Although the terms are sometimes deployed interchangeably in a healthcare setting, augmented reality, virtual reality, the metaverse and extended reality refer to different ways of interacting with a digital environment. Augmented reality layers information onto what a user sees in real life—such as a car displaying speed and navigation on the windshield, so the driver doesn’t have to look elsewhere. Virtual reality conveys a completely different set of visuals, usually requiring goggles ranging from less than $10 for a piece of cardboard that holds a user’s phone to upward of $5,000 for more immersive set-ups. While the metaverse has been defined several ways since its creation in the early 1990s, its latest iteration, popularized by the company formerly known as Facebook, involves a 3-D social platform where users can interact with each other’s avatars. And extended reality is an umbrella term to describe any or all of the above concepts.
Curiosity about the use of technology to access a digital world is growing in the medical field. The number of studies and research articles mentioning virtual reality on PubMed, a biomedical literature database maintained by the National Center for Biotechnology Information, has increased each year over the past decade. In the first two weeks of 2023, the topic was mentioned more than 150 times.
Some leaders believe the technology has the potential to change care delivery. A report from Accenture last year found nearly half of executives from payer and health provider organizations believed digitally enhanced interactions would have a “breakthrough” or “transformational” impact on their systems.
“It’s important to start thinking about this, if you haven’t already,” said Rich Birhanzel, senior managing director and global health lead at Accenture.
Health systems have begun to use virtual reality to supplement education for new doctors. Five years ago, the Hospital for Special Surgery found it was dedicating significant staff time to training residents on the fundamentals of surgical procedures that could be learned just as easily outside of the operating room.
Leaders at the organization’s education institute proposed seeking an alternative. Dr. Michael Ast, chief medical innovation officer and an associate professor of orthopedic surgery at the academic health system, helped create a virtual reality training program for orthopedic surgery residents to complete before entering the operating room. By wearing goggles, residents at the main campus in New York City simulate several procedures they’re likely to perform during a surgery.
Ast said the virtual programs have helped residents make better use of their training time. While the organization doesn’t evaluate residents based on their performance in the modules, it is gathering data to potentially set eventual benchmarks.
“We ask our residents to go through the basic surgical procedures for each of those subspecialties—fracture, joint replacement, hand and pediatrics—right as they start the rotation,” Ast said. “Go through it 10, 20, [or] 50 times, whatever fits within their schedule.”
The training “allows them to get a lot more out of the rotation, since they really come in at a very different level of experience,” Ast said.
The hospital worked with Osso VR, a virtual reality surgical training and assessment platform, to help create the clinical training software. Ast said the level of vendor involvement enabled the program to grow over the past five years from a small number of modules to its campus-wide expansion.
“I think that’s just the way innovation is done,” he said.
Some older surgeons were initially skeptical, but Ast hasn’t encountered much pushback once they enter the virtual operating room and see the technology firsthand. He said finding clinical employees to work with technology officers and push for adoption internally is vital to integrating virtual reality in any health system.
“You want to find the person within your system who believes in it—who wants to put some time into understanding and developing how you’re going to implement it,” Ast said. “You want to find your champion.”
Dr. Justin Barad, Osso VR co-founder and CEO, said he presents the technology to healthcare organizations as a way to augment, rather than replace, training. Osso VR provided the platform and equipment for free, but the Hospital for Special Surgery has devoted what Ast characterized as significant staff time to developing and maintaining the program. The leaders are considering co-developing a training initiative for use at other orthopedic hospitals.
“This is going to take a little time to be implemented [in other health systems], but ultimately, I see this as eventually the standard of care for the training of orthopedic residents,” Ast said.
