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From the cockpit to the OR: safety and simulation in surgery


Southwest flight 1380 is the aviation industry’s latest example of pilot preparedness. The pilot’s ability to not only safely but calmly navigate the tragic and dangerous event can be somewhat attributed to the industry’s stringent simulation and assessment requirements. Unexpected emergency events happen far more often in medicine, and “standard” operations are arguably more complex, yet assessing for the ability to handle “low frequency, high urgency” situations is not performed.

Throughout a surgeon’s career, many new techniques and procedures will be introduced. In recent years, studies have begun to increasingly look at misuse and adverse events associated with medical devices. While these new advances typically allow for less invasive procedures or the ability to treat conditions that previously had limited options, these modern procedures are dependent on a technically competent surgeon that is dedicated to learning and mastering them. One qualitative study assessing device use errors and the prevention of adverse events found “the top three reported factors leading to the adverse event were the user, design problems, and lack of training.” A report from the World Health Organization analyzing the challenges of increased complexity of technology notes primary reasons for adverse events with these new technologies are the result of improper training and longer learning curves. It also highlights an important implication of this challenge: medical devices are prevented from achieving their “full public health potential.” In other words, providers continue to use older technologies simply because they don’t have the time and opportunity to properly train on the newer products.
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Traditional training scenarios for complex medical devices involve the surgeon traveling to a one- to two-day training workshop, typically sponsored by the medical device company. This off-site training is time consuming for all parties, and costly. Following these courses, it could be four to six months between the time one learns a procedure and the time the doctor gets to perform the procedure on a patient.

Surgical simulation seems like an optimal solution to the above challenge, which should provide the opportunity to practice and assess oneself repeatedly over time. Unfortunately the prior generation of simulation technology has not adequately addressed these training gaps. Thankfully, the field of simulation is evolving due to recent breakthroughs in immersive technologies, such as augmented and virtual reality, which increase the accessibility and effectiveness of surgical simulation for all members of the surgical team. The immersive nature and portability of these technologies open the door for the regular practice of procedures before treating patients, offering a safe place to make mistakes and work up the learning curve at one’s own speed. Simulation also has the ability to standardize training, so that we can quickly disseminate best practices and techniques from experts and governing professional bodies through the cloud. Finally, the next generation of simulators can accurately assess a surgeon’s objective technical skill. Virtual reality, like the system we have created at Osso VR, gives surgeons device- and procedure-specific training opportunities, and the ability to train with multiple users for team and leadership skills.
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