Simulation training is an integral part of a trainee's learning journey in graduate medical education, and over the past few years, many institutions have adopted new teaching and training technologies.
The COVID-19 pandemic, while an obvious driver of this adoption, shined a light on existing challenges institutions face. Training simulations can be costly, access to simulation equipment isn’t always available and trainees lack time in their schedules to train in the lab. The pandemic caused many programs to rapidly search for resources that met critical training needs without disrupting learning or patient outcomes.
Studies report different methods of how these shifts of instruction occurred at institutions – including pre-recorded teaching lectures, libraries of surgical videos, closed social media groups, video conferencing software and simulations that were less expensive, remote and accessible anytime, anywhere.
Studies offered insight into how technology pushed these programs to innovate with emergency remote teaching (ERT) practices; however, limitations of these technological shifts and recommended best practices for future teaching. Some of these insights include:
The teaching tools used during the pandemic had advantages on their own, but a key takeaway was that further innovation in programs would be required. A technology incorporating active learning, collaboration, immersion and on-demand training in one solution to connect face-to-face concepts could address limitations and set up future success.
Virtual reality is that training tool.
Virtual reality (VR) has many advantages for graduate medical education programs, including:
In addition to meeting the needs that many digital tools lacked during the pandemic, virtual reality training has done something else — demonstrated effectiveness.
In multiple studies, virtual reality training has proven results. In a study conducted in 2020, cohort participants had 20% faster test completion and, at retesting, showed significantly higher knowledge retention. Another study showed that participants had 67% fewer errors, 92% procedural step accuracy and 25% faster procedural completion than traditional training methods.
So, if virtual reality is the bridge between evolving the digital tools needed during the pandemic and supplementing existing, traditional training methods for medical programs — and it’s proven to work — how can it be used successfully post-pandemic?
Below, we’ve put together three strong virtual reality training use cases for graduate medical education programs.
Accredited medical education programs require simulation training, such as two-dimensional simulations or physical models.
Most two-dimensional simulations provide guided medical scenarios and allow trainees to make choices in a clinical setting. For many institutions, hands-on training comes next in the curriculum after exposing trainees to tools like two-dimensional simulations. However, hands-on training, such as a Sawbones model or cadaver, is a big leap from a simulation without going through the movements and interactions on a given procedure. These models are also often single-use specimens, costly and not evenly distributed across teaching institutions for learning opportunities.
If training with virtual reality occurs before using physical models, trainees can set a foundation by learning hands-on in a virtual environment. This allows for trainees to practice until proficient, become better prepared for using physical training models and be ready to make the most of the time spent with them.
“Immersive virtual reality training complements other simulation and live training forms. With a single piece of hardware, VR can prepare trainees for multiple surgeries by reducing cognitive load for basic visual surgical tasks,” says Dr. Gregg Nicandri, orthopedic surgeon and educator.
“This allows them to focus their precious OR time on learning tasks that are more complex or cannot be taught using this type of simulator. As trainees experience a multitude of surgical scenarios, they gain critical exposure to what normal and abnormal anatomy looks like, allowing them to better recognize key pathologies during surgery.”
One dramatic shift medical trainees faced during the pandemic was the increased dependence on telehealth to reduce the load of in-person patient visits. This method requires trainees to consult with a patient remotely, gather history and then work with an attending surgeon over the phone or face-to-face (if possible) to create a procedural care plan.
A study analyzing the effects of the pandemic on resident training stated that telehealth, however, cannot, and should not, replace in-person time in the operating room. “While virtual academic conferences and telehealth can be used as a temporary replacement for learning done during didactic and clinic time, this will not make up for the significant decrease in the amount of time in the operating room.”
“Immersive virtual reality simulation lets residents repetitively practice a case, make mistakes and learn from them, and understand how they are performing relative to their peers through metrics and benchmarks.”
While the United States has been recovering from the pandemic, hospital systems remain at capacity and struggle with resource constraints, limiting trainees' access to time in the operating room. And, with increased caseloads, trainees have even less time to access facilities where training would be available.
Before a live case, instead of pulling up a technique guide or video, a virtual reality module can easily be accessed anytime to practice the procedure as many times as needed to feel confident and prepared.
“Residents typically prepare for a surgical case by watching a video or reading a technique paper. In my experience, we tend to overestimate how much we comprehend from viewing that type of source material. Immersive virtual reality simulation lets residents repetitively practice a case, make mistakes and learn from them, and understand how they are performing relative to their peers through metrics and benchmarks,” adds Dr. Nicandri.
“To pass a module, trainees must know what an acceptable repair construct looks like and all the steps that are required to get there, and they have to know it so well that they can do it efficiently. These are all things that can be taught outside of the OR, but often we are relying on using valuable OR time to teach these things. Removing that part of the early learning curve for trainees allows faculty to spend more time on surgical nuances and for residents to actively participate in the case,” Dr. Nicandri continues.
Many early practicing physicians may be taking calls across specialties and have less experience with these cases. Virtual reality lets trainees gain additional exposure to the procedure before a case and preserves the maintenance of skills acquired earlier in their training.
With the ongoing hospital staff shortage and the influx of travel nurses supporting hospital care teams, it isn’t uncommon for physicians to have to perform procedures with rotating staff regularly. This makes dress rehearsals with a new care team critical. Virtual reality provides a collaborative environment for care teams to quickly hop into a virtual operating room and walk through a procedure together step by step and understand the process, roles and responsibilities required before a live case. For attending surgeons, it also means that trainees are one less unknown variable in the operating room when it comes to understanding the procedure and instrumentation, providing them with another set of helpful hands during the case.
Rotating on every service during training is commonplace, but most residents, especially in a field such as orthopedics, will select a specialty. While curriculum tools and live cases can expose trainees to these specialties and help them decide on a focus, finding opportunities to practice those techniques can be difficult. Virtual reality opens access to those techniques when practice or cases are unavailable and helps trainees have visibility into areas they would not have otherwise had.
With work-hour restrictions implemented in hospital systems, virtual reality offers another avenue for making training more accessible. Graduate medical education programs can loan out headsets to residents, allowing them to train anywhere or anytime.
“To be effective, virtual reality must be built into the surgical training curriculum. Program directors and faculty will get feedback on how many residents use the modules and how they perform so they can assess the level of engagement of the residents and the value of the simulator.”
Lastly, some trainees may need additional support or intervention. It can be challenging for program directors or faculty to identify when remediation may be appropriate and where extra practice or support could be beneficial. Virtual reality with built-in analytics provides benchmarking and a view for supervisors to intervene when necessary. This feedback from the virtual reality module and faculty allows trainees who need support to increase procedural repetition and build confidence in areas that may need extra practice.
“Faculty time is extremely valuable. Getting someone to train at the elbow is always hard. Immersive virtual reality training offers two ways to overcome this,” says Dr. Nicandri.
“The faculty who may be remote can join them in the virtual operating room and instruct them from anywhere. If faculty isn't available, trainees can also use immersive VR for self-directed practice. The modules are constructed in a way to coach and provide proximate feedback so that an assistant isn't needed.”
The pandemic pushed many educational institutions to adopt technology quickly, but that doesn’t mean adoption should now fall by the wayside. One study recommended that “after a rapid, forced shift from physical courses to digital, it is crucial to utilize experiences to create better preconditions for digital technology to facilitate learning in the future.” Learning from past limitations and setting preconditions for digital technology begins with program needs and fit.
Dr. Nicandri recommends making curriculum integration a key focus when implementing virtual reality in a training program.
“If you just put the VR headsets in a room and tell trainees to use them, it won't move the needle on getting your residents better in the operating room. To be effective, virtual reality must be built into the surgical training curriculum. Program directors and faculty will get feedback on how many residents use the modules and how they perform so they can assess the level of engagement of the residents and the value of the simulator. To drive adoption, you need to look at and use the data, and residents need to know you are doing it. Faculty engagement is key as well. When the residents recognize that their faculty feels it is important or faculty endorses that they notice that residents who use the simulator are more proficient, resident utilization goes up significantly.”
It’s important to consider:
A virtual reality partner offering curriculum integration best practices and modules aligned to support curriculum standards will make implementation easier and more successful.
If your organization can benefit from virtual reality, reach out to the Osso team to chat with us. With over 25 orthopedic training modules aligned to standards that contain an integrated analytics platform and a team designated to provide support on curriculum alignment, we’re here to help advise on your next steps.