VAST

Today a surgical competence is performing a total of 1,000 thyroid surgeries or performing 50 thyroid surgeries per year. For competence-based learning, performing the same procedure repeatedly in a non-systematic way is not enough. Skills to train here include cognitive skills and flow of steps, swiftness, precision, and later on speed.

VAST's allows for:

• Demonstrable anatomy of the neck.
• Running commentary Step by step procedure of surgery of the thyroid gland in a 360 degree theater environment.
• First surgeon experience through virtual reality 

Self assessment using prototypes on the phone application with quizzes or  prompts during the procedure plus vibration feed back on the phone application.

Also during full immersion Virtual reality and a mini Haptic prototype Technology software will be deployed for 7/12 delicate steps in thyroid surgery for practice and a sense of first-surgeon experience with tactile feedback.

-Peer or senior assessment using the validated Modified Objective structured Assessment of Technical skills (OSATS) tool.

The VAST project uses video simulation technology to create a baseline for virtual apprenticeship, learning and mimicry and a benchmark to assess competence and behavior change. It will be implemented in three major stages, providing functionality of increasing level of training and interaction complexity at each stage: 

1. Introductory anatomy and physiology animation, which will provide the fundamental basis of proficiency in thyroidectomy operative skills in 7 modules or steps.

2. Contains a 360 degree video simulated surgery which will be accessible on trainees’ smartphones and other compatible mobile-devices. These videos will detail a demonstration of the anatomy of the neck and the required surgical procedures with running commentary, 

• Takes a training participant through a step-by-step procedure of thyroidectomy, 

• Promotes cognition and enhances memory of key steps of thyroidectomy

• Allows the trainee to follow the procedure of thyroidectomy and interact with the training videos in a virtual theater environment not to miss out on the theater experience or reality.

• With clearly defined steps of the procedure and running commentary , this promotes self-training, self-assessment by comparison on one's own performed procedure and peer-assessment using a validated tool progressively for all cadres.

• Enhanced interaction mechanisms that mimic haptics through proxy functions on the mobile device in order to provide practice surgical functions for a sense of first-surgeon experience

  3. A full-immersive virtual reality experience that will enable the trainee to rehearse and  consolidate the required operative skills that includes motor skills, flow, motion and speed.
  

Effective surgical skills transfer and training follows the Halsted’s basic model of ‘see one”, then assisting and building confidence, on to “doing one” procedure as a primary surgeon with minimal or no supervision depending on the complexity and the learning curve of different procedures after which one can then be in a position to ‘teach one”. It has become a requirement to adapt to the non-conventional methods of teaching and assessment, including but not limited to different types of simulation.

This project will teach 12 steps of Thyroidectomy observing Anatomy and surgical orientation, building mental and cognitive skills, and all the tenets of Halsted surgical skills principles including: Gentle tissue handling:

Meticulous hemostasis, Preservation of blood supply, Aseptic techniques, Accurate tissue apposition. 

We are certain to archive and asses from this project including;

Cognitive skills

Psychomotor skills eg precision, speed, asses swiftness, flow, precision, and movements, adjustability through pop up prompts with unfamiliar scenarios during video simulation and virtual reality feedback. 

The approach to thyroidectomy will be delivered in chunks across five categories as follows:

1)Preoperative preparation 

2) Anaesthesia, positioning, skin preparation and draping 

3)Incision and exposure of the thyroid gland

4)Step-by-step dissection. 

5)Wound closure.

Uganda stands short at 1 doctor per 12,000 population and 1.05: 100,000 surgeons per Population compared to the WHO recommended Physician to population ratio of 1:1,000. It is no wonder there is not a clear surgical services job description for qualification, experience or cadre as could be the case in the developed world.

We do not have a single endocrine surgical training center in the region a big percentage of thyroid surgeries being performed by incompetent surgeons with associated poor surgical outcomes. We have been carrying out surgical camps to meet clear patient back logs and training health workers on thyroid surgery.

VAST will serve medical officers  that perform thyroidectomies in limited-resource and hard-to-reach areas. It will serve General Surgery trainees, Fellows of Endocrine Surgery, Ear, Nose Throat (ENT) surgery or Head and Neck surgery, general surgeons, and existing specialist surgeons of the above sub specialties.

Unlike using an abstract theory based surgical skills transfer method that is typically aided by text books, the methods employed in this digital training module create an animated and relatable concept to thyroid surgery that is easy to follow and assimilate to.  Furthermore, when compared with telemonitoring trainees’ surgical skills via specialist devices and an internet connection, this novel solution will provide a self-assessing tool that will be able to provide feedback in real time, without an active internet connection using locally available mobile devices.

• Team leader: Cathy Kilyewala (Endocrine Surgeons and Educator  Makerere University School of Medicine College of Health Sciences Department of Surgery Uganda)
• Surgeon/Educator: Vanessa Msosa, General Surgeon Malawi Blantyre
• Nsubuga Mike : Uganda Developer, VR Expert IT Specialist at the African Center of Excellence in Bioinformatics and Data Intensive Sciences (ACE) within the Infectious Disease Institute (IDI), where he is undertaking graduate training for an MSc in Bioinformatics.

• Jjingo Daudi Uganda Bioinformatics/ Technical expert  Director of the African Center of Excellence (ACE) in Bioinformatics and Data Intensive Sciences at Makerere University
• Mujib Tusuubira, Uganda creative visual director who is solely responsible for 3D graphics development, videography of Thyroidectomy modules. As we move to full immersive VR, he will be responsible for the creation of 3D simulation objects for the learners
• Dr Yamiko Msosa: UK Computer Scientist, Research Fellow –Digital Health & ICTD  
• Lydia Nagayi, Uganda Computer Programer
• Educator: Moses Galukande. Professor of Surgery and Educator  Makerere University School of Medicine College of Health Sciences Department of Surgery Uganda
• IT personnel: Edward Kakooza Makerere University School of Medicine College of Health Sciences Department of Surgery Uganda

• Medical illustrator/ artist: e.g. Nucleus Medical Media nucleusmedicalmedia.com or World academy of Science Engineering and technology waset.org
• Statistician/data analyst