Say goodbye to ‘what if’ in surgery — Dr. Jonathan Schoenecker on how VR helps orthopedic surgeons train for the OR

Surgical training technology company Osso VR launched its first pediatric orthopedic procedure module in partnership with the Pediatric Orthopaedic Society of North America.

Board-certified orthopedic surgeon Jonathan Schoenecker, MD, PhD, an assistant orthopedics, pediatrics, pharmacology and pathology professor at Nashville, Tenn.-based Vanderbilt University Medical Center and POSNA member, recently spoke with Becker’s Spine Review about the intersection of opportunities in pediatric orthopedics and virtual reality training.

Question: Why is POSNA venturing into virtual reality?

Dr. Jonathan Schoenecker: Surgical training is a complex and demanding process. Although new technologies are frequently introduced in the operating room, much of the foundation, such as knowledge of anatomy, how to hold a surgical instrument or handle various tissues, has remained largely unchanged over the last 50 years. Mastering orthopedic surgical performance requires a considerable amount of ‘deliberate practice.’ Although excellent surgeons often have an uncanny ability to focus for hours on end, surgical skills are not innate but rather must be learned.

Importantly, the experience of the trainee, especially in residency and fellowship, is completely dependent upon chance: chance that the trainee’s hospital cares for the number and variety of trauma and elective cases and that there are mentors dedicated to teaching. Additionally, with the implementation of work hour restriction for physician trainees as well as the business of medicine driving more efficient operative practices, hands-on experiences are dropping in most training programs. Not only is this a concern for the trainee and the training program, but it is a huge concern for the patient and the healthcare system. There is never a moment where one would desire to have a lesser-trained orthopedic surgeon perform a surgery on them or a loved one.

Recognizing these shortcomings, over the last decade POSNA has been searching for innovative means that permit simulated deliberate practice with near perfect translational validity to reduce the reliance of orthopedic training on chance alone.

No current platform provides the point-of-perspective immersive experience of virtual reality. Osso VR’s ability to rapidly run simulations countless times and to program in changes and potential catastrophes makes it easy to realize the potential of surgical simulation. Virtual and potentially augmented reality can remove the variable of chance from the equation of orthopedic education. Not only will this greatly enhance the ability to produce skilled orthopedic surgeons, but also will reduce training time increase the capacity to assess skill. Most importantly, this should lead to safer clinical practice.

Q: Are there special applications for pediatric patients?

JS: Pediatric orthopedic procedures present unique challenges for surgeons, especially when they have not subspecialized in the field. The pressure associated with pediatric procedures combined with the variable experience of practitioners can lead to suboptimal outcomes. Procedures like the one Osso VR has simulated are not able to be practiced effectively with current tools like sawbones. VR allows providers to not only learn, but also refresh the skills and steps necessary to effectively treat critical conditions.

Q: What opportunities do you see in the pediatric orthopedic surgical market?

JS: It is an exciting time right now in the pediatric orthopedic space. Recent advances have led to a rapid expansion of the devices and procedures we have available to treat a variety of conditions, some of which may drastically improve the quality of life for our patients. Unfortunately, many of these technologies are significantly more complex than those that we have used in the past, and we don’t have the time or resources to effectively train our surgeons and staff on how to integrate these higher-value devices into their practices.

Virtual reality training has the potential to allow surgeons and OR staff to rapidly get up-to-speed on these critical procedures, assess their readiness, and finally bring them to their patients in the safest way possible to better treat some of the most challenging musculoskeletal conditions our children are facing today.