CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2024; 65(02): e55-e57
DOI: 10.1055/s-0044-1790257
Editorial

Transforming Education in Orthopedic and Trauma Surgery: Integration of Extended Reality

Article in several languages: español | English
1   Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Las Condes, Región Metropolitana, Chile
2   Hospital Sótero del Río, Puente Alto, Región Metropolitana, Chile
,
Ernesto Pino
1   Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Las Condes, Región Metropolitana, Chile
,
1   Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo, Las Condes, Región Metropolitana, Chile
› Author Affiliations
 

The integration of Extended Reality (XR) technologies, encompassing Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), is increasingly transforming medical education. These technologies are revolutionizing the way future surgeons are trained and educated, immersive learning experiences that were previously unimaginable.

Relevance of XR in Medical Education

Providing an appropriate balance between theoretical and practical training in medical education has been a constant challenge.[1] [2] [3] Student exposure to and practice of procedures depends on multiple factors, including the prevalence of the pathology, location, and length of the rotation, student's personal motivation, and their relationship with their instructor.[4] Traditional Medical-surgical education, based on Halsted's “master-apprentice” model (see one, do one, teach one)[5] and practice on physical or cadaveric simulators, is being complemented and, in some cases, replaced by XR tools. These technologies provide an immersive learning experience in a three-dimensional (3D) digital environment, allowing students to interact with simulated cases, generating active, accessible training that is considerably more economical than other medical simulation methods in the long term.[6] [7] For example, VR offers simulations where users can practice surgical techniques with immediate feedback and without risk to patients, while AR overlays digital elements with crucial information directly into the user's field of view during a procedure, facilitating real-time decision-making.


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Impact on Learning

XR has been positioned as an academic tool that improves theoretical, practical, and spatial knowledge,[8] [9] critical thinking,[10] memorization of steps to complete a procedure, motor skills,[11] [12] [13] [14] attitude, and commitment to learning,[8] [15] [16] even as much or more than a traditional medical simulation.[17] In addition, it offers the opportunity to train in techniques that are not performed in the institution or region in which residents work, offering an opportunity for developing countries. For these reasons, the simulation of orthopedic and trauma surgery procedures in XR is being formally integrated into training programs.[18] [19] The application of XR allows for more equitable access to high-quality education. Residents can practice repeatedly in controlled and safe environments, which is crucial in a discipline where skill and precision are essential.[20]


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Challenges

While XR simulation offers the advantages mentioned above, its implementation is not without challenges. These include the initial cost of the equipment and the necessary infrastructure, as well as the choice of one or more specialized software that meets the needs of the academic program. It is also important to consider that current technology, while immersive, is still unable to generate a 100% realistic scenario, especially due to shortcomings in haptic feedback. However, there are already XR simulations that incorporate this technology, demonstrating its improvements in the learning process.[21] [22] Moreover, technology drives continuous improvement as it constantly evolves and adapts to address new needs and challenges. Simultaneously, as this evolution takes place, its costs tend to decrease.[23] Finally, any teaching intervention and innovation can lead to resistance among users and hinder their integration,[24] therefore, a progressive insertion that considers continuous measurement and analysis of the difficulties encountered is of utmost importance.


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Local Experience

XR simulation has been formally integrated into our training program. During the pilot implementation, XR training showed that more than 90% of residents reported that this tool is beneficial to them, allowing them to better understand and apply their knowledge and recommend it as an entertaining way to learn. 91% were confident that through simulation they were acquiring knowledge that allows them to perform in a real clinical scenario. Confidence to act as first surgeon and assistant for the trained procedures increased from 9% to 50% and 55% to 92% before training and after the last session, respectively. As challenges, elements like those reported in the literature were identified,[19] particularly logistics, physical space and technology, solutions were proposed for each of them ([Figure 1]). Once the solutions began to be implemented and with 546 simulations carried out, user satisfaction increased from an average Net Promoter Score of 38 to 48.

Zoom Image
Fig. 1 Challenges encountered and proposed solutions to the integration of simulation with XR in a orthopedic and trauma surgery training program.

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Conclusion

XR is becoming established as an essential tool in medical education, particularly in orthopedic and trauma surgery. It is crucial that educational institutions and healthcare professionals recognize these technologies, not just as adjuncts but as an integral part of medical training. Future research should focus on refining these technologies and assessing their long-term impact on the quality of medical care. We invite academics and those responsible for orthopedic and trauma surgery training. In the country to explore and implement these tools in their programs. The promise of XR lies not only in improving the technical skills of future surgeons, but in transforming continuing medical education to meet the challenges of the future and provide the best care to our patients.


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  • Referencias

  • 1 Buja LM. Medical education today: all that glitters is not gold. BMC Med Educ 2019; 19 (01) 110
  • 2 Palés JL, Rodríguez De Castro F. Desarrollo Profesional Continuo (DPC) y Regulación de La Profesión Médica Retos de La Formación Médica de Grado. Vol 9. 2006
  • 3 Swanwick T, Forrest K, O'Brien B. Understanding Medical Education. (Swanwick T, Forrest K, O'Brien BC, eds.). Wiley; 2018.
  • 4 James HK, Pattison GTR, Griffin DR, Fisher JD. How Does Cadaveric Simulation Influence Learning in Orthopedic Residents?. J Surg Educ 2020; 77 (03) 671-682
  • 5 Kotsis SV, Chung KC. Application of the “see one, do one, teach one” concept in surgical training. Plast Reconstr Surg 2013; 131 (05) 1194-1201
  • 6 Farra SL, Gneuhs M, Hodgson E. et al. Comparative Cost of Virtual Reality Training and Live Exercises for Training Hospital Workers for Evacuation. Comput Inform Nurs 2019; 37 (09) 446-454
  • 7 Mao RQ, Lan L, Kay J. et al. Immersive Virtual Reality for Surgical Training: A Systematic Review. J Surg Res 2021; 268: 40-58
  • 8 Cai S, Chiang FK, Sun Y, Lin C, Lee JJ. Applications of augmented reality-based natural interactive learning in magnetic field instruction. Interact Learn Environ 2017; 25 (06) 778-791
  • 9 Carbonell Carrera C, Bermejo Asensio LA. Augmented reality as a digital teaching environment to develop spatial thinking. Cartogr Geogr Inf Sci 2017; 44 (03) 259-270
  • 10 Ikhsan J, Sugiyarto KH, Astuti TN. Fostering student's critical thinking through a virtual reality laboratory. Int J Interactive Mobile Technol 2020; 14 (08) 183-195
  • 11 Bowman DA, Sowndararajan A, Ragan ED, Kopper R. Higher levels of immersion improve procedure memorization performance. In: Proceedings of the Joint Virtual Reality Conference of EGVE - The 15th Eurographics Symposium on Virtual Environments, ICAT, EuroVR 2009. Eurographics Association; 2009: 121-128
  • 12 Pastel S, Petri K, Chen CH. et al. Training in virtual reality enables learning of a complex sports movement. Virtual Real (Walth Cross) 2023; 27 (02) 523-540
  • 13 Richlan F, Weiß M, Kastner P, Braid J. Virtual training, real effects: a narrative review on sports performance enhancement through interventions in virtual reality. Front Psychol 2023; 14: 1240790
  • 14 Fahl JT, Duvivier R, Reinke L, Pierie JEN, Schönrock-Adema J. Towards best practice in developing motor skills: a systematic review on spacing in VR simulator-based psychomotor training for surgical novices. BMC Med Educ 2023; 23 (01) 154
  • 15 Moro C, Štromberga Z, Raikos A, Stirling A. The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ 2017; 10 (06) 549-559
  • 16 Yoon SA, Elinich K, Wang J, Steinmeier C, Tucker S. Using augmented reality and knowledge-building scaffolds to improve learning in a science museum. Int J Computer-Supported Collab Learn 2012; 7 (04) 519-541
  • 17 Banaszek D, You D, Chang J. et al. Virtual reality compared with bench-top simulation in the acquisition of arthroscopic skill: A randomized controlled trial. J Bone Joint Surg Am 2017; 99 (07) e34
  • 18 Clarke E. Virtual reality simulation-the future of orthopaedic training? A systematic review and narrative analysis. Adv Simul (Lond) 2021; 6 (01) 2
  • 19 Kuhn AW, Yu JK, Gerull KM, Silverman RM, Aleem AW. Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives. JBJS Open Access 2024; 9 (01) e23.00142
  • 20 Stirling ERB, Lewis TL, Ferran NA. Surgical skills simulation in trauma and orthopaedic training. J Orthop Surg Res 2014; 9: 126
  • 21 Azher S, Mills A, He J. et al. Findings Favor Haptics Feedback in Virtual Simulation Surgical Education: An Updated Systematic and Scoping Review. Surg Innov 2024; 31 (03) 331-341
  • 22 Gani A, Pickering O, Ellis C, Sabri O, Pucher P. Impact of haptic feedback on surgical training outcomes: A Randomised Controlled Trial of haptic versus non-haptic immersive virtual reality training. Ann Med Surg (Lond) 2022; 83: 104734
  • 23 What is Moore's Law? - Our World in Data. Accessed August 27, 2023. https://ourworldindata.org/moores-law
  • 24 Herur-Raman A, Almeida ND, Greenleaf W, Williams D, Karshenas A, Sherman JH. Next-Generation Simulation—Integrating Extended Reality Technology Into Medical Education. Front Virtual Real 2021; 2

Dirección para correspondencia

Rodrigo Guiloff, Profesor
Facultad de Medicina, Clínica Alemana, Universidad del Desarrollo
Las Condes, Región Metropolitana
Chile   

Publication History

Article published online:
25 September 2024

© 2024. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referencias

  • 1 Buja LM. Medical education today: all that glitters is not gold. BMC Med Educ 2019; 19 (01) 110
  • 2 Palés JL, Rodríguez De Castro F. Desarrollo Profesional Continuo (DPC) y Regulación de La Profesión Médica Retos de La Formación Médica de Grado. Vol 9. 2006
  • 3 Swanwick T, Forrest K, O'Brien B. Understanding Medical Education. (Swanwick T, Forrest K, O'Brien BC, eds.). Wiley; 2018.
  • 4 James HK, Pattison GTR, Griffin DR, Fisher JD. How Does Cadaveric Simulation Influence Learning in Orthopedic Residents?. J Surg Educ 2020; 77 (03) 671-682
  • 5 Kotsis SV, Chung KC. Application of the “see one, do one, teach one” concept in surgical training. Plast Reconstr Surg 2013; 131 (05) 1194-1201
  • 6 Farra SL, Gneuhs M, Hodgson E. et al. Comparative Cost of Virtual Reality Training and Live Exercises for Training Hospital Workers for Evacuation. Comput Inform Nurs 2019; 37 (09) 446-454
  • 7 Mao RQ, Lan L, Kay J. et al. Immersive Virtual Reality for Surgical Training: A Systematic Review. J Surg Res 2021; 268: 40-58
  • 8 Cai S, Chiang FK, Sun Y, Lin C, Lee JJ. Applications of augmented reality-based natural interactive learning in magnetic field instruction. Interact Learn Environ 2017; 25 (06) 778-791
  • 9 Carbonell Carrera C, Bermejo Asensio LA. Augmented reality as a digital teaching environment to develop spatial thinking. Cartogr Geogr Inf Sci 2017; 44 (03) 259-270
  • 10 Ikhsan J, Sugiyarto KH, Astuti TN. Fostering student's critical thinking through a virtual reality laboratory. Int J Interactive Mobile Technol 2020; 14 (08) 183-195
  • 11 Bowman DA, Sowndararajan A, Ragan ED, Kopper R. Higher levels of immersion improve procedure memorization performance. In: Proceedings of the Joint Virtual Reality Conference of EGVE - The 15th Eurographics Symposium on Virtual Environments, ICAT, EuroVR 2009. Eurographics Association; 2009: 121-128
  • 12 Pastel S, Petri K, Chen CH. et al. Training in virtual reality enables learning of a complex sports movement. Virtual Real (Walth Cross) 2023; 27 (02) 523-540
  • 13 Richlan F, Weiß M, Kastner P, Braid J. Virtual training, real effects: a narrative review on sports performance enhancement through interventions in virtual reality. Front Psychol 2023; 14: 1240790
  • 14 Fahl JT, Duvivier R, Reinke L, Pierie JEN, Schönrock-Adema J. Towards best practice in developing motor skills: a systematic review on spacing in VR simulator-based psychomotor training for surgical novices. BMC Med Educ 2023; 23 (01) 154
  • 15 Moro C, Štromberga Z, Raikos A, Stirling A. The effectiveness of virtual and augmented reality in health sciences and medical anatomy. Anat Sci Educ 2017; 10 (06) 549-559
  • 16 Yoon SA, Elinich K, Wang J, Steinmeier C, Tucker S. Using augmented reality and knowledge-building scaffolds to improve learning in a science museum. Int J Computer-Supported Collab Learn 2012; 7 (04) 519-541
  • 17 Banaszek D, You D, Chang J. et al. Virtual reality compared with bench-top simulation in the acquisition of arthroscopic skill: A randomized controlled trial. J Bone Joint Surg Am 2017; 99 (07) e34
  • 18 Clarke E. Virtual reality simulation-the future of orthopaedic training? A systematic review and narrative analysis. Adv Simul (Lond) 2021; 6 (01) 2
  • 19 Kuhn AW, Yu JK, Gerull KM, Silverman RM, Aleem AW. Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives. JBJS Open Access 2024; 9 (01) e23.00142
  • 20 Stirling ERB, Lewis TL, Ferran NA. Surgical skills simulation in trauma and orthopaedic training. J Orthop Surg Res 2014; 9: 126
  • 21 Azher S, Mills A, He J. et al. Findings Favor Haptics Feedback in Virtual Simulation Surgical Education: An Updated Systematic and Scoping Review. Surg Innov 2024; 31 (03) 331-341
  • 22 Gani A, Pickering O, Ellis C, Sabri O, Pucher P. Impact of haptic feedback on surgical training outcomes: A Randomised Controlled Trial of haptic versus non-haptic immersive virtual reality training. Ann Med Surg (Lond) 2022; 83: 104734
  • 23 What is Moore's Law? - Our World in Data. Accessed August 27, 2023. https://ourworldindata.org/moores-law
  • 24 Herur-Raman A, Almeida ND, Greenleaf W, Williams D, Karshenas A, Sherman JH. Next-Generation Simulation—Integrating Extended Reality Technology Into Medical Education. Front Virtual Real 2021; 2

Zoom Image
Fig. 1 Desafíos encontrados y soluciones propuestas a la integración de simulación con XR en un programa de formación en traumatología.
Zoom Image
Fig. 1 Challenges encountered and proposed solutions to the integration of simulation with XR in a orthopedic and trauma surgery training program.