The operating room of any health system is its most lucrative and expensive asset.
Recent advancements in surgical technology have led to skyrocketing demand for minimally invasive, robotic procedures, a trend that promises enhanced patient outcomes. However, rapid transformation in surgical practices have inadvertently created a daunting gap in training, leaving senior residents and fellows struggling to stay ahead.
A telling 2017 study from the University of Michigan found 30 percent of surgeons couldn’t operate independently after residency[1]. Five years and a global pandemic later, that percentage today is most certainly higher. Continued staffing shortages, pervasive burnout, and the ever-escalating demands of value-based care have further strained the capacity for hands-on training and mentorship.
As surgical procedures become increasingly more sophisticated, budding medical professionals are struggling to acquire the complex skills required for today’s modern operating rooms. In this high-stakes environment, where patient safety and outcomes are of paramount importance, hospitals must prioritise opportunities for skills development.
Residency training in the era of modern surgery
In healthcare’s budding era of digital transformation, the traditional ‘see one, do one, teach one’ training approach is revealing inherent shortcomings in preparing the next generation of surgeons, particularly in the context of robotic surgery. This age-old method, which once formed the backbone of surgical education, is now facing its limitations, particularly in the context of robotic surgery. Over the past decade, the field of surgery has experienced a profound evolution, necessitating the adoption of new tools, technologies, and methodologies to nurture a competent and prepared workforce. Amid this evolution, four pivotal challenges that have emerged:
- Overwhelming body of knowledge: There is just too much to learn. The rapid advancements in science and technology have inundated surgical practice with an ever-expanding body of knowledge and skills required for modern surgery. Keeping every procedure at sufficient levels of proficiency on demand has become a formidable challenge, often verging on the impossible.
- Complexity of techniques and technologies: Newer surgical techniques and technologies are more intricate and difficult to master. The learning curve for traditional open procedures are typically between 10 to 20 cases, while most robotic and minimally invasive procedures require 50 to 100 cases.
- Absence of objective standards: Presently, the field of surgery lacks objective methods for evaluating surgical proficiency. The absence of standardised criteria causes surgical assessments to rely on subjective judgments rather than empirical measurements.
- Transition to team-based surgery: Contemporary surgical practice has shifted from an individual endeavour to a team sport. While training has historically focused on the surgeon, the importance of training the entire surgical team in today’s OR is increasingly evident.
These four challenges, intertwined and multifaceted, contribute significantly to the expanding training gap in surgery, underlining the urgency for innovative solutions to bridge this divide.
A new dimension in training
Research continues to demonstrate how simulated and remote-based technologies like augmented and virtual reality are disrupting traditional training approaches to improve accessibility, cost and proficiency. A 2020 study from UCLA found residents training in VR improved surgical performance by 230 percent[2] compared with traditional methods. Subsequent findings by researchers at the University of Illinois College of Medicine at Chicago found VR surgical training demonstrated a 300 percent improvement in procedural accuracy[3]. Further, research led last year by Community Memorial Health System found VR outperformed guided instruction, with participants completing procedures eight minutes faster with fewer step corrections and higher assessment scores[4].
These immersive technologies are poised to revolutionise residency and fellowship training, offering a potential solution to the lengthy process of becoming a surgeon. By harnessing immersive AR and VR technology, medical students and residents gain access to hands-on training experiences that fast-track their journey to becoming highly skilled and proficient surgeons. This technology-driven approach not only accelerates learning but also fosters continuous skill enhancement, ensuring that healthcare professionals remain at the forefront of surgical practice. Currently, it takes approximately 14-16 years to become a surgeon in the United States. Training with VR presents an opportunity to transition residency programs from a time-based model to a competency-based one, potentially enabling medical students to become highly skilled and competent surgeons more quickly and efficiently.
AR/VR technologies also allow for highly-collaborative training and mentorship. In VR, students from all over the globe can gain insight and expertise from the world’s most renowned medical experts. This means an aspiring surgeon in Malawi can access the same level of medical training as someone in Los Angeles, without the cost, time, resources or waste. Virtual reality also enables large-scale collaboration so surgeons can share groundbreaking techniques and rehearse procedures together with their surgical teams.
Utility for the medical device industry is essential for increasing the adoption of higher value surgical techniques and technologies. Newly FDA-approved procedures require immense logistical planning and training on the part of the device company to ensure maximum public safety and clinical effectiveness. Traditionally, getting surgeons up to speed on new tools and techniques begins by flying them to cadaver labs or two-day training seminars.
As newer devices and techniques are rapidly introduced, it becomes increasingly more difficult and expensive to fly busy clinicians to cities like Las Vegas, Hawaii and Florida. Moreover, there is often a significant delay, lasting six to eight months, before most surgeons will perform these new procedures, creating a gap between learning and implementation. To maximize the effectiveness of training, device companies are increasingly turning to remote-based virtual and augmented reality to onboard their technologies and benefit more patients more quickly.
As the acceleration of high-precision, minimally invasive surgeries continue to proliferate, medical practitioners at every career level are facing an enormous uphill battle to keep pace. Immersive technologies like virtual reality offer a promising path forward to meet the demands of modern healthcare. These innovations not only empower medical professionals to master complex procedures but also hold the potential to significantly enhance surgical care and outcomes.
Today’s medical schools and residency programs are on the cusp of a profound transformation. The time to embrace immersive technology as an essential instrument for upskilling and training is now. By integrating virtual reality and other immersive technologies into the surgical curricula, we can arm the next generation of healthcare professionals with the skills they and their patients need to thrive in an ever-evolving landscape.
Author:
Leif Goranson is the Vice President of Provider Solutions at Osso VR, a virtual reality company dedicated to democratising surgical training.
At Osso, Leif plays a pivotal role in transforming medical education through the company’s Osso Academy offering for residency programs.
Leif is a staunch advocate for incorporating digital strategies into healthcare organizations, believing that the future of healthcare hinges on the seamless integration of innovative digital solutions. With over a decade of experience in customer success, he has earned recognition through numerous industry awards, including two Rx Club Awards of Excellence and the MM&M Silver Award for “Best App for HCPs.”
Before joining Osso VR, Leif served as the Program Director of Interactive Marketing for Medtronic, where he spearheaded digital marketing, strategy, and multi-channel education to attract and engage customers. Leif holds a Bachelor of Arts in Marketing from The University of Memphis.
References:
- Observational Study. Ann Surg. 2017 Oct;266(4):582-594. doi: 10.1097/SLA.0000000000002414. Readiness of US General Surgery Residents for Independent Practice. https://pubmed.ncbi.nlm.nih.gov/28742711/
- Randomized Controlled Trial. J Surg Educ. 2020 Jul-Aug;77(4):969-977. doi: 10.1016/j.jsurg.2020.01.002. Randomized Trial of a Virtual Reality Tool to Teach Surgical Technique for Tibial Shaft Fracture Intramedullary Nailing. https://pubmed.ncbi.nlm.nih.gov/32035854/
- Orland, M.D. Clinical Orthopaedics and Related Research, 2020. Does Virtual Reality Improve Procedural Completion and Accuracy in an Intramedullary Tibial Nail Procedure? A Randomized Control Trial. 478(9), 2170-2177. DOI: 10.1097/CORR.0000000000001362. https://journals.lww.com/clinorthop/fulltext/2020/09000/does_virtual_reality_improve_procedural_completion.36.aspx
- [4] McKinney, B., Journal of Surgical Education, 2022. Virtual Reality Training in Unicompartmental Knee Arthroplasty: A Randomized, Blinded Trial, 79(6), 1526-1535. DOI: 10.1016/j.jsurg.2022.06.008. https://www.sciencedirect.com/science/article/abs/pii/S1931720422001532
