28. The Role of XR Technology in the Field of Plastic Surgery Training

Abstract

Background: While early innovations are often disruptive and met with resistance, adoption of new technologies occurs when the benefits become readily apparent. Recently, eXtended Reality (XR) is gaining momentum as surgical training use cases are being explored. XR consists of a user wearing a head-mounted display (HMD) that blends the physical and digital world for enhanced visualization, communication, and understanding. To understand the potential impact of this novel educational tool, the receptiveness of resident and attending plastic surgeons must first be assessed for its usefulness and useability. Methods: Michigan Medicine Plastic Surgeons watched recorded XR interventions concurrently piloted within the department and completed a survey assessing applications for: (1) remote consultation; (2) surgical tele-mentoring; (3) pre-operative planning to visualize patient-specific anatomy. Recordings were stored for future educational purposes. Results: In total, 11 attending and 10 resident physicians (21/44, 48%) responded to the survey. Attendings were more willing to use, and most optimistic about, the value of remote consultation; residents were most optimistic about surgical tele-mentoring. Both attendings and residents considered the HoloLens2 unnecessarily complex (60% & 56% respectively). Simpler device interventions, such as with the Iristick, were rated more favorably for usability. In all Iristick interventions, attendings were more confident than residents in their ability to use the devices without technical support (72% vs 45%, respectively). Conclusion: Attendings were overall more receptive than residents to the integration of XR in Plastic Surgery training. Responses suggest residents are under an increased cognitive load, and novel processes may be perceived as stress-inducing if trainees are the intended wearer of HMD. Residents appreciated XR technology for its value of increased visibility in the operating room, paralleling the added benefit of viewing cases remotely and asynchronously for case preparation. Residents noted the Hawthorne effect, whereby an attending wearing a HMD during an operation was more inclined to verbalize tacit knowledge that might have gone unnoted in the absence of a recording device. Selecting the most valuable use cases and executing it with the most usable technology, in a process that is mindful of role stress, is paramount to advancing Residency education efforts.