“Sometimes someone’s like, ‘Hey Justin, we need you for this training experience,’ So I’ll pull over on the side of the road, I’ll put a headset on my head, and jump into a virtual operating room with other people,” says Justin Barad, MD, CEO and cofounder of Osso VR. “And now we’re doing all of those things without needing anything but a headset. Like I said, you have the instruments there, you have the other people there, you have the patient, and you could run through it again and again.”

Osso VR is a virtual reality platform designed to train surgeons with simulated patients and operating rooms. It works using the cloud, so rather than requiring each hospital to purchase the equipment to run the software, students can train with just a headset, from anywhere in the world. 

A competitor in the space, Level Ex, also offers cloud-based training alongside its library of video game apps students can play from their phones. 

“Doctors will play the cases over and over again, because they’re fun and intriguing and it gives them an opportunity to try out a new device in a low-pressure environment on a virtual patient, really to play with it,” says Sam Glassenberg, founder and CEO of Level Ex.

Peek into a classroom where these technologies are being used and you might feel you’ve caught students at play. In reality, they’re learning better and faster than their predecessors, all thanks to the cloud. 

“Doctors are very, very short on time, so to be able to click a link and suddenly we’re doing surgery together is a huge benefit from an educational standpoint,” Glassenberg said. 

How gaming can help doctors

As a video game developer, Sam Glassenberg was the black sheep of his family. When his doctor father asked him to put his skills to use actually helping medical professionals, Glassenberg did it as a way to appease the man who had for years urged him to join the same field. The result was an easy-to-use app students in his father’s class could use to simulate fiber optic intubation, a rarely used but tricky procedure anesthesiologists sometimes face. 

It took a few weekends, but Glassenberg produced a practical app that pleased his father. Two years later, Glassenberg’s dad asked him to check on the download stats. Glassenberg was blown away. What had started as a way to make his dad happy had garnered more than 100,000 downloads from medical professionals around the world claiming the app had helped them. 

“So I googled, and I discovered, unbeknownst to me, they’ve been doing efficacy studies on this crappy game I made for my father at institutions all over the world that shows it’s drastically improving physician performance,” Glassenberg said. “So that was the motivation for starting.”

Glassenberg is now the CEO and founder of Level Ex, which makes games for doctors. About 3 million people play their games and 800,000 medical professionals are earning continuing medical education credit while they “cut and cauterize on diagnosing and treating virtual patients.” Game titles include Top Derm, Cardio Ex, Airway Ex, Gastro Ex, and Pulm Ex. The company developed three COVID-19 games during the pandemic to help experts navigate diagnoses, cardiac problems, and airway problems associated with the virus. 

More importantly, Glassenberg’s father is proud of him. 

“He’s happy,” he said. 

Of course, gaming is really just a fun marketing spin on what is true, interactive training that doesn’t require the use of cadavers. What this style of training does is eliminate the need for physical spaces, expensive equipment, and dead bodies. It also ensures that doctors can learn from anywhere, regardless of the kinds of resources to which they have access. 

Medical professionals know that the only way to get good at these procedures is to practice, but even the best technology today has limits for how many times you can use it to replicate the same activity. Virtual reality and video games let you hit replay a million times. And it’s through that repetition that students learn. 

Barad said the problem is threefold. First, there is too much for doctors to learn these days. 

“We’ve gone from French Laundry to Cheesecake Factory,” he said, citing the chain restaurant’s massive menu. 

Second, modern-day surgery techniques are harder to learn than the old-school versions. 

“A traditional surgical procedure takes 10 to 20 cases to learn, meaning you have to do the surgery typically 10 to 20 times until you reach a basic level of proficiency,” he said. “Modern procedures like robotics, invasive surgery, it’s more like 50 to 100 times, so it’s like 10 times harder to learn.”

Finally, there’s not a great way to assess a surgeon’s skills to know whether they’ve picked them up. 

The platforms make their money by offering their services to universities and hospitals, but they also make money by designing tutorials and games for medical device companies and drug manufacturers trying to sell their wares. 

Barad says immersive, repeatable training helps students pick things up quickly, and studies show that students who train on Osso VR do better in tests than others, according to a handful of studies. 

One study research from UCLA’s David Geffen School of Medicine showed that Osso VR training “improved surgical performance by 230%” compared with traditional training methods. Another 2022 study showed that Osso VR students could complete tasks eight minutes faster than other students with fewer corrections. 

Barad says the training makes even practiced doctors more confident about adopting new devices and procedures that are often cutting-edge, but difficult to become proficient in, giving the learning curve. 

“It’s really stifling the adoption of these newer, higher-value technologies which are better for patients and everybody because of these learning curves,” he says. 

Osso VR can develop a presentation to sell these devices and a training module doctors can use to get comfortable with it before using it on a real patient. That’s good news for medical device companies that might otherwise have a hard time selling their products. The World Health Organization estimates that there are about 2 million different kinds of medical devices on the market, across 7,000 categories. 

Level Ex does the same and also offers this technology to drug manufacturers. Those demonstrations let users click around dragging molecules to trigger chemical reactions and watch how the drugs work in the body. Glassenberg said during a test of the technology, the sales team that used the platform saw a 6% lift in sales and a 65% increase in conversions. 

“This technology really does move the needle for these companies,” Glassenberg said.

The platforms work as you might expect, with hyperrealistic 3D computer graphics of various parts of the human body in a surgery room setting complete with other “players” or doctors in the virtual world wearing scrubs. Prompts guide you through the use of various tools and drugs. It looks and feels like a video game because it is. 

Barad said one survey showed students found the platform fun and easy to use. Barad believes Osso VR should be educational, realistic and usable. With a team of practicing clinicians, designers, and educational artists, as well as experts on video games and special effects, the staff “rivals what you might find at Disney.”

How the cloud makes it possible

It used to be you needed a hundred CDs to play your favorite PlayStation games. Consoles like XBox now allow you to access those titles from the cloud. It’s more affordable, it requires less equipment, and it gives you access to a massive library of content. The same is true for medical training on these platforms. 

“The cloud is making a huge difference, both in terms of allowing people to get together physically and not needing physical objects to be able to train,” Barad said.

During a demonstration of the Level Ex platform, Glassenberg shares links with trainees who can begin training within seconds. All you need a solid internet connection. 

“There’s no download, there’s no plug-in; you just click a link or snap a QR code and boom, you’re doing surgery,” Glassenberg says. 

The cloud has simplified how medical device and pharma companies sell their products with these high-end, interactive demonstrations and training sessions. But when it comes to doctors in the field, the technology has the potential to replace entire buildings and facilities. 

Another contender in the space is HoloLens by Microsoft. The technology helps doctors to treat real patients using holograms and a headset. It’s a type of mixed reality that also has a training component for students and doctors learning new procedures, techniques, and medicines. The technology is currently being used by professors at Case Western Reserve University among others. HoloLens offers a way for students to learn through a digital and cloud-based program, without tons of expensive equipment.

Professor Mark Griswold has been using HoloLens for more than seven years. When Case announced it was going to build a new campus in conjunction with the Cleveland Clinic in 2014, they were looking for a way to teach human anatomy digitally in order to avoid having to build a new cadaver lab at the building. 

“We had tried several technologies, like touchscreens and VR, but none of them really worked, especially at the scale of our institutions,” Professor Griswold said. “In late 2014 we had the opportunity to see HoloLens before it was public and we instantly knew it was going to change our world.”

The proof is in the pudding

Gaming is fun, yes, and this training method might be popular, but does it work? Studies provided by both Level Ex and Osso VR say it does. 

Physicians who played Pulm Ex felt more confident doing real world procedures because they were better able to recognize anatomical and pathological structures endoscopically and felt they had retained the materially better. 

Those using Airway Ex performed better in terms of accuracy, skill, and speed when demonstrating their skills on mannequins.

Barad works as an orthopedic surgeon and says part of the training process for doctors relies on the trust you establish with those who are training. Typically, he won’t let a surgeon take the lead in the operating room until he’s seen them demonstrate their skills time and time again. With training tools like Osso VR, the process happens more quickly. 

“First they’re working out the learning curve themselves, and second, they’re demonstrating proficiency so I feel comfortable giving them the knife sooner,” Barad said. 

And Professor Griswold says his students are learning all the same material but at a faster pace with HoloLens. 

“We’ve done multiple studies to show how well students perform using HoloAnatomy as compared to conventional cadaver-based dissection,” he said. “Our results show that students are learning to the same level but about twice as fast. One of our recent studies also showed that students scored 44% better on long-term retention after learning with HoloAnatomy as compared to those who just learned in a cadaver lab. So in the end, the data shows that our students are learning faster and retaining knowledge better. This is a teacher’s dream.”