Believability of virtual reality, use of Net are impacting health care

BBI Newsletter, The, March, 1997

These subjects clearly illustrate how the rapid growth of Internet familiarity and the increasing believability of virtual reality (VR) environments are having impact on health care around the globe. Telemedicine is now affecting many people living in remote areas and there is considerable promise for its use by even the urban apartment dweller for medical care at home. VR may - if Alfred Cuschieri, MD, of the University of Dundee (Dundee, Scotland) is to be believed - guide medical schools in the selection of applicants for surgical residencies allowing only those with proven "ADEPT-ability" to be admitted for further education.

Cuschieri (acuschieri@ninewells.dundee.ac.uk) spoke as the SAGES (Society of American Gastrointestinal Endoscopic Surgeons; Santa Monica, California) invited lecturer for the MMVR: 5 meeting. He said one of his objectives is to wipe out the perception that virtual reality is all hype, with little scientific or medical value. In fact, the University of Dundee is using VR to evaluate psychomotor skills as a predictor of future surgical success.

Choosing surgeons with VR

The Ambidextrous Dundee Dexterity Tester (ADEPT) project at the Scottish university is being used to study the three domains of motor skills - psychomotor, cognitive and affective - in order to selectively recruit people for endoscopic and open surgical specialties where the demand for manipulative dexterity is high. The project seeks to assess the innate motor skill qualities of applicants, a subject largely ignored until now. According to Cuschieri, dental schools require potential entrants to pass a psycho-motor chalk test before being accepted, while medical school applicants are never tested for manual dexterity even though spatial ability tests are known to correlate strongly with surgical skill.

Proposing that the next generation of surgeons be more carefully selected, the ADEPT project intends to develop an aptitude test measuring manual dexterity and spatial ability. The testing unit incorporates a virtual reality environment where intelligent microprocessors measure movements on three axes in real time. Using a standard laparoscope and laparoscopic instruments, the system software directs the tasks to be performed by the student and then measures the degree of perfection attained by that student. There is a real-time recording of the candidate's performance time, error rate and deviation from instruction. "Flight patterns" of the dominant and passive instruments through the VR environment are measured from the inside of a closed hemisphere where 36 separate panels carefully map the inner space.

The students can and do improve with practice on the ADEPT system, but certain facets of the testing error rate and handedness - appear to be both innate and significant. In a comparison study of left- and right-handed medical students, the Dundee researchers found that right-handed individuals took less time to complete the ADEPT testing and successfully reduced their execution time averages compared to the results from the left-handed test subjects. The right-handed advantage persisted even with practice. Basically, right-handers were faster than left-handers. But practice did not make perfect: the effort rates remained constant, even though each task was repeated five times. The ADEPT team found the error rate to be a good way of predicting innate ability. If further testing bears this out, the ADEPT system could be used as a tool for selecting endoscopic and open surgery residents.

This is Mr. Jones' VR appendix

Virtual reality has indeed moved from its hype stage when it can now be used to practice a specific patient's required surgical procedure beforehand. Surgical procedures don't allow much room for error or for practice, but systems like those developed by HT Medical (formerly High Techsplanations; Rockville, Maryland; www.ht.com) and by Medical Media Systems (Interact Medical Technologies; West Lebanon, New Hampshire) are allowing surgeons and students to practice complicated operations on computer-generated virtual reality patients.

Over the last five years, technology has been developed that incorporates the physical/behavioral, visual, and tactile realism necessary for lifelike medical simulation. HT Medical's software allows for the creation of virtual tissues and organs that look and act like the real thing; they react to gravity, have inherent behaviors such as involuntary muscle contractions, bleed when cut - and the user can feel deformation with the operating instrument.

Now virtual reality technology holds tremendous promise for medical training because the caregiver can practice the procedure over and over again, until he or she reaches perfection without ever adversely affecting a patient. For a wide range of diagnostic and therapeutic procedures, doctors doing their first few to several dozen cases are much more likely to make a greater number of errors - the ubiquitous learning curve. To help ensure a base level of competency, a number of the medical specialty boards governing the quality of medical education in the U.S. are considering the use of virtual reality programs for certification.