OssoVR Lets Surgical Training Continue Virtually Despite COVID Limitations
MAY 11TH, 2020 ALICE FERNG EXCLUSIVE, INFORMATICS, ORTHOPEDIC SURGERY, SURGERY
Over the past few months, medical student and resident training has been severely limited due to Covid-19. However, knowledge, coordination, dexterity, and experience may not have to suffer because of quarantine and social distancing restrictions. OssoVR, a leading virtual reality surgical training and assessment platform, has been able to expand its curriculum to encompass multiple resident specialties. In an up and coming research article accepted by an orthopedics journal, a study performed by OssoVR will show about a 300% improvement in ability of participants to complete a surgical procedure without any supervision.
OssoVR has recently partnered with Johnson & Johnson, and as of April, has begun distributing Oculus Quest headsets to doctors-in-training and surgeons in the United States. The VR company hopes to obtain excellent training performance in surgeons that use its platform that will help propel its virtual technology forward, and the goal is to expand this program worldwide over time.
We spoke to Dr. Justin Barad, CEO and Co-Founder of OssoVR, and one time Medgadget editor, to find out more about what his company is up to.
Alice Ferng, Medgadget: How has Osso VR improved its platform over the past couple of months, and what have been some immediate changes made in the face of COVID?
We’ve also seen Osso VR move from a cool supplemental educational modality to an integral need-to-have-tool for our 20+ residency partners. Dr. Bullock at Marshall University recently sent us this feedback: “We have integrated Osso VR into our curriculum for resident rotations including trauma, pediatrics, and arthroplasty. We have been using the system for the past 2 years and feel it has become an integral part of training.”
Medgadget: What have been the largest challenges faced in scaling up your platform use? How many users did you have pre-COVID, and how many now? How quickly is it growing?
Dr. Barad: A typical surgeon will be expected to perform any of hundreds (if not thousands) of procedures on demand. This results in a huge need for a wide variety of procedures to be able to practice on at a moment’s notice. Luckily we have spent years developing a platform that allows us to rapidly develop almost any procedure in a way that’s intuitive, educational and engaging.
We’re definitely living in unprecedented times, and healthcare professionals are facing the toughest challenges. They are either on the frontlines, risking their lives, or they are staying at home, unable to train and hone their skills given that elective cases are mostly on hold. This unique situation has led to massive demand for ways to train remotely without needing to be in the hospital, and we’ve seen a 10x spike in demand from teaching hospitals.
To keep up with demand, we’ve been aggressively scaling the team with hires from Apple, Microsoft and Industrial, Light & Magic. Our team comes from not only AAA game studios but also consists of an Oscar and Emmy award winner … seriously!
Medgadget: What types of surgical training modules do you offer, and which procedures/specialties do they target? What’s in the works?
Dr. Barad: We offer modules in arthroplasty, pediatric orthopaedics, foot & ankle, orthopaedic trauma, interventional pulmonology, vascular surgery and robotics. We’ve found strong demand in the field of interventional cardiac and vascular procedures and are starting to expand more heavily into that area as well.
Medgadget: Do you offer additional accessories to both software and hardware pairings for these trainings to make things as realistic as possible?
Dr. Barad: A common misunderstanding is that realism = improved skill transfer. In fact, a very interesting study actually asked 20 surgeons this very question, and 17 responded that they felt it was the most important aspect. However, after trying a high fidelity haptic simulator, 18 out of 20 surgeons preferred the simulator with no haptic feedback at all. This is a very common response in the field of simulation and robotics. A simulator only needs to be realistic enough, something also called the minimum fidelity threshold, to lead to exponential gains in skill transfer. Realism beyond that can lead to issues including but not limited to:
Excessive performance requirements
Uncanny valley issues
Usability challenges leading to user frustration (realism does not mean easy to use)
This line of thinking has led to a steady stream of simulation technologies that are too expensive (often in excess of six figures), frustrating to use, and not very accessible outside of well funded simulation centers.
Medgadget: What types of metrics and data are you using as feedback to improve virtual training? Flight path? Haptics? Averaging a person’s stats against their own?
Dr. Barad: We collect a variety of metrics and provide automated guidance to improve performance in a consistent and efficient manner.
We view early procedural learning as 3 things:
Knowledge of steps
Surgery is like a symphony. If you have your part memorized, you are going to have a much smoother and higher quality performance. This is the foundation of learning any new procedure and can be overwhelming as many surgeries can have hundreds of steps. OssoVR allows for not only rapid learning and retention of steps, but allows you to granularly assess your knowledge of them.
Knowing a step to a procedure is great, but doing it well is important too. We challenge users to perform specific steps well and give them feedback in terms of how close they were to perfect and whether their performance was acceptable, allowing for failure. These types of steps need to be specifically tailored as you don’t want them to be too easy and not educational, but you don’t want them to be frustrating either.
Moving smoothly and efficiently through a procedure has been shown time and again to be associated with improved patient outcomes and has been a reliable foundational metric in the world of simulation.
In addition to these metrics, we collect motion data from our run throughs, and with the support the NSF are developing an artificial intelligence to assess not only proficiency, but aptitude for certain skills and procedures.
Medgadget: What are the limitations of traditional training? What about this type of virtual training?
Dr. Barad: Right now traditional training is thought of as practicing on patients or cadavers. I think it’s obvious why we probably don’t want to be practicing on unsuspecting patients, so let’s talk briefly about cadaveric training. These trainings can take place in specialized bioskills labs, hospitals, or even in hotel conference rooms (more more information on that interesting phenomenon check out this excellent Reuters article. The limitations of these labs are as follows:
Expensive – They can cost $200k+ to put together
Requires donated bodies – This can be taboo for certain cultures and regions
Tissue consistency – Cadavers have a different consistency than living breathing humans conveying a different “feel”
Hazardous Environment – Cadaver labs expose you to bodily fluids, sharp objects and radiation . The other day I was speaking with a colleague who suffered a deep laceration in a cadaver lab leading to permanent numbness of the forearm
No assessment – At the end of a cadaver lab there is no objective or automated way to know if you learned what you were supposed to
Inconsistent guidance – Cadaver labs can be an ad hoc environment. In some situations you are left independently to work through some procedure with minimal guidance or feedback – leading to a suboptimal educational experience – but in other instances such as at an industry sponsored lab you are given too much assistance, which can be overwhelming and also lead to a suboptimal educational experience
Crowding – Given the limited supply of cadavers it is sometimes common to “group up” on cadaver stations where on person will be the surgeon while everyone else observes, leading to a significantly diminished experience for those not in the driver seat
Limited repetitions – Cadavers can only be utilized once or twice typically, but most modern medical procedures have learning curves of 50 or more
Travel requirement – While cadaver labs can be local, some of the bigger/higher quality ones require a multi-day trip, which for the foreseeable future may be something that is done far less frequently
The way Osso VR uses virtual reality (not all VR is created equal) solves many if not all of these issues:
It is affordable (the Oculus Quest is $400 dollars)
You do not need donated bodies, animals or live patients
No exposure to hazardous fluids, radiation or sharp objects
Automated, objective assessment of performance metrics and detailed motion analysis
Repeatable and quality controlled guidance
Personalized experience – no crowds to worry about (unless you want colleagues to join virtually)
No travel required – connect across continents with collaborative training
Now to answer your initial question virtual reality is an absolutely incredible, game changing technology but it certainly isn’t perfect.
Let’s talk about the controllers:
What’s exciting here is that the Oculus Quest has the ability to track your hands and fingers as a built-in feature. We are rolling this out as an experimental feature later this year, which will allow more intuitive interaction with the environment in addition to more fine motor control.
VR controllers can be unintuitive for new users and require around a minute to onboard.
You don’t get a sense for object weight and inertia, but you do get a great feel for tissue and bone resistance through the cutaneous haptics in the controllers.
Some fine motor activity can be a little cumbersome with the controllers
Stepping Out During Lockdown? Here Are 5 Tips to Stay Protected
While it’s important to stay indoors at all times during the lockdown, you might have to venture outdoors to get your essentials. Whether it’s to buy groceries or medicines, some things are simply unavoidable. But the question remains, how to protect yourself from coronavirus when you go out, and ensure the safety of those at home when you return? We’ve listed some coronavirus prevention methods that you should keep in mind when stepping outside during this lockdown.
#1: Use a mask to cover your nose and mouth
Avoid coughing or sneezing in the open to contain the spread of the virus
If you walk into your neighbourhood grocery store, only to find that it’s compulsory to wear masks before stepping in, don’t be surprised or alarmed! We were initially advised to wear masks only if we showed symptoms of the disease. But now, the Ministry of Health and Family Welfare (MoHFW) recommends wearing masks for a variety of reasons, along with guidelines on safe disposal. Learn more here. This is because we might be infected, but not show signs of the disease immediately. COVID-19, as we know, has an incubation period of upto 14 days. So it’s best that we stay safe and keep others safe, too!
Now, we’re sure that you’re wondering about how to protect yourself from Coronavirus, given that most pharmacies and retailers have run out of them. That’s exactly why we found a way for you to make masks at home! Check it out!
#2: Stay an adequate distance away from others aka social distancing
Keep at least 1 metre away from other people
Whether you take a walk around the block or simply step out to receive delivered goods, it’s common to think of how to protect yourself from coronavirus. While it might seem obvious that you should stay away from others, did you know that WHO recommends a minimum distance of 1 metre from others? Keep your distance from other people you might meet on the way. Also, as has already been said too many times, avoid physical contact!
#3: Use elbows or knuckles instead of fingers, wherever possible
Avoid touching objects at public places with your hands
How to protect yourself from Coronavirus while you’re outside? Try and minimise the number of surfaces you touch. When absolutely unavoidable, try using a different body part! Make the most of your knuckles, elbows, knees and even your feet as you step out. And when you use an elbow or a knuckle to press the lift button, you’ll be safer if you accidentally touch your face later!
#4: Wash your hands thoroughly when you get back (and change your clothes too!)
Wash your hands with soap and water for 20 seconds
Once you manage to navigate the outside world and return to the relatively safer confines of your home, do the precautions end? Not immediately! Once you come home, you need to follow coronavirus prevention methods to ensure that those residing at your home stay safe too. The first and foremost way of doing this is to make sure that your hands are clean. So, wash your hands with soap and water as soon as you get back home. Alternately, you can use a sanitiser with 60% alcohol to clean your hands. Also remember to sanitise the essentials – your glasses, phone and keys! Don’t miss out on keeping these essential surfaces clean.
If you want to know the best way to wash your hand, the MoHFW has you covered! Watch this.
Source: Ministry of Health & Family Welfare
#5: Clean your purchases and wash hands again
Sanitise all the packages you bring home
Once you’ve washed your hands and sanitised the essentials, make sure your purchases are germ-free too! Since COVID-19 survives on different surfaces for different lengths of time, it’s safer to clean all the packaged goods you just purchased. For those wondering about how to protect yourself from coronavirus, if you had food delivered to your home, we’d suggest you sanitise the package, or transfer its contents to a plate and dispose of the one you just received. Once you have finished cleaning up all the goods, remember to wash your hands again.
For more detailed insights, we’ve got a reference for you! Watch this.