VR Teaching Tool May Transform Training for Interventional Radiologists

Dr Ziv HaskalFor the first time, physicians can learn how to perform a difficult surgical procedure by experiencing it in virtual reality. Ziv Haskal, MD, recently debuted a 10-part series that transports the viewer into the operating room as he creates a transjugular intrahepatic portosystemic shunt (TIPS). Dr. Haskal, a professor of interventional radiology at the University of Virginia and the editor of the Journal of Vascular and Interventional Radiology (JVIR), shared the VR teaching tool for the first time at the Society of Interventional Radiology meeting in Los Angeles. He joined us to talk in detail about the educational value of the tool, the process behind the VR shoot, and his plans for the future.

What sparked your interest in bringing VR technology to physician education?

I’ve had decades of experience in innovative education specifically seeking means of reaching audiences and engaging them, and VR technology seemed like a natural next step. Additionally, I have an interest in experimenting, and I wanted to see whether VR might be a tool that could improve provider comfort, experience, quality, and engagement with procedures. As the editor of JVIR, the platform allows me to distribute this to people, so I felt especially suited to undertake this project.

VR is a broad term and is being used in a variety of different contexts. Can you elaborate on the specific type of VR used in your project?

The experience we’re engineering is an immersive and transformative demonstration of a procedure. The goal is for the viewer to disappear into it and experience the content without being aware of the medium. It’s an indescribable experience until you have it, and we’re aiming to make this possible even with the lowest level of the open platform. We can scale from a $5 Google cardboard platform to every higher level, including the Oculus, the Samsung, and new Google platforms. I gave out 800 of the cardboard viewers at the SIR meeting specifically to show that even at the lowest level, this is an immediate value add.

Why did you choose to focus on the TIPS procedure for this project?

TIPS remains one of the more difficult procedures for physicians to perform, and I’ve spent years lecturing on it and training people all over the world. Nevertheless, it remains best taught in an apprenticeship fashion, one to one, so I thought VR might bring value. In the case that we filmed, there are parts where I struggled a bit in a step that I’ve done thousands of times, yet I’ve left all of that in the video for teaching purposes.  I wanted to experiment with VR to see if we could deliver this apprenticeship experience through technology.

What were some of the logistical and educational challenges you encountered with the shoot?

This was a big shoot.  There were months of planning, negotiation, and storyboarding, and it took days to set up the shoot and multiple cameras. We needed to understand what was interesting to the viewer in a VR space and think about how to translate information in a useful fashion. There was a tremendous amount of editing to move objects, play with perspectives, and consider viewing ergonomics.

Similar to film production and theater, there are quite a few things that happen backstage that allow viewers to enter a space and feel as if they inhabit it. We want viewers to have the freedom to look around yet still focus on the important areas that we know they need to see in order to learn.

There is a steep learning curve to producing a VR experience. It’s far beyond the idea of buying a VR camera, setting it up, turning it on, and seeing what happens.  This is not a Go-Pro video of a ski run, and it’s not the 4K wrist-mounted VR movie of the bungee jump that I did in New Zealand either. There’s a necessity for what I’m loosely calling medical intelligence, which is understanding what needs to be transmitted, how to emphasize it, what to show and to film, and how to manage the filming and the editing. Essentially, this is film production, so we put together a formal film crew.

Did you draw on any prior experience in film?

About ten years ago, I created a live entity called The MasterClass that I’ve produced all over the world, starting at the GEST meeting that I co-founded. The success of that project came from a particular understanding of how people think, how they want to receive information, and how to drive adoption. The decade of lessons I gained from that experience have gone into thinking about how to deploy the VR.

When will the program be released widely, and what has been the audience feedback thus far?

We’re aiming for a full release by end of May, and I’ll be creating some how-to videos so that anyone who gets viewers will be able to access this content worldwide. Our goal is to make the entire series live shortly and release it through JVIR for free.

Every person who has watched the program so far has told me something like, “Wow, this is amazing.” That positive reaction comes from our students, our chief medical officer, leaders in the field, our nursing staff, technical staff, and others around the world.

Are you planning any formal studies tracking the educational value from the program?     

There’s no question that there will be academic opportunities to assess physician performance.  Standardization is important, and we want to be able to improve, repeat, and retrain when educating physicians. The VR program is the type of tool that could be used to accomplish those goals. I’m certain that physicians will be confident in these tools after they are studied and found to have provable patient advantage. 

What are your plans for continuing the project beyond the TIPS procedure?

I imagine this initiative extending far beyond a single demonstration of a procedure. There are at least six or seven completely different directions that we could pursue. The next steps will depend on collaborations with others, the size of the team we can assemble, and the resources available to manage a series of side projects. I’ve already assembled a professional crew and company (ZVR LLC) to undertake complex endeavors filmed and edited in highest quality stereoscopic VR, both our own projects and on-spec.

I believe that VR education programs have the potential to one day become a mandatory aspect of certain procedural training. Physicians will check off on having completed these modules as part of their training and will have the ability to return and refresh as needed before performing a complicated procedure.