Sometimes, location is everything.
When Dr. Eric Bing started working at Dallas’ Southern Methodist University (SMU), the person in the office next to his would give him a new perspective on how virtual reality can be instrumental in teaching medical students.
SMU happens to have one of the world’s best graduate schools for video game design and Bing’s office neighbor, Professor Anthony Cuevas, helps create the curriculum for it. Surgery and first person shooters may seem worlds apart, but over the course of several months, the professors’ neighborly chitchat gave rise to a low-cost VR training system that can be implemented in locations where medical schools are limited, such as sub-saharan Africa.
In order to meet the basic need of surgical care in the developing world by 2030, the surgical workforce there would need to double, according to the Lancet Commission of Global Surgery. Shafi Ahmed, co-founder of the VR health training platform Medical Realities, has highlighted this problem as one he hopes his company’s content can address. Dr. Alex Young of the startup VR company Virti is developing a platform that gives students access to training programs for free, with an eye toward improving medical care in the third world.
Bing has spent much of his medical career working in impoverished communities in south central Los Angeles as well as overseas countries like Zambia, Haiti, Nigeria, and Belize. Throughout his decades of treating patients, one challenge has always been present: Numerous people suffer and die from easily preventable and curable diseases such as cervical cancer. That condition that ended the life of Bing’s mother.
Precancerous cervical growths are easy to diagnose with diluted household vinegar, explains Bing. They can be removed as simply as warts. However, such treatable diseases often end lives when they could be treated because the lack of local medical expertise means needy patients schedule exams too late. In the case of cervical cancer, the disease spreads and the resulting remedy may be more extensive, such as a hysterectomy, or untreatable.
“There are just not enough surgeons in developing countries to provide the care that people need.”
“We’ve always been trying to think through “How do we scale up the number of surgeons who do these procedures or any surgical procedures?” explains Bing. “There are just not enough surgeons in developing countries to provide the care that people need.” Many sub-saharan African countries, for example, have no medical schools or just one.
Bing and Cuevas brainstormed the potential for training students in virtual reality.. While diagnostic and surgical simulations are now a regular part of many American medical school programs, they’re much harder to find in the developing world given the associated costs, which can quickly rise into six figures.
When the doctor running the med program at the University of Zambia teaching hospital stopped by SMU to pick up an honorary degree, Bing got him together with Cuevas to figure how to create a VR program.
Along with doctors and professors from the University of North Carolina, King’s College London and SMU, the three created a study on teaching oncology with low-cost virtual reality headsets. Around that time, the price of Oculus Quest had recently dropped, making the budget for VR instruction feasible.
Using SMU’s VR program, numerous medical students at the University of Zambia have practiced the steps for performing a radical abdominal hysterectomy, needing to complete it within a target time and accuracy rate. The simulation’s operating room is outfitted with equipment commonly found in Zambia. Studying the VR surgical program, the dev team found users need to reflect on what they’re learning to retain information. As a result, no student can attempt the virtual procedure more than six times in one day.
Trainees “need to reflect on what they’ve learned or missed for it to stick,” explains Bing, who underscores that VR learning augments class lessons and book chapters and doesn’t replace them.
“In U.S. teaching hospitals, you have a lot of oversight and support,” explains Bing. Med schools in developing countries don’t always have those necessities. “By using the simulations, [students] are able to identify potential gaps in knowledge.”
Building Soft Skills in VR
Dr. Alex Young was snowed in on a weekend a few years ago when he started thinking about new ways to train med students. At the time, the British orthopedic surgeon was a resident at New York’s Hospital for Special Surgery (HSS) and reflecting on the thing his experience wasn’t teaching him: how to deal with the stress of emergency medicine.
“When you’ve got people sent to the E.R. from car accidents, you never know what’s going to come through the door,” says Young. Doctors at HSS, one of the United States’ top hospitals for orthopedic surgery, regularly see worst-case scenarios.
After working through a few difficult cases, a new surgeon might get used to that surge of adrenalin, explains Young, but new doctors often make mistakes because they panic. “There’s no real way in a clinical environment to test your skills under pressure,” he says.
Young’s weekend brainstorm eventually led him to co-develop Virti, a medical training platform focused on building “soft skills” in augmented and virtual reality simulations. Users are transported into real world scenes, either by themselves or with a team of fellow students, to diagnose and treat patients, often ones suffering trauma.
Virti’s system utilizes artificial intelligence and natural language processing to analyze decision making, leadership, communication and other capabilities that aren’t typically a focus of med school training.
“We look at how well the team communicated. Did they empathize with the patient? Did they come to the correct diagnosis?” explains Young. The VR headsets can also track where the students are looking during fast-moving situations and how quickly they identify relevant problems. The company has published research showing that students who work with the Virti system have reduced stress that transfers to real-life experiences.
As Young developed Virti, he also kept in mind the experience he had working in Tanzania soon after he graduated from med school. Not only were the doctors facing stress, they also had to deal with limited resources.
Seeing the potential for training medical professionals in the developing world, Young designed the Virti platform to function on any mobile phone as well as with a VR headset. The basic level of the platform, geared at teaching new medical professionals, is free.
In 2020, the Virti team will be launching simulations specifically for med students in Kenya and Ethiopia, in partnership with Oxford University and Torbay Hospital. To develop the new scenarios, the company needs teams on the ground capturing 360 video that includes appropriate imagery and protocol for attending to patients.
Both Young and Bing view the opportunity to offer affordable, accessible medical education in underserved communities as exciting and rewarding. “For those people who do this, it’s a lot of hard work,” says Bing. “There has to be meaning behind it.”
Bing, in particular, sees the potential to save the lives of people stricken with easily treated diseases, such as the one that took his mother’s life.
“When you’re able to help other people survive from these things, it helps the work have more meaning for you.”
