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Sally An Ms. HardjowasitoAP Seminar25 January 2018Applying Virtual Reality Simulations in Surgical Training; Futuristic LensResearch Question: To what extent should virtual reality technology be implemented in the medical field in developed countries?IntroductionThe surge of technological advancements in the Twenty First Century has drastically changed the quality of treatments and services in the medical field of developed countries. However, there is a particularly growing interest in the application of virtual reality (VR) technology in the training of healthcare professionals. VR, an user-interactive “three-dimensional computer-generated environment” (Nwaneri 604), addresses the continuous debate on the ethicality of the traditional surgical training method. The current surgical curriculum consists of supervised operations on live animals and patients, putting the subjects at risk (Van Der Meijden and Schijven 1181). Hence, the it is highly debated as unethical by advocates of minimal invasive surgical training; who pose VR surgery simulations as an alternative method to train surgeons in its immersive environment, without the controversial use of live individuals. However, major implications of the future application of VR systems are its high financial cost and the unauthentic surgical environment it creates. For example, trainees reviewed prototype simulations to be insufficient in recreating the stress (DeMasi et al. 28) and realistic visuals of a surgery (Chim et al. 26). On the other hand, VR system developers expect the VR market to face an increase in global demand, which will promote research on software development to overcome such setbacks (“Worldwide Spending”). Therefore, although present VR simulations do not meet the technical requirements to recreate the full surgical experience, it poses as a solution for the current issue of unethical training in healthcare because it eliminates the necessity of live subjects, and conveys future economic growth.Perspectives of Advocates of Minimal Invasive Surgical Training    Advocates of minimal invasive surgical training claim that the traditional method of practicing surgical skills on live subjects is unethical, and should be replaced by the future integration of VR simulations into the medical curriculum. According to an article by Surgical Endoscopy, the official medical journal of the European Association for Endoscopic Surgery, the present “on the job training” method raises the concern of patient safety, as the operation is performed by the trainee under the supervision of a professional (Van Der Meijden and Schijven 1181). Unlike VR systems, this current method incorporates subjective evaluation of the trainee (1181), undermining the accuracy of the assessment results. Moreover, according to Roberts et al., professors of the Department of Surgery at Yale University School of Medicine, VR systems provide automatic objective feedback on a trainee’s performance (3221); allowing for flexible practice schedules as it is not obligatory for a trained surgeon to be present. In addition, VR software can be adjusted to train multiple types of surgical skills and to accommodate different levels of difficulty for individuals (3221). However, experimental research on animal dissections published by the Edorium Journal of Surgery, found practicing live surgeries reproduced a high-pressure environment (DeMasi et al. 28) – a key facet VR simulations cannot recreate, concluding its inability to teach trainees essential psychological skills to overcome stress. Hence, VR simulations provide an immersive surgical environment that is modifiable to train individual goals, but is incapable to teach vital skills to cope with psychological challenges – a major setback in its future use.Reviews of Trainees and Clinicians    However, despite the absence the of the stress inducing psychological component, a Likert-type questionnaire on the usefulness of VR training, published by Clinical Otolaryngology, the official journal of Otorhinolaryngological Research Society, reveals trainees giving the prototype curriculum an overall high score above ? (Arora et al. 157). Moreover, Medical Education, an academic journal investigating health education, presents survey results stating that “students trained by VR simulations described it as ‘great’, ‘excellent’, … etc.” (Owen and Plummer 639), further validating the support of VR into the current curriculum. Yet, Ya Ru et al., first year core trainee physicians at the Pinderfields Hospital, claim contradicting evidence about clinicians critiquing the lack of realism due to the low quality image processing for particular operations, such as bronchoscopy (26). This technical impediment testifies the technology’s incapability to “substitute for developing skills to use in real patients” (26) due to its inaccurate visuals. However, despite this condemnation, a double-blind study by Seymour, et al., professors from Yale University School of Medicine and Queens University, support the transferability of VR-trained skills as trainees make significantly less surgical errors than the traditionally trained group (561-62). Furthermore, in a report by the American Journal of Surgery, research comparing the skill development of VR-trained and traditionally trained surgeons confirm that VR-trained surgeons are more time efficient in the operating room (Ahlberg et al. 802). Both claims corroborate a positive outlook on VR training, but considerations must be taken into account that the success rate of a surgery depends greatly on the severity of the patient’s health status. Therefore, VR training will not guarantee an increase in promising surgery recoveries. Furthermore, the insufficient visual quality of specific operation simulations reduces the applicability of the system across the varying areas of the medical field.Economic Outlook of Developers    In response to the “graphical obstacles” trainees faced, Minimally Invasive Therapy & Allied Technologies, the official journal of the Society for Minimally Invasive Therapy, expects future advancements will be made in the VR market to overcome these visual setbacks (Halvorsen et al. 222). Additionally, the VR market of developed countries is expected to “increase by 100% in the next four years”, with major growth of 166.2% in total spending in the lab and field areas (“Worldwide Spending”). This statistical forecast by the International Data Corporation supports the validity of the assertion that large investments will be made towards the manufacturing and development of VR software(“Worldwide Spending”). Therefore, as the prominence of VR technology escalates, investment for system improvement will surge as well, which will elicit significant software upgrades to address the current dissatisfactions. However, clinical educators, from Szent István Hospital and the Surgical Department of Semmelweis University, argues that despite the growing interest, VR simulation is a new way of teaching that users and educators must familiarize themselves with in the first place, delaying the system’s direct incorporation into the surgical curriculum (Sándor et al. 104). Hospitals willing to use VR simulators must also recognize the high financial cost in buying, maintaining, and updating the system (Sándor et al. 104). Nonetheless, in Computers and Graphics, an international journal focusing on the systems and applications of computer graphics, VR businesses claim that new models, such as the “virtual reality modeling language” (Lu et al. 283) technology, are being designed to make the systems affordable and “deployable in the classroom” (283). Thus, developers of VR technology forsee the incorporation of VR in medical training to take place in the near future as the current trend of significant VR purchases will continue to exponentially increase. In addition, the rising investment rate allows for ongoing research to improve the VR experience, especially in regards to the realism of simulations, and economic accessibility to encourage sales for a broad range of consumers.Conclusion    In consideration of the multiple viewpoints on the future implementation of VR simulations in medical training, it is evident that this new computerized system has high potential in addressing the controversial issue of the current training method as it removes the need of live dissections. However, it lacks vital components to recreate the full surgical experience. For instance, as reviewed by trainees using the system prototype, the lack graphical quality and realism did not meet their standards. On the other hand, developers support the expansion of VR use in the medical field as they expect considerable industry growth, which will prompt significant development of the technology to resolve present technical challenges. To further raise the acceptance of VR technology training, an analysis of the engineering process of VR simulations by Medical Teacher, a peer-reviewed journal published by the collaboration of Informa Healthcare with the  Association for Medical Education in Europe, recommends closer “user–developer relationships” to promote active contribution from the medical and educational perspectives (Lövquist et al. 61). Since the target users of VR systems in the medical field are surgical trainees and educators, developers should be heavily guided by their clinical feedback. Therefore, involving clinicians into the early development stages of the technology will greatly impact the future acceptability of the final product, as industries will be able to design VR systems that will meet the specific demands and concerns of their target users.Word Count: 1320Headings and in-text citing: 90 wordsWorks CitedAhlberg, Gunnar, et al. “Proficiency-based Virtual Reality Training Significantly Reduces the Error Rate for Residents During their First 10 Laparoscopic Cholecystectomies.” The American Journal of Surgery 193.6 (2007): 797-804. PubMed. Web. 21 Jan. 2018.Arora, Asit, et al. “Virtual Reality Simulation Training in Temporal Bone Surgery.” Clinical Otolaryngology 40.2 (2015): 153-159. EBSCOhost. Web. 12 Jan. 2018.DeMasi, Stephanie C., et al. “Live Animals for Preclinical Medical Student Surgical Training.” Edorium Journal of Surgery 3.2 (2016): 24–31. PMC. Web. 20 Jan. 2018.Halvorsen, Fredrik H., et al. “Simulators in Surgery.” Minimally Invasive Therapy & Allied Technologies 14.4 (2005): 214-223. EBSCOhost. Web. 16 Jan. 2018.Lövquist, Erik, et al. “Virtual Reality-Based Medical Training and Assessment: The Multidisciplinary Relationship between Clinicians, Educators and Developers.” Medical Teacher 34.1 (2012): 59-64. EBSCOhost. Web. 17 Jan. 2018.Lu, Jianfeng, et al. “Virtual Learning Environment for Medical Education Based on VRML and VTK.” Computers & Graphics 29.2 (2005): 283-288. EBSCOhost. Web. 20 Jan. 2018.Nwaneri, Crystal. “Ready Lawyer One: Legal Issues in the Innovation of Virtual Reality.” Harvard Journal of Law & Technology 30.2 (2017): 601-627. EBSCOhost. Web. 22 Jan. 2018.Owen, Harry and John L Plummer. “Improving Learning of a Clinical Skill: The First Year’s Experience of Teaching Endotracheal Intubation in a Clinical Simulation Facility.” Medical Education 36.7 (2002): 635-642. EBSCOhost. Web. 20 Jan. 2018.Roberts, Kurt E., et al. “Evolution of Surgical Skills Training.” World Journal of Gastroenterology?: WJG 12.20 (2006): 3219–3224. PMC. Web. 18 Jan. 2018.Sándor, József, et al. “Minimally Invasive Surgical Technologies: Challenges in Education and Training.” Asian Journal of Endoscopic Surgery 3.3 (2010): 101-108. Wiley Online Library. Web. 16 Jan. 2018.Seymour, Neal E. et al. “Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study.” Annals of Surgery 236.4 (2002): 458–464. PMC. Web. 17 Jan. 2018.Van der Meijden, O. A. J., and M. P. Schijven. “The Value of Haptic Feedback in Conventional and Robot-Assisted Minimal Invasive Surgery and Virtual Reality Training: A Current Review.” Surgical Endoscopy 23.6 (2009): 1180–1190. PMC. Web. 19 Jan. 2018.”Worldwide Spending on Augmented and Virtual Reality Expected to Double or More Every Year Through 2021, According to IDC.” International Data Corporation, 03 Aug. 2017. Web. 21 Jan. 2018.Ya Ru, Chim, et al. “Virtual Reality Simulator Training: First Experience at Pinderfields Hospital.” Mid Yorks Medical Journal 2.3 (2011): 23-27. EBSCOhost. Web. 12 Jan. 2018.

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