According to Dr. Jyoti, one of the problems as a surgeon or as a doctor is that there are many changes coming through, certainly in the United Kingdom, where training is concerned. "We have the European work and time directory stating that we have to work shorther hours. People are being tucked into bed to guarantee that they have protected sleep. Nevertheless, the work keeps coming through. Even our specialist training is now shorter and more streamlined, more structured."
The problem, as pointed out by Dr. Jyoti, is that surgeons are getting less experience. Twenty, thirty years ago, it was all right to practise on a patient and do your first operation on a patient, having barely ever seen one. At present, it is ethically not possible to do that anymore. "We are running into lots of problems relating to how we are going to practically learn to do a procedure since we have got less time, less hours. We are not allowed to practise on a patient. So where do we do our first operation, where do we do our first procedure?"
More and more, surgeons are turning to training outside the operating theatre, such as simulation environments. Simulation traditionally meant for example practising on latex models. These have their limitations besides the fact that they are not objective: how do you measure suturing on something which provides no parameters to measure? "Slowly, we are starting to accept virtual reality and computer-based simulation", Dr. Jyoti noted.
The advantages of WebSET and similar applications are that they are completely objective: one can set criteria. You can use the objective score as feedback but also as a marker to better yourself next time. "WebSET at the moment has a few limited applications which are a start and as we develop these, we are going to become involved in doing a lot more and create tools applicable to many other specialities as well."
Dr. Jyoti found that WebSET is doing a great job in bringing tools to education and medical training. Surgeons have to practise somewhere so this is ideal. The project offers a surgeon the opportunity to organise private training sessions using his own feedback but also to do it in a group while practising separately since there is absolutely no need to be geographically placed in one classroom in distance learning.
"The bottomline is we really need to demonstrate that learning these skills on a computer actually transfers the skills to the patient. Currently, we do not really know which skills we are transferring to the patient. Once we have established that, for example that performing one hour of lumbar punction on a computer equates to half an hour or ten patients in reality, we will be able to develop a lot more applications", Dr. Jyoti stated.
Dr. Jyoti is specialised in urology procedures but she also performs general surgery, including laparoscopy. Some of the skills are pretty basic, such as suturing or making incisions. These skills are generic and needed in all kinds of procedures. A procedure can be understood as any act performed on a patient like for instance lumbar punction, stitching, blood taking, putting in a canular. Procedures consist in a number of steps which have to be standardised.
WebSET has the additional advantage to abstract the ways in which the steps are performed in a procedure, the so-called textbook ways, as Dr. Jyoti put it. In this regard, WebSET constitutes an opportunity to standardise medical training globally and have doctors of equal standard everywhere. Dr. Jyoti expressed her amazement about the reality of the graphics, produced sofar by the WebSET team. "Together, we are adding a dimension of physical reality as well as visual reality. For example, when we pinch our skin, we see it deform. We witnessed the same effect by pushing the tool on the computer, we see the application visibly deform. These are important cues for a surgeon."
Admiring the physiological reality, Dr. Jyoti stated that the only thing lacking were the forces but once these capabilities have been integrated, the surgeons will be provided with realistic force-feedback as well. More details on WebSET are available in the VMW October 2001 article WebSET project shows first simulator results and at the WebSET project Web site.