Surgery has always struck me as a miraculous process. A patient with crippling arthritis can be pushed into a hospital in a wheelchair and start walking that same day after a hip replacement. While the surgical team has a lot to do with these incredible cases, there is another critical element: a medical device. In the 1940s, Girdlestone described a revolutionary treatment for hip arthritis that entailed cutting out the hip. The surgery, while simple to perform, left people disabled with a debilitating limp. Today, thanks to the invention of technology like hip replacements, we have far more effective therapies for conditions like these.
 
While these devices are incredibly powerful, they also introduce a lot of complexity to the procedure. For example, when compared with Girdlestone’s treatment, a hip replacement is far more sophisticated, which eventually necessitated the creation of a new subspecialty. This complexity unfortunately leads to longer learning curves, and with technologies like navigation and robotics coming into prominence, this problem is only getting worse.
 
In addition to the higher complexity, there are also more and more products offered every year. For example, there are over 60 brands of hip replacements surgeons can choose from, each with its own unique instrumentation sets that can have hundreds of different components. To make matters worse, within a single company’s catalogue, there may be several different versions of the same product, which all have their own distinct learning curves. In 2010, the World Health Organization highlighted this issue in the conclusion of its report, “Increasing complexity of medical technology and consequences for training and outcome of care” [PDF].
 
“New technologies are entering medical practice at an astounding pace... The ‘side effects’ resulting from the introduction of new, often-complex technology in health care, however, can be considerable—both for patients and health professionals. This paper has shown the consequences of the increased complexity of technology used for the treatment of patients. Three facts emerged:
 

1. The devices are often not well designed for the medical environment in which they are used;
2. The user is often not trained properly to use these devices; and
3. The (new) procedures often result in long learning curves for health professionals.”

 
So how do surgeons get trained to use these powerful yet complex devices? The answer is through courses offered by the medical devices companies themselves. Courses are typically one to two day affairs in a remote location where there is time for didactic learning and then some hands-on cadaver time. If the surgeon is a fan of the device featured at a course, the typical turnaround time to her first in-patient use of said device is four to six months. Now think about that for a second. Imagine studying for a test once, and then taking that test six months later.
 
The gap is one part of the problem, but another issue is the lack of the ability to train repeatedly, otherwise known as practicing, before using a device on actual patients. To better highlight this issue, we can take anterior hip replacements as a case study. In the paper, “What is the learning curve for the anterior approach for total hip arthroplasty?” the rate of complications of patients undergoing anterior hip replacements were compared with the experience of the surgeon involved. The study revealed that a surgeon needed to perform the procedure at least 50 times before their complication rate reached normal levels, and even then, there was still a trend for a higher complication rate up until 100 procedures. So once again, having only practiced the procedure once before adopting this new technique does not seem to be in the patient’s, or the surgeon’s, best interest.
 
Core to the issue with the current paradigm of device training is the lack of spaced repetition, a widely-validated concept in educational science, which a professor at Dartmouth describes succinctly in a 2016 review article titled “Spaced Repetition Promotes Efficient and Effective Learning: Policy Implications for Instruction.”
 
“Most people know from personal experience that if one is trying to learn something well—be it a set of facts, concepts, skills, or procedures—a single exposure is usually inadequate for good long-term retention. We are all familiar with the adage ‘practice makes perfect.’ But what is less obvious is that the timing of the practice (when it occurs) matters a great deal: Having the initial study and subsequent review or practice be spaced out over time generally leads to superior learning than having the repetition(s) occur in close temporal succession (with total study time kept equal in both cases).
 
This phenomenon is called the spacing effect (sometimes also referred to as the benefit of distributed practice) and was first observed by researchers over a century ago (Ebbinghaus, 1885/1913). Since that time, literally hundreds of experiments by cognitive psychologists have demonstrated the advantage of spaced/distributed over massed practice (Cepeda, Pashler, Vul, Wixted, & Rohrer, 2006), and a recent comprehensive review of the utility of various learning strategies awarded distributed practice one of the highest ratings based on the available research evidence (Dunlosky, Rawson, Marsh, Nathan, & Willingham, 2013).”
 
The ideal solution to the current problems with medical device training would be a way to have immediate access to a training solution that allows the user to practice repeatedly over time before they are proficient enough to perform said procedure on a patient. What we have built at Osso VR is a virtual medical device training platform that brings hands-on courses to the surgeon. It is a highly interactive mobile training experience allowing its user to practice a procedure in a hands-on, intuitive way. Our world-class team of surgeons and leading VR developers is working with top-tier medical device companies to give surgeons the tools they need to bring their patients cutting-edge procedures effectively and safely. 
 
We have only scratched the surface of the power of medical technology and its ability to improve the lives of patients all around the world, and with a new generation of training technology we are on the cusp of a medtech revolution.
 
Check out this virtual reality training tool in this brief video.

 

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Justin Barad, M.D., is the co-founder and CEO of Osso VR, an award-winning surgical training platform helping to increase patient safety and the adoption of cutting edge medical technology. Early in Dr. Barad’s career, he fully intended to become a game developer, but when he realized he could use his technology background to help people, he moved into medicine. With a strong interest in gaming and a first-hand understanding of the challenges facing residents and experienced doctors, he co-founded Osso VR. This technology allows surgeons of all levels to practice with the latest medical devices through a fully immersive, hands-on virtual reality simulation. In addition to managing his company, Dr. Barad is also a board-eligible orthopedic surgeon with a bioengineering degree from UC Berkeley, and an M.D. from UCLA where he graduated first in his class.