How VR will rewire the Indian Medical Education

Could Virtual Reality swing the fate of medical education in India? A HE Report.

What's new? It's the question asked all the time by academics, researchers as well as policymakers. In a fast-moving world, the answer has to be good. Stanford University has a good reply.  There was a recent report in a business publication about how Stanford University is embracing virtual technology to train doctors and surgeons. The University has set up a Neurological Simulation and Virtual Reality Centre.   

Digital Downpour

Simulations were first used in the airline industry for training pilots. It grew out of the 1977 Tenerife Airport Disaster, where two Boeing 747 aircraft collided on the runway killing 583 people.

Cockpit Resource Management is a set of training procedures for use in environments where human error can have a devastating effect. CRM focuses on interpersonal communication, leadership and decision making in the cockpit of an airline. They also started using flight simulations to train pilots for various emergencies they might face while flying.  Today, flying has become one of the safest modes of transports compared to the 1970s.

High-end disruptors often produce innovations that are leapfrog in nature, making them difficult to imitate rapidly. Ivy league institutes are built around this idea.

Even in the field of education and medicine, doctors have woken up to the fact that errors in medicine happen due to a lack of soft skills. Sometimes a nurse gives a wrong dose of injection because she misreads the prescription or misunderstands the doctor. Most of these errors happen not because the doctor is incompetent but because there is some issue with teamwork or communication. There was no convenient way of training doctors in the last three or four decades, in non-technical skills.

Promise

Experts see the potential. “Simulation is the way to go in medical education and proven across the globe. There are two types of simulators basically— task trainers or part-task trainers. These are meant to train people for specific tasks. There are physical simulators to train students to do tasks like suturing, inserting a urinary catheter or nasogastric intubation. There are complex simulators like Virtual Reality Simulators, where essentially you are doing an operation looking at a computer screen, but it’s all in virtual reality,” says Dinker Pai, Professor of Surgery and Director, Medical Simulation Centre, Mahatma Gandhi Medical College, Puducherry. He adds that there are simulators available for doing laparoscopic surgery and arthroscopic surgery too.

“There are also hybrid models, where you have a physical model like the arthroscopic knee model; there is a physical knee there, but inside the knee everything is virtual. When you put the telescope inside, you see a physical structure inside the knee. Further, when you superimpose VR on a real environment, you get augmented reality. Microsoft HoloLens is a good example of that, and they provide extra information about the real world. Today there are childbirth simulators, equipped with Microsoft Hololens. Then, there is also VR with Haptix, which gives users a realistic touch and feeling of resistance. Immersive Reality transports you to the environment, and you can explore the environment and also with the help of hand-held devices interact with the environment. I.R. will transport the user to an operating room, where they can see patients. It is not widely used, but it’s coming up,” adds Pai.

There are several premier Indian medical institutions like AIIMS, JIPMER Puducherry and AFMC that already use it. They have set up simulation labs to train their postgraduate and undergraduate students.

Another application of the technology is a Virtual Reality Anatomy Table. “Traditionally, when you learn human anatomy, you cut the body to understand more about the structure. Because it’s a preserved dead body, the anatomical structures are often not like a real patient,” explains Pai.

What does this mean for the Indian medical education sector?

In most of the medical colleges of India, students are often taught how to handle cases as an individual. The institutes often don’t teach them how to work together as a team. The first time a doctor works with a team is on the job when they go to the hospital.  That’s not a great idea and mistakes are often made due to this. Simulations bridge this gap and provide team training. Majority of the medical errors happen because doctors are not trained in non-technical skills.

What are the economic impacts?

That's the promise. The challenge? Bhupesh Deshmukh, the founder of Inception X, an Augmented and Virtual Reality startup, divulges that the startup is keen on collaborating with medical colleges, adding, “With the current advancements in interactive experiential technologies, many new areas are emerging even within the healthcare sector. Augmented, Virtual and Mixed Reality will be of great use in explaining complex or new innovative procedures to doctors. These interactive applications can help with more critical tasks, like providing Virtual Training Simulation modules to the tech-savvy new breed of doctors on complex heart surgeries. However, it requires commitment from the management side, as the required hardware and software are expensive.”

Dr Sunil Chandy, former director of CMC Vellore seconds his views. He points out that there is no doubt that technology can play a vital role in training medical students, but the cost is a big factor for medical colleges. “And technology cannot replace the human factor in medical education,” he adds.

Meet the New Moguls of VR

Still got the urge to invest in VR? There are several startups, which offer VR solutions for the healthcare market.

"VR based training sessions can play a crucial role in preparing doctors for delicate and complicated procedures that require precision, fewer complications and reduced trauma. With the help of technology, anybody can observe operations in real time. We had offered a VR-based training and education module for cardiologists, neurosurgeons, critical care and emergency medicine doctors. Buzz4Health also offers CME courses to doctors, nurses as well as paramedical staff. We have created specialised content for medical devices and pharma industry,” says Hitesh Ganjoo, CEO of Buzz Health.

Last year Global Hospitals Hyderabad organised the first-ever live VR surgical training for 700 doctors and students from across India. The VR feed from the operation theatre was live telecasted on the sidelines of a medical conference where students— wearing VR headsets— witnessed laparoscopy surgery performed by foremost urologists in the country.

Insiders point out that the technology has been around for a long time. However, it has not been used so extensively in Indian hospitals, as they often lie in a corner. Many often use simulations for task training rather than team building. 

Further, it is proven that skills that you learn on a simulator are transferable to a real patient. Management also saves money in terms of patient safety. Every patient likes to be operated by a surgeon with years of experience. However, the young students churned out by medical colleges also need training. If they never get a practice, how will they do that?

The Road Ahead

With patients becoming more aware of their rights and increasing number of medical litigations, it does make sense to invest in the technology. Further, with the increase in the number of students admitted to medical colleges, the number of patients available for students to learn has also come down. So, a student might not see a particular kind of patient or might never get a chance to do a specific type of operation. Another reason why simulation is essential.