‘Cost-effective, scalable and high-quality’: optimising XR’s potential in medical education

Joe Varrasso is regional director of strategic alliances for apoQlar Medical, founder and CEO of XR consultancy Kiedimi, and founding member of HoloMedicine Association. Following publication of our XR paper, he explains how XR tech can address the skills shortage by training a new generation of highly competent health care practitioners.

17th June 2024 about a 7 minute read

Q: What do you perceive as the greatest challenge in this space that we need to overcome? 

A: I think there are a few challenges. There are a lot of use cases that are almost becoming mainstream, but it’s still early adoption for many. So we need to improve the awareness and the evidence that it’s no longer a gimmick – it’s a tool that can be used today.

Related to that is sharing that evidence of best practice, and one of the challenges is the resistance of existing educators in adopting the technology.
Apart from that, specific to the NHS, information governance is a challenge, and one of the reasons is that it’s not harmonised, so there’s a bit of a barrier for startups.

There is a proliferation of point solutions at the moment as well. There are a lot of solutions that meet a particular need and won’t necessarily scale.
The greatest challenge is understanding where to invest the dollars and how to scale adoption.


Q: What are the most fruitful opportunities that could have the greatest impact? 

A: I think the power of XR is the ability to create cost-effective, scalable, standardised, high-quality training experiences. The opportunities are in places where there are limited resources. For example, cadaveric labs are very expensive to run, they can be a biohazard and it’s difficult to get access. As we open up more medical schools, there is pressure on that resource, and the same goes for hands-on simulation labs. One of the most fruitful opportunities is to increase access to high-quality learning that’s scalable. It’s the next best thing to actually having hands-on learning, and in some ways better, because you’ve improved the access in a safe, repeatable environment.

And you can do that in a self-directed way – you don’t have to access a lab. You can do it at home with an immersive headset, but you can also do it in a collaborative way with your peers, and a guest tutor might join from the other side of the world and deliver high-quality content as well.

The roadmap for the platform that apoQlar Medical are building also includes the ability to stream content from the hospital. One of the biggest challenges is access to hospitals: how do you provide those high-quality experiences if you can’t get into the hospital to see them? And if you get into the hospital, you’re 10 deep in terms of students and seeing the action. One way to do that is to be able to stream the surgery or the ward into a virtual space so you can safely participate and observe, as well as combine it with the medical data and the livestream of first-person view.

So that’s the kind of platform that will help improve access, not only for students, but to connect trainees in hospitals everywhere to be able to observe the latest procedure wherever it’s taking place.


Q: What does good look like and how do you measure impact? 

A: I think the NHS is going some way towards setting up some frameworks and standards, but information governance being harmonised across the board would be useful. I think good will look like a centre of excellence to aggregate all those best practices to share. One way that I’ve played a small part in this is helping found an independent association called the HoloMedicine Association, which is potentially a platform that could help consolidate and share and proliferate use cases and best practice in this environment.

I think what is also good is distributed content creation – the ability to give the tools to the educators to create this content and not rely on point solutions and custom solutions. One thing I’d love to see is that all healthcare institutions actually appoint an XR lead, someone who can really coordinate between the educators and the industry, and be able to facilitate what’s needed, because there are quite a few moving parts.

In the UK we have a skills shortage – we lost 40,000 nurses last year, so in terms of impact, can we train the new generation quickly to reduce the gap in terms of resources that we need to onboard? I think that that’s one level of impact. Can we do it more cost-effectively? is another level.  Can we produce better-qualified students because they have more time to actually practise?  You don’t go and fly a plane straightaway, you get in a simulator. You don’t necessarily need to get into a high-end simulator these days, you can use immersive tools and practise flying. So giving those tools as early as possible to students, and then trainee surgeons and nurses, to be able to practise in a safe environment, should hopefully turn out better and more competent and confident practitioners.


Q: What is the most innovative application of extended reality technology in healthcare education you have come across? 

There’s a number I’ve come across. I ran the ecosystem of partners for HoloLens, for Microsoft, for some time, so I came across quite a few use cases in this space – everything from patient simulation scenarios to procedural learning using mixed reality to allow nurses to practise step by step. My favourite is probably the ability to take complex medical data, CT scans, MRI scans, and convert those to interactive 3D models that you can visualise of the anatomy.

apoQlar Medical who I’m working with closely has a medical-certified platform that allows you to do that automatically and stream that to your device and allow everyone, from anatomy undergraduates through to practising surgeons, to visualise and plan surgical procedures using a 3D representation of the complex anatomy. Another area that’s quite innovative is the role of AI. Increasingly AI is used to automatically segment this medical image information, so you can see the structures in 3D relative to each other – the tumour, the veins, the nerves – and be able to better visualise and plan surgery. And there’s also the use of AI and large language models for simulating clinical reasoning, so being able to practise having a difficult conversation with patients, whether it be mental health or palliative care.

I think we’re going to see the emergence of this technology also for practising in triage scenarios, by simulating a patient. To do that now requires an investment in time in terms of paying actors or getting volunteers to role-play, and that is not a scalable solution. It’s not standardised and it’s not cost-effective, so I can see the role all the way through to AI tutors as well. So anatomy students might have a self-directed experience in a virtual anatomy lab and ask the AI avatar questions about what they’re seeing. And that could extend to medical equipment training or procedural training.


Q:  How does your role and organisation fit into the bigger picture of large-scale adoption?

I have an XR advisory business. My company advises partners and customers on how to adopt this technology and what use cases make sense and what devices make sense and what platforms are available.

But one in particular that I’m working with, apoQlar Medical, has a platform for education that allows you to scale indefinitely because it’s a cloud-based system.
I think organisations that have a platform, that have tools for content creators, will help us scale quickly because you can rapidly innovate on a cloud-based platform, and having creator tools available will allow distributed content creation. So you can very quickly then develop a body of learning content faster than you would be able to if you’re dependent on one company.


Read associated blogs or download the XR in Healthcare Education paper by clicking here.

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