The trauma and orthopaedic department at North Tees and Hartlepool NHS Foundation Trust has deployed RealWear Navigator 500 headsets running Microsoft Teams to support student training.
The trust is an integrated hospital and community healthcare organisation serving around 400,000 people in Hartlepool, Stockton-on-Tees and parts of County Durham.
The trust successfully applied for funding from Health Education England, which is now part of NHS England, to use technology innovatively to increase student capacity. It initially trialled Microsoft HoloLens, but has now selected RealWear to provide a head-mounted device surgeons can wear to livestream footage of operations to a classroom.
“The biggest problem we’ve got in the NHS is the lack of nurses and junior doctors. We encourage the nurses and other students to get involved in the theatre experience. They go through their nurse training on the wards or in intensive therapy units, but a lot of them don’t have that [theatre] experience,” said Jean Angus, head of nursing education at North Tees and Hartlepool NHS Foundation Trust.
She said the RealWear technology enables students to see exactly what the surgeon in the operating theatre sees. “In a theatre environment, you’ve got to get to the student to scrub up next to you. I can see what I’m doing, but they’re in the corner of the theatre. They can see the surface of the skin, but they can’t see inside the hole and what we’re actually operating on,” said Angus.
There are a number of medical schools in the vicinity of North Tees and Hartlepool NHS Trust. With most medical schools taking in 150 to 200 students per year, orthopaedic consultant Nick Cooke said there was a huge volume of students who could gain from the experience. “One of the things we find with surgery is it’s difficult to give the students the same experience that they would hopefully gain if they were in my place,” he said.
Cooke said he tends to do two knee replacement operations a day, which means there is scope to provide many students, across all areas of the medical profession, with “theatre experience”.
Explaining how the system works, Angus said while Cooke is in theatre, she has a group of students in a classroom. “We have the operation livestreamed onto a large screen and the students can interact with Nick. He can point things out, they can ask questions, and the whole experience is live. We never know what’s going to happen,” she said.
Prior to surgery, training begins in the classroom by looking at X-rays and implants, which Cooke said helps them to understand what is going to occur. He then goes down to theatre and does the knee replacement with them watching.
Angus said the training setup allows 20 to 30 students at a time to view the livestream of the theatre. “Learning the skeletal system on a skeleton or by looking at diagrams or going on the internet is one thing, but to actually see it is much more real. The students are able to relate what they see in an operation to the underpinning knowledge they’ve been taught. When they look after the patients on the ward, they’ll say, ‘Well, I can see why, because Nick’s pulling limbs in different ways.’ So anatomy and physiology, all of a sudden, is real. You can handle implants and you can look at skeletons, but when you see it the way Nick sees it, it’s real.”
During interprofessional learning sessions, the trust realised that paramedics, who are often the first responders to emergencies, could use the technology to connect with specialists and emergency departments to provide a visual of the patient’s condition and explain the treatments given in real time before arriving at the hospital. Going forward, this will enable the trust to bridge the gap between different disciplines and create a holistic understanding of a patient’s journey.
North Tees and Hartlepool NHS Foundation Trust initially tried Microsoft HoloLens, but Cooke found it less suited to the operating theatre due to its bulk and the viewing angle. “We experimented with HoloLens, but we found we were only seeing the top half of the wound and not the bottom half because I wasn’t tilting my head down far enough. Having to tilt your head at 45 degrees with a great big computer on your head [means it’s] not the most comfortable thing to wear,” he said.
Working with Angus and RealWear, Cooke said the team also found the RealWear-based training system they planned to deploy would meet the trust’s information governance requirements.
From a practicality perspective, he said RealWear is generally configured with Wi-Fi, which is unsuitable in the operating theatre environment. “Theatres often have quite thick walls and some of them have lead in the walls for X-rays. We tried using Wi-Fi a few times and it kept cutting out, so we now use SIM cards in the RealWear headset, which works much better.”