Kashif Ikram MSc. MA. MBA is a MedTech industry expert, and we reconnected with Kashif to follow up on his article in the 2020 Mentice Annual Report – What has changed in the past year?
Kashif has twenty-six years of working with renowned companies such as Zimmer Biomet, Edwards Lifesciences, Medtronic, and Siemens Healthineers, and has vast experience and knowledge within the field. Kashif is the former EMEA Head of Corindus Vascular Robotics (a Siemens Healthineers’ company) and is currently Vice President at C-RAD AB (Sweden).
What has been the greatest impact you have seen with simulation over the past year?
The past year has been like no other in living memory with the pandemic affecting all our lives and especially those of our healthcare professionals. We have all become more thankful for the professionals who strive every day to keep us healthy. Our thoughts also go out to those who have been unable to meet with or have lost loved ones and friends.
As the day-to-day focus shifted, the pandemic brought physicians additional challenges in terms of maintaining skills and learning new methods such as robotic-assisted vascular interventions. At the beginning of the pandemic, hospital managers wanted physicians to be close to their hospitals and reduce travel to a minimum. It was no longer possible for physicians to travel to exhibitions, congresses, or teaching centers. The portability of the simulator was now key, and systems were brought to the physicians enabling virtual simulation training and learning in a safe environment. Using simulation, physicians could attack a problem multiple times and try different approaches. The procedure level could be scaled up from simple to complex, and physicians suddenly had the means to pause, contemplate, and reflect. Simulation-based training has been appreciated among the physicians who have tried it. The legacy of this pandemic could be that it guided people to become more comfortable with working in the digital space faster than anticipated.
What are your thoughts on continuous and proficiency-based learning in a safe environment?
Starting with proficiency-based learning (PBL), I am a great fan of the work of Prof. Anthony Gallagher  and multiple others who have investigated the psychology of learning and human factors and proposed a progressive training approach combined with simulation. The important aspect of PBL focuses on the acquisition of skills after the knowledge has been attained. During PBL, cognitive and psychomotor learning takes place and there is observable and measurable progression up the learning curve. After all, football fans do not become expert players simply from watching their local professional team play each week. Training needs to be part of a carefully crafted curriculum and should take place in multiple sessions over a set longer period, rather than in one short period. Using this paradigm, training becomes uniform, potentially less costly, and studies have shown that skills acquired from virtual reality training in a medical setting are transferable to the operating room. 
I am a keen motorcyclist, and it is not uncommon for motorcyclists that live in areas with colder climates to partake in training rides or even a refresher course in the spring to re-awaken their riding skills. Does the ”continuous” or regular training make motorcyclists safer on the road and more proficient? I would like to think so. Pilots are also accustomed to continuous training at regular intervals, though more importantly with the addition of re-certification requirements. Based on these examples, clinicians returning to the simulation training suite at regular intervals doesn´t seem to be a bad idea and should therefore be encouraged. However, it would need to be managed by the appropriate organization, such as a medical or surgical society (of that discipline) and contain relevant learning modules developed by experienced clinical experts. Implementing appropriate assessment would also be required, perhaps anonymized recordings that are reviewed by independent experts (or even AI) based on a prepared scoring system.
Where do you see simulation technologies having the greatest impact in the future?
Simulation will play an important role in the future of several areas. For example, as multiple vascular robots are launched, each with its own user interface, the VIST® Virtual Patient simulator will help physicians adapt to each new interface. Resulting in safer technology adoption with fewer errors. In addition, as seen in the field of Surgical Robotics, a training simulator is now provided built-in to the robot. The built-in simulator will provide angiography and vascular robotics companies with a competitive advantage, as it creates new opportunities for clinical teams to improve their performance and operational efficacy. Hospitals that have access to the VIST® Virtual Patient can further use it to plan cases and for extensive training. The new ability for hospitals to upskill their physicians and offer more complex procedures to the population could create a disruptor in the hospital market. To help improve outcomes and reduce costs, medical societies can set standards of continuous learning and assessment.
From a long-term perspective, I see simulation technologies developing further using machine learning and AI and utilizing real-time angiographic imaging to become a digital assistant to the clinician, constantly monitoring the procedure, providing real-time insights and valuable information to the clinician as well as helping the nurses to prepare and plan. The objective would be to reduce the cognitive load for the clinicians and nurses. I'm looking forward to seeing how these various threads develop in the future.
Interested and want to read more? Check out the blog Virtual and Physical Sim: The future of measuring physician proficiency? - where Kashif Ikram shares his thoughts on education and training as physicians transition into robotic-assisted vascular interventions.
 Prof. Anthony Gallagher: https://pubmed.ncbi.nlm.nih.gov/?term=Gallagher+AG&cauthor_id=25211267
 Seymour N, Gallagher A, Roman S, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Ann Surg. 2002;236:458–464.