Key drivers and advancements in VR based Surgical Simulation.

An interview with Dr Philip Pucher, Imperial College London

By Chris Scattergood, co-founder of Fundamental Surgery

I recently interviewed Dr Philip Pucher who is an expert in surgical simulation and education at Imperial College London, a world leader in medical education research, and who is a key part of our clinical advisory board here at Fundamental Surgery.

Chris: Dr Pucher, you are acknowledged as a leader in the field of research in surgery, curriculum theory and adult education, how would you describe the current state of simulation in surgical training?

Dr Pucher: So we are now at a point where we have a very well established body of evidence and we know that simulation works, that it shortens learning curves, that it can improve outcomes, software and hardware can give us a fairly realistic simulation of surgical medical procedures. 

The evidence base is such that we know that actually this is a technology that can improve patient care and can improve patient outcomes. We know that the Royal College of Surgeons in the UK is pushing simulation heavily but for various reasons, the uptake on a national level has actually been quite low and that trainees access to simulators is actually quite scarce.

Chris: Why do you think simulation is not being adopted as quickly as you might expect?

Dr Pucher: The research on this is clear, the challenge is multifactorial with access a major issue. Firstly, the cost of hardware, often a six figure up front investment and the second element is operational challenges; there are very few of the large simulators, and it is often difficult to gain access to them at times that suit trainees.

Chris: What are the main arguments for more easily accessible simulation from systems such as Fundamental Surgery?

Dr Pucher: The advantages of simulation are really very well documented, as well as the savings from not running a live operating theatre, it is the enhanced learning capability that only simulation can provide. This is especially relevant in the issue of how to best educate a trainee who is developing a certain skill set, but who is often not in the real life operating room at the ideal learning times. If you consider that most of your learning happens when your right at the edge of your competency, if you allow your trainee to just do the simple stuff in the real world then they may not be pushing themselves and their learning curve is slowly going to grow, but not at an optimal level.

Chris: And how does simulation help push their learning curve?

Dr Pucher: Well if you can enable this learning in a simulated environment you can present the surgeon with an increasingly complex scenario, that continues to push that boundary of their learning. We also know from lots of evidence and research that actually the learning curve involved in developing a new skill or learning a new procedure is really highly attenuated when you go through a simulated based learning environment, versus learning something through the more traditional apprenticeship model of seeing it over and over again. So I think the advantages of simulation really are clear and for people who can introduce that, there can only be benefits.

Chris: Our simulator, Fundamental Surgery, allows the sense of touch through haptics within VR simulations, and will be available on a SaaS model, dramatically reducing investment levels. How might that impact the simulation marketplace?

Dr Pucher: In terms of advancements in simulation, the inclusion of haptics and immersive VR headsets is where all the cutting edge devices now are going and undoubtedly will be in the future. 

As we continue to drive for a simulation model that is more realistic more immersive and better approximates the actual feeling of being in the OR, then achieving this via a low cost SaaS based model avoids one of the major negatives of simulation adoption, high upfront costs.

Chris: What do you think will be key drivers to adoption of simulation training in the future?

Dr Pucher: As the mandate becomes stronger and stronger to provide simulation training, and the acceptance of simulation as an education modality continues to increase, I think there will probably become an obligatory aspect to simulation training.

Already in the United States we are seeing that their very basic low fidelity box trainers are mandatory to progression in surgical training, and I can only see that increasing.

Chris: Do you believe advanced VR simulators like Fundamental Surgery will become mandatory in the near future?

Dr Pucher: At the moment the lower fidelity models are the best validated. They are not even particularly cheap, so I don’t think that cost is an issue here. As the higher fidelity models become more realistic and the increasing body of supporting evidence solidifies behind them I can only see the mandate to employ the more advanced simulators progressing, beyond just the current basic generic skills.

To find out more about Haptic VR simulation and apply for a free trial, click here

About Fundamental Surgery:

Our mission at FundamentalVR is to give provide healthcare professionals access to the best simulations on a day-to-day basis. We believe that every surgeon should have the opportunity to rehearse, practise and test themselves within a safe, controllable space that is as close to real life as possible and is within an arm’s reach of their work place. Fundamental Surgery is a software platform that takes advantage of readily available virtual reality software combined with cutting edge haptics (the sense of touch) to create a simulation system that can be used on any modern PC set up, even a laptop. The result is a simulation system that requires a hardware investment of as little as $4,000 – $10,000 and a simple ongoing licence fee. www.fundamentalsurgery.com

As well as offering access to our procedures through a licence model, we help medical device companies and organisation to create their own simulations for surgical education. For more information email [email protected]

About Dr Philip Pucher:

Dr Pucher is a surgical registrar and honorary clinical lecturer at Imperial College London. He is a recognised expert in surgical simulation and education. His work has been published in some of the highest impact surgical journals, and includes international collaborations with North American, European, and British surgical societies and institutions. https://www.researchgate.net/profile/Philip_Pucher