Virti: The startup challenging traditional medicine

It was probably the hardest conversation Dr Alex Young had ever had to have. In 2018 he was trying to explain to his grandmother that he was giving up medicine (she had been so proud when he qualified as a surgeon) to become, as he puts it, “a start-up tech guy doing something a little bit hard to explain”.

She took it on the chin, but maybe he could have guided her through it gently using the virtual reality goggles that come as standard at Virti, his new enhanced learning system.

We all tend to worry about the kids who get addicted to gaming, headphones on, faces glued to a screen. But no longer will parents be able to say, “Hey, get off that computer and go and do something serious!” Because the smart kid will be able to reply, “I am learning how to become a doctor.” 

Young reckons he learned a lot of his surgical skills playing video games growing up. “I was a huge nerd,” he says. He even built his own primitive computer and taught himself coding. 

But he was a particular fan of Super Mario, the Legend of Zelda, and a Tony Hawk skateboarding game. “It sharpened my reaction time. Games are great for hand-eye coordination,” he says.  “I knew I wanted to pursue a career using motor skills. It had to be something practical.”

But it was only after he had collected a few injuries as captain of football and rugby at school that he decided he ought to turn his hand to medicine. Surgery is becoming increasingly tech-reliant. 

Orthopaedic surgery in particular reminds Young a lot of the games he played as a kid. “For keyhole operations, you’re mainly looking at a screen and you have to use your judgment, moving your hand in 3-D space.” Orthopaedics is a great realm for innovation. Young gives a hat-tip to John Charnley, for inventing the hip replacement, and Gavriil Ilizarov for developing “external fixators” to help repair fractures.

Young’s mother was a headmistress at an all-girls school in Liverpool, and his father and grandfather were shipping magnates in the northeast. His great-grandad was mayor of Newcastle. 

But as an undergraduate Young went to Bristol University medical school. And like everywhere else, there were a lot of exams. If you failed one of them you had to do the whole year all over again. “It was so stressful,” says Young. “I was seeing a lot of my friends burning out.”

He also thought the way he was having to learn, systematically wading through text books and technical manuals, was “boring”. Most people assume that a certain amount of stress and a degree of boredom are the price you have to pay for learning. Not Alex Young. “I was thinking all the time – how could this be made easier and more fun? Why can’t we change it and improve it?”

Even before he had graduated he had come up with a training system “Medvent”,  that put on events in Bristol and London, and was collaborating with the Royal Society of Medicine.

After graduating Young set up another company Meddicle (“I thought that was humorous at the time,” he says), trying to make exams and education for doctors more fun and accessible. That has now gone global, providing trainee doctors with preparation for tests and interviews.

Young says it’s not just a question of what you know as a doctor. “How medics are trained doesn’t prepare you for real world experience, especially in the realm of emotion. On your first day on the ward, you’re really stressed – and that’s when mistakes get made.” 

There is an old adage about operations among surgeons: “See one, do one, teach one.” Young thinks that you’re typically underprepared as a junior doctor and that the potential for errors “poses a risk to patients”.

Young wants to stress that he has no complaints about Bristol, where he learned his trade. On the contrary, he says, “I was lucky to be on the Bristol rotation. It’s one of the best in the country. But then it could be very different elsewhere in the UK.” Or in other countries. “There is variability between Harvard and Ethiopia.”

His big idea is to level it up and give all doctors equal preparation. Surgery relies on a system of apprenticeship, but feedback from any one guru figure is always going to be aleatory. 

There was no way, back in the day, to collect all the accumulated wisdom of surgical precursors and put it all in one place. Now there is. “It’s not so much the rote learning,” says Young. “It’s the more tangential things – how do you react when something goes wrong, for example.”

Virti really got started when Young was snowed in. He was on a “trauma fellowship” in New York in the winter of 2017 when the storm hit. It was one the heaviest snowfalls ever and Young was trapped in his hotel room in Manhattan for two and a half days. 

“Up until then I was so busy I hadn’t had a chance to reflect on what I wanted to do with the rest of my life,” says Young. So, aged 31, he wrote down his life goals, which included improving training and “human performance” on a global scale. On day two of his involuntary isolation he wrote down the outline of what would become Virti. Soon he was pitching it to investors in Silicon Valley.

Virti uses the “gamification” approach, with extra augmented reality on top, but drawing on the example of all those skateboarding and streetfighting games that Young was so into as a kid.

Now he is employing games developers to work on hospital simulations using 360 degree videos. Young reckons that the Virti system reduces the time taken for training by 40 per cent and cuts costs by a third.

The interesting thing is that it doesn’t just work for medics. In the US the oil and gas industry has taken a keen interest too. “We’re content agnostic,” says Young. The system is relevant to any “infrequent hazardous environment”, which explains why NASA and the Brooklyn Navy Yard have been among their early customers. 

In the context of Covid-19, it has been used to upskill doctors and nurses in the use of ventilators. “We’re taking the subjective and making it objective,” says Young. He even has a podcast every Thursday on “human performance”.

A few weeks ago he interviewed Scott Parazynski, who is a NASA astronaut and surgeon who has also climbed Everest (and started his own tech company too, as if that wasn’t enough). 

Virti-style simulations will be used to train the spacemen and women of the future. “His space station got hit by debris,” says Young. “Smashed the solar array. It’s not that different to doing orthopaedics. And it’s a great example of how you cope under pressure.”