Scaling Surgical Education: Dr. Ghazi’s Vision for Global Training Standards

GU Oncology Now Advisory Board Editor David Ambinder, MD, of New York Medical College/Westchester Medical Center, sat down with Ahmed E. Ghazi, MD, of Johns Hopkins Medicine, to discuss in length his groundbreaking work on advanced simulation models as a urology training resource.

In Part 3 of this series, Dr. Ghazi concludes with the impact and reception of his surgical simulation models, highlighting the challenges and successes in developing and disseminating these tools.

He emphasizes the importance of realistic training environments, shares insights into the data supporting the effectiveness of his models, and reflects on personal and professional challenges, including the persistence needed to overcome obstacles and the goal of setting new standards in surgical education.

View their previous comments on Revolutionizing Surgical Training: Advanced Simulation Models.

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Dr. Ambinder: Many people have attempted to move beyond traditional surgical teaching methods, such as the “see one, do one” approach. Some virtual simulations have failed, and simulations alone have limitations. However, your work seems to be gaining traction and showing promise. What feedback have you received, and what does the data show?

Dr. Ghazi: As a research entity, we collect a significant amount of data. Our goal is to achieve a level of training similar to what pilots experience in flight simulators. Pilots spend most of their learning time in highly realistic VR simulations. These simulations are effective because they closely replicate the actual flying experience, making the transition to real flights seamless. The equivalent for us would be ensuring that surgeons are thoroughly trained before they operate on real patients.

Currently, we lack operating manuals for patients, making each procedure high-risk. We aim to ensure that surgeons have completed a comprehensive curriculum before they enter the operating room. Ideally, residents would refine their skills to a fellow’s level during their training, leveraging the resources we have available.

Other disciplines like orthopedics, anesthesia, and plastics have adopted similar approaches in various countries. Urology, however, has yet to fully embrace this model. There are resource constraints and barriers, but I believe we can set standards and pave the way for broader adoption. We are interested in partnering with institutions to share our models and help them develop their own systems.

For instance, in our single-port curriculum, endorsed by the Endourology Society, we provide models and online access to 10 fellows free of charge. We also offer proctoring at our September SIRS meeting. We have sought societal and industry funding to support this initiative, but our goal is to democratize this technology, not to commercialize it.

We are working on a confidential project to enable institutions to create these models using specific equipment. This would allow institutions to develop models locally, reducing the burden of significant annual lab expenses, which range from $300,000 to $400,000. While we have substantial grants, not every institution can bear these costs. We hope leading institutions will replicate and spread this technology, potentially partnering with organizations like the American Board of Urology to distribute models widely.

Dr. Ambinder:
It is truly remarkable what you are achieving. The growing adoption of your models indicates your success. Can you share a moment when you felt like giving up and how you overcame it?

Dr. Ghazi:
There have been many such moments. I learned a lot from Kotter’s book Our Iceberg is Melting, which discusses how to manage change and lead effectively. The key takeaway was to establish a new status quo and celebrate small wins.

One of my first significant wins was when our simulation video won Best Video at the AUA Annual Meeting. That recognition was a major boost. Over time, these small victories, like positive feedback from users and seeing residents excited about the models, keep me motivated.

My goal is to play a significant role in training urologists across the U.S., with our models becoming the standard not just because they are unique, but because they are highly realistic and widely available. The challenge is overcoming institutional barriers and protecting technology. We have been fortunate to provide many models for free, but our aim is to set a standard that encourages widespread adoption.

Our next step is to establish a training center at Hopkins where people can use our models and learn from experts. This center will also serve as a blueprint for other programs, encouraging them to develop their own training programs. By sharing data and collaborating, we can demonstrate the benefits of this approach for patient care.

Dr. Ambinder: It is exciting to think about the future. We are at the beginning of a transformative period in surgical education, and it is fascinating to interview you at this pivotal moment. I usually ask where people see us in 15 years, but in this case, it seems the sky is the limit and the need is vast.