Bench Talk

(Source: ipopba- stock.adobe.com)

Virtual Reality (VR) and Augmented Reality (AR) are emerging as complements to a cadaver-only approach in medical education. Medical students at Case Western University are using VR to learn about human anatomy. Stanford’s Virtual Heart enables medical students to wear a VR headset and learn about the intricate workings of one of the most vital organs.

Spurred on by necessity during the COVID-19 pandemic lockdowns, technologies such as virtual reality and augmented reality are increasingly complementing cadaver dissection as essential teaching tools in medical education.

The acquisition of cadavers has been fraught with ethical implications and local legislation. While the donation of cadavers in the United States has increased¹ in recent years, using this technique is quite literally a cut-once approach. Students cannot review materials efficiently, and sometimes, you have to destroy a whole body part to get at another one tucked underneath. Deeper understanding and experience come with repetition, something that is not always easy to achieve with a cadaver-only approach.

Surgery is not just about working with the human anatomy but also about understanding how different organs are connected. Unfortunately, such interdependencies are more challenging to observe in live dissection practice, and rare conditions are even more challenging to visualize and understand.

While VR and AR, and even mixed reality, are not expected to replace cadaver-based surgery education fully, they are powerful tools to complement existing approaches².

AR helps by overlaying augmented 3D representations of models over textbooks or curriculum materials to give more immersive experiences. In essence, AR offers more realistic 3D views of otherwise static two-dimensional images.

VR helps by simulating the experience of dissection, so students feel like they are there. While some have argued that the tactile experience and fidelity of images are factors that need to be resolved, improvements in high-resolution and network connectivity and haptic feedback technology can get us very close to the real experience.

AR and VR and mixed reality (MR) technologies can work in tandem. Software that delivers these educational tools feeds on hours of live surgery video and/or medical imaging and CT scans that add to the thoroughness of models.

The company Medical Realities, for example, builds on hours of live surgeries with comprehensive views of the theater as well. Students wear a virtual reality headset to tour the procedure as it happens and can choose from a roster of techniques and watch them on demand. Users can also select the views—for example, laparoscopic feed—to observe surgeries and review anatomy overviews. At the same time, the image of the corresponding organs is displayed on the screen. The net effect is a much more immersive experience that ties lessons learned to real-life procedures.

Prestigious medical schools like the Langone School of Medicine at New York University (NYU) use 3D printed models of complex organs to complement the VR and AR training their students go through. For example, NYU's Living Anatomy class integrates thorough imaging in real-life with these technology platforms to give students a more comprehensive understanding of the human body and the surgeries they have to perform. Students can rotate models for different views and study the complex network of blood vessels to understand how the parts all "fit" together. 3D anatomy models embedded in digital course materials also drive home lessons better.

Stanford University has developed a Virtual Heart, which students can actually "tour" using a VR headset. They can also open components and see how the different parts of the heart connect.

The goals here are also to increase equity in medical education across the world by making such programs and associated technologies more readily available. But, unfortunately, cadaver labs are expensive to build.

Integrating VR and AR technology in medical education provides many benefits including:

• While technologies that simulate the natural environment had been gaining traction for a while, the COVID-19 pandemic moved adoption at a faster rate. Using VR as an educational tool is a safer approach when COVID-19 protocols are in place.

• Students are also able to review materials effectively and personalize learning to meet their own pace. They can review portions they do not understand and redo relevant parts of the surgery accordingly. VR and AR help with continuing education too.

• VR techniques enable viewing on-demand endlessly, which is difficult if not close to impossible with the cadaver route.

• Experienced surgeons can revisit techniques or learn new ones and collaborate with surgeons remotely to deliver best practices in a fast-changing field. They can also practice digitally before performing complex surgeries in the real world.

While cadavers have their place in medical education, VR and AR are already revolutionizing how surgery and human anatomy are taught. A new generation of doctors is leaning on these technologies to complement traditional learning techniques with excellent outcomes. It is not an either-or approach to conventional methods but an "all of the above" formula that delivers the best of all worlds to students and experienced practitioners alike.

• 1. Kalter, Lindsay. “Compassion Begins with the Cadavers.” AAMC.org, April 15, 2019. https://www.aamc.org/news-insights/compassion-begins-cadavers.
• 2. “Human Cadavers vs Virtual Cadavers in the Educational Setting.” MEDCURE.org, April 4, 2022. https://medcure.org/human-cadavers-vs-virtual-cadavers-in-the-educational-setting.