Dr. Rafael Grossmann, trauma surgeon and medical futurist, and Dr. David Abbasi, board certified orthopedic sports medicine surgeon and MMA/UFC ringside physician, discuss surgical training trends with a focus on orthopedics. Hear their perspectives on emerging medical device technologies and ways that medical device companies can partner with surgeons to improve patient outcomes.
“One thing that's exciting about technologies like Level Ex is that if there were any areas that surgical trainees didn't get the full experience in, there may be opportunities to supplement it from a virtual standpoint, or at least compare case logs and see, ‘I've done a good amount of tibia nails, but I haven't done a lot of total knee replacements.’ That may be a good opportunity to supplement those lower numbers with a virtual platform. That's where Level Ex has an opportunity to help allow that type of supplementation so we can be training the best surgeons possible.”
—David Abbasi, MD, board certified orthopedic sports medicine surgeon and MMA/UFC ringside physician
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Melyssa Nocar: Hello, and welcome to our market trends discussion, powered by Virtual Technique Guides™, a Level Ex solution that allows sales teams and medical device companies to train surgeons located anywhere in the world, replicating any type of medical device, surgical procedure, patient type, or surgical complication. My name is Melyssa Nocar, Senior Vice President, Marketing at Level Ex. Today, I am thrilled to be joined by two incredible physician thought leaders, Dr. Rafael Grossmann, trauma surgeon and medical futurist, and Dr. David Abbasi, board certified orthopedic sports medicine surgeon—and might I add, pro MMA/UFC ringside physician. Should make for an exciting discussion all around today. We will cover trends surrounding surgical training and emerging medical device technologies with a focus on orthopedics, as well as ways that medical device companies can partner with surgeons to improve patient outcomes.
To start, let's dive into the state of the market: The pandemic impacted the global orthopedic market significantly, both with elective procedure cancelations and surgical restrictions,1 as well as with surgical training.2 How did you see medical device companies successfully pivot in the last year, especially as it relates to surgical training? What trends will we be taking with us as we look to the future?
Dr. Grossmann: [00:01:30] Thank you. It's great to be here, Melyssa, and it's great to join you in this great endeavor. As you said, the last year and a half has been really difficult in many ways. With respect to teaching and learning, that has been especially impacted. One of the ways that we have overcome the difficulties has been by using technology, digital health, and digital transformation in learning and teaching in healthcare. I've seen a lot of people implementing techniques and platforms—incredible platforms like Level Ex—in order to facilitate how we do this. It's been refreshing to see how people have been embracing these technologies in order to be able to allow the transmission of knowledge to happen despite all the difficulties.
Dr. Abbasi: [00:02:43] Yeah, a difference that I saw, especially with the pandemic. Many times the ways that orthopedic surgeons get our education would be through annual meetings, such as the AAOS meetings. It's a chance for us to go and learn. Those opportunities were not present during the pandemic. One thing that I noticed—a lot of medical device companies stepped up their social media game on LinkedIn or Instagram. I noticed more content production by companies such as Arthrex, where they would start to show their technologies and technique guides for certain types of surgery. I thought that was a nice way to pivot in terms of the difficulty in finding a new way to distribute what they have available to surgeons and therefore patients. I enjoyed being able to devour content on platforms like Instagram. That was another way for them to distribute what they have available.
Melyssa Nocar: [00:03:50] Most definitely. I couldn't agree more personally and professionally. For me, there were many pivots in content marketing that are here to stay and certainly applicable to how healthcare stakeholders reach and engage with each other.
Despite the challenges brought on by the pandemic, some product categories showed resilience, such as enabling technology and robotic navigation system placements.3 In fact, robotic guidance or navigation is predicted by some to become a standard of care.4 With the breadth and volume of developments in med device, especially in orthopedics—planning software, 3-D bioprinting, AR, smart implants, AI-driven 3-D modeling,5 and the list goes on—which of these areas are you most excited about from a provider perspective as well as from a patient outcomes perspective and why?
Dr. Abbasi: [00:04:57] Especially in the field of orthopedic surgery, what is exciting is that we have developed more patient-specific techniques in terms of planning out surgery specifically and implants that are unique to the patient's own anatomy. For example, we have technologies, such as patient-specific CT scans or other types of imaging where patients will go and get a CT scan that aligns with the medical device company, and therefore we can 3-D print or have specific implants, for example, in the total knee, total hip, or total shoulder replacement space. We can fine tune these surgeries specific to each patient's own anatomy, and therefore we think this is going to decrease complications and have better outcomes.
Dr. Grossmann: [00:05:50] I agree with Dr. Abbasi. For me, one of the most exciting fields is artificial intelligence (AI), or augmented intelligence. Machine learning and computer vision, computer recognition of voice and imaging, the power of analyzing vital signs remotely, analyzing visual fields intraoperatively, that is going to have a tremendous impact on how we teach and how we operate. The advancements that we've had in regards to facial recognition computer vision in endoscopic or laparoscopic, minimally invasive robotic surgery—there's a growing field of knowledge out there that is going to become somewhat of a guide for surgeons and for young or learning surgeons. That is going to be the standard of care within a very few years. Performance improvement, based on this database of a blended or artificially intelligent algorithm, is going to be phenomenal, where you can be operating, and there was a critical part of the operation, and you might have a warning system to alert you and make you think twice about you cutting a certain structure or drilling. That is exciting. And again, 3-D printing and customized, instantaneous printing of tools and/or structures, or devices is going to be the new thing now that is going to be standard pretty soon.
Melyssa Nocar: [00:07:45] Yes, so many exciting developments on the horizon that have quite the learning curve, which is the perfect segue to discuss remote learning opportunities.
You've both experienced Level Ex Virtual Technique Guides. To our viewers, Level Ex has leveraged cloud gaming tech to enable surgeons and sales teams of medical device companies to practice high-fidelity virtual procedures over web conferencing, also to help surgeons independently refresh on medical procedures online at their convenience. I have a couple thoughts I'd like to explore specific to your individual experiences here. Dr. Abbasi, we'll start with you. You've seen some wild injuries from the ringside. What is the craziest scenario you'd like to see featured on the platform?
Dr. Abbasi: [00:08:35] In terms of the UFC and MMA world, Conor McGregor, the sport's biggest star, had very severe long bone fractures of his leg, tibia fractures and fibula fractures. We know that he's had a rod placed in his tibia. He had plates and screws placed on his fibula. Those are very common orthopedic procedures. Some examples that we could replicate from a virtual standpoint—we could incorporate, “How do we nail long bones of the tibia, of the femur?” or “How do we do very basic fracture care in terms of plates and screws?” Then as a sports medicine guy, I would love to see that get into sports medicine in terms of arthroscopic surgery: arthroscopic knee, arthroscopic elbow, arthroscopic shoulder. There's opportunities to replicate those types of surgeries from a learning standpoint in the virtual space.
Dr. Grossmann, from a trauma perspective, what class of procedures would benefit the most from a platform like Virtual Technique Guides?
Dr. Grossmann: [00:09:45] For me, it's about using the available technology in a smart way in order to improve how we communicate and connect. If I think about general and trauma surgery, which is what I do, and about the fact that five billion people in the world don't have access to safe or affordable surgery, for example—just that fact is such an impactful thing to think about. Any sort of common surgical procedure that we see as “basic” in many parts of the world is not basic. If we go even beyond surgery, the healthcare team is not just physicians and surgeons, it's nurses, physician assistants, nurse practitioners, paramedics, EMTs—there’s a whole community of people that make healthcare happen. In many parts of the world, it’s not even surgeons who do surgery. Anything that is basic and procedural has incredible potential to be the perfect target for a platform like Level Ex’s: simplifying things like putting in an IV, setting up a pump, setting up a basic lifesaving device in the ICU or in the field; doing a thoracentesis, thoracostomy, or cricothyroidotomy; or things that are lifesaving or basic. That would be game changing because you can narrow it to a specific subspecialty field in surgery, but you can also open it up to the rest of the world and make a technology using a simple device that we all have in our pocket to really change paradigms. That has got a lot of power.
As we conclude, can each of you share one thing that's keeping you up at night as you consider the future of surgical training?
Dr. Abbasi: [00:12:04] I think about when I was in training back in residency and in fellowship. There's this thing now—we have resident work hour restrictions, which is good in terms of limiting the amount of hours because people can be exhausted, and the decision-making can take a toll. One of the downsides of that is that current residents in training with these current hour restrictions may not be getting the same amount of repetitions, the same type of experience, and the same type of exposure in their training. If you're an orthopedic surgeon, you should be doing this many tibia nails and this many femoral nails, and with work hour restrictions, for example, that may be a rate limiting step in allowing you to do that. One thing that's exciting about technologies like Level Ex is that if there were any areas that that they didn't get the full experience in, there may be opportunities to supplement it from a virtual standpoint, or at least compare case logs and see, “I've done a good amount of tibia nails, but I haven't done a lot of total knee replacements.” That may be a good opportunity to supplement those lower numbers with a virtual platform. That's where Level Ex has an opportunity to help allow that type of supplementation so we can be training the best surgeons possible.
Dr. Grossmann: [00:13:33] I agree with Dr. Abbasi. Again, using technology is smart. We now have ways to connect and to communicate using technologies that five years ago were not even a thought. I’m very passionate about the field of immersive reality, virtual reality, AR, or mixed reality, what we call XR. That field has tremendous potential in how we connect and communicate and how we teach and learn. If you look at platforms like FundamentalVR, PrecisionOS, or OSSO VR, they’re changing the game in regards to training anywhere, anytime, at a distance, especially in times of the pandemic and beyond. For me, that is sort of a basic step, but when you add haptics, and when you add the power of sense, touch, at a distance, remotely, which is something that FundamentalVR is doing—using gloves or using different devices in order to make you feel through a VR headset what you are seeing in the digital world—to me, that's giving you the full experience. It's almost like teleporting yourself somewhere to practice or to do a procedure. This is the best next option and something super exciting that would change education and allow us to massify, expand, and make education more available and more equitable. That's something that we should do with technology, right? In a way, technology helps us democratize how we learn and how we teach. That’s really exciting to me.
Melyssa Nocar: [00:15:30] Looking forward to sharing these details with our team and collaborating with our medical device partners. It should be fun identifying interactive ways to address and create the best, most engaging experience for you and your colleagues so that we can collectively deliver better patient care. Thank you both for today's discussion. It was a pleasure speaking with you. To our viewers, thanks for tuning in today. We would love to hear from you and what these considerations mean for your business priorities.
For more information or to request a demo, please visit https://www.levelex.com/partnerships/medical-device.
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