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Section um this afternoon. Um I'm delighted that this session is really looking very much into the future with the way in which surgical education in the future. And my colleague rich expert network and then introduce our speak this afternoon. Thanks. Thanks very much Rachel. That's very kind. Um So well done for making it to the end all of you. It's been a long and interesting day. Um First of all, I'd just like to um thank B Braun, whose support of this initiative has been very solid all the way through and they continued to offer us support for the er expert advisory network. So what is this, what is this thing that we call the expert advisory network or the EAN for for short? Well, I, I think that there was a recognition earlier on um particularly after the commission was published back in 2018. But also, I think before then is that there is um a huge amount of professional education that goes on outside of medicine and particularly as we look towards the, the digital explosion that's going on. Er, are there areas that we can learn from outside of medicine? To bring that learning into how we deliver surgical er education and training. And that can be from a hugely diverse group of people, whether it's from the aviation industry, from the motor industry, from um from the space program doesn't matter what it is, there are training needs within all, all of those programs. And is there some way that we can begin to engage with colleagues professionals from those areas that we can subsequently use to maybe help us in the way we deliver surgical education. And the expert advisory network was really born from that thought that we can maybe collaborate with experts from a range of, of not only clinical but non clinical fields of innovation research uh in surgical education. Um So the aims of this is really to um support the development and enhancement of surgical education in technology. It's about making sure that surgical education is available for the whole team. It's about understanding how other industries and other educational environments are utilizing these new technologies to, to develop education and training. It's about testing those new ideas of training in what we call a safe space. So in other words, a place where you can go to talk about new ideas, new concepts um and, and those opinions will be respected and they will be er embraced to try to see how we can bring the positive out of that and make sure we don't develop the negative. Um And from that we can try to develop and enhance the college's own learning provision by, by taking the positives that come out of that. Um And obviously, that has to be done in, in a sustainable and equitable way. So it was established back in March 2020. Um The aims I've already talked about. So across 2020 21 we had a, a lot of engagement with industry to develop insights and also begin to sorry er develop that community of individuals who would er feed into this. In January 2021 we launched the first of a series of proof of concepts in other word to, to look at ways that we might develop and change educational programs and see how effective they can be. And there were some grants awarded for three projects and we're going to hear about two of those projects this afternoon, which is really exciting to do that. And then looking forward, we want to learn from those projects and, and feed that information back into the learning offers that come through the college. We want to further enhance the community that's within the expert advisory network and the strategy that goes around that. And actually we want to drive innovation within surgical education in this way. Er So we're gonna hear from, as I said, two of the colleagues who have been involved with these proof of concept works and they, they'll provide a presentation and then there'll be an opportunity to have some questions after that. And what I'd also like to invite you is to engage with the ean the Expert Advisory Network. And that that's engagement can be in a whole variety of ways, whether it's simply knowing about this, whether it's bringing ideas to it, whether it's wanting to actually apply for funding from this. And we are able to just say that this year's funding scheme is going to be open and there is a, a code there which you can download to enable you to do that. So once again, our thanks to be brought, who are continuing to support this without the support. I don't think some of this would have been possible. So what I'd like to do is to ask our first presenter to come and talk to us about the project they've been involved with. So, Felix, I think you're up first. Felix unfortunately, has to run off reasonably soon after this. But if you could just briefly introduce yourself the project and then talk us through it and if you're prepared to take a few questions, that would be great. Perfect. Thank you very much. Indeed. Bye. Thanks very much. Um Hello, everyone. I'm Felix Joa. Um I'm just going to be presenting this work on behalf of Hanny Marcus and who leads this group at Queen Square in remote mentoring in neurosurgery, which is the uh the project we were awarded to, to undertake as part of this scheme. Um So as a background to our study, um surgical training, neurosurgery, um and the other specialities has changed a lot over the past decade or more. And this is in general resulted in reduced operating trainees um opportunities for trainees because of these pressures. At the same time, there's been a big advance in simulated surgical technologies through virtual reality and augmented reality as well as the improvement of kind of high fidelity surgical models. And alongside that, um illustration is a specific kind of um adjunct to that whereby the the the mentor in the surgical simulation can be in a different place to the trainee um and kind of provide teaching in a remote place. So there's been a little bit of study about this remote mentoring um in other parts of the surgical literature, but we wanted to see in neurosurgery um how this um might work and and if it's feasible. So we want to assess, as I said, the feasibility of remote mentoring in in neurosurgery and surgical other surgical specialities in general, we want to look at the cognitive load of the trainee because this is an important metric that's used in kind of educational studies of this kind. Um But I'll talk a bit about later on the kind of performance of the trainee and the quality of the supervision um and kind of put that all together to see if remote monitoring could form a part of kind of future surgical education. So this is a proof of concept study. Um It was a randomized group um trial um and we're going to perform noninferiority statistics to see if remote mentoring is um not non inferior to kind of a standard in person mentoring. So we took 72 groups of seven early stage trainees in neurosurgery as the trainees and the mentors were senior fellows and consultants. They have to perform a surgical task, which is kind of illustrated here. So it's AAA realistic model of um of a herniated lumbar disc with blood and CSF and a fecal sac um and bony material. And the surgical task is to dissect and free the kind of nerve root and um from from any herniated disc material and avoiding kind of operative errors such as CSF leak. Um This is the kind of overview of how it looks. So um on the left is the operating theater and the blue table with the trainee number one standing there and the green squares are the surgical um microscope, the exo with its screen and then um the kind of the console which transmits the surgical video to the mentor who's in this remote room here and they can annotate on the on the screen which then comes up in the theater for the trainee and they can also talk to each other. So we wanted to look at the cognitive load, as I said, using the validated score. Um the NASA TLX score, which kind of looks at a variety of things such as um the perceived effort, frustration, physical demand, temporal demand and a kind of global score. For the for the the task we wanted to use subjective measures of um the quality of mentoring after the fact, using kind of questionnaires and also objective surgical measures by looking at the video from the from the um the actual study um both looking at the time the trainees took to, to perform each part of the task and also um marking the videos as if it were a, you know, an oy examination or a, you know, a a um a surgical exam examination task. So briefly the um results, oh that's uh looks like it's just restarted. Don't know. Shit. Huh Yeah. No, no worries. Uh where I get to. Right. Yeah. So this just shows that the kind of the two groups are equal in terms of their neurosurgical experience, the number of, of these procedures they've assisted in um and their seniority looking at the, the TLX score. So there was no um significant difference between the remote and the in person groups. Um This is a kind of the the aggregate score and looking into each component individually. Interesting. Actually, the only significant difference was that the remote mentoring trainees found marked the the experiences as um more effortless or less of an effort than the in person group. So actually improved. Um So, um in terms of the quality of mentoring after the study, we asked the, the trainees a series of 1 to 5 like scales about the sound quality, the general experience receiving and giving feedback to instructions, various other things. And again, there was no difference with the in person or the remote mentoring. Whereas with the mentors, they did find that the um the platform was they had some difficulty expressing kind of verbal instructions um than they would like to have to have had. Um but the the image quality and the the visual cues and the annotation they found um they found acceptable. So that's something that uh to, to kind of think about for future studies in terms of the objective data we have so far. Um The OS A T kind of statistics is still kind of in process, but we do have the time to completion of the surgical task for the trainees. And again, there was no difference between the in person and the remote uh mentoring groups. So going back to the questions we mentioned at the beginning, uh seems that remote mentoring basically is is feasible for this kind of level of surgical simulation training. Um It didn't show any increase in the cognitive load of the trainee and the time to completion of the task as a as a a measure of the surgical performance also showed there was no difference. But as I said, there's more data still to be kind of churned through. Um So, in terms of the experience, the trainees felt, um the two groups were the same, as I said, there was some difficulty with the remote mentors in terms of giving instruction, but that's something that could be worked on, we think. Um And so we, we feel that these results do support um remote mentoring in the future for as a way of delivering surgical courses. Um So we want to kind of um deliver that message that it seems it's a feasible and effective way. Um and kind of underline that um you know, the impact this could have on surgical education delivery could be quite significant in terms of delivery of courses around the UK and globally. Um But it's likely to depend on the cost of the simulation model locally because the that's technology that the kind of the local center needs to buy in order to engage with the with the remote mental. So we'd like to see kind of more studies looking at this. Um And with an aim to perhaps integrating into surgical courses, maybe at the college or as part of the curriculum, perhaps as things advance further. Um So that's the end of my presentation. Thank you very much, Frank you. That was a very elegant presentation. It's funny, I seem to remember when I was a surgical trainee in A&E and I called a neurosurgeon about a head injury. He always remained fairly remote. So, with due respect to Richard, of course, who I'm sure never remained remote won't rise to it. This looks like a very good way of, of dealing with various training issues. And are you planning to extrapolate this to other specialties along the way as well? Yes. Um, there have been some, some studies in, uh, kind of laparoscopic general surgery as well in terms of delivery of subspecialty training as well. So, there are some other, um, studies already out there. This is the first that we're aware of in neurosurgery. Um, but yeah, I think it's something that could be applied to all, to all of the surgical specialities. Yeah. Could I ask, um, just about the applicability of this to the live operating as opposed to a simulation model? I mean, has there been any work done on that? And, and are the results comparable? I've not seen that in neurosurgery there again, there has been some in, um, in general surgery, um, in kind of disaster surgical delivery and things like that in disaster areas. And, but I suppose that would be another step. Um, obviously there's more involved in terms of um, ensuring patient safety in that kind of, yeah, um, set up if you want to do a trial or a study to look at that. But I think that's, that's kind of the other arm of where this could be really useful overnight if there's a trainee who has to do a lumbar decompression, for example, and may runs into some trouble or wants some help and, and the, if the consultant is at home, could this be a way of the consultant just giving um the bit of guidance that would get the, the trainee um through the procedure without them having to come in. Um So I think that's definitely a possible future application of it. Yeah, it's a safety issue, isn't it? Mhm. Is a Andrew is on? So this would, this would be a really good transition, um, rather than consulting with senior trainees sitting in the coffee room, wouldn't it? Because that's what happens. Now, the consultant goes and sits in the coffee room while, while, while the senior trainee is, um, doing, doing the case and on the whole, there's no issues but if there is, you're there to be called in, I mean, this is kind of a bridging to that. Have you thought of trying to, you even just introduce it in those sorts of terms? Um, just again, as sort of proof of concept just for a live thing because that's probably safer, isn't it? Than not having eyes on a case? Yeah, that's really interesting. I hadn't thought of that. We'd always thought of it in terms of, um, as a compliment to, to early surgical training. But that's a really good point. It's probably safer to do it for a senior trainee who probably doesn't need a consultant there anyway. And just as that kind of last option if it's, if it's needed. So that, yeah, I think that might be a, a better way of trialing it in a real patient setting with, with senior trainees. That's a good, good point anymore. No. Ok. They were all done. Thank you. Thank you very much. Indeed. Well done. All done. Mm. So we're going to move on is the presentation on the, uh, Ken's going to talk to us. Um He's a med student at L MS Computer Science Graduate. Um And he's passionate about building in the intersection of health care and technology. So we look forward to hearing what you, what you've built. Great. Thank you very much for that. Fortunately or unfortunately, you have me, me last. So I try to be quick to send you all home. So today I'd like to present to you. Augment Augment is a pilot study looking at augmented reality for surgical education. So, where did augment begin? Augment began from NSTS? And we've been running since 2018. We're a society focusing on delivering free and accessible surgical education for undergraduates and postgraduate students. Augment forms one of six studies that we've managed to run over the past few years, all of which have led to international presentations and publications and we've come a long way since last year. So we've recently completed a study last month. So where did the idea for a augment begin? So, augment began from my personal experiences be being within operating theaters. Um operating theaters are a difficult learning environment. So exposure is highly dependent on the specialty you're with and the surgeon you're with is an unfamiliar learning environment for some students which can be intimidating as well as this poor interaction with the surgeon, as well as reduced surgical, uh visibility of the surgical field can impact your learning. So how does this all fit in with innovation and surgical education? So we decided to use proxy and proxy is an augmented relative platform that allows students and clinicians to connect. Students are encouraged to draw using annotation tools as well as communicate with the surgeon using chat features. And what was our aim from all of this? Well, we wanted to provide accessible cost efficient ways of learning, provide a welcoming learning environment for students and provide, provide interactive teaching between the surgeons and students. So we recruited 84 final year medical students from 25 different universities and we went and taught them free core surgical procedures. And on the platform here you can see what the surgeon's uh what a surgeon's view would be. And so what did the students think about all of this? So 70% agreed that they received better instructions through the online platform than in traditional operating theaters. 75% of students found proxy's tooling system to be beneficial for their understanding of the procedure itself. 55% of students were better able to identify anatomy more clearly on the platform than they were to do in person. And 50% felt more comfortable in the operating theater after a session of augment than if they had not. But there's still an imperfect era of research here. So there's split opinions about whether students felt more comfortable to ask questions on the online platform than in person. And that leads me on to limitations of this study. So we noticed that there is teaching inconsistencies, whether that's in person or whether that's online as well as this. We found it difficult to achieve the sufficient response rate for the sbas and that's in line with clashes of um student electives as well as exams. Furthermore, group sizing could have been a big issue and further research needs to identify the optimal group size to teach students that should have been an emoji in between but ignore the boxes. So where does this lead to us? This leads us to um we received really good feedback or positive criticisms about uh the platform itself and really constructive comments on how we can improve. But in summary, there are three areas where we can, where we believe augment plays its role. One overcoming geographical barriers. Augment allows students to see procedures that are not offered in their local hospitals. Two early career development, we know if students are exposed to certain specialties as well as surgery early on in their career that cultivates interest and knowledge. And the last one, increased learner accessibility, more students can see a certain procedure at one time. So I'd like to thank um R CS England and be born for this opportunity. And I'd like to invite Alice part of the Augment team to join me for questions. Anyone has any? Everyone wants to go. I sit right down, no questions. It, road trip and you use the proxy system for this, which a lot of us are familiar with and other platforms are available as it were. But what I wanted to talk to you about maybe with your background is to say something about how we work with industry and commercial organizations and so on because I don't think this is something, you know, in the sort of new technology field that we as medics and surgeons can do alone is it? And how do we work ethically with those kind of organizations? Yeah, that's a, that's an interesting question is it's not an easy question to answer when I mean, the EIC application for this project was a long long list, but I, I think it needs to be research led regardless of how we deliver things. So this was the first study that actually looked at using augmented reality within medical students and using the platform proximate specifically. Um I th I think any other platform would have delivered perhaps different results, but that needs to be research led rather than industry led. Yeah. And it needs to work come from both sides really because they're industry led, they have different priorities. They've got a business to run. So they want to see that it's going to be utilized and um productive. As opposed to for our side, it would be in medical schools, they need to pay for the platform. So they want to see that it's going to be effective and a good tool for their students. So there's aspects from both sides that need to meet in the middle. Just coming, just the college does have a publication called Learning in the operating theater, which is due to be revised on the back of the undergraduate curriculum. No, I think that's a paper but there is, there is actually an advice sheet on how to learn in the operating theater, which definitely needs updating and maybe your team would consider writing a small piece for that on the use of augmented reality in theater. That would be very helpful. Yeah, absolutely. I think so. Can I just ask a bit more about the um the range of applicability of this from basic anatomy learning at one end to um getting a much better understanding of surgical procedures and surgical techniques and tissue handling and all the rest of it at the other end, is, were you able to assess whether it was equally valuable for those both of those things? Or is this more about uh functional anatomy and actually demonstrating the the anatomy in situ. I think that will differ from who the students are. All our feedback was how mainly based on anatomy and surgical anatomy and how their students increase their confidence in that because they're at that final year medical student phase. I think if you implemented this, I'm a core surgical trainee bit higher up. My, what I would want to learn would be the techniques extension dangers. So I think it would, it depends on the, you know, the tutor and student their outcomes that they want from the session. But it's not something we looked into, but kind of anecdotally, the students found the anatomy mainly probably based on what they wanted to know as opposed to what was specifically trying to be taught. And do you think that this gave a level of excitement about surgery? I mean, part of what we're talking about is getting people into surgery. We want people to become surgeons. Do you think this is a platform that helps in that process to, to stimulate interest, stimulate excitement? Yeah, absolutely. I guess this was a, a voluntary project. So there has to be a little bit of interest already there from someone in surgery. Um But if you could prove that it was a good adjunct to medical education, like I think someone in the audience said earlier, they weren't considering surgery until they got a good mentor. If this was implemented commonplace with medical students. You might find that you're getting people excited earlier. Yeah, I'd like to add that. The surgeons we had were fantastic. So good. They, they were doing tertiary centers almost day in day out. This is their procedure. And oftentimes students don't, they don't have access to that surgeon. Yeah. So, finding a really good surgeon might inspire some students to join. Well, more than a really good surgeon. It's the surgeon who wants to be involved with this. And actually, yeah, they're self selected. Yeah. Yeah, Andrew. So was this a one way thing? So were the medical students able to ask the surgeon as it was going on or was it just the surgeon pointing things out? Yeah. So I wasn't able to make it a bit more clear. But um the platform here is actually the surgeons um are operating on one side and they're overlaying their images to teach the students are in the corner somewhere and they're able to use their microphones, they're able to use the chat tools they're also able to draw on top to, to ask like take a guess as to what vessel this is and they able to draw on top of that? That's, that's brilliant. Um As a a kind of add on, would you do you keep a library of all these so that you can then use them rather than having to do this all of the time? If you've got a fantastic example of appendicectomy or you know, fracture surgery or whatever type of surgery you're doing. Um, could you then build a library of that so that it would further reduce the cost? Although you don't have that two way element. Is that a thought that that your team or group have been having? Yeah, so definitely you'll be able to build a library of that. Um, I, I think the issue is, is having good quality videos and one of the challenges we had in the project was actually searching for videos where the anatomy was clear and there were no complications with that. So a good teaching case is, is the limitation of that. But we, we have, we have a library of videos which um we can tap into reason. Hello. This one's actually just from me rather than I have the advantage of having had some of the conversations with you right at the start and you mentioned the scalability and I think that's one of the things that we were really interested in when we first had those conversations. So is there anything you said there's more work really that needs in there to understand if that's a factor? Is that something that you're wanting to take forward? Are there ways that we can understand that better? Yeah, I, I think the first thing we want to do is try to push an initial paper out there. So having some sort of framework to work from before we dive into more work, but definitely looking into having more videos or at least changing the way we've, we've designed our studies is one of the ways that we can improve on this, you know. Ok. I, I think, uh, we've come to the end of the question here. Thank you very much. Just to bring things to a conclusion. I personally have gained a great deal from today. I think we've had a fascinating day with a range of different topics. We probably could have spent the whole day on just one of them, I think. But it's certainly given us much to think about learned a lot and I hope will inspire you at whatever stage in your career you are to be involved with surgical education and training. You know, the, um the background at the moment, there's a lot of fairly depressing things going on in the sort of NHS and the fields of education and training and so on. But I think what's come across today are actually some very positive messages, huge amount of goodwill and enthusiasm from the surgical community just talking to people in the breaks. I've just been thrilled by the um age range, the geographical range and the career stage range of the delegates I've met in the room and no doubt even more so online representing surgery in its entirety, both in the UK and beyond. And um I would just like to encourage all of you to keep on with not only your own training, but however, junior, you think you are, somebody said to me, I'm just a foundation doctor. I said there's no just about it earlier on in one of the breaks. Even if you are just a foundation doctor, there are students below you. Even if you are a student, there are six formers considering careers in medicine. So however, junior, you may think you are, there is always someone And also if you got old like me, I need the young ones to teach me about technology like this. So whatever stage you're at, you have both a teaching role and a learning role and we can all go on learning. I think I just need to say a few special thanks, Louise leads the team in the learning department. Louise. Thank you so much and Rebecca, thank you particularly. It's been fantastic the way you've put things together. It's not just today today represents the tip of the iceberg of the work that the learning department does. And on that note, I need to thank Richard again, who chaired the learning committee for a number of years. And really, this represents a fraction of the work that he's done and the leadership that he provided for the college in that realm. I'd like to thank Jane and the events team for making everything run so smoothly, particularly Eduardo, who has been the face of the meeting for all of us. Brilliant as usual I want you to be my life organizer. If you ever want to give up the day job. And thank you to all of the delegates both here in the room and those of you online for your participation. Please don't let today be the end of it. The college wishes to engage with our members and with our potential future members. And if you have a passion for improving surgical standards through education, then the college will want to hear from you and work from you. And just lastly to remind you all that there's an invitation to join the group downstairs in the library for the celebration of 30 years of basic surgical skills. I understand some refreshments will be there and the Hunton Museum is open for those of you that have not yet visited the new and revamped here and it's an absolute must. So if you haven't done so, please have a look in there and hope to see you all at future events either virtually or in person. And thank you also to our sponsors, Limbs and Things. Carl and Sim formed, who partner with us, not just today, but as you've seen in some of the other endeavors that we have that interface between the college, the profession and industry in education is just as important as it is in technical surgery. And we hope to continue to do that in an ethical and productive manner. So thank you all very much and look forward to seeing you again. Thank you. Mm.