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Touch Surgery Interview

10 October 2016

Interview feature

With competency vs time on the agenda for this year's conference, FST speaks to Touch Surgery’s Andre Chow about what the ground-breaking application means for both trainees and trainers

TouchSurgery main

What is Touch Surgery?
Essentially, it's a completely mobile-based platform that empowers and connects the global surgical community, allowing surgeons to learn and rehearse steps of an operation before picking up a scalpel. Because it's on a mobile platform, it’s very scalable – it has potential to reach every surgical trainee on the planet and they can carry it with them. Our ultimate aim is to improve the delivery of surgical care around the world.

When and how did Touch Surgery come into being?
My Co-Founder Jean Nehme and I were both surgical trainees in London and we started Touch Surgery about five years ago to address a need that we experienced every day. There are so many things getting in the way of surgical training, be it the increasing need for service provision, working time directives, and so on. But, essentially, surgical trainees worry that they're not getting into the operating room enough. When they do get access, they often find it difficult to make the most of the experience because there's not been enough preparation, formal training or assessment before that point.

What we planned to do with Touch Surgery was build a platform that could help ready surgeons for the operating room, and therefore help to improve patient safety and care. Looking through the literature, we found that there was a separation of surgical skill into technical and cognitive skills. Jean had just finished an MSc in surgical simulation and we realised that most training tools focus on technical aspects of surgery. So there wasn't a tool that focused on making sure that surgeons understood steps and procedures or complications.

Who is it aimed at?
Over the last 10 years, new areas of surgery have developed and consultants continue to improve their techniques and learn from their colleagues. Even the experienced surgeon needs to keep learning and improving to be the best for their patients. Depending upon what content we put on it, our platform can be applicable to the entire spectrum of surgeons.

What were the main challenges in starting up?
There were a lot of technical challenges associated with two surgeons doing the initial coding. Then there was the challenge of growing a team. From a personal point of view, the decision to leave clinical training and pursue this full-time was a big challenge.

Was there much competition when Touch Surgery launched?
There are a lot of surgical training tools and some of them are very good, but there aren't any major competitors that do exactly what we do. That’s partly because it's actually quite difficult to do. Building a product for the medical community takes a lot of medical input, and it sometimes takes people from within the profession to come out to build this sort of technology.

How has the team developed?
We like to call it our own multi-disciplinary team. We knew that the visual effects and the 3D models were very important so we recruited people who had worked at places like Pixar in California, people who've worked at major movie houses like Framestore and Double Negative. They had worked on well-known movies like Gravity, Avatar, Dark Knight and the Harry Potter series. We realised that we needed experts in gaming and interactions, so we hired mobile game developers, designers and graphic engineers.

How do you first build awareness for the product?
Initially we didn't spend anything on marketing, we just built a product, put it out there and let it spread by word-of-mouth. There are a few peer-reviewed articles that have been published which prove the validation of the platform from an academic perspective. More and more institutions, like the RCSEd, have taken an interest and endorsed the platform. For example, we already have a number of residency programmes in the US, including at Harvard and Johns Hopkins using our platform as part of their formalised training programme.

Will simulation remain something that people do in their own time?
There are institutions with absolutely brilliant facilities, but they are often only available to staff. Then there are hospitals that would like to have a sim centre but cost is a barrier. Very low fidelity simulators still cost thousands of pounds, and really expensive haptic feedback simulators cost hundreds of thousands of pounds. On top of that, a physical space is needed and staff to support that service – so it ends up being a very expensive endeavour.

What we found on visits to the US is that facilities can often be underutilised because people are expected to use them in their own time. Those who want to use the lab after they finish work might find that it’s closed in the evening. We wanted to provide a platform that people can use wherever they are; on the bus or train, at home, they'll still have access to that training.

Because it's on the mobile platform it doesn't limit who can access it, so if you're at Harvard, if you're at Imperial, if you're training in India or in China you could still access the programme. One of the aims of Touch Surgery is to connect that global surgical community around better training and education. We could have an impact on training in developing countries around the world. For example, we're currently working with Harvard’s Global Surgery Department on a digital training programme in Rwanda.

What happens if a user performs a procedure wrongly on the application?
One of the beauties of mobile technology is that we collect a huge amount of data; our system collects all of the interactions and decisions that users make whilst rehearsing a simulation. That data can be fed back to the training directors. For example, at Harvard the training programme director has access to a data dashboard that tracks the training progress of all of their residents. The director has an overview of how much people are practising, which particular simulations they're doing, their scores, learning curves, points of the procedure where they most commonly go wrong, and so on. It represents a new wave of data and can be a revelation to them.

How do trainees feel about their performance being monitored in that way?
With each of our simulations you can practise as many times as you want, you can fail as many times as you want. But the idea is that you'll get to a point where you have reached enough cognitive understanding of a procedure and then at that point your programme director will sign you off as being competent for that particular training milestone. It's not about being Big Brother, it's just about proving competence and proving learning.

Is there more that you'd like to do to develop the product?
The current public-facing product represents only about 5-10% of what we think we can achieve. People who visit our lab see some of the technologies that we're developing, but there's a huge amount that we can do in terms of not only our mobile platform, but virtual and augmented reality. Eventually we believe that we can take our technology back into the operating room and help surgeons at the point of care.

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