Mobile technology has the potential to help educate colleagues around the world through the sharing of cases, images and errors, yet finding a platform on which to do so has been evasive. Enter ICUC, a new iPad app developed strictly for the education of surgeons by other expert surgeons through case-based sharing and commentary. Although only in its infancy, ICUC is an impressive and free app that provides tips, techniques and learning points previously inaccessible in any format.
In many ways, ICUC represents the future of surgical education. With a concept founded by orthopedic surgeons in 2003 and an app launched in 2014, ICUC has a high-quality and intuitive user interface. After selecting a body region from the main screen, the user has access to the ICUC Library. The library includes a continuous and complete registration of surgical procedures performed by a group of selected surgeons. Because all cases are collected during a given period, cases both with and without errors exist.
An overview page for each case includes the AO fracture classification, assessment of outcome, approach and highlights. The entire case can then be downloaded and reviewed. The case is of high quality and includes preoperative imaging (radiographs and CT), intraoperative photographs and fluoroscopy images, and postoperative radiographs and clinical function measurement. As an example of the level of detail, a proximal humerus case we reviewed had more than 170 images and commentary. Of note, the comments are quite honest, and appropriately critical about imperfect techniques or non-ideal outcomes. The amount of information here is extraordinary, with just the proximal homeruns having 49 detailed cases.
The app also includes reference cases with animations representing approaches and treatment techniques. There is also expert opinions with recommendations for various parts of a procedure. Overall, the interface is easy to navigate and when cases are selected and downloaded, they are stored in the “briefcase” for easy access and reference
We sat down with the three founders of ICUC — Alberto Fernández Dell’Oca, MD; Stephan Perren, MD, DSc (honoris causa); and Pietro Regazzoni, MD — to learn more about the motivation behind this app. Fernández is professor of Traumatology and Orthopedics at the Universidad de Montevideo, Uruguay. He received the TK Innovation Prize from the AO Foundation in 2008 and was selected as member of honor of the SECOT in 2013. Perren is a founding member of the AO Foundation and has been head of the AO Research Center in Davos for 3 decades and chairman of the AO Technical Committee during 2 decades. He is the world’s leading scientific authority on bone biology. Regazzoni is professor at the University of Basel, Switzerland, where he was head of trauma surgery from 1985 to 2008. He is honorary trustee of the AO Foundation and received the AO Recognition Award in 2012.
Orrin I. Franko, MD, and Matthew J. DiPaola, MD: What does ICUC mean and what is its mission?
Alberto Fernández Dell’Oca, MD; Stephan Perren, MD, DSc (honoris causa); and Pietro Regazzoni, MD: The term ICUC stands for “I see, you see,” in reference to the sharing of visual data through case presentations. The ICUC app itself is a learning platform that is based on the concept of complete, reliable and transparent data acquisition and sharing. We believe ICUC presents a unique approach to share and generate new medical knowledge, with the final goal of improving the execution of surgical procedures.
Franko and DiPaola: What inspired you to develop this app?
Fernández, Perren and Regazzoni: The ICUC concept and app were the result of a need for more transparency in orthopedic surgery. This began by introducing the concept of open-source format for publications in 2003, developed by Fernández and Perren, and was the predecessor of the ICUC iBooks, published in 2012. It evolved to the actual iPad application, the “ICUC app,” in 2014.
We realized that the lack of transparent, complete and detailed documentation of surgical cases compromises medical progress. For example, readers of scientific publications can only accept the authors’ conclusions, as they do not have access to the full set of data that the authors used. Moreover, conventional medical teaching tends to forget the gap between planning and outcomes of surgeries. We feel that analyzing shortcomings and problems encountered curing a case provides experience based on understanding with a strong and long-lasting effect. Basically, shortcomings are an excellent source for learning. The technological platform of the iPad allowed us to present data in a way that conventional publications cannot, and being able to compare surgical cases from different medical centers allows the learners to broaden their minds.
Franko and DiPaola: What were greatest challenges faced while creating this platform?
Fernández, Perren and Regazzoni: While there were many challenges in developing this app, one recurrent theme from various hospital sites was the effort needed to convince hospitals to accept the recording of their surgical cases, especially in respect to handling the administrative overhead. Following that, we also had to overcome challenges related to collecting follow-up data for the patients. And, of course, all of these required a significant commitment from surgeons who performed the cases who also accepted to be audited and let us use for free the pictures of their cases, as well as expert surgeons who were asked to review and comment on the cases.
Franko and DiPaola: How do you see this app being utilized by trainees and providers worldwide?
Fernández, Perren and Regazzoni: Orthopedic trainees can easily review cases to learn about potential surgical complications as well as their possible avoidance. Thus, in preparation for surgery, a trainee has the ability to watch an expert surgery from a “front-row” position at home. Similarly, a department chief could use cases from the app for discussions at grand rounds. Ideally, that conversation could be recorded and used for feedback within the app, as well. We anticipate that we might find other ways to use the app, and we welcome other creative uses. We believe this app provides the opportunity to create a strong and lasting contribution to improve orthopedic learning.
We thank the founders for taking the time to share with us about their vision and app creation. Overall, this app represents an extraordinary advancement in surgical education and transparency. The inclusion of a high volume of cases, combined with honest expert opinion, provides the opportunity for enhanced resident and surgeon education that is not limited by geographic barriers. We recommend this app highly for all trainees and surgeons. The app can be downloaded from the Apple App Store here.
Orrin I. Franko, MD, is a PGY5 orthopedic resident at UC San Diego. He has an interest in promoting mobile technology within orthopedic surgery and founded the website www.TopOrthoApps.com to help surgeons and trainees find the most relevant orthopedic apps for their mobile devices. He can be reached firstname.lastname@example.org.
Matthew J. DiPaola, MD, is an assistant professor in the Department of Orthopaedic Surgery, Sports Medicine & Rehabilitation
Shoulder and Elbow, at Wright State Physicians. He can be reached email@example.com.
Fernández Dell’Oca AA., et al. Open source format publishing of scientific data. 2003; Stuttgart, New-York, Thieme.
Disclosures: DiPaola and Franko report no relevant financial disclosures. Fernández, Perren and Regazzoni are the co-founders of the ICUC medical research group, which produced the ICUC app.