developing a dynamic learning environment for resident education, training and research,” noted Calendina.

PROPOSAL

Calendine discovered virtual reality technology from supplier Osso through its partnership with Stryker. He was immediately drawn to technology.

“Beyond the cool factor, I was really surprised by what a robust type of VR training is,” he recalls. “Not only can I teach the steps to the residents, but they can also practice on their own, as many times as they want, without any risk for the patients.

“Furthermore, the platform can measure and score performance and skills at any level of training, which is extremely valuable as it allows me and other faculty members to objectively define in how well we train the next generation of surgeons,” he continued.

Traditionally, surgical training, whether one is a resident or a fellow student learning the ropes or an experienced surgeon training on a new device, requires immense logistical planning and then travels to a one or two day workshop .

“For many surgeons, it can take six to eight months before they use that unique training to perform that procedure, device, or technique on a patient,” Calendine explained. “Surgery is big business, and virtual reality has the extraordinary ability to deliver the latest and greatest in surgical innovation to any experienced or aspiring surgeon with a headset, anywhere in the world.

“The price of headsets has come down significantly, so if you’re calculating airfare, hotel, and shipping of devices or materials, virtual reality is a cost-effective way to empower surgeons of all skill levels the most innovative and up-to-date training on a large scale,” he added.

TRY THE CHALLENGE

Calendine has spent over eight years practicing and training in robotics. And traditionally, this education was done in person on categorical specimens. Over the years he has traveled all over the world, training a variety of surgeons, from residents and fellows to private and private practice, all on a cadaver from scratch.

“Typical training scenarios involve a surgeon going to a one- to two-day training workshop,” Calendine explained. “In some situations, surgeons are asked to take a one or two-day workshop on a new surgical device, and then months later they have to perform that procedure with confidence.

“Offsite training is not only expensive and time consuming, but also lacks opportunities for the surgeon to continue practicing,” he added. “It could be six months before the surgeon actually uses this device in a procedure.”

Industry figures estimate a surgeon needs to perform at least 75 cases to achieve peak proficiency, he said. The lack of an objective surgical skill assessment tool further complicates the issue, so a surgeon and his team never really know when they are ready, he added.

“With the appropriate VR platform, headset, and controllers, residents can learn and practice specific procedures outside of the operating room, even in the comfort of their own home,” he noted. “These realistic simulations can be reset and repeated without consequence, and dramatically improve procedural skill and confidence, directly translating into better clinical outcomes and overall patient care.

“VR’s level of authenticity provides users with a truly authentic experience that you see and feel immediately,” he continued. “It’s extremely impressive.”

RESULTS

Multiple studies have shown that virtual reality is not only fair compared to physical simulation, but also superior to traditional methods of medical education, Calendine said.

“A 2019 study from UCLA’s David Geffen School of Medicine found that surgical performance using the Osso VR platform improved surgical performance by 230 percent,” he noted.

“Subsequent findings by researchers at the University of Illinois College of Medicine in Chicago – who conducted a blinded randomized validation study using the Osso VR platform – revealed that the use of virtual reality for surgical training dramatically increased the accuracy and completion rate of procedures, which more than tripled the odds of a successful procedure and demonstrated a 300% improvement in accuracy when residents trained in the Osso VR mod.”

This study and others demonstrate the undeniable advantage of virtual reality to significantly improve surgical performance and outcomes at all levels, he added.

TIPS FOR OTHERS

“My vision of virtual reality is that we integrate it into all academic and private training programs,” Calendine said. “Virtual reality is going to play a major role in medical education in the future, and I would strongly recommend the early integration of virtual reality systems into residency and provider education curricula.

“Just as EHRs – for better or worse – have revolutionized the paper record, virtual reality will become a valuable, standardized and necessary tool in medical education and training,” he said. “Everything from integrating virtual reality into residency programs to learn, rehearse and practice surgical skills, to introducing new techniques and instruments during virtual lectures.”

Twitter: @SiwickiHealthIT
Email the author: bsiwicki@himss.org
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