The document proposes using virtual reality technology for medical training at the University of Washington Medical School. It summarizes research showing virtual reality training results in faster procedures, fewer errors, and better outcomes for patients. The author urges adopting virtual reality to improve how students learn procedures and treat mental health conditions like PTSD. Virtual reality could help minimize the increase in patient deaths that occurs when new medical residents start each July. As virtual reality technology advances further, it will likely become an essential tool for medical education.

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University of WA, Medical
School
To: John Klein, dean of University of Washington Medical school
From: Warren L. Sprecher, MD
cc: Kate Mobrand
Date: April 13, 2015
Re: Virtual reality in military training
Introduction
With the innovations going into modern virtual reality technology, the applications have grown
immensely. In the medical field alone, virtual reality may be used as a way to create 3D
modelings of organs for procedures, or more importantly, provide safe practice of medical
procedures for students [1]. Modern innovations within the area of virtual reality allow much
more accurate user inputs and visual graphics. If fact, experiments revolving around medical
uses of virtual reality have provided very strong evidence towards a benefit to using virtual
reality in training procedures [2]. Through these experiments, using virtual reality in medical
training has shown an increase in speed of operating, and five times less likely to cause
unnecessary injury to the patient [3]. Because of the clear benefit of using virtual reality as a
training tool, I urge you to implement this new technology in our medical school at the University
of Washington. This memo will address the current weaknesses of the medical schooling
system, provide a solution through virtual training and rehabilitation, and propose future
implications of virtual reality in the medical field
Current weaknesses
Every July, the concentration of medical fatalities spikes significantly in counties with teaching
hospitals. This is the same month that medical students begin their residencies. Studies have
shown that this is not just a coincidence, and conclude “that the July mortality spike results at
least partly from changes associated with the arrival of new medical residents” [4]. This increase
in death shows a separation between what students are currently learning in medical school and
what they are responsible for performing in real operations. When a separation such as this
causes deaths from medical error to increase by as much as 10% [4], it is imperative that a
solution be found.
In addition, there are many mental disorders, such as PTSD, which are difficult to treat. Due to
this difficulty, even the best schools have trouble preparing their students with the skills needed
to diagnose and treat mental disorders. This leaves incoming doctors unprepared to treat

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patients with mental disorders, and leaves many ill patients improperly treated. This is
understandable, as patients with mental disorders generally “have diverse needs and
prognoses” [5], yet mental disorders are nonetheless a serious medical issue, and must be
addressed.
Virtual Training and Rehabilitation
In addressing these weaknesses, we should look to the technological advances made in virtual
reality. In tests comparing virtual reality training to traditional training procedures, results
continuously were in favor of virtual reality training. First, an experiment where subjects were
graded on a laparoscopic cholecystectomy after being trained via virtual reality or traditional
training. The experiment’s results showed that “Gallbladder dissection was 29% faster for VR-
trained residents, shown in figure 1. Non-VR-trained residents were nine times more likely to
transiently fail to make progress and five times more likely to injure the gallbladder or burn
nontarget tissue. Mean errors were six times less likely to occur in the VR-trained group” [3].
Other experiments on virtual reality training show similar results, with decreased surgery times
and decreased injury rates.
Furthermore, with the addition in recent years of haptic feedback, or feedback involving touch
sensations, virtual reality has become an even more reliable teaching tool. Haptic feedback in
training has resulted in more consistent improvement when learning, as well as a slightly faster
learning curve than virtual reality without haptic feedback [6].These experiments show that
students may learn surgeries and procedures faster with the use of virtual reality, while
simultaneously decreasing the amount of errors during the procedures.
The second issue we may address with virtual reality is the treatment of patients with mental
disorders. New studies and experiments have emerged that show a strong correlation between
the use of virtual reality and improvements in symptoms of disorders like post-traumatic stress
Figure 1: average duration of operative procedure for each group [8]

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disorder. In fact, in a study of war veterans with PTSD, participating patients who used virtual
reality for treatment “improved an average of 35 points on the CAPS (Clinician Administered
PTSD Scale)” [7], whereas the patients who were treated as usual only showed a 9 point
increase on the CAPS [7]. What is truly unique about virtual reality as a treatment towards
mental disorders is that it allows each patient to act in their virtual environment uniquely, letting
each user react to their treatment in different ways to provide the best personal results for each
patient. With the results coming from this use of virtual reality, it will become integral that virtual
reality treatment be provided as an important treatment tool for medical students.
Future Implications
Virtual reality has already reached a point where it may fundamentally improve the way students
learn and execute medical procedures. As the technology in virtual reality continues to increase,
the uses and importance of virtual reality in the medical field will grow as well. Even as it
currently stands, the technology towards virtual reality is showing incredibly impressive results
[2] [7] [8]. Clearly, this technology has shown us that it has the ability to more properly equip
medical students with the skills needed to perform in the hospital – which will directly result in
minimizing deaths in hospitals. With further advancements in technology, virtual reality training
may become the irrefutably best way to prepare students for real operations. Schools using
virtual reality in their training will produce the highest quality of incoming doctors that will be
more consistent, more efficient, and make less mistakes than those without this training [8].
Conclusion
To summarize, I urge you to use and invest in this proven effective tool. If you use virtual reality
as an additional training tool you may improve the efficiency of students’ procedures, and
simultaneously provide a higher quality of training that has proven to help students make less
mistakes in performing procedures. Furthermore, I urge you to provide virtual reality as a
resource in treating mental disorders. Using virtual reality in this way would provide your
students with a unique and effective approach to treating difficult disorders. This new technology
will more adequately prepare your students to address real operations they will face in their
career. Perhaps this new technology will save lives every July.
If you would like more information, please contact me at warrenls@swedishcare.com. Thank
you for your time and consideration.

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[1] R. Satava and S. Jones, 'Current and future applications of virtual reality for
medicine', Proc. IEEE, vol. 86, no. 3, pp. 484-489, 1998.
[2] N. Rudarakanchana, L. Desender, I. Van Herzeele and N. Cheshire, 'Virtual reality
simulation for the optimization of endovascular procedures: current
perspectives', Vascular Health and Risk Management, p. 195, 2015.
[3] J. Fox, D. Arena and J. Bailenson, 'Virtual Reality', Journal of Media Psychology:
Theories, Methods, and Applications, vol. 21, no. 3, pp. 95-113, 2009.
[4] Phillips, D. P., & Barker, G. E. (2010). A July spike in fatal medication errors: a
possible effect of new medical residents. Journal of general internal medicine,
25(8), 774-779.
[5] Gelberg, Lillian, Lawrence S. Linn, and Barbara D. Leake. "Mental Health, Alcohol
and Drug Use, and Criminal History Among Homeless Adults." Mental Health,
Alcohol and Drug Use, and Criminal History Among Homeless Adults (1988): 191-
96. Web. 12 April, 2015
[6] Zhou, M., Tse, S., Derevianko, A., Jones, D. B., Schwaitzberg, S. D., & Cao, C. G. L.
(2012). Effect of haptic feedback in laparoscopic surgery skill acquisition. Surgical
endoscopy, 26(4), 1128-1134.
[7] McLay, R. N., Wood, D. P., Webb-Murphy, J. A., Spira, J. L., Wiederhold, M. D.,
Pyne, J. M., & Wiederhold, B. K. (2011). A randomized, controlled trial of virtual
reality-graded exposure therapy for post-traumatic stress disorder in active duty
service members with combat-related post-traumatic stress disorder.
Cyberpsychology, behavior, and social networking, 14(4), 223-229.
[8] Seymour, N. E., Gallagher, A. G., Roman, S. A., O’Brien, M. K., Bansal, V. K.,
Andersen, D. K., & Satava, R. M. (2002). Virtual reality training improves operating
room performance: results of a randomized, double-blinded study. Annals of
surgery, 236(4), 458. 12 – April, 2015