Training with Virtual Reality - Accelerating Confidence, Competence & Experience
Richard Vincent is CEO and Co-founder of FundamentalVR, a company that is focused on improving patient outcomes by revolutionizing medical training through virtual learning platforms. Richard is experienced in building international businesses and has a keen interest in seeking out opportunities to disrupt markets through development and adoption of new technology. In this episode Richard shares insights into past medical training methods, where they excel and the limitations of the different methods, what virtual training is and its benefits, the data supporting VR learning, what haptics are and why they matter, and how medical device companies can get involved.
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Episode Transcript
This transcript was generated using an automated transcription service and is minimally edited. Please forgive the mistakes contained within it.
Patrick Kothe 00:31
Welcome! I want to take you back a few years. I think all of us remember learning how to drive. I learned to drive from the DMV pamphlet, a class I took in high school and included those scary videos. You know, what I'm talking about mine was called Blood on the Streets. And by being a passenger for 1000s of rides, but nothing prepared me for the first time I was in the driver's seat. And my dad was beside me. And I was controlling that two ton vehicle while all the other cars were moving all around me. Well, after many hours of practice, I was prepared to take that rite of passage, the DMV driver's test. Now imagine if I had only one practice session, and then was sent out alone for that DMV test with my safety and the safety of everybody else in my path, at risk, not a pretty sight. In many ways clinicians are faced with the situation when training on a new procedure, not because they want it to be this way, but because it's often hard and expensive to get multiple repetitions on the models available to them. Our guest today is Richard Vincent, CEO of FundamentalVR, a company that's focused on improving patient outcomes. By revolutionising medical training through virtual learning platforms. Richard is experienced in building international businesses, and has a keen interest in seeking out opportunities to disrupt markets through development and adoption of new technology. In our conversation, we discuss past medical training methods, where they excel, and the limitations of the different methods, what virtual training is, and its benefits, the data supporting VR learning what haptics are and why they matter. And how medical device companies can get involved. Here's our conversation. You You've come into medical education after a pretty successful career in other areas. So can you tell us a little bit about your journey? What's the common thread? And what was your journey, like coming into the medical education area?
Richard Vincent 02:58
Sure, yeah, love be delighted to, as you say, I perhaps not come up the route that many do within the industry, the common thread that runs through my entire career has been an obsession with new technology, and the application of it. And what I mean by that is, you know, people get very caught up with how cool tech is, but actually, you've got to ground it, you've got to make it something that the average person can use. And that's really where that's a common thread in my career. So if I go back, you know, early stages, I was born in London, and I, you know, studied marketing and business, and then came into commerce. And we're talking early 90s here. So a lot of what today is very much everyday technology, it was just breaking at that time. And the one that I really got involved with, at the early part of probably 2000s was mobile technology. I could see back then, with my good friend, and actually business partner, Chris, we could really see that mobile was going to change the way that people interacted and they live their lives. And so you know that that was the start point for me really, in the first business that we built to really get hold of that, that mobile opportunity. And so as I've gone on from that point, or and forward through different iterations and different businesses, some that I founded some that I've joined, it's really been that common theme of what's the next technology that's going to have a significant impact on commerce, on humans and on society at large. And that's really why I'm where I am today.
Patrick Kothe 04:34
And Virtual Reality kind of hit you pretty hard. It sounds like and when we get into that, we'll get into that in a couple of minutes. But I wanted to start our conversation more on historical training. Because VR is is such an important topic for us going forward, but it's built on what's happened in the past, and what's worked and what hasn't worked. To within the past. So I'd like to kind of start there. And I want to divide this out into basically two buckets in the medical space. The two types of training opportunities. One is you've got a simple device or a discreet machine. So let me just say, for example, you've got a new syringe that you're introducing into a hospital, or you've got a new IV pump that you're that you're introducing into the hospital, that's kind of a different training scenario, versus you've got a new technique or a new surgical operation, that you're you need to train somebody on it, you know, for example, and maybe a new knee, knee replacement product where you've got surgery, as well as you know, new technique, new surgery new device that's going in there. So I want to kind of divide those two out, because I think that the training is always dependent on what the use case is. So can you explain to me a little bit about historical training within the space? And kind of what works and what what hasn't worked?
Richard Vincent 06:10
Sure, sure. I mean, it's, as you eluded it, it's a, it's a big subject. So I'll try and simplify as much as I can, at the very top level, as most of the listeners will, will appreciate the common theme has been one that's been an approach to training and education that really has been around for, well, 150 years or more, you know, and it's kind of encapsulated in that idea of See One, Do One, Teach One, which we all know. And obviously, that's not true reality, but it's still a big part of the way that training and education happens. You know, there's a lot to learn, it's complex, even. So let's just take your two scenarios, even in those simple devices, those simple elements, even just down to a syringe, you have a number of factors that you need to technically understand how that product works. Even a syringe, you need to understand how that's used, how you fill it, how you aspirated etc, then you've got to understand how you interact that device with a human being. And that's when obviously, it gets very complex and high risk. And again, even with a syringe, it can be a very high risk scenario. So you've got a couple of things going on there probably three axes, I think about it, you've got confidence, you've got competence, and then you've got experience, and all three of those is what really makes up good skills transfer, traditionally, has that happen? Well, you know, staying with the syringe, you know, injecting oranges, injecting chicken breasts, and injecting prosthetic arms, or legs is been the traditional approach to that injecting each other. Again, we've seen a lot of that happening in the past. And, and it's not that any of those are wrong, they're all good and valid ways to create rehearsal opportunities. But they all have limitations. And again, with that simple example, it's pretty easy to see where those limitations lie from, you know, the fidelity of what you're doing through to the scarcity of supply. And, of course, they're pretty in that example, they're pretty one dimensional as well, you know, if I'm injecting into an inanimate object, I'm not really thinking about the vascular structures underneath. And that's really what I want to be doing in that particular example. So, traditionally, we've we've seen a pretty standard and proficient training technique around, you know, teaching, didactic teaching, apprenticeship type models, which are slow and challenging to the dynamic nature of the way that the medical marketplace and industry and profession has developed over the last 50 years. And I think, you know, everybody within this industry has been looking for new ways to approach training on a constant reoccurring basis. And what we're seeing now with with our discipline of virtual reality, and immersive technology, is really just the next step of that of that iteration, building on the foundation, and very much standing on the shoulders of all the success that's gone so far. That's the kind of the simple version with our syringe or other objects of that type of nature. And again, it ultimately comes down to, can I build enough competence? Can I give you enough confidence? And do are you going to get enough experience through repetition to be able to be safe and effective with the human beings that we're interacting with? When we go to the other extreme, and start to think about the complexity of surgery and devices and often they're both of those two are happening not in all cases, obviously, there's obviously a lot of surgery that's using using less third party product But but often they're together. Well, there you've got everything I've just said. But it goes up in complexity, several digits, some of the surgical procedures that we see today, you know, they can be 100 200 steps of processes and, and then there's a skill. So again, going back to my model, firstly, you've got to learn the steps involved in that particular procedure. And that's really where a medical student and an early resident is going to be focused, then you're going to start to think about the the technique and the skills as you start to progress and start to get involved in those different surgical techniques. And then you've got to build up your experience, and get access to as many different case scenarios as possible. And what we see across the world really, and you know, we we spent a lot of time working with a lot of organizations from, you know, very developed countries through to third world. And what you see is, is a limitation in all three of those vectors. So again, finding new ways to remove some of the friction, to increase the fidelity to allow for vaster repetition is really what I think everybody in this industry continues to look for. And I think what we've seen with our technology and others, like ours is, is perhaps the next opportunity to again stand on the shoulders of the success that's happened so far.
Patrick Kothe 11:30
The See One, Do one teach one model has has obviously been the standard. But some of the other methods that are used are cadavers on the do one not do one on a live patient, but do one on a cadaver, it may be a model, plastic model, type of situation, it may be an animal, or an animal organ that people PRAK practice on, or other types of simulations. So that's kind of historically where where things have been, you mentioned that people have been searching for this reproducible model to give them more confidence, more competence. What what is it about the past tools that people have used, that has people searching for a different teaching model?
Richard Vincent 12:27
I think what you find there is, if we take each of those, in turn, when we're talking about animal and wetlab training, you have, by definition, a non human specimen, and therefore, there are immediately differences there that need to be factored in. There are clearly with both animal and categoric ethical issues that are challenging in some parts of the world. There's a supply issue there as well. But most importantly, when it comes to Canterbury, which is a fantastic, high fidelity, brilliant way to learn surgical procedures, the challenge that you have there is actually getting the right case. And again, as I talked to our Surgeon partners across the world, what you often hear is you will go to a categoric lab where you're going to learn the theory of a particular patient presentation. But actually, when it comes to that specimen, it's not really what you need, it's not the particular pathology that you were looking for. And therefore, you have to adapt. And again, all of our partners are fantastic at adapting to what they have in front of them. But it creates that challenge. So what you have there is you have friction, when it comes to interacting with those types of training environments. And the friction I'm thinking about there is firstly, the consumables, the supply of those products, those cadavers, those wet labs, are challenging. Secondly, you've got the logistics of moving the experts to those environments to train the trainees. And obviously, moving the trainees themselves to those environments as well, that can often involve enormous amounts of logistic challenges. And particularly, what we've seen is post COVID. There's a resistance to being out of the clinical environment as much as perhaps we had prior to that, for lots of good reasons. One, there's a lot of work to catch up on. Secondly, there's concerns about potential exposure that might result in you then not being able to continue your work back in the clinical environment. And so what we've certainly heard and seen is is a desire to try and bring that experience closer to the point of care, bring it into our hospital and medical environments. So there's there's a lot of challenges with those those different modalities. Again, I want to emphasize you know, they've all been and are high Add valuable, but where they all struggle particularly is in repetition. So finding the right case, and having the opportunity to do it a number of times, is highly is really difficult within categoric and wetlab training. And if you think about learning curves, and the learning curves for different products can vary wildly, but somewhere between 30 and 90 cases is probably the average in a robotics scenario, let's just use that as one example. So if you're looking for repetition of 32, to 90 cases, you're never going to have that many categoric sessions. And so it means where most of the repetition will happen, and where most of the learning is going to happen, is in the operating room. That's a scenario that we all recognize, it's been accepted, because it's just the reality we have to work with, for the first time now, what we have with immersive technology is the opportunity to create that repetition away from the operating room. So I use this phrase as our as our vision around pre human competence. So the idea being, let's try and get a high degree of competence and confidence before being presented with a human specimen, whether that's a categoric one, or a live patient, so that you have a much better outcome, whether it's again, using that categoric specimen or a wet lab specimen, or indeed, in the operating room itself. So pre human competence is I think that the prize that we have in front of us with really good immersive training.
Patrick Kothe 16:40
The other thing you mentioned is, things don't always go smoothly, and in a procedure in an operation. And it's not, it's not only practicing on a static environment, but it's practicing on a changing environment, because everything is changing on a human, alive, human. So it's kind of like the, the flight simulators that pilots go through. It's not just how do you fly a plane? But how do you fly a plane when this engine goes down, or when you're hit with a particular problem? And the same thing happens in surgery, everything doesn't always go smoothly. So how do you react when something isn't going right?
Richard Vincent 17:19
Exactly that you want to in those scenarios, you're against the clock, and you have a human life in front of you. And I certainly want as many practicing healthcare individuals to have the opportunity to rehearse those scenarios, as we can, as we can achieve, you know, the, the more that you've had an opportunity to go through that scenario to think it through to understand using your analogy to understand what it's like to have a bird strike to suddenly see a bleed out. And not to face that for the first time. Incredible, you know, and as you know, as complexity within the devices, increases risk, in some cases reduces and in some cases becomes more acute, and therefore get the opportunity to just understand not just what good looks like, but also what bad and and failure looks like and therefore to deliberately fail within a controlled environment where you can just press reset, and go, Okay, let's, now let's try that from a different perspective. It offers us an enormous amount of capability and opportunity going forward. I think it's a very exciting space.
Patrick Kothe 18:31
So you founded your company, how many years ago, seven years ago, fundamental VR. And seven years ago, the technology was at one space, and it's at a different space today. So you talked about mobile, back in the 90s. And that's obviously made made a huge step. But you kind of had the vision of what mobile was going to be when you started getting interested in it. So let's take you back seven years and start thinking about VR at that point in time. What got you excited about it, for this space
Richard Vincent 19:09
is a really interesting journey. And I can, as you say, back back in 2014 2015, the VR technology was really really nascent. But what you could see through the picture I could see through the potential of the immersion was a new paradigm. And it reminded me and Chris, my co founder, very much of the same feeling we had back in the late 90s When we were thinking about and looking at the way mobile was working. You know and I today I still when I look at things have moved on a lot but when I look at the the VR headsets and the mixed reality headsets and the haptic systems we have today, they're still for me there equivalent of a Motorola phone in 1994. You know, we barely scratched the surface here. But you can see where the destination could be. And so So to answer your question, what was it that excited me about it, the idea that we could create a new reality, by simply putting on a set of glasses, and giving someone a completely different experience was mind blowing, and is mind blowing today, you know, we've lots of people that may have tried it, but it's still phenomenal, when you then bring in some of the other things that we've been able to do since you know, with collaboration, etc, it really starts to get super exciting. In summary, the the opportunity that that technology offered, and offers that we could see right back at the beginning, was, for us very clear, you know, we could we could see the endpoint destination, we could see where this could go. And we'll go knowing full well, it will take time. It takes a long time. You know, it took 10 years really for for from the very first smartphone concept. Before really, it became a standard within common usage and within industry. And and the same is true with VR, you know, and I think, as I talked about, when I talk to my team, I say, look, I think if this is a 10 step process, we're probably just about done step one, we've got a long, long way to go yet.
Patrick Kothe 21:29
Some people have a technology and they look for markets to apply that technology. Some people are in a market and see a technology and say I can apply it into my market. How did things start with you? Where did you approach it from the technology and say it would work? You know, we could apply this into oil pipelines are we can apply this into pilot training or we can apply? Why medical?
Richard Vincent 21:55
Yeah, yeah. Well, as a technologist, as opposed to a medic, I definitely came at it from the technology standpoint and said, Okay, I think I could see a game changing opportunity here. The question now, having built a number of businesses over the last few years, you know, the next question is, where's it going to touch down first, hey, there's no point having a great piece of technology that doesn't solve a problem that's important enough that people will finance it. So you kind of have to do that piece of work. And for those who have done startups, you know, you know, you'll know the phrase bootstrapping, I know, you know it well.
Patrick Kothe 22:30
Fun. It's a fun concept.
Richard Vincent 22:32
Right? Yeah. So so we bootstrap the business for a year and a half. And during that year and a half, we went out into industry, and looked at the application of immersive tech and virtual reality against different industry sectors. So we looked at newscasting and said, Okay, what about virtual 360 video for putting someone into a war zone, putting them into a drought environment, etc? How's that going to impact and we've worked with some leading players in that space. That was interesting. We looked at it for enterprise collaboration. So, you know, in a workplace, how could you bring people together? And how would that work? We looked at it, of course, in gaming, quickly discovered that one of there was a lot of noise in gaming already. And so we went through a number of verticals. And one of those verticals that we picked at the beginning, was medical. And after about, I don't know, maybe eight months or so maybe a year, we took a good hard look at what what we'd built. You know, as technologists, we, we'd had a bunch of people coding with us. And we built a number of different MVPs. So minimally viable, viable products, things that we did some really clever things. And all of them were exciting. All of them were really cool. But there was only one, that when you thought about the market and looked at the market, he was addressing that really stood out as something that was difficult to walk away from. And that was the medical use case. And so we jettisoned everything else, double down on the medical space, and then really started to push into that. And that's when we bumped into haptics and when Okay, now we've got another problem. But I'm sure we'll talk about that down the line.
Patrick Kothe 24:17
So looking, looking back at how you came to medical, she spent that year and a half doing doing market analysis as well as technology development at that point. At that point, did you do it correctly? If you were gonna go back? Did you have some learning that says GZ? I wouldn't have developed product at that point. I would have learned from the marketplace or I went down this road too long, or what kind of learning did you have in that point at that point in time?
Richard Vincent 24:50
Yeah, it's a great question. I think. We were pretty nimble. And I think that's important and and If we didn't stay in an ivory tower, you know, we got out into into commerce, and worked with people inside each of those verticals, on real cases, as opposed to theoretical cases. You know, nobody wants a perfectly formed product to just appear, it just doesn't happen. You've got to iterate it with hands on experience. What would I have done differently? I think we correctly vectored in on on medical from a very early stage. I think one of the things that I would have started sooner is probably the discussion around how and what the sense of touch and haptics means within a medical use case, and started that development and analysis line at the same time as we were, we were doing the early stage work. But Hindsight is a beautiful thing. Right? You, you, you fought you follow the path?
Patrick Kothe 26:06
Yeah. So did you hear about it and disregard it? Or did you just not pull enough information out of the customers to see that that was going to be an important piece?
Richard Vincent 26:18
We we just didn't, at the initial stage, we didn't think it was going to be as important as it is. And again, it's the kind of sounds counterintuitive, because touch is such an important factor when it comes to interacting within a surgical environment, particularly but in lots of others as to back to our syringe, right? You can learn the theory of putting a syringe into A into an arm, but if you don't know what it feels like, how do you know you're getting it? Right. So it's the difference between gaming it and doing it. So I think we didn't spend long enough at the very early stage thinking about quite how important that was. And then we had a Fanta, I remember being in New Jersey and in a in a room with seven or eight orthopedic surgeons, and, and asking those questions and having a having a very early stage simulation, one with haptics and one with not, and actually trying to convince them that the one without haptics was probably the one they wanted, because frankly, it was a lot easier for me to produce, and, and getting quite quite a visceral reaction to that. That hypothesis,
Patrick Kothe 27:28
or a mousetrap looking for a mouse, right?
Richard Vincent 27:31
Yeah, yeah. So, ya know, they made it, they made it very clear.
Patrick Kothe 27:37
Do you think that at that point, you were you were still technologists? And at that point, did you have anybody that came inside your team? Did you have anybody that came from the medical space?
Richard Vincent 27:49
Oh, yeah, we had medics on the team from really that first decision point where we said, let's, let's go, let's jettison everything else and focus in on the medical side, you know, you can't navigate without experts. But the really interesting thing about our spaces, it's so broad, you know, the application is so broad that everyone specializes. Yeah, so one person can't possibly hold all the knowledge. So in a traditional medical device company, you'll have a CMO and a number of med ed people who will probably come from one sector, because of course, that's the area if you're in cardiovascular, that your cmo will be from that background. But in our space, we're in cardiovascular, we're in orthopedics, we're in ophthalmology, you know, and so on. And so what we discovered quite quickly as you need a fairly broad church of experts to pull on. And so we went about building that from a very early stage. And I guess what we're doing is quite interesting. And I guess there's a lot of great educators out there and great surgeons who just want to give back a bit. So we were able, even at the very early stage, you know, when we were still bootstrapping, we were able to bring in some pretty amazing minds to help us work through those early problems.
Patrick Kothe 29:08
So moving from the bootstrapping phase to the real company phase. What was fundraising like at the time? How did how did your message resonate with investors?
Richard Vincent 29:20
Good question. Well, I have to think back so we were using your analogy. So I was talking about the flight simulator for surgery, it seemed to be the thing that most people within the investing community could get their hands their hands around and could understand what we were trying to do. There was a lot of excitement, you know, at that time, again, as we think about 2016 1718, VR was starting to hype up quite a lot in it. Facebook had bought Oculus for come into the nomina at 1.2 billion, I think and there was a lot of interest in in that space at that point. But they were Also a lot of concern within the investor community and mainly because they were worried that trying to commercialize a product eventually into the institutional part side of the medical industry, as in the HCP side was going to be challenging. Again, you'll know this, well, Pat, VCs want to know when they get their money back,
Patrick Kothe 30:24
and how much what's my multiple,
Richard Vincent 30:28
exactly. But there was a lot, there was a lot of enthusiasm there. And people could see the vision, and I think could understand the opportunity and could see it as truly a global market. And again, the good thing for us to know and what I think one of the things I was able to do is draw on all of those existing behaviors. So there is there is already a very established simulation market. Inside the healthcare industry. It uses capital equipment, it uses mannequins that uses categoric. But there's a large investment made in that space. So you could talk about how that was going to complement and in some way, in some places, perhaps, replace some of those elements who is shift of commercial interests, as opposed to creating a new one. So that helped. But yeah, we've we found, we found some people who believed in our dream, and believed in the opportunity and and, you know, came in alongside us, and we were really pleased to see that, you know, you allowed us to start to build the platform.
Patrick Kothe 31:30
Richard, I would assume that your product is a combination of a hardware device and software. And some people will say, OK, hardware is always going to change, we're going to use off the shelf hardware, some people will say, I need to have my own system. How did you approach that that decision?
Richard Vincent 31:46
Yeah, Pat, we are, we are pure software, exactly. As you describe it, we've chosen to work with commercially off the shelf products that are available hardware products that are available. And that was a very early unconscious decision that we made. And the reason for that was twofold. One, the hardware is going to change a lot. And it's a significant challenge to develop, develop and maintain hardware. And frankly, it was one that we didn't want to take on. Also, we could see there was a lot of great players within the hardware space, highly commercialized. And with a lot of backing, who could do that heavy lifting for us. So again, using my analogy, we wanted to stand on the shoulders of those experts, and put the software into that. So we focus very much into the software play. We also took a decision as part of that. And as a consequence of that, that we is that we could be completely hardware agnostic. And that was really important for me. And still, it's because in any new technology market, you're gonna have massive amounts of iteration. on the hardware side. You know, we saw it for the 15 years I was in the mobile market space, we've seen it for the seven years that we've been in the VR market space, and that's not going to slow down. And so when it comes to our customers, and our users who use the platform, they they want to know that their investment isn't going to be stuck into a headset that is no longer viable. And that's where our software comes in. We future proof it, we make sure that being agnostic allows us to always work with the best mainstream VR headsets, the best mainstream haptic devices, haptic gloves, grounded haptics. And to really work with those leaders in the hardware and those spaces so that we can put the two things together and really bring together quite a magical product solution.
Patrick Kothe 33:43
So let's talk about the company and the solutions that you have. You've got a non haptic and explain to us what haptics are, and to two basic systems that you that you have.
Richard Vincent 33:57
So as I said, you know, the platform that we've built, it's called fundamental surgery. And there's really three elements in it. But just to use the two that you've talked about to start with, the three elements are standalone, virtual reality. So that's using a standard off the shelf headset, a quest or HTC headset that could cost as little as 500 bucks, you then have the haptic VR solution. That's a much more high fidelity experience. And then you have collaboration, VR, which is the collaboration piece, but if we focus on the first two is you've, you've called those out. So the standalone VR solution, as I said, uses that standard headset, from any of the mainstream manufacturers. It's a fantastic solution for early stage learning. So if you want to learn as I said, surgery and medical is complex, there's a lot of steps to learn and understand. It can give you situational awareness, it can give you put you into that environment, whatever that environment is, whether it's an opera Waiting Room or treatment center. It can give you situational awareness. You can have other people around you, whether they're computer generated or real, or within that virtual space. And you can get used to the 3d fidelity of the patient and the scenario as you go through those steps. Fantastic for procedural rehearsal. So really good for medical students really good for early residency, when you're trying to acquire that knowledge. It's also incidentally, really good for a lot of medical device companies, when they're trying to train their salespeople again, they need to understand the process, the steps, but they don't need to unnecessarily acquire the skill. So really good for all of those things. And because it's very cheap hardware, it scales really well. So a really nice solution, but it has a ceiling to it. And that ceiling is really skills acquisition, so you can acquire the knowledge. But if you want to acquire the skill, you've then got to get into more hands on experience, just as you would traditionally by going into a wet lab, or categoric lab, or, dare I say, the operating room. So our haptic VR system allows us to deliver that high fidelity, situational awareness you get with standalone plus the haptic interaction. So what is haptics? Haptics are force feedback, resistance, weight, flow, pressure, the general terminology for it is something we call kinesthetic haptics, so those are delivering all of those types of elements. And it allows us through really intricate programming allows us to create almost near life experiences to to that patient interaction.
Patrick Kothe 36:49
So you've got a lot, as you explained, you've got a lot of different applications for the product. So it could be cardiothoracic surgery, doing a cabbage it could be a knee replacement could be a neurosurgery, you know, some type of shunting procedure, all types of different things. How do you develop the system? How do you decide which ones to develop? And who's paying for it?
Richard Vincent 37:13
Yeah, great question. You're right. I mean, there are 1000s of procedures that you could pick from so do you go? High risk, high value? Do you go high volume? Where can you have the most impact? That's that's an ongoing question that we we are constantly asking ourselves, who pays for it? Well, the industry and the listeners who are funding medical device industry will know that the medical device industry and the pharmaceutical industry funds education significantly within the healthcare marketplace. rough calculations, I think, from from the different sources I've looked at would suggest that somewhere in the region of two to 3% of revenue is spent on acquiring the knowledge and skills you need to use those drugs, those procedures and those, those devices. And so they're where most of the funding comes from. We work with, you know, leading medical device and pharmaceutical companies at all stages of their commercialization from pre FDA, through right through to full commercialization, we help them with their skills transfer challenge, you know, that they, they need their audience, their surgeons, their nurses, their health, their search surgical techs, to acquire the skills as efficiently and as effectively as possible, and we're able to help them with them. So they are often the funding source for the product that ultimately will land and touch down within the healthcare environment that the hospitals, but it will often be funded by those, those industry partners.
Patrick Kothe 38:53
Within our space data is always important. What type of data do you have that shows and demonstrates to companies that this method is a great method for doing education?
Richard Vincent 39:10
Yeah, you're right, data is key, right? If you can't prove efficacy, then you probably shouldn't be doing this. So there's a lot of there's a lot of studies that have been going on for a number of years into the use of simulation. And in the most in more recent time, the use of virtual reality, and haptic virtual reality for skills transfer. And the data is pretty clear now. And we have a number of studies available from our website. And I know there's lots out there in in publications. So what do we see? So if you take traditional training techniques, as we've talked about, and compare it to virtual reality, the vector that you see there is somewhere in the region of 85 To 300% improvement in this in the knowledge acquisition of the individuals using virtual reality. So significant on any vector is a significant improvement. And that's measured by their assessment to do certain tasks to remember steps to read perform those steps, different studies do it in different ways. But the range you see is kind of that 90 to 300%. And I, if I'm picking a number, I took about 233%, which is what from one particular study that was done a couple of years ago. So you see a massive step up when it comes via it's VR versus traditional training techniques. So then the next question is, well, what does haptic give you on top of that? What does that sense of touch resistance, weight force feedback? What does that do for you? And again, as you think about it, you think well, okay, I understand that there's going to be an additive there, because I'm getting hands on with this experience, what we found, and there's been a few studies done now I think five or six are out there, a couple that we've been involved in, what we see on average is about 40, to 45% improvement in the accuracy of a have a user. So what I mean by that it's, it's their ability to not just know the task, but also then to have the competency to deliver that task effectively. And those studies have been done in general surgery, they've been done in orthopedic surgery, we were involved through both NYU Langone, and also the NHS, in a couple of studies, looking at some orthopedic work. And there, we saw about a 44% improvement in the accuracy of an individual learning through VR. So you've already got that, let's say 230% improvement from traditional training, and then you get the accuracy plus up on top of that when you add VR and haptic VR in. So it's pretty significant.
Patrick Kothe 41:59
That's, that's great data. The other thing that you mentioned earlier, we started talking about the two things, standalone, and then haptics and then groups. The group piece is very interesting, too, because a surgeon is not operating by themselves. A surgeon is operating within a team on a on a patient. So it's not just the surgeon, the team is there, too. So can you talk to us a little bit about the group, and the importance of of that particular product?
Richard Vincent 42:31
Absolutely. Yeah, you're 100% Correct. You know, bringing the teams together is really where it really comes to life. We have a system, we call it collaboration, VR, and the name kind of explains what's there. It's so important for the procedures and the experiences, we have the ability to bring people together from different parts of the world, through a headset into one shared space, we can do that with up to 50 individuals within one space and have multiple spaces within within an experience. Each of them can then learn together, they can pass tools, they can put past technique, but they can do so much more than just have a virtual version of meeting in a training center. If you and I were having this conversation in one of our collaboration spaces, I could ask you to come and stand exactly where I'm standing. And you could see exactly what I was seeing at that time, you could then place your hands onto the haptics and feel that same technique, as I was feeling so you get a shared experience that's almost impossible to replicate. In many other situations, it just removes the friction from that learning experience. But it's more than that. Because one of the real challenges for our industry is as all this innovation happens, as our leading educators create new techniques, the ability for those techniques to really move across the globe, is limited often by the innovators, readiness to get on a plane, travel the world, tell the story, teach the technique and do it in those different environments. Well, what we can do now is to in effect, digitize that capability and put it virtually into a into a room where anybody can access it at any time and have that experience and come and stand in the same place at the same time and feel the same thing to collaborate together. So it can be really, really powerful. And then you have the other side of it, which you touched on, which is the surgical teams. There's a lot of training that they need to do even without the surgeon or the radiologist or whoever in the room, you know, just to prepare. So technical setup training, again can be really enhanced and accelerated through the use of the Collaboration tools that exist within our virtual virtual reality platform.
Patrick Kothe 45:04
Depending on where the technology is, it will have a certain effectiveness. And you've talked about some of the effectiveness. But where the technology sits today, and and historically how training has has been done with cadavers or animals or models? How does VR sit within the training? Is it is it replacing? Is it augmenting? Where does it sit?
Richard Vincent 45:35
In most cases, it's augmenting at the moment, it's and I think that's the right place for it at the moment in terms of the adoption of that tech and understanding of it. It can help immensely in getting much higher value out of a catabolic training session, it can offer the opportunity to rep replicate and repeat a particular technique multiple times, which you might not get in any other scenario. But I don't think it replaces those scenarios today. In most cases, it really augments them. There are some edge use cases where the training isn't possible in other situations, and we have a couple of those in in the gene therapy space where it is the only modality that's available. But those are still kind of edge cases, really, I think it should be seen as mentioned, or augmentation of the current practice. But what it can do is deliver massive scale in the build up towards the training process that somebody is going to go through. So it's a real plus up opportunity.
Patrick Kothe 46:40
So they can enter that kind of Eric session with a whole lot of knowledge. And it could accelerate the time in learning, learning a procedure or technique.
Richard Vincent 46:51
Absolutely. And then also, and again, I'm sure lots of listeners will will relate to this one. After that Catterick training session, there's a gap, you may not get presented with the right patient case for some time. And the longer that gap lasts, the more that knowledge and skill and capability decays. And that's where again, these sort of systems can come in, and they can help fill that gap.
Patrick Kothe 47:15
That's a great point. Timing is, is very important when you're doing training, you know, so the time the distance or the time lapse between when you train and when you do your first case, I think what's happening is the confidence is eroding every day that you're not doing that with your thoughts earlier about, you know, confidence being one of the key key drivers in here. That time lapse is something to really keep an eye on too. So if a company is interested in in getting involved let's let's talk about an implementation. So let's say that there's a there's an orthopedic company, they've got a new hip procedure that that they want to help they use categoric sessions to do this, if they wanted to add VR in. What does that program? What does that implementation look like? How does it get started? What are the steps associated with with developing a product for that?
Richard Vincent 48:16
The the process of coming into and adding VR into an established program, I think really starts with first working out what the value additional value add is of the VR and hopefully the haptic VR system. And what I mean by that is, yes, of course, we could build into our platform, a full replication of an entire procedure. But there's probably three or four pinch points, actually, during a procedure that really matter. And it's probably identifying what those are and focusing in there, rather than necessarily doing the whole thing. Like I said, foot both are either easily within scope, but I think what we found from experience is if you focus into those key areas, a an organization can stand up something of value much faster. So that's important. Then there's a
Patrick Kothe 49:13
so are you working with are you working with like marketing people and the clinicians at that point in time to develop or to identify those pinch points?
Richard Vincent 49:22
Absolutely, yeah, yeah, it'll be the medical education team, it will be their care wells. It will be our Kol some medical panel as well, working with them to really identify the the areas where the value is created. The last thing any of anybody wants is to create something that costs a lot of money and doesn't really deliver very much you know, we want to make sure that it's it's hitting the sweet spot as quickly as possible. So that it's seen as a value add and and a value creator as opposed to a cost line.
Patrick Kothe 49:56
And then as far as drawing the anatomy all of those different things. How does that happen?
Richard Vincent 50:03
So we've got an amazing team thread across the world, particularly, a lot of development of the development team sits in Europe, but a lot of it also in the US, and we create from Daikon models, we all create models simulations of the anatomy that's in question, we will work with the medical experts that we have within our team and within our customer teams and our end user teams to understand the nuances of that procedure, which again, you know, if you're into interventional could be the way that that particular device navigates within a vascular structure. And we've got very good at doing this, we will draw down the key elements of visual of physical of haptic that allow us to then codify it. And it, it's amazing how much within our industry, there's so much opinion on how things should be done. But actually, to bring it down to something that you can actually say, okay, that that's it. And now we're going to code that through and create it as a finished flow. It's quite a complex process. And we've got pretty good at doing it, we've got an amazing team of artists of designers of engineers have massive brains when it comes to the haptic part of what we do to put all of those pieces together. So we can do a lot of the heavy lifting for our customers and our end users, they can get there pretty quickly.
Patrick Kothe 51:34
And the business model side of things, is the cost of the company in the development, or is it development plus usage?
Richard Vincent 51:42
Yeah, so it's, it's on a SaaS based model. That's how we, we run it. So for those who don't know what that means, we, we license access to the platform for our customers, so that we can stay fully engaged with their product with the application on our platform and make sure that it does exactly what they want it to do. What we want is for them to focus on what their business imperatives are, which is about good skills, transfer and getting the right skills in the right place to use those devices. And let us worry about making sure that the software does what it needs to do at the time. And so we run it on a on a SaaS based model, much the same as Netflix for MediCal.
Patrick Kothe 52:25
Richard, we've talked about what's happened in the past and where the current technology sits, and how education can be performed today, looking forward into the future. What do you see the medical education developing into what types of tools are going to be used? And how are things going to be done? A few years in the future?
Richard Vincent 52:48
Somebody wants very wisely told me never predict the future. But hey, I'll take a run at it anyway. What do I think is going to happen? I think what we've seen now is that the industry has has probably crossed the paradigm in terms of this it okay, we understand that immersive technology has a major player part to play in training, education, skills, transfer, product adoption, etc. So So I think there's no question mark about it being part of the future. So what's going to happen? I think we're going to see it broadened out into more and more disciplines, you know, we're already in, I don't know, maybe 910 different surgical disciplines. Now with as wide reaching is endovascular, and cardiovascular through to orthopedics, you know. And so it's it's very different sets of skills there. And we see no real challenge in the platform handling those type of things. I think one of the big things that will happen over the next five years is we will see, and rightly so some standardization, and some consolidation around the way that these systems like ours work. We need our end customers, our end users, the nurses, the surgeons, the healthcare providers to not have to learn or relearn a different login technique, a different navigation technique, etc, for every procedure or device that they're using, because it happened to have come from a different company. So it happens in all technology. You start with lots of people creating it in different ways. And then you start to see consolidation. And I think that will certainly happen over the next few years. And by consolidation, I mean, consolidating approaches, so that you, if you've used one of our simulations, you'll understand what it's like to navigate around that space. And you could do that equally with one that was provided by another company, rather than having to learn a different technique. So I think that will certainly happen. I think the other thing we will see and we've been seeing it really over the last few months and year a couple of years is A recognition of the importance of the haptic part of immersion, the sense of touch. You know, it's easy to say, Well, maybe it's not important, maybe there's a distraction that comes from that. But the reality is, if you want to put somebody into a secondary reality and give them a near life experience of conducting a procedure to not have the ability to interact physically with that space, is a nonsense. And so I think we will see a growth in haptic capability. And we certainly will be licensing out that capability to a number of partners to help them on that journey, as well, as the industry says, We need to have that as part of our other part of our solutions. So I think that will certainly happen. And I think, and rightly, so we'll continue to validate, and start to move that validation into more of the journey of a patient. You know, ultimately, we want to be able to say, here's the health economic outcome of this input. Today, we can validate it in very controlled ways. But over time, I think with the data that we're producing the data that we're starting to, to be able to line up against other outcomes, we can start to say, this is what it means for the industry. This is what it means for patients. And most importantly, I guess this is what it means for cost. You know, anything that can reduce cost in the industry has got to be a good thing. And I think we will start to see some real focus around the impact of good training, having better outcomes, resulting in lower cost, and, of course, better patient recovery and better patient outcomes as well. So I think it's a really interesting time. But I did start this bit by saying, I was told never to predict the future. So you can you can take from that what you offer.
Patrick Kothe 56:58
VR is in its early stages, and there'll be much more development of the hardware and software. However, the benefits of making training more accessible and available, will help clinicians deliver better patient care, a few of my takeaways, first, confidence, competence and experience. I really don't think you can say it any better than that when you're talking about skills transfer. If we focus on increasing our customers confidence and using our product, make sure they're competent in everything about the product and how it fits in their procedure surgery, and provide them with that pre human experience with simple cases. And when something goes wrong, we're really set setting them up for success. Second, finding a cool technology isn't enough, you need to find that killer application of that technology. Richard's team, as he described, evaluated several different markets before focusing in on medical education. Once they did that, they brought in experts to really dig down into that chosen market, to be able to identify the key areas where they can bring value. Finally, focusing on your strength, Richard described, they're a software company, they're not a hardware company, they're not going to get into that development cycle with that hardware product. If you focus on your non essential products or components, what it's going to do is it's going to slow you down, and it will limit you when especially when technology is rapidly evolving and is coming out from other manufacturers. So using it opportunity to partner really is a strategic decision that he's taking. Thank you for listening. Make sure you get episodes downloaded to your device automatically by liking or subscribing to the mastering medical device podcast wherever you get your podcast. Also, please spread the word until a friend or two to listen to the mastery medical device podcast. As interviews like today's can help you become a more effective medical device leader. Work hard. Be kind
