Lessons from Dr. Justin Barad, Osso VR, on reimagining surgical training with virtual reality

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Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1.

Today, we’re excited to get to know Justin Barad, CEO and Co-Founder of Osso VR, a surgical training platform that uses virtual reality to accelerate surgical training and improve surgical outcomes.

Designed for medical device companies and practicing surgeons of all skill levels, Osso uses cinema quality-VR to offer a realistic, hands-on training environment. In two recent randomized peer-reviewed studies, surgeons training with Osso VR showed anywhere from a 230% to a 306% improvement in overall surgical performance compared to traditional training. Today, Osso VR is available in more than 40 countries, partnering with leading global medical device partners including Johnson & Johnson, Stryker, Zimmer Biomet, Medtronic, Endologix, and Smith + Nephew.

We talk about how Justin came up with the idea for Osso during orthopedic surgery training, the importance of having a prototype, and the difference between early funding rounds and Series A onward. Justin also shares what he’s excited about in VR and healthcare.

Founded in 2016, Osso VR most recently raised a $66M Series C led by Oak HC/FT, with other investors including Signalfire, GSR Ventures, Tiger Global Management and Kaiser Permanente Ventures.

In addition to his role at Osso VR, Dr. Barad is a pediatric orthopedic surgeon. He completed medical school and residency at UCLA, and fellowship in pediatric orthopedic surgery at Boston Children’s Hospital.

If you prefer to listen:

‎Pear Healthcare Playbook: Lessons from Dr. Justin Barad, Osso VR, on reimagining surgical training…

Lesson 1: Understand the problem

As a teenager, Justin wanted to be a video game developer, and even did an internship with Activision. After a family member became ill, Justin started to think seriously about how to use software and technology in healthcare, so he went to U.C. Berkeley to study Biomedical Engineering.

He still felt unsure about how to get started with inventing new healthcare technology. He asked his mentor, a gastroenterologist, for advice.

[My mentor] told me something that sticks with me to this day: if you want to invent something, you really need to understand the problem you’re trying to solve first. And he was very persuasive that the best way to understand medical problems is to be a doctor.

Justin heeded his mentor’s advice and went on to medical school and orthopedic surgery training, where he first began thinking about the ideas that became Osso:

It was really during my training that I started experiencing firsthand the problem of how we are trained as healthcare professionals, in procedures and in surgery… [a phenomenon] started happening in the operating room… where someone would ask: “Hey, can you run to the computer real quick and look for X or Y?” but what they’re effectively saying is: “Can you Google what to do?”

After reflecting on the gaps in surgical training, Justin identified four problems:

1. There is too much to learn. New technology and new procedures expand the library of tasks a provider needs to know how to do, often on demand. Providers may be called upon to perform a procedure they haven’t done in years
2. Modern procedures and surgery require more repetition to learn due to increased complexity and new technologies
3. There is no method to objectively assess surgical skill
4. Surgery has become a team sport, but it is difficult for a surgical team to train or prepare together before a case

The product: Virtual reality for surgical training

Osso VR is a hands-on surgical training platform that uses off-the-shelf VR technology (e.g., standard VR headsets) to prepare surgeons to operate. When a surgeon puts on the headset, they are suddenly in a virtual operating room (or other procedural setting, like a cardiac catheterization lab). With Osso, they can practice any procedure in a hands-on, haptics-enhanced way. The technology also enables healthcare providers to train together, whether they are prepping 20 minutes before a trauma case, or training together from halfway around the world.

Additionally, the platform objectively assesses surgical skill, a new tool in a world where assessment is subjective (based on what colleagues think of you) and post-hoc (performed after a bad outcome). Surgeons are provided with objective scores on their efficiency, accuracy, and procedural knowledge .

Lesson 2: You can tap yourself

Once Justin had the idea to bring virtual reality into the operating room, he spoke to everyone he could about the concept — expecting someone else to “take the idea and run with it,” with him helping from behind:

I [spoke with] a number of people about [the idea] — healthcare professionals, engineers — and almost everybody said, this is the stupidest idea they’ve ever heard.

After realizing no one was going to pick up his project, Justin remembered an exercise he did during a leadership program in college. In the exercise, a group of people sits on the ground and closes their eyes. The facilitators tell the group that when they feel a tap on the shoulder, to stand up and open their eyes, and then you can tap others. At the end of the exercise, the facilitators asked the first person who got tapped — which facilitator do you think tapped you? And it turns out that the first person to be tapped, had tapped himself.

Reflecting on this memory, Justin realized that as a video game developer — capable of programming — and a surgeon — he could “tap himself.” Then, he built his first prototype.

Lesson 3: Any prototype is better than no prototype

Once Justin had a prototype, he began to get initial traction for his idea of VR for surgical training. After he showed the prototype to a VR engineer on a “random forum,” the two began discussions about building a more complete prototype. Justin used his bar mitzvah money to pay the engineer, Matt Newport, who became his co-founder. With a more professional prototype, the team began to win awards and gain wider recognition.

How to leverage accelerator programs

In its early days, Osso participated in two accelerator programs, including MedTech Innovator. Justin advises founders to consider carefully the advantages of various accelerator programs versus the time they may occupy while you are building your business. The two areas that he found most helpful were:

1. Meeting other founders at the same stage: Justin is still friends with his MedTech Innovator cohort, and he turns to them for both strategic advice and emotional support
2. Connections to potential customers: Osso’s primary customers are medical device companies, and MedTech Innovator’s connections in that space were instrumental in some of Osso’s biggest deals

Lesson 4: Identify the right customer

Early on, Justin realized that hospitals would not be the primary customer for Osso. While many hospitals maintain simulation centers, these resources tend to be static facilities, often outside the hospital, where a trainee might go once or twice a year. Perhaps more importantly, simulators do not directly impact a hospital’s revenue, cost structure, or patient outcomes — so there is no incentive for hospitals to change or overhaul them.

At the same time, medical device companies would fly Justin and his colleagues into training sessions at conferences to practice with their technologies, like a new minimally invasive or trauma system. The device companies’ hope was that the surgeons would like what they saw and continue using these tools in their operating rooms; the problem was that these trainings required expensive cadaver setups, often with each surgeon only getting one or two “reps” of the procedure. After the training session, the surgeon might wait months before using the new system, at which point Justin would see situations like doctors googling answers from the operating room.

This suboptimal training system was an opportunity for Osso, and they got their first contract with a medical device company in 2016. By partnering with Osso, the med device companies could train more surgeons, allow for more repetition of techniques, and objective assessment of progress. This more comprehensive training drove adoption of newer medical technologies as well as utilization of existing technology, like surgical robots. Today, Osso works with institutions and professional societies, but the device industry remains the bulk of their business.

Lesson 5: “Network as much as humanly possible”

Once Osso had a business, it was time to recruit. Justin acknowledges that recruiting is challenging!

Especially in the early days, you’re basically convincing people … in a stable career… to take a huge risk… So it’s a big deal for people to join you in the early stage, especially if [this is your first startup] and you don’t really have a proven track record.

Justin heeded the advice of friend who was already a serial entrepreneur: network as much as humanly possible. He already had healthcare connections, so he went to gaming and community events, eventually building a network of friends who knew the right people. In the early days, Osso relied heavily on these networking events and on friend referrals from early hires. In addition to investing in your professional network, Justin has the following recommendations for startup recruiting:

• Tell a compelling story! When your company is early, you are what the recruit is joining
• If you are raising money, think about which investors will attract candidates and/or help you recruit the best people
• Always have an application form available on your website — you never know who might apply!

Four topics to be prepared for during Series A fundraising

Justin credits Osso’s pre-seed and seed success to his strong team and the groundswell beneath VR during the time they were raising their early rounds. But when it came to Series A, the team had to develop a more sophisticated, numbers-oriented approach to convincing others to invest in their business. Here are four areas Justin remembers explaining during Series A fundraising:

1. Cost structure and margin — both current state and future trajectory
2. Deal pipeline — not just who is in the pipeline, but how do you estimate the size of the potential deal and when (or if) it will close
3. Performance metrics for staff — for example, measuring sales rep performance and designing the right compensation scheme
4. Long-term strategy — not only this year, but also three years down the road!

Series C: What’s next for Osso?

Justin describes himself as “terminally optimistic.” Here’s what he’s most excited about for Osso in the near future:

• Broadening access for healthcare professionals through new and different training models, including partnering with residency programs at academic medical centers. Justin is also hopeful that Osso can be used by students to explore potential surgical careers — even at the high school level!
• Zeroing in on strategic specialties and modalities: Osso has been focused on real-time imaging simulation, which includes tools like ultrasound, fluoroscopy, and CT scans
• Using Osso to reduce variability in surgical outcomes: by identifying strengths and weaknesses and offering more targeted training to the surgical workforce, Justin hopes that we’ll get to a world where every patient feels as confident in her surgeon as she does in her airline pilot (no surprise, pilots do a lot of simulation)

Finally: what’s next for VR and medicine?

Justin reminds us that even with constant innovations in VR, today’s tech is way past the point of good enough:

I try and remind [my team], let’s focus on what we have, and not what’s coming down the road… We need to value scaling technology more than we need to seek out the next thing… We’re well past the point of being good enough to get [VR] to everybody.

That being said, here are some VR innovations he’s excited about:

• Tracking hands and fingers during surgical procedures, and combining this tracking technology with more sophisticated controllers
• Eye tracking and face tracking technology, which will enable more social VR training experiences
• The intersection of augmented reality (AR) and VR, for example holographic headsets that now have a VR mode
• Apple is coming out with something — nobody knows what, but it’s a great sign for the longevity of AR/VR!

He’s also bullish about new applications, such as:

• Improving the patient experience: using VR to allay patient anxiety during cast removal and blood draws (for example, Abbott just rolled out a mixed reality experience for blood donors)
• Scenario training: companies like Health Scholars and SimX recreate hospital code scenarios to train staff (SimX just announced a partnership with the Air Force)

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Interested in Osso VR or joining their team? Learn more on their website, Twitter, and LinkedIn.