Creating a Silicon Valley for surgery skills in Amsterdam
More than 400 years after Rembrandt visited an anatomy lesson and created the world-famous painting based on his experiences, Dr Jaap Bonjer reveals the 'Amsterdam New Way of Learning Surgical Skills' only a few miles from where the operational theatre of the infamous Dr Nicolaes Tulp was once based.
A renowned surgeon, Dr Bonjer has always wondered why his medical education took so long and cost so much. On average, it takes more than 30,000 hours of study and training before a surgeon can operate independently and lead a surgical team. That time frame is almost four times the length of time it takes to train a helicopter pilot, and three times as long as it took for Jimi Hendrix to become the world’s best guitar player. And why do surgical students have to practice on real patients? Not only does this drive up costs (up to €1 million per student) and increase health risks, it also creates a bottleneck-effect. In fact, every 60 seconds 271 essential surgeries cannot be performed in low- and middle-income countries because of a shortage of qualified surgeons. In the coming years, at least an extra two million new surgeons must be trained to guarantee that at least two-thirds of the world’s population has access to basic surgical care.
Photo: Dr Jaap Bonjer
“With the existing educational model, it is impossible to achieve this,” Dr Bonjer says. “That is what the Amsterdam New Way of Learning Surgical Skills is all about: creating a paradigm shift in surgical training methods by shortening the learning time with at least a third and steepening the learning curve. We do this by building an open source learning platform. In it, we combine the latest available technologies, scientific insights and learning methodologies, and present them in a competency-based and learning-off-the-job curriculum for surgeons and students from all over the world.”
A state-of-the-art facility featuring cutting-edge tech
The physical evidence of this ambition is the newly built UMC Amsterdam Skills Centre, which is based on the southeast campus of the Dutch capital’s UMC medical centre and less than 15 minutes away from Amsterdam Airport Schiphol by taxi.
One the day that I amsterdam meets up with Dr Bonjer and his operational manager Peter van Felius they are proudly testing the centre’s new furniture. It arrived earlier that morning and will soon be used by the first of the expected 3,000 students who are set to start their training after the centre’s launch. Dr Bonjer and Van Felius are also guiding a group of visitors around the state-of-the-art wet and dry labs, and the luxurious class and leisure rooms.
As Bonjer had in mind when he first ‘doodled’ the architectural layout of the building, the operating theatre is its heart. Here 12 highly advanced operating tables are ready to provide training services 24/7, allowing students to learn complex procedures on preserved human tissue or improve their hand-to-eye coordination by working with surgical robots. Virtual-reality simulators are also on hand to replicate any emergency situation a surgeon could encounter during a procedure, such as unexpected interventions or malfunctioning robotics while performing microsurgery.
A new, unique approach to surgical training
The unseen parts of the Amsterdam Skills Centre are just as impressive. By offering students the latest technologies and methodologies for e-learning, they can literally take their training home with them. Trainees can also use mobile training kits to practise their newly acquired skills.
The centre’s state-of-the-art training equipment enables Dr Bonjer and his fellow tutors to move away from a ‘master-apprentice’ approach and instead stimulate students by allowing them to personalise their own training. “We can actually export our curriculum,” Dr Bonjer explains, “and each part of the program is designed as a building block. This makes it possible for our students to personalise their programs, and to decide when to come to Amsterdam for a personal boost or to do this in their own time in their own hospital. Some are here for just a couple of days, others for weeks or months. All will stay online for the rest of their careers. That is the plan.”
Financing the centre through public-private partnerships
The realisation of Dr Bonjer’s vision took a giant leap forward when he met Kevin Lobo, the CEO of American MedTech firm Stryker. Actually, Dr Bonjer saw a picture of Lobo in Stryker Europe’s Amsterdam offices and remembered working with him in Canada.
“Kevin shares my vision of how we need to change our learning model,” Dr Bonjer explains. “We must learn to integrate new technologies into our procedures. The future will only bring more disruptions. Minimally invasive surgery is advancing, and through advanced imaging techniques we can now diagnose the effects of surgery or any other form of treatment in real-time. To take advantage of this, the surgeon must constantly redevelop their skills. As a manufacturer of medical equipment, Kevin and his management team are aware of the necessity to improve and scale-up the aptitude of surgeons in, for example, eye-to-hand coordination and controlling robotically-powered medical instruments.”
When Stryker joined as a launch partner, the financing of the public-private partnership which helped build the Amsterdam Skills Centre became relatively easy. The recently established UMC medical centre helped to provide the remaining funding needed to complete the project. To preserve scientific independence, the latter holds all shares in the centre.
Developing the Amsterdam Skills Centre further
When the first batch of trainees arrives, their freshly-appointed CEO and senior tutor will already be developing the vision of his initial plans. Dr Bonjer points out the empty spaces on the campus and shows a virtual reality-presentation of the future expansion of the Amsterdam Skills Centre: a series of five buildings, each dedicated to training specific capabilities that are vital to working successfully in medical care.
“We can build the equivalent of Silicon Valley for surgical cure and care here,” Dr Bonjer says. “There are many elements in our new way of learning that we are not addressing yet, and we invite partners to join us and make their contribution to complete the learning cycle. Our final goal is to build a scalable, low-cost and mobile learning environment that can be implemented anywhere in the world.”