Disruption is everywhere. Quickly evolving technologies – robotics, virtual reality, artificial intelligence, etc – are forcing professionals to continually update their skills. Happily, these societal changes were factored in during the recent and radical merging of Amsterdam’s two main training hospitals into Amsterdam UMC.

As the dust settles, and with the launch of the Amsterdam Skills Centre and the Amsterdam UMC Imaging Center, the city seems to be in an enviable position when it comes to providing quality and future-proof medical training and education.

Thinking outside the black box

A professor of surgery at Amsterdam UMC, Dr Marlies Schijven has many titles – including the futuristic-sounding ‘chair on simulation, serious gaming and applied mobile healthcare’. However, she plays down the magnitude of the changes brought on by recent technologies.

“The training schedules for becoming a surgeon have not changed markedly, nor have the patients,” says Dr Schijven. “We may have more insights into certain diseases and access to better and more refined treatments. And the tech in the operating room has changed in that we do much more laparoscopy than ten years ago. We are currently stepping into the era of robotic enhanced surgery – which may eventually become part of the curriculum, but then still not for many years.”

Dr Schijven is a firm believer that training should be a lifelong undertaking. She was the initiator behind installing the first “black box” in a Dutch operating room. As with aviation, the box tracks and analyses information during surgery and uses AI algorithms to flag abnormalities that can be discussed by the surgical team afterwards.

“The black box is very much about team training. It’s about looking back on joint performance – which is really the best way to improve,” says Dr Schijven. “It’s a way for surgical teams to better understand each other: to get together and discuss potential improvements. It’s also a great way to test new instruments – to observe bottlenecks and research best practices.

But as with many new technologies, there were challenges during implementation. Since the privacy of patients and medical staff had to be respected, the data was anonymised – faces blurred, voices altered – at the source.

“Implementing new tech like this is not easy: you are already a seasoned professional and you must again be brave enough to risk being scrutinised. So, you must go about it carefully with lots of monitoring and sitting down with people,” says Dr Schijven. “In the end, it’s about creating a safe place for people to learn. So we can become even better professionals for our patients.”

Using new ways of learning to cut training times

“We’ve already been talking about installing a black box in one of our ORs,” enthuses Dr Jaap Bonjer. He’s the innovator behind the Amsterdam Skills Centre, a public-private partnership with MedTech company Stryker and Amsterdam UMC.

As an R&D centre for new ways of learning, the ground-breaking training programme seeks to drastically cut the training time of surgeons. Since opening nine months ago in February 2019, 3,500 people from 49 countries have taken a course at the centre.

“Basically, we want to cut the seven or eight years spent after medical school training to become a surgeon down to six months,” says Dr Bonjer. “And we want to collaborate with anyone and anything that can help us achieve this.”

“At the moment we train on human tissue, but I expect in five to 20 years to move to a more simulated environment. VR still has a long way to go: the graphics are unrealistic and there is no haptic feedback when you touch the instruments. But I’m very hopeful. Dutch company Moog has already developed a cataract simulator that has fantastic graphics, excellent haptic feedback and different scenarios built in. Our first tests are very hopeful. I think we’ll be able to train a cataract surgeon in six months. I’d call that impact. I’d call that disruptive change!”

“Our final goal is to build a scalable, low-cost and mobile learning environment that can be implemented anywhere. In January we are welcoming our first surgeon from Kenya who we hope to work with to build a curriculum for their country. And we have similar short-term goals for Uganda and China.”

Amsterdam’s all-in approach to imaging and education

Opening on 31 October 2019, the Amsterdam UMC Imaging Center represents the biggest concentration of cutting-edge medical imaging techniques in Europe. Naturally, it has become a magnet for top academic talents, as well as MedTech and pharmaceutical companies.

This immense project – both integrated and multidisciplinary – began as a vision in the mind of the project’s leader Guus van Dongen to reveal the secrets of what’s happening in the human body. “It’s about creating an open and collaborative environment,” he explains. “By bringing all these imaging technologies together, we are creating a navigation system. We hardly know what’s happening inside the body – it’s a black box. So, we need a more complete image of all the body’s functions. We also need to be able to analyse treatments to make sure they are effective.”

With everything in place, Van Dongen is now working out how to develop training programs best suited for this unique hybrid environment. “It’s through the clinical care we provide here today that we can develop the clinical care of tomorrow. And certainly, we offer researchers a much broader scope than the traditional lab. But as with the Skills Centre, we must make sure our activities maximise real-world impact.”

“While it’s still early days, I am confident. Look at what happened when all the city’s different oncology centres began working together: Amsterdam immediately became one of the top cities in the world,” says Van Dongen. “But yes, it’s not just about technology. It’s also about contact with patients. It’s about the balance between the two and how to use this balance. While the technologies might change, the importance of soft skills won’t.”

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