Performing an operation for the first time is a very daunting task for a surgeon. Training opportunities at this early career stage are limited. At best, first-time surgeons were able to perform the surgery on a cadaver once prior to the real procedure, after which point the safety of the live patient was fully in their hands. The need for improved surgical training procedures is evident, and one company that aims to potentially fill this void is Osso VR, previously covered on DocWire News, using virtual reality (VR) to reshape the surgical training process by providing life-like simulations of many operations.
The concept was created by Dr. Justin Barad, CEO of Osso VR and a practicing pediatric orthopedic surgeon. In addition to being an established physician, Barad also has extensive experience with technology and coding. Prior 
to being an undergrad at UC Berkeley, he had a passion for video game design and even has a game credit with Activision. It wasn’t until a family member fell ill that he shifted his focus from game development to health care.
“For me it was a wake-up call,” said Barad in an interview with DocWire News. “I realized that I didn’t want to use software technology for entertaining people anymore, but that maybe there was a way to use it to help them–especially in people with medical problems.”
Graduating first in his class at the David Geffen School of Medicine at UCLA, Barad continued his journey into medicine as a resident there. It was at this point he realized the scope of the need for improvements in surgical training and assessment and how technology could be harnessed to help achieve this.
Issues in Surgical Training & Assessment
“I knew there was a problem when I was scrubbed into a surgery, and I was urgently asked to scrub out and run to the computer to Google what we were doing,” he said. “After seeing this happen multiple times, I started to feel like something was not quite right.”
Barad noted that a previous study found 30.7% of graduating residents to be incapable of operating independently, even after completing medical school and between five to seven years of residency. Barad attributed this concerning statistic to a lack of hands-on training.
“You get to practice on a dead body once, and that’s essentially it,” he noted.
Another gap Barad identified in healthcare was the lack of assessment for surgeons. Barad said that he had only been assessed for his technical skills one time, in which he was asked to play the game “Operation”. He referenced the infamous “Dr. Death,” a neurosurgeon who killed two and severely injured thirty of his first thirty-three patients, as a prime example of this deficit in assessment. Currently, the gold standard for assessment is to have a professional watch you do the surgery. Barad doesn’t think this is a scalable solution.
“Patient outcomes are actually directly tied to the skill of the surgeon, and yet, we don’t measure it in any way,” he added.
Can Osso VR Bridge the Gap?
With Osso VR, those who are learning new surgeries now have access to clinically accurate simulations. Wearing a VR headset, the user can look around the simulation as they use tools to perform a simulated surgery that Barad said is very similar to the real operation. Research has validated the use of these training modules, with one recent study comparing 10 traditionally trained surgeons to the same number trained with Osso VR. Barad also said that when observed by a professional, those trained with VR performed 230% better than those who were not.
In addition to providing realistic practice, Osso VR functions to effectively assess the surgeon during the simulation. The company’s clinical advisory board of established surgeons created what they believe to the foundational elements of learning a new technique: precision, accuracy, and efficiency.
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To measure the knowledge of steps during assessment mode, the user is not told what to do and must go from memory. If the user gets stuck, they can request a hint to keep moving forward. The system records which sections the user is struggling with, quickly targeting areas they need to emphasize with practice.
For assessment of accuracy, the system analyzes how well the user aligns a pin, inserts a screw, or performs several other critical tasks. These skills are measured and compared to the ideal metric to give the trainee meaningful feedback. This can be used to tell the user if they are close to perfect, or need to repeat the procedure to get a passing grade. Efficiency is measured by recording the time required to run through the module.
Barad noted that Osso VR is currently working with the National Science Foundation to apply machine learning to analyze how the individual is performing during the procedure.
“We can tell if you’re hesitating, shaking, or looking at the wrong part of the anatomy,” he explained. “These are all areas we can identify with artificial intelligence to see that you’re not quite ready for game day.”
Other VR Projects
In addition to training residents who are about to enter into practice, the technology can be used to train existing surgeons in new techniques on “things like robotics, navigation and patient-specific implants are things that are really exciting and of high value but are sometimes harder to learn,” Barad said. “That’s one of the major spaces we’re in, and we work with some of the top medical device companies in the world.”
Among these companies is industry leader Smith & Nephew. This past month, Osso VR collaborated with the medical device company to create a VR module for their robotic NAVIO Surgical System. The robotic device is used by the surgeon to facilitate knee arthroplasty.
“We’re really excited to work with Smith & Nephew on this because they’ve been very innovative and forward-thinking when it comes to pushing robotic orthopedic surgery,” Barad said. “Just having the robot is not going to solve the problem–you need to provide a platform for people to easily learn how to use a novel technology.”
Going forward, the company plans to focus heavily on research and expansion. The modules currently include orthopedic and spinal surgeries, but Osso VR plans to add structural heart and non-orthopedic robotic simulations. Osso VR has also announced an expansion of their services within the UK just weeks ago, with the Newcastle Surgical Training Center in England using the simulations to help train surgeons. Barad felt this is a major step in addressing the issue of insufficient training at the global level, with the technology now in use at 16 different programs in the US and UK.
“It’s exciting to see that they not only want to take the steps to solve it, but that they see this is really the pathway to best address a large chunk of what is an existential crisis,” Barad said. “We have very aggressive plans, with the ultimate goal of getting every single health care professional into VR for training and assessment.”
Newcastle Surgical Training Centre employs Palo Alto, California-based Osso VR’s technology https://t.co/btkjgJwJ3N #DrHIT
— MobiHealthNews (@MobiHealthNews) April 15, 2019
All Images Provided Courtesy of Osso VR
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