The document discusses the development of an augmented reality app for surgical skills training. The app uses motion tracking markers on mock instruments to simulate technical skills for procedures like shoulder arthroscopy. It provides an affordable and accessible alternative to current simulators, which require specialized hardware and software. The app demonstrates how trainees can practice implant positioning for different procedures and anatomies. It represents a stage 2 low-fidelity simulation resource as part of a 4 step model for surgical skills acquisition. Studies will evaluate its validity and impact on trainee learning.

1. “Using Augmented Reality to train surgeons to Operate More Skilfully”
Maulik J. Gandhi, W. Angus Wallace
When carrying out an arthroplasty, implant positioning is crucial. Understanding and
implanting a prosthesis with the correct version, inclination and rotation in varied anatomy is
challenging. “Simulation”, “deliberate practice”, “rehearsal” have all been used to describe
safe acquisition and practice of skills and is used to progress the trainee through their
learning curve before patient contact. Operative skills simulation has remained a challenge
because of current methods of motion tracking requiring specialised hardware and
sophisticated software. The resultant resource or simulator becomes cost prohibitive and not
widely accessible to the trainees who would most benefit from using it.
Although hardware costs have decreased, current technical skills simulators have remained
largely confined to enthusiasts, academics and the privileged. We have concentrated our
development on making a resource that is not cost prohibitive and is widely accessible. We
have developed and present the 1st
use of an augmented reality app that motion track
markers placed on mock instruments. It can run on smartphones or tablets and is not
location dependent, meaning it can be used by surgeons and trainees all over the world. Our
1st
app demonstrates how it can be used to simulate technical skills required for shoulder
arthroscopy. This technology can be modified both for anatomy and the technical skills being
taught.
Our technology can demonstrate and simulate the position of implants with their prosthesis
holders, thereby providing muscle training and memory to the trainee. This skill can be
taught for any laterality, joint, deformity or implant.
We see simulation training as a resource to enhance the trainer-trainee relationship. Our 4
steps to skills acquisition are:
Stage 1: understanding of anatomy, equipment, and skills required;
Stage 2: practice on low fidelity simulators (our app, synthetic models);
Stage 3: practice on high fidelity simulators (cadavers, Virtual Reality);
Stage 4: assessment on performance intra-operatively.
This unique app is an example of a stage 2 simulation resource. Studies are being
commenced looking at its validity for specific skills training, trainee engagement and
knowledge acquisition. An affordable and widely accessible resource that every surgeon or
trainee in the world has access to will help progress the individual faster through their
learning curve, and this has global implications for patient safety, training and theatre
efficiency.