Interview: Richard Vincent FundamentalVR - Digitise the expert

The adoption of VR surgical training simulations has rocketed during Covid-19. Paul Milligan hears from FundamentalVR CEO and co-founder Richard Vincent on the advantages it offers both teacher and student.

In business it is often those who spot an opportunity who succeed. For FundamentalVR when the Covid-19 pandemic struck it was a case of having the right technology at the right time. “We were looking for an opportunity to really test out our @homeVR proposition, and we took advantage of all this mayhem we've had over the last three to four months where people can't come together physically to show how an at home platform is really useful for them,” says Richard Vincent, CEO and co-founder of FundamentalVR.

The lockdown period took place during a planned series of activities FundamentalVR already had in place to develop its systems into residency programmes and teaching hospitals around the world.

FundamentalVR launched its Fundamental Surgery SaaS platform in August 2018. It combines VR with haptics to create a scalable experience for medical students and surgeons. Fundamental Surgery is unusual in that it is equipment agnostic, and is compatible with any VR-enabled laptop, VR headset or haptic device, enabling it to be delivered at a lower cost of traditional simulation systems. Important in healthcare where price is often the barrier to adoption.

FundamentalVR Surgery Multiuser 3

VR training systems, while rare, are not unheard of in healthcare, but the really innovative aspect of Fundamental Surgery is how it provides haptic technology. Its Surgical Haptic Intelligence Engine (SHIE) has been calibrated by a team of surgeons to mimic real-life sensations of numerous medical tools and tissue variants within a submillimetre accuracy of resistance.

“It’s called kinaesthetic force feedback," says Vincent, "you feel the difference between cutting through skin and hitting a bone. If you have a touch-based clue that you need to adjust your behaviour in real surgery, we can create that within our simulation. Given that in 50% of surgery you don't have clear line of sight of what you're doing, a sense of touch is essential.” Crucially the Fundamental Surgery platform also provides remote data analytics covering surgical skills to provide insight into surgical capability and progression.

While the FundamentalVR platform has been establishing itself for two years, in a number of medical institutions including Mayo Clinic and UCLA in the US, UCLH in the UK and Sana in Germany, what has arisen out of the Covid-19 outbreak has been the emergence of its @HomeVR system. Currently on a joint trial with two of the world’s most renowned medical teaching programmes, St George’s Hospital in London and NYU Langone in New York, the system provides access to accredited (CPD points are available for each session) surgical simulations built into standalone VR headsets.

FundamentalVR Surgery_Multiuser 4

Vincent explains how @HomeVR works: “We look at it as a companion to the main haptic system. @HomeVR works off standalone headsets like Oculus Quest, which means you can just pick it up and use it anywhere. You get the same education content, the same training experience, but you won't learn the muscle memory, it has haptics, but they are just buzzes. What it does do is to allow you to go through procedural rehearsal.”

The exciting aspects of this  technology are the unlimited nature of the audience, and that location is no barrier to standing in a (virtual) OR receiving internationally renowned teaching.

Location and audience are two advantages, but there’s more adds Vincent. “One of the hardest bits with education in medicine is the apprenticeship model – ‘I'm the expert so you watch me’. The challenge with that is it's all down to how much time the teacher can give you. What this system does is solve that problem by what the industry calls remote proctoring. Our system has digitised the expert, in terms of the cues that it gives them, the feedback, the verbal and visual instruction that it gives. It means that as a surgeon I can let a pupil go through a procedure, assess them in real time, and say to them when you get to level x then let's talk specifically about what we do next.

The second advantage is repetition. If we are teaching in the traditional way, whether that's in a live environment with a real patient or in a practice environment with a specimen, I've only got one example to show you there and we can only do it once. In our environment you can do it 100 times and press reset again and go again and again and try different scenarios. The other advantage is impartial assessment. As surgeons go through their residency and start to become qualified, they're assessed by their peers all the way. If you look at some of the research around assessment, what you see is that the way I think your skills are developing might be different to how my colleague thinks your skills are developing. And you can benefit or suffer from that. Our system is completely impartial, we set benchmarks and you either achieve them or you don't, and we can assess them gradually in real time against that.”

Richard Vincent FundamentalVR

Continual assessment using data does two things to the cost of a system adds Vincent (pictured above); “Over the long term it makes things cheaper because you will accelerate faster into a more competent and confident state. Because the pupil doesn’t need to use so much of the expert’s time, you can do that in a much more cost-effective way, so you'll get to a competency faster. We hope as a result of that to create a reduction in error.”

Collaboration is as key in healthcare as it is in the corporate world says Vincent, and VR can help that, especially in Covid times where people can’t congregate in large numbers: “In some operations you might have 20 people in and around that patient to support that procedure, so to collaborate is key, they've just always been able to do it physically before, so now being able to do that virtually allows them to continue that learning.”

The sessions can all be recorded, and watched on demand, which helps cut another
cost adds Vincent. “Healthcare professionals spend thousands every year going to conferences, to listen to or speak to the expert in a certain technique. Now we can put that expert into a room, allow them to host that virtually with as many people as they want in that room at that time, and record it so that if you missed it, just like a Zoom call you can play it at a later date."

Does Vincent see this usage uplift in VR as temporary or something that will sustain post-Covid? “I think we have hit an inflection point here, adoption has been steady over the last couple of years, but it's about to go into rapid acceleration. Both sides, whether it's hospitals or life sciences businesses, have set up some sort of task force in the last few months to look at the adoption of immersive technology. I think we're going to
see a rapid development, not just in VR, but also in the use of AR and MR. When we look back at Covid we’ll say there were lots of negatives, but on the use of immersive technology, I think this will be a positive change.”

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