Confronted with the high costs and limitations of current training methods, Mr. Stefan Hudson, Clinical Innovation Fellow, and Mr. Ryan Kerstein, Consultant Plastic Surgeon at Buckinghamshire NHS Trust, sought a more effective way to train surgeons in burn assessment and care. Their journey led them to partner with Cambridge-based medical technology design experts, Team Consulting. Together, they embarked on an ambitious project to harness the power of mixed reality, resulting in the creation of an innovative training tool that offers surgeons immersive and customisable burn simulations.
Simulating a burn for surgeon training
The current training process for burns involves employing specially trained prosthetics artists to overlay burn patterns on medical mannequins. However, the cost of each mannequin is in the region of £120,000, making them an expensive training tool for the NHS.
The mannequins used often have generic characteristics for skin, age and sex, which does not provide much-needed context for burn injuries or an accurate simulation of how they can affect different patient presentations. For surgeons, the absence of diversity can cause a lack of confidence when working with real-life patients. The cost and time investment in producing these mannequins also means that the training process isn’t delivering as much value as it could be.
A cost-effective burn training model for surgeons
Working in close collaboration with the surgeons of Buckinghamshire NHS Trust, Team designed a concept training tool for surgeons using a mixed reality headset that maps custom digital burns onto a mannequin, allowing exposure to diverse patient characteristics and burn scenarios. Crucial for training, the tool includes a live-stream feature for trainer feedback on burn assessments. The aim of the headset concept is to offer surgeons a richer experience, reduce costs and boost confidence as surgeons refine their skills through optional assessment prompts.
De-risking the technology at minimal cost
Before undertaking any significant development of this mixed reality concept, the team needed to prove that the technology was feasible. To de-risk the technology, Team Consulting’s software engineering experts combined existing software packages with phone apps and custom code to build a demonstrator in just two days. This gave confidence that the technology was de-risked and that they could move forward with refinement of the prototype and UX/UI activities.
Innovating through collaboration and contextual research
Team Consulting’s UX designers and software specialists collaborated closely with Mr Kerstein and Mr Hudson to identify opportunities for design improvements in the training model. The project team conducted contextual research by taking part in the NHS’ burn simulation course at Stoke Mandeville hospital. This allowed them to see first-hand the challenges surgeons face during training when responding to different burn scenarios and assessing their patients.
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“To achieve mixed reality in a burn simulation, we had to overcome several technical challenges. The software team went though iterative prototyping and testing to prove feasibility rapidly. Collaborating closely with clinicians to understand the problem they were faced with, overcoming technical hurdles while continuously learning something new, and finally presenting them with an innovative solution, was immensely rewarding.”
Thorbjorg Petursdottir, Consultant Electronics & Software Engineer, Team Consulting
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Re-creating different types of burns using a mixed reality headset
Initially, the focus was on creating the ability to customise a burn based on a patient’s physical characteristics, which can affect the appearance of the burn. These characteristics provide context for the training surgeon to aid in their assessment. The user experience team then concentrated on defining parameters for the burn itself: depth, size, cause, and location, to present surgeons with varied patient scenarios. The user interface of the headset then displays a tailored ‘digital burn’ on the mannequin, ready for the training surgeons to begin their assessment.
Software engineering: redefining what technology can achieve
Proving the concept with minimal effort and investment was essential, so the focus was on developing a simulator based on a mannequin arm. The technology could later be developed to cover an entire body. The headset needed to detect and track the movement of the ‘real-world’ mannequin arm while keeping the digital burn in place on top of it. To achieve this, software engineers took a 3D scan of the mannequin arm and used it to train a computer vision model to recognise it in real life. Once the arm is detected, the digital burn can be seamlessly overlaid on top of it, matching its size and shape.
The software team redefined the 3D scan and created high-fidelity digital burn wounds directly on top of the arm. The phone app allowed manipulation of the digital overlay by selecting various skin colours and types of burn wounds for assessment during training. Because the training surgeon can interact with the physical mannequin arm while using the mixed reality training app, the prototype maintained good hand occlusion. This was crucial to avoid obstruction of both the digital overlay applied on the mannequin and the hands of the training surgeon. Maintaining good hand occlusion also provided a good level of realism and ultimately, a better training experience.
Outcome
The mixed reality solution Team Consulting developed for Buckinghamshire NHS Trust substantially expands the exposure of training surgeons to diverse burn scenarios, improving their learning outcomes and ultimately, patient care. This solution significantly reduces training costs and resource requirements for the NHS. The team at Buckinghamshire Healthcare NHS Trust currently have plans to develop it into a commercially available product.
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