The presentation above is a recorded version of the same one delivered at the 2018 VR Voice ‘VR in Healthcare Symposium’ held at Harvard Medical School, Boston, USA.
Please follow the link below to access a PDF version of the full paper from the above presentation, including the results of the survey conducted on the experiences and awareness of VR and AR within the veterinary profession.
Click link below to access paper
Mixed Reality & Virtual Reality
In 2016 I was fortunate enough to be at one of the conference parties where someone happened to have two Microsoft HoloLens headsets and was demonstrating them to the small crowd of curious nerds that had gathered around him. Well, I was one of those nerds and before long had the pleasure of donning one of the sets and so was introduced to the wonders of true mixed reality.
Much like a small welding mask, in both look and feel, the HoloLens is essentially a set of transparent screens that sit in one’s field of view by means of the headstraps that keep the device in place. Whilst not especially comfortable and certainly not something anyone is going to ever be in a rush to wear out in public on account of looking, frankly, ridiculous, the experience that it delivered was compelling. With the use of a simple gesture, specifically an upward ‘throwing’ movement, a menu popped into view suspended perfectly in mid-air and crystal clear as if it were right there in the real world in plain sight of everyone around me. Of course it wasn’t and the only person able to see this hologram was me. Selecting from the menu was as simple as reaching out and ‘touching’ the desired option and within seconds a holographic representation of the Earth was spinning languidly before me. I could ‘pick up’, ‘move’ and otherwise manipulate the item in front of me as though it were a physical object, and if I did move it, for example off to the right, out of my field of view, that is precisely where it remained and where I found it again when I turned back round. The human body application was similarly cool, as I was able to explore the various layers of anatomy through interaction with a highly rendered hologram. Whilst comical for onlookers not wearing a HoloLens, as I appeared to apparently be pawing away at thin air like someone suffering a particularly lucid acid hallucination, the thrill of what I was actually seeing and engaging with myself allowed me to ignore my daft appearance.
What are the medical education applications for such mixed reality technology? Whilst holographic visual representations of anatomy are, at first, a magical phenomemon to experience and a pretty cool party piece, it is the fact that mixed reality sees realistic holograms merged, or so it appears to the user, onto the real world, in contrast to virtual reality, which replaces the real world experience with an entirely digital one, that lends itself to unique educational applications. Anatomy instruction by being able to accurately overlay and track in real-time deeper layers onto a real-world physical specimen, enabling students to understand the wider context in which various anatomical structures sit is a far more compelling and useful application of MR than a simple floating graphic. Similarly, surgical training involving holographic overlays onto a real-world, physical object or combined with haptic technology to elicit tactile feedback, offers the potential to deliver programmable, repeatable, easily accessible practical training with minimal expense and zero waste on account of there being no need to have physical biological specimens.
Imagine: a fully-functional and resourced dissection and surgical training lab right there in your clinic or home and all at the press of a digital button. Imagine how confident you would become at that new, nerve-wracking surgical procedure if you had the ability to practice again and again and again, physically making the required cuts and placing the necessary implant, being able to make the inevitable mistakes that come with learning anything new but at zero risk to your patient. Being able to step up to the surgical plate for real and carry out that same procedure that you have rehearsed and developed refined muscle memory for, feeling the confidence that a board-certified specialist with years of experience has, and all without having had to put a single animal at risk – that’s powerful. That’s true action-based education at it’s most compelling and it is a future that both VR and MR promises.
I predict that the wide adoption of graphically rich, immersive and realistic digital CPD programmes, through both VR and MR, will result in a renewed engagement of professionals with CPD training and ultimately lead to more confident, skilled, professionally satisfied and happier clinicians. I, for one, know that were I able to complete practical CPD by simply donning a headset and loading up a Vive or HoloLens experience from the comfort and convenience of my clinic or home, all whilst still being able to interact in real-time with colleagues both physically present and remote, my CPD record would be bursting at the seams. That has to be a great thing for the profession, our clients and society in general.
“Virtual Reality was made for education.” I have no idea who first said that – can I claim it? – but I am sure it has been uttered countless times since and I assure you that it will be said countless times in the future. From feeling as though virtual reality (VR) was nothing more than a sci-fi promise of things to come yet never quite delivered to the current situation in which VR feels as if it is undergoing a true renaissance.
With the arrival of devices, such as the Vive, Oculus Rift and Samsung GearVR, that are finally capable of delivering truly-immersive, high resolution and, most importantly, non-nausea-inducing experiences that captivate both young and old alike, VR has arrived and the exciting truth is that we are simply getting started!
There are already creative, innovative and fast-moving teams working on sating the appetite for immersive content, with gaming naturally leading the charge, and 360-degree video experiences also offering many their introduction to the world of VR. This, however, is not where VR ends and it continues to excite me to see the educational promise that this technology offers and that pioneers in the field are indeed delivering on. Unimersiv, one such team, refer to the idea that whilst 10% of knowledge that is read and 20% of that heard is retained two weeks later, a staggering 90% of what is experienced, or physically acted out, is recalled. If that is indeed the case then VR, with its power to immerse users in any environment that can be digitally rendered, offers a hugely powerful educational tool. The fact that the big players in the tech arena, such as Google, are now taking VR seriously speaks volumes for how impactful it is predicted to be, and that I believe it will be.
Potential medical, especially educational, applications abound, with veterinary no exception. Whilst my interests in the technology are NOT limited to veterinary, it is an area that I have direct experience of working in and so where perhaps I am most effectively able to postulate on the future applications of a technology that IS, I strongly believe, going to shake things up for all of us. In terms of medical and science education, for example, work such as Labster’s simulated world-class laboratories, where students can learn cutting-edge science in a realistic environment and with access to digital versions of professional equipment. It may be digital and simulated but that does not diminish the educational power that such experiences delivers. I can see Labster’s technology inspiring a new generation of scientists to develop a fascination for the subject and ultimately help solve many of the world’s most pressing problems, such as the issue of antimicrobial resistance and the drive to develop new drugs.
So what about the potential uses for VR within veterinary? Well, perhaps some of the following….
- Dissection – Anatomical training without the need for donor animals/ biological specimens. More efficient, with multiple ‘reuse’ of specimens in a digital environment, leading to revision of key concepts and better learning outcomes, translating into better trained, more confident practitioners.
- Physiology – take immersive ‘journeys’ through biological systems, such as the circulatory system, learning about how these systems work, both in health and disease. Simulation of the effects of drugs, parasites, disease processes can be achieved, with significant learning outcomes compared to traditional learning modalities.
- Pharmacology – model the effects of drugs on various biological systems and see these effects up close in an immersive, truly memorable manner, thus deeply enhancing the educational experience.
- Surgical training – simulate surgical procedures thus enabling ‘walk-throughs’ of procedures in advance of actually physically starting. With advances in haptic technologies, tactile feedback can further augment the experience, providing rich, immersive, powerful learning environments. Surgeons, both qualified and training, could learn in a solo capacity or with team members in the digital environment – great for refreshing essential skills and scenario role-playing with essential team members. For example, emergency situation modelling to train team members to carry out their individual roles automatically, efficiently and effectively.
- Client education – at home and in-clinic demonstrations of important healthcare messages, helping drive healthcare messages home and driving clinic sales, revenue and profitability, and leading to more favorable healthcare outcomes and client satisfaction.
- Communications training – many of the issues faced in medical practice stem from breakdowns or difficulties in communication with clients or between colleagues. Communications training is now an integral part of both medical and veterinary training and should be extended to all members of a clinic’s team, from receptionists to nurses and veterinary surgeons. With the immersive power of VR and the ability to create truly empathetic experiences, it offers the perfect tool for communications training.
- Pre Vet School education/ Careers counseling – think you know what it means to go into veterinary practice? Can’t arrange a farm placement but still believe you have what it takes to pursue a veterinary career? Imagine being able to experience a range of VR simulations that guide you through a host of realistic scenarios faced by veterinary professionals, enabling you to make informed career decisions based on ‘real’ experience. It has been demonstrated that those who experience high-quality VR feel genuine empathy for those situations into which they digitally stepped. The power of this for making informed choices about future plans and for challenging preconceived notions about what it means to be or do something is compelling.
- Commercial demonstrations/ trade show experiences – custom-made VR experiences for showcasing new products and services to prospective customers, creating truly memorable and impactful campaigns. I for one look forward to VR becoming a mainstream component of company presentations at trade shows.
These are simply a snapshot of some of the potential applications for VR with most easily being applied in other, non-veterinary contexts. I look forward to continuing to grow my knowledge and expertise in this exciting area and welcome anyone who shares the same sense of wonder and optimism at the possibilities to get in touch.
Technology advances and its impact on veterinary practices – including e-CPD and e-learning options
(as printed in the Vet Nursing Times – see links to PDF versions at bottom of post)
The word technology means different things to different people. Many of us think of smartphones or sophisticated computers as cutting-edge technology and perhaps don’t imagine that there is much in the way of technological advancement occurring in everyday clinical practice. The truth is that there is a lot of advancement in a variety of technologies taking place in veterinary practice, and it is some of these that I aim to share with you today.
Technology is, for me, anything that helps us to do our jobs better, whether it be enabling us to perform tasks faster, more effectively, or to enable us to achieve a better outcome for our patients and clients. In essence, technological advances should, and usually do, enhance both our personal and working lives. There are three areas in which we see advances in technology in practice. The first is clinical technology; the classic ‘vetty’ gadgets, gizmos and systems that make the process of diagnosing, treating and managing our patients easier and more effective. Secondly, there are the advances in practice management and client communication technologies, an area which in my opinion has probably seen the biggest changes and which offer the biggest opportunities for really impacting on our clinics’ bottom lines. The third area for focus is the use of technology in education and CPD, important in ensuring our personal and professional growth and where technology is certainly having a big impact.
Although our focus is on first opinion practice, it is worth noting the fact that as general practitioners we have ready access to the very latest clinical technology and cutting-edge diagnostics and treatments through our ability to refer to our specialist colleagues. We are, as vets, able to pretty much do anything that is clinically possible and this is, in large part due to the huge advances in knowledge, expertise and technology at our disposal within the specialist fields.
Imaging is probably one of the main areas in which technology is at it’s most obvious. Gone are the days, for many of us, of long periods stuck in a dark, hot, generally uncomfortable radiography suite taking multiple radiographs and getting more and more frustrated at how long it can take just to get a simple series of images. It was a revelation when I moved to my second job and discovered the joys of digitial radiography. No need to fumble in the dark with open cassettes and film or handle noxious chemicals, and the images were pretty much instantaneously available. The system I first encountered was CR-tech, or Computed Radiography technology, involving the exposure of a plate, as per traditional methods, and then the processing of these films by way of a digital system. Since then there have been further advancements with the emergence of DDR-tech (Direct Digital Radiography), in which the plate is exposed and an image almost instantaneously appears on screen without the need to manually place the plate into a processing unit. This is possible due to the use of a syntillated plate, or direct digital panel (DDP), which effectively replaces the plethora of film cassettes that we’re used to using at present. Never has the phrase “take a quick X-ray” been so accurate!
In parallel to advances in the technological hardware itself comes developments in software, meaning that the process of taking, processing and working with radiographic images is much more user friendly and clinically helpful. There are, for example, bespoke software packages that will guide the vet through the correct measurements required for planning a tibial plateau levelling procedure, for example. The reduction in the sheer size and amount of necessary hardware, coupled with the options of cloud storage, where digital files are stored on a remote server away from the clinic (think Facebook, whereby your profile is actually hosted on a server in the US, or elsewhere, and not all on your desktop) has meant that even the smallest of clinics can boast an impressively powerful and versatile radiography capability, with none of the hassle associated with the secure storage, organisation and retrieval of hundreds of radiographs. Much simpler and much more elegant.
Ultrasound technology is another area where we have seen impressive changes in practice. From super-powerful, all singing, all dancing set-ups, such as the Logiq S7 Expert, which makes use of new matrix probes and B-flow technology, useful for assessing vascularisation in tumours, for example, to the miniaturisation of the scanners, allowing us to both reduce the amount of space taken up in our clinics and ‘take the scan to the patient,’ whether in a hospital or out on calls, the changes have been staggering. To have the kind of imaging power that we have in a device no bigger than a laptop computer is a sure sign of the advances in technology that we are enjoying as vets.
One of the key attributes of a true technical advancement is one which takes an established way of doing something and completely rethinks it, or revolutionises it. One such example of new technology that does just that is the v-gel, a new airway system for ventilating anaesthetised patients. The point to note is that it isn’t an endotracheal tube – that’s the revolutionary thing about it. Instead of inserting into the trachea, through the larynx, the v-gel creates an effective seal around the pharyngeal, laryngeal and upper airway tissues, thus positioning a large diameter opening directly over the larynx to permit normal gas exchange with no trauma to, or even contact with, the larynx. One of the key advantages of this new system is that rather than needing a tube that is in effect smaller in diameter than the trachea, the v-gel allows the tube to be larger in diameter than the patient’s trachea thus maximising air flow and exchange. The soft rubber tip, that atraumatically ‘plugs’ the oesophagus, also serves as a good counter to the risk from regurgitation under anaesthetic. Currently available for both rabbits and cats, with dog versions in development, these new tubes represent a fantastic example of a smart, cleverly designed advancement of an existing technology.
We’re all aware of the need to better engage with and market to our clients, both current and prospective, with the level of competition between practices apparently increasing all of the time. The methods for doing so these days have never been so plentiful nor powerful, yet many of us are still failing to maximise on the potential returns that doing so could bring. One of the simplest ways of better engaging with our clients, and those who show an interest in our services, is through email and the careful but effective management of email lists. Email management services such as MailChimp, which enable even the most technophobic of users to set-up a mailing list, design a web form to be posted on a website, social media, or even accessed via a link which can be emailed, and then organise, manage and communicate effectively with the people on that list, are brilliant and it is amazing how useful they can be for practices. Imagine, for example, how impressed your clients would be to receive an email on their pet’s birthday wishing them many happy returns. Combining such a thoughtful gesture with a suggestion of a senior health check if the pet has just turned seven, for instance, could be an easy yet effective way of driving more business through your doors. Through careful segmentation of lists, such as having a list containing only those clients who own cats under 7 years of age, for example, it becomes much easier to provide them with relevant information that they will find interesting and useful, with the result being a much greater level of trust in and bonding with you and your practice. How many of us actively ask our clients or new prospects, for their email address? My guess is very few. The truth is that these days people almost expect to be asked for it and we should be making a greater effort to make use of the advances in email and online marketing, much of which is available either free or very low cost, especially when compared to other marketing media such as print. Done well, email could be the best use of technology you have in your practice at present.
Social media is another potentially powerful way to engage with our clients and to help make us stand out from the crowd. People are interested in what we do as vets and what can often seem like the most run of the mill, mundane, day to day event in our clinics may form the basis for a fantastic Tweet or Facebook post, which can encourage a conversation between people and raise the prominence of us and our clinics in a good way. Obviously care has to be exercised, like with anything, but Social Media is one surefire example of a recent technology that veterinary practices have a lot to potentially gain from. Some clinics have embraced this aspect of marketing, using it to converse with clients and to provide updates, information and education through the use of videos, for example. Engaging clients in such a manner is a great way of strengthening the bond they have with your practice.
Some clinics have embraced technology more than others with some even rewriting the rule books on how we can manage our practices. Vets Klinic in Swindon have just one desktop computer in their practice, with each vet and nurse issued their own, personal iPad on which the clinic’s bespoke practice management system is accessed, meaning that patients’ records are readily accessible no matter where you are in the clinic and making the consulting rooms, and other areas feel clutter free. Use of tablets also enables patients’ time within the clinic to be recorded, and photos and notes about their stay easily uploaded to their clinical ‘timeline.’ Owners can access their pet’s timeline and see in realtime how their pet is getting on. Clients are actively encouraged to register and book everything from appointments to surgery online, with an airline style booking system showing prices and times of appointments with each vet, with real-time variable pricing a feature and a discount on offer for clients who prepay in advance of their appointment.. Tablet computers do appear to be excellent devices for use in a busy hospital environment, with the ability to readily access a patient’s notes wherever you, as the vet or nurse, happen to be within the clinic.
The internet has quite simply revolutionised the way in which we access and consume CPD, with webinars and online learning resources becoming ever more commonly used, and available across virtually every platform, from smartphones to tablets and the trusty desktop computer. The advantages are clear: access to reliable, interesting CPD without the need and expense of taking time out of our busy clinical lives or the hassle of travel to attend lectures. With a plethora of providers, including many of the drug companies, learning online can be achieved at little to no cost and represents a very cost effective way of ensuring we keep our CPD current and maximising our CPD budgets. The only limitation that I could see from my experience of ‘attending’ a webinar was the fact that as the event was taking place on my computer and in the comfort of my own home, unless the speaker was particularly engaging, it was very easy to get distracted with other activities whilst convincing myself that I was still learning as I had the lecture playing. This coupled with the knowledge that I could always go back to the lecture and view it again at another time only acted to fuel my distraction. Somehow there just seems less risk of this happening when you’re physically present with the lecturer and other CPD attendees present in the same room. But then, maybe that’s just me and everyone else is a consumate good student at home. With so many other distractions constantly vying for our valuable attention the challenge, as I can see it, is for e-CPD providers to ensure that their content is as engaging and interesting as possible, including the use of mixed media, from standard lecture-style presentation slides and speech, to clever use of graphics, video and animations to really bring subject matter to life and inspire people. After all, the last thing any vet wants after a long, hard day in the clinic is to sit through a dull lecture, even if they do have the option of switching over, as it were.
One of the exciting challenges for the future will be in seeing how e-CPD can deliver more practical training, with a physical presence still very much required at present for practical CPD courses. Maybe a stepping stone will be the provision of ‘learning kits’, complete with necessary equipment and materials which the student can make use of whilst receiving remote instruction via a webinar or other means of e-learning. Although e-learning is delivering a wider and more accessible range of CPD to the profession, available at any time, anywhere and in any format, it is unlikely that it will completely usurp the strong desire we have as humans to actually congregate in the same space to receive educational instruction and socialise, as is clearly demonstrated by the continuing popularity of congresses, such as the London Vet Show.
Whether we realise it or not, technology and advances in it are all around us in practice. From the scanners we use to make diagnoses to the equipment we employ to safely manage our ill patients, or the plethora software tools, both bespoke and consumer options, technology is pervasive and empowering. It has changed the way we engage with clients, market our services, and continue our professional development, and all pointers are in the direction of yet more innovation and technological advancement, I for one watch on excitedly.
Links to the PDF versions of the original article, as printed in the Vet Nursing Times:
Is it possible to mix business and pleasure? Well, yes, I believe it is and I think I managed it during my recent trip to New York. One of the days I spent out there saw me take a break from the usual tourist efforts and instead saw me head east, to 510 East and 62nd Street, in order to visit the Animal Medical Center, one of New York’s most revered veterinary establishments and a world-renowned teaching hospital.
Arranging the visit couldn’t have been easier, with the power of Twitter as a medium for more than just pointless digital static being proven as I managed to make initial contact via the social networking tool. A simple follow-up email later and a tour of the center for the friday of my visit was booked. Simple.
Set within viewing distance of the Queensboro Bridge and the Rockefeller Island Tram, a cable-car connecting Manhattan to Roosevelt Island a short skip across the East River, the building itself doesn’t quite do justice to the state of the art work conducted inside. Still, early twentieth century architecture was what it was and the important thing is that the center has been devoted to advanced treatment, research, education and exemplary veterinary healthcare since 1910, over 100 years, and has grown impressively in that time. Covering eight entire floors of their current building, the main action happens on the second, where clients are registered, patients triaged, including 24/7 emergency provision, and many of the center’s services are provided. The Animal Medical Center has everything, from it’s own on-site pharmacy, to a dedicated emergency ward, state-of-the-art imaging equipment, with everything from echocardiography to digital radiography, to MRI and CT, and beyond. The surgical facilities alone would make any surgeon worth their salt weep with delight and feel convinced that Christmas had come early. All in all, a very impressive set-up and it is little wonder that the Animal Medical Center is the first place vets from around the world think of when planning a trip to NYC.
Education is one of the core focuses of the Animal Medical Center and each year they take on a number of veterinary undergraduates and graduates for externships (short placements, normally during university vacations), internships and residencies. The competition is fierce, and the fact that New York is one of the toughest states in which to become registered to work as a vet, comes as little surprise. I had the chance to meet briefly with a German undergraduate who was a week into an externship before returning to complete her studies in Germany. She was incredibly complimentary and enthusiastic about the center and cited the high standard of teaching as being a major draw, something that was exemplified by the evidence I saw of the daily seminars and tutorials that take place.
“So, how do I actually go about working in the states?” Good question. The answer is that the process is neither simple, quick or, by any means, cheap, with the total cost likely to be in the region of $10,000, assuming you pass all of the stages first time. There will be another dedicated post on this subject but in the meantime, this AVS page gives a pretty good overview of the process.
Talking of working overseas, if any students find themselves at the Animal Medical Center and have any inclination to apply to study veterinary in the UK, they now have the advantage of their very own copy of Vet School: My Foot In The Door, which I gifted to the center during my visit.