Digitally enhanced hands-on surgical training (DEHST)—from idea to product
Three years after its first concept, DEHST, the AO project enabling digital solutions for hands-on training, is being deployed under the AO Milestones trauma program.
DEHST is a novel skills training platform augmenting practical exercises with advanced digital technologies. The system features a miniaturized model of an intraoperative image intensifier (C-arm) with an artificial X-ray imaging engine generating radiation-free simulated X-rays enabling an enhanced training spectrum and new type of user experience.
Now fully embedded under the AO Education Institute’s (AO EI) activities, DEHST is a showcase of how an idea, triggered by an unmet need in a mastered segment (trauma education), has developed into a stand-alone product. “DEHST addresses the need for standardized skills training and assessment, ensuring consistent, high-quality training. By assessing the learner and gathering data on competency gains, we aim to offer micro-credentials, enhancing residents' readiness and proficiency in the OR,” said Marc Stal, Head of Education Portfolio—Focus Programs at the AO EI.
DEHST brings together all three AO institutes, from AO Research Institute Davos’ (ARI) Jan Buschbaum, Leader of the Concept Development Focus Area, inventor, and main developer of the DEHST, to the AO Innovation Translation Center (AO ITC) and its innovation funding that carried the project through its seed funding phase, and the AO EI with its AO Milestones trauma program, now offering the 0-series of DEHST stations as an additional feature of the AO’s signature hands-on trainings.
DEHST is a novel skills training platform augmenting practical exercises with advanced digital technologies. The system features a miniaturized model of an intraoperative image intensifier (C-arm) with an artificial X-ray imaging engine generating radiation-free simulated X-rays enabling an enhanced training spectrum and new type of user experience.
Now fully embedded under the AO Education Institute’s (AO EI) activities, DEHST is a showcase of how an idea, triggered by an unmet need in a mastered segment (trauma education), has developed into a stand-alone product. “DEHST addresses the need for standardized skills training and assessment, ensuring consistent, high-quality training. By assessing the learner and gathering data on competency gains, we aim to offer micro-credentials, enhancing residents' readiness and proficiency in the OR,” said Marc Stal, Head of Education Portfolio—Focus Programs at the AO EI.
DEHST brings together all three AO institutes, from AO Research Institute Davos’ (ARI) Jan Buschbaum, Leader of the Concept Development Focus Area, inventor, and main developer of the DEHST, to the AO Innovation Translation Center (AO ITC) and its innovation funding that carried the project through its seed funding phase, and the AO EI with its AO Milestones trauma program, now offering the 0-series of DEHST stations as an additional feature of the AO’s signature hands-on trainings.
“This project is a great example of a successful cross-divisional effort, delivering an innovative training solution for surgeon education, right when needed.”
Stefano Crespan
“This project is a great example of a successful cross-divisional effort, delivering an innovative training solution for surgeon education, right when needed,” said Stefano Crespan, Senior Project Manager Technology Transfer at the AO ITC. “The AO’s innovation funding not only provides financial support but is also a catalyst for great ideas to foster on fertile ground.” ARI’s Jan Buschbaum confirmed that the strategy fund’s involvement was much more than just financial: “They were not merely a ‘funding body’ for this project. Their connections with internal and external stakeholders made it possible for us to showcase our prototype at important events and get connected to people who fostered our ideas.”
“The first DEHST prototype showcased its capabilities, earning unanimous support from the AO Milestones taskforce,” said Stal. The first functional module for the free-hand distal interlocking training was developed in 2021, followed by a prototype module for proximal femoral nailing in 2023. The full Nailing Package, consisting of three modules covering the most relevant surgical skills for intramedullary nailing, was completed when the product 0-series was delivered for testing during the AO Davos Courses in December 2023. “The gamification and deliberate practice approach are ideal for our needs, to train and assess residents to be better prepared and proficient in the OR, ultimately benefiting the patient. In addition, DEHST’s low cost compared to other simulators allows for sustainable training and assessment of future orthopedic surgeons,” explained Stal.
“Their connections with internal and external stakeholders made it possible for us to showcase our prototype at important events and get connected to people who fostered our ideas.”
Jan Buschbaum
The whole training and assessment station is compact, fits into a padded box, and can be easily transported to courses, events, or hospitals. Further modules and packages are currently being developed by ARI’s DEHST team, which has grown from what Buschbaum calls a “one-man-show” to three employees. “The plan is to keep it all in one transportable box, even once additional modules and packages are added.”
The ARI team has further proven its capacity to drive development, tapping from the AO’s network of committed surgeons, when delivering another proof of concept with the pedicle screw for spine applications. Yet another application of DEHST is its potential to train course participants’ imaging skills, using the device’s miniature C-arm, which simulates intra-operative x-rays. An imaging module involving DEHST will be introduced at the AO Trauma Course—Basic Principles of Fracture Management during the 2024 AO Davos Courses, and additional imaging modules for veterinary and pediatric surgeons are currently being discussed. Meanwhile, two validation studies* have successfully assessed DEHST’s training efficacy.
The ARI team has further proven its capacity to drive development, tapping from the AO’s network of committed surgeons, when delivering another proof of concept with the pedicle screw for spine applications. Yet another application of DEHST is its potential to train course participants’ imaging skills, using the device’s miniature C-arm, which simulates intra-operative x-rays. An imaging module involving DEHST will be introduced at the AO Trauma Course—Basic Principles of Fracture Management during the 2024 AO Davos Courses, and additional imaging modules for veterinary and pediatric surgeons are currently being discussed. Meanwhile, two validation studies* have successfully assessed DEHST’s training efficacy.
“The first DEHST prototype showcased its capabilities, earning unanimous support from the AO Milestones taskforce.”
Marc Stal
“The future of DEHST is promising, with plans to expand its applications to more procedures and skills, covering the standard training needs of orthopedic residents worldwide. It is amazing to collaborate with the AO Milestones taskforce of experts, shaping the development of new modules that will cover additional anatomical-specific procedures and basic skills. For example, an upcoming module will train the skill to drill and hit a point in space 'blind,' a fundamental skill every orthopedic surgeon must master,” said Stal.
*Digitally enhanced hands-on surgical training (DEHST) enhances the performance during freehand nail distal interlocking | Archives of Orthopaedic and Trauma Surgery (springer.com)
Medicina | Free Full-Text | Validity of a Novel Digitally Enhanced Skills Training Station for Freehand Distal Interlocking (mdpi.com)
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