African Briefing (AB): What is AmoSmile?

Dr Naidu: The AmoSmile app is an innovative, resource-conscious training platform that allows surgical trainees and practitioners to independently become confident and competent in performing foundational facial reconstruction techniques. It is a collaboration between the Operation Smile Global Surgery Fellows and AmoDisc Ltd, a UK-based simulation technology organisation.

It utilises a mixed-methods training platform using virtual and physical simulation to teach Z-plasty reconstruction in low-resource settings. This local flap recruits tissue adjacent to the wound to release the scar, improve mobility, and reduce pain. It is very useful in treating conditions such as burn contracture, or large wounds from trauma or after removing cancer.

The mobile app guides learners through an entire curriculum, including step-by-step simulations and dynamic, customised training with competency tracking.

Additionally, we have built a physical simulator. It is low cost, easily assembled, and entirely locally sourced with the ability to simulate key steps of the procedure in a manner that is self-directed, accessible, and clinically translatable.

AB: What was the reasoning for developing such an App?

Dr Naidu: Around the world, nearly 40 percent of medical trainees reach the end of their training without the necessary skills to do the job and nearly one-third (1/3) of trainers don’t have the dedicated time to fulfil their roles as educators. When my team learned about the Global Surgical Training Challenge, we saw a chance to create a low cost and easily scalable module that could provide opportunities for self-directed learning to ensure trainees are able to work at their own pace and achieve competency before moving on to the next steps in their careers.

As a doctor in sub-Saharan Africa, I understand the challenges, the resource shortages, and the high burden of patients who require surgical care. This means that most of my time was often spent in providing care, and I had limited opportunities to further my education. Not to mention, access to medical education resources is incredibly expensive and not widely available. I think the AmoSmile app really addresses this unique aspect.

AB: Why does AmoSmile Focus on plastic surgery?

Dr Naidu: For over 40 years, Operation Smile has focused on reconstructive surgery for cleft lip and cleft palate patients around the world. Therefore, for the Global Surgery fellows on this team, this is a major part of our expertise. Even more importantly, however, is that around the world, plastic surgery is often overlooked with regard to essential surgery. A recent publication demonstrated that nearly 2/3 of the unmet surgical need can be ameliorated by plastic surgical expertise. (Borelli, WJS, 2018).

Sub-Saharan Africa is particularly impacted by these conditions, which account for 19 percent of all disability years and 22 percent of all deaths. However, training in plastic surgery is limited – there are few programs, and that is because training a plastic surgeon can be expensive.

AB: How is AmoSmile funded?

Dr Naidu: Earlier I mentioned that we are developing this as part of the Global Surgical Training Challenge. It’s a programme that was launched by The Intuitive Foundation, in partnership with Nesta Challenges and MIT Solve, to stimulate innovation in global surgical education through the creation of novel, low-cost surgical training modules.

The Challenge aims to create a paradigm shift in how surgical practitioners learn and assess surgical techniques. The validated modules will be free to download and inexpensive to reproduce in a variety of global settings. There are multiple stages. Each time a team advances to the next round of the challenge they receive more funding. So far, we’ve received the Discovery Award Grant which has been an invaluable source of funding and we have been able to build a platform and develop a z-plasty module with an associated physical simulator. This funding has allowed us to create a working prototype free of charge with online and offline content for everyone to use. However, the further we engaged in this process, the more we realised the potential for this platform and the ability to scale to other essential reconstructive surgical procedures.

It was through this challenge that we were able to team up with AmoDisc. What is inspiring about this collaboration is that we have brought together experts and individuals in technology, simulation, adult learning theory, corporate, and global medical education to support achieving this goal. There is historically very little coordination and collaboration when it comes to global medical education. This is something I have often thought about in global surgery – the ability to bridge silos and share knowledge, which is what I believe this challenge inspires, and what our collaboration symbolises.

AB: What is next for AmoSmile?

Dr Naidu: We are continuing to beta-test. This app will only be useful if it is contextually relevant and tailored to the environments that trainees in sub-Saharan Africa work in. Beta-testing will give us the opportunity to show proof of concept to assess the viability of long-distance training.

Once we have proof of concept, we will assess the impact this app has on surgical volume, number of trainees trained. We would also love to scale this app to other essential surgical procedures. While the competition does present us with an opportunity to secure additional funding, we want to continue to make this simulation technology available regardless of whether or not we progress to the next round – because we believe in the purpose of this simulation technology.

Our team would also really like to commend MIT, Nesta, and the Intuitive Foundation for creating this platform and opportunity to innovate. Since 2015, we have been talking about the unmet surgical need globally, and the fact that 5 billion people worldwide lack access to safe, timely, and affordable surgical care. This challenge has given teams an opportunity to create an innovative solution to these identified problems.

I hope this challenge and the work of all the teams will continue to inspire similar platforms and funding opportunities to develop context-relevant solutions to ensure safe surgery.