How virtual reality is turning surgical training upside-down

The field of orthopedics is highly complex and continually evolving, particularly as the fast and furious pace of new surgical devices and technologies accelerates.


The importance of highly effective, accessible tools and resources, in addition to exposure to hands-on surgical training, is critical.

“Amid the digital acceleration of healthcare transformation, we can no longer rely on the age-old mantra, ‘See one, do one, teach one,’ to train the next generation of surgeons,” said Dr. Cory Calendine, chief of orthopedic surgery at Williamson Medical Center and orthopedic surgeon and founder of the Bone and Joint Institute of Tennessee.

“Rather, we should implore them to ‘Do as many as possible,'” he continued. “In fact, the more practice a resident or attending surgeon can conduct, the more proficient they will become.”

With the aggressive pace of new devices, technologies and techniques, it becomes ever more important to track and measure performance metrics. These shortfalls in proficiency can come with real consequences for patients, surgeons and their healthcare institutions.

“Training should never stop for a surgeon, and we need better methods,” Calendine said. “While fellowship programs remain an option for additional training, numerous studies highlight an opportunity to develop a better system of training.

“Further, recent changes by the ACGME, as a result of the COVID-19 pandemic, have imposed restricted scrub hours, severely limiting resident and fellow exposure to patients, mentors and procedures,” he continued.

The correlation between surgical volume and performance to patient outcomes is undeniable. A recent study by the University of Michigan found that 30% of surgeons could not operate independently after residency.

“A 2019 study conducted by UCLA’s David Geffen School of Medicine found that the surgical performance using Osso VR’s platform improved surgical performance by 230%.”

Dr. Cory Calendine, Bone and Joint Institute of Tennessee

“Prevention of surgical errors requires the attention of all personnel involved in the patient’s care, including the institutions tasked with developing a vibrant learning environment for resident education, training and research,” Calendine noted.


Calendine was introduced to vendor Osso’s virtual reality technology through its partnership with Stryker. He immediately was drawn to the technology.

“Beyond the cool factor, I was really taken aback by what a robust type of training VR is,” he recalled. “Not only can I teach residents the steps, but they can practice on their own, as many times as they want – without any risk to patients.

“Further, the platform can measure and score performance and proficiency at any level of training, which is incredibly valuable because it allows myself and other faculty members to objectively define how well we’re raising the next generation of surgeons,” he continued.

Traditionally, surgical training, whether one is a resident or fellow learning the ropes or are an experienced surgeon training on a new device, requires immense logistical planning and then traveling to a one- or two-day workshop.

“For many surgeons, it can be six to eight months before you utilize that one-time training to perform that procedure, device or technique on a patient,” Calendine explained. “Surgery is high stakes, and VR has the extraordinary ability to deliver the latest and greatest in surgical innovation to any seasoned or aspiring surgeon with a headset, anywhere in the world.

“Headsets have come down tremendously in price, so if you calculate the airfare, hotel and shipment of devices or hardware, VR is a cost-effective means to give surgeons of all skill levels the most innovative, up-to-date training at scale,” he added.


Calendine has spent more than eight years practicing and training in robotics. And traditionally, that education was performed in person on categoric specimens. Over the years, he traveled all over the world, training a variety of surgeons, from residents and fellows to attending and private practice, all on a cadaver from ground zero.

“Typical training scenarios involve a surgeon traveling to a one-to-two day training workshop,” Calendine explained. “In some situations, surgeons are asked to complete a one- or two-day workshop for a new surgical device, and then months later be expected to execute that procedure confidently.

“Offsite training is not only costly and time-consuming but lacks opportunity for the surgeon to continue to practice,” he added. “It could be six months before the surgeon actually utilizes that device during a procedure.”

Industry numbers estimate that a surgeon needs to perform at least 75 cases to achieve optimal proficiency, he said. Further complicating the issue is the lack of any objective assessment tool for surgical proficiency, so a surgeon and their team never really know when they are ready, he added.

“With the right VR platform, headset and controllers, residents can learn and practice specific procedures outside of the operating room, even in the comfort of their own homes,” he noted. “These lifelike simulations can be reset and repeated without consequence, and dramatically improve procedural competence and confidence, directly translating to better clinical outcomes and overall patient care.

“VR’s level of genuineness gives users a truly authentic experience that you see and feel immediately,” he continued. “It’s wildly impressive.”


Multiple studies have shown that VR is not only equitable to physical simulation, but also superior to traditional methods of medical education, Calendine said.

“A 2019 study conducted by UCLA’s David Geffen School of Medicine found that the surgical performance using Osso VR’s platform improved surgical performance by 230%,” he noted.

“Subsequent findings by researchers at the University of Illinois College of Medicine at Chicago – which conducted a randomized, blinded validation study using the Osso VR platform – found that use of virtual reality for surgical training significantly increased procedural accuracy and completion rate, which more than tripled the odds of completing a procedure successfully and demonstrated a 300% improvement in accuracy when residents trained in the Osso VR module.”

This and other studies demonstrate the undeniable advantage VR has to significantly improve surgical performance and outcomes across the board, he added.


“My vision for VR is that we integrate it into all academic and private practice training programs,” Calendine stated. “Virtual reality is going to play a major role in medical education moving forward, and I would highly advise early integration of VR systems into resident and provider training programs.

“Just as EHRs – for better or worse – have revolutionized the paper chart, virtual reality will become a valuable, standardized and required tool in medical education and training,” he said. “Everything from integrating VR into residency program curriculums to learn, repeat and practice surgical proficiency, to introducing new techniques and instruments during virtual conferences.”

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