Virtual Reality Check

In order for residents to become great surgeons, they need to log hours upon hours in surgery to practice perfecting their techniques and ensure that even the most subtle movements become permanently ingrained in their muscle memory. Of course, this is a long and time-consuming process. Sometimes the only thing separating a so-so surgeon from a really good one is a lack of repetition and practice. That’s where VR comes in.

Virtual training modules help surgeons develop their skills more quickly by simulating procedures and scenarios that come remarkably close to the real thing. “VR gives you a three-dimensional representation of being in an operating room, near a patient, going through the exact steps of a surgical procedure,” says Gideon Blumstein, MD, MS, an orthopedic spine surgery fellow at Rush University Medical Center in Chicago. 

Consider what it takes to place a rod during an intermaxillary fracture repair. “VR helps surgeons clearly visualize and practice the exact steps of the procedure, and it prompts and shows them what instrument they will need next and at what angle they need to use it,” says Dr. Blumstein. “There’s also a virtual fluoroscopy element that helps learners envision how to best view the appropriate anatomy correctly.”

VR training can be an effective way for surgeons who perform complex procedures such as minimally invasive spine surgery to practice surgical approaches and learn how to correlate the angles needed to introduce implants, dilators or retractors.

Although surgeons and other clinical staff naturally get the most out of VR, there are some inherent benefits to the technology for educators. “VR gives them a little more objectivity when it comes to analyzing how their residents are learning to perform surgery,” says Dr. Blumstein. “A lot of times training ends up being a subjective process, and VR can make it more impartial.”

The technology is advancing to the point where reports are generated based on how well residents place implants, follow the required steps of a procedure, and position patients and equipment. Dr. Blumstein notes this type of tracking can provide invaluable ways of pinpointing weakness and identifying areas of needed improvement.

While providers may love the realistic training that VR offers, getting them to use it on a regular basis can present a significant challenge for facility leaders — particularly with busy, over-extended residents. The good news is that the very nature of the technology makes it easy for users to learn and practice on their own time and at their own pace.

“Surgical professionals’ schedules can be unpredictable, so opportunities for independent practice often take place during off hours,” says Nate Walsh, MHA, director of high-fidelity simulation for the Center for Clinical Skills and Simulation at Rush University Medical Center in Chicago. Facility leaders should make this independent practice as convenient as possible by placing VR headsets and modules in an area close by the clinical setting where access isn’t an issue for staff, he adds.

The benefits of realistic simulation training for newer providers are many, especially when a procedure involves a multitude of small steps. “Even if you know how to perform basic surgeries, the specifics of which steps to take and which instrument or implant to select can be confusing,” says Dr. Blumstein. “You really need to perform the procedure step by step multiple times to get a sense of the flow.”

Surgical residents, in particular, can benefit from this simulated, realistic training prior to entering the OR for the first time. “They can use the training to perform a procedure they might not have done before,” says Dr. Blumstein.

VR cannot teach you to be a surgeon, and it’s not a substitute for live education. It’s a strong supplemental training tool.
— Dr. Gideon Blumstein

Mr. Walsh echoes Dr. Blumstein’s assessment of the potential usages of this rapidly growing technology. “VR allows residents or learners to hone their surgical skills in an environment that replicates the actual OR setting,” he says. “It’s an opportunity to practice, independently, in a safe and protected environment. At Rush, we’ve found VR to be most useful for residents and surgeons looking to refresh their procedural skills.” Rush has been using VR systems for more than three years, and more than two dozen residents have used the technology for training purposes. In addition to true VR, the facility has relied on haptic-based tech for the past 14 years to better prepare residents for whatever they encounter in the OR.