The 4th Industrial Revolution has enabled the Second Surgical Renaissance to be harnessed for a once in a century opportunity.
NextGenSurgery The IoSxT
The Evolution all Simulation Platforms Require for the XR-OR Moment
#Human Factors #Critical Moments #Data Science #Neurotecnology #BCI #IoSxT #Technical Sills #Power Skills #Robotics #Haptics #IamASurgeon
The WHO estimates three million patients suffer a major preventable surgical complication every year, 500,000 of which die within the immediate peri-operative period. Similarly, in developed countries the cost of treating preventable harm amounts to $606 billion USD/year.
The complex problem of patient safety needs innovative solutions.
Considerable advances in medical and surgical technology have been made over the past four decades, yet patients continue to be unintentionally harmed at unacceptable rates. Even the most advanced interventions are relatively simple compared to keeping people safe while executing these techniques
Surgical education primarily focuses on skill acquisition and execution leading to automaticity, mastery, excellence, and operative autonomy. While technical expertise is a critical skill in surgery, it represents only one aspect of performance. Self-regulation, awareness, and control of the body as well as cognition and emotion are the harder requisite skills to develop but have never been part of the surgical curriculum.
Stressors in the OR are inevitable and affect both technical and non-technical skills.
Greater than 40% of surgical residents report having seen a significant complication resulting from the primary surgeon’s inability to manage their stress or self-regulate, which is individual, most surgeons have never received training in how to best cope with all the demands required to perform in high acuity situations. In other domains where delivering under pressure matters, the world’s top performers can control their physiological and psychological state to maximize their performance during stressful moments and return their physiological indicators to baseline levels after the stressor has ended. These are not soft skills as defined but the “Power Skills” needed when moving from moment-to-moment to critical moment, where bio behavioral control while shifting attention between open and closed awareness, taking in information, processing it, and making critical decisions while still performing technically so the operation flows but is never rushed, these are the integrated neural signatures of expertise. The importance of the non-technical human factors has become a major focus in education over the last decade due to their direct role in preventable harm. Validated assessment tools and practice range from cognitive training, serious gaming for surgeons and other forms of individual/team simulation with 360 debriefs to the novel use of Intraoperative Artificial Intelligence (AI) for decision support have all been used with varying success. However, these are subjective and based on self-perception and self-reporting which is often discordant to what is happening in the mind and body.
We believe that assessing an individual’s psychophysiological response to a stressor with neurotechnology, biometric data capture and non-invasive brain computer interfaces (BCI) allows for assessment and training using objective metrics (The IoSxT) to provide constructive evaluations. Digital precision performance assessments and training are critical as without EEG neurophysiological feedback we do not know the state of the brain when performing well or poorly, and therefore we have no way of knowing if in fact any training is occurring. Multimodal programs are designed with purpose built neurotechnology that fit underneath hardware agnostic XR HMDs. Training combining neurofeedback, biofeedback, advanced performance psychology with objective metrics based on traditional brainwave speeds (bands/bins) and their associated cognitive and affective psychophysiologic processes and body inputs can then be trained for bio behavioral moment to moment interactions on every level between surgeon, nurse and anaesthetist to be fully present for the patient.
We refer to this as Integrated Mental Training (NGSx~IMT™) for enhancing the “Power Skills” of attentional focus, distraction control, situational awareness, decision making, communication, teamwork and leadership to develop elite performance in a stress resilient surgeon. By applying validated objective performance metrics, we are creating a new standard in education and new performance market where an individual has a precision program targeting their specific strengths and weaknesses for a wider range of adaptability to foster resilience.
This is “Surgeon Training 3.0” which will elevate existing surgical education and technical skills training with the addition of NGSx~IMT™ mind-body integration and tuning to develop elite performance in stress resilient surgeons and teams. Using a neurocognitive approach across all immersive/interactive environments from XR (VR AR MR), mannequin+/-AR/AI overlay, box trainers+/-AR/AI, cognitive, metacognitive and motor imagery tuning. A further critical aspect is the integration of our new physics engines (see separate description) to create the exactitude of the robotic haptic feedback to the real world. (a world first)
Training is aimed at developing seamless transfer of skills, the area where most platforms fall short, for self-regulation and adaptability between modalities/environments at every level of difficulty for experiential dependant neuroplasticity. Embodiment and Exactitude need to provide the hyperrealism and richness at the immersive level necessary to foster the XR~OR moment, rapidly equilibrate, with a calmness of mind and the confidence to perform. The objective for the new curriculum is be accreditation at the Royal College of Physicians and Surgeons of Canada as mandatory resident training to run simultaneous and complimentary to the first two years of residency in Foundations of Surgery for technical and non technical skill following the Competence By Design (CBD) criteria for Competencies, Experiences, and Entrustable Professional Activities (EPA’s). This occurs in the already present 3-month blocks (on/off) so an individual will train with neurotechnology /bci feedback 6 months/yr. with IoSxT in a staggered rotation. Mental performance training is maintained by using the tool/skills learned using feedback by continuing a 3-4d/wk. program. In years 3-5, Core of Specialty, the focus will shift to procedural based environments using XR simulation and traditional simulation for training the Human Factor requisites leading to stress resiliency for the Critical Moments inherent in every procedure that impact patient safety and surgical outcomes by decreasing the known lapses implicated in causing preventable harm.