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.
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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.
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“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. 
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