Bringing Virtual Reality front and center in medical training: Interview with Ryan Ribeira, MD, CEO of SimX

Have you ever trained in a medical simulation lab and felt the stiff mannequins and repetitive scenarios were outdated? Ryan Ribeira, an Emergency Medicine resident physician, wants to change this. He is the CEO of SimX, a Silicon Valley-startup that aims to bring virtual reality and augmented reality to medical training. I recently interviewed Ryan about SimX, emerging technologies, and the interesting approach he is taking towards simulation education.

Q: Ryan, thank you for taking the time to do this interview. Can you briefly describe your company, SimX, and what it hopes to offer for healthcare training?

Ryan: SimX offers cutting-edge, customizable simulations for training. SimX can project virtual patients to any empty space, be it a hospital bed, classroom table, or even a countertop, and run medical simulations on it. It can replace mannequins with virtual, completely customizable patients. Cases may be done by individuals, or even by groups of trainees at the same time.

Q: SimX’s early promotional material focused heavily on the use of augmented reality (AR) rather than virtual reality (VR) for medical simulation training. Tell us about the design decisions behind that choice.

Ryan: In the past, VR hardware was too limiting, so we initially picked AR instead. We used a smartphone camera in a headset, tapping into an available camera, and projecting the view with marker tracking technology to the viewer’s eye on screen. While this worked, it was very taxing to the phone (virtual content plus streaming actual video feed). In the end, this is simply too taxing and potentially choppy with current phones. Since then, we’ve stuck with mobile devices in a headset, but moved to VR from AR. We’ve been working with Sixsense mobile VR tracking with great results. This includes hand controllers, base stations, and headtracking, and only requires one plug in. Some of our customers actually prefer the VR version, as it is easier to adjust for custom scenarios, such as inside of a helicopter or in a grocery store. The VR system allows training boundaries to be set beforehand, and the fidelity of motion tracking with mobile VR is actually even better than Vive and Oculus from what I’ve seen. MobileVR just makes so much more sense, as phones get better and better. They already have many of the features needed for VR including a dedicated IMU, HD screens, and so on. The software is built in Unity and thus is compatible with Hololens, Meta, and other AR systems. It is also compatible with Oculus, Vive, Google Daydream, and other VR systems.  While we think VR provides a better customer experience right now, we can easily develop AR cases for our platform immediately, if that’s what better serves the needs of the hospital.

Q: As both a CEO of a healthcare startup and a medical resident, any advice for medical students and resident physician entrepreneurs?

Ryan: Working as both a physician and a CEO is pretty time consuming. I was a business major in undergraduate, and I have a background working with startups throughout medical school while simultaneously getting my Master’s degree. During my 4^th year, I took a simulation elective and realized the mannequins were terrible and the training was often compromised by their limitations. I also learned how much equipment and support personal are needed to operate simulations. I thought this seemed like an area that needed improvement  and felt the design was very behind the times. I had been following the budding VR/AR scene at the time, and back in 2014 I got in contact with an AR company. We started investigating the potential role of AR in simulations, started a company, won a developer’s contest, and then SimX evolved to what it is today from there.

Balancing both of these roles is very challenging. I would tell anyone contemplating something similar not to go into it with the idea of making a ton of money. It has to be something you really enjoy doing, and you have to realize you aren’t going to be able to do anything for leisure or for fun. In my free time, my relaxation is my startup. It’s my cognitive break from the hospital. Logistically, I always set aside 3-4 hours per day ahead of shifts to work on the startup.

If that sounds like too much, there are a lot of ways to be involved in a startup without being a CEO. There are positions open in many startups as medical advisors and part-time positions that are much less demanding and often readily available.

Q: I heard about SimX’s “Case Marketplace” in your 2014 Tech+ Forum speech – describe the role of this and what it can offer to an institution.

Ryan: SimX allows the user to develop and share training cases with others.  If you develop a case for your institution, you can make it available to other institutions with just one click. They can send it out for free, or even license it for a cost and make revenue off of it. This should help even smaller institutions get complex and detailed cases from larger hospitals, similar to the Harvard Business model. The other benefit of the Case Marketplace is that it allows physicians in remote and unique areas (military, tropical medicine, etc.) to disseminate information and cases quickly.  One physician we worked with remarked how helpful such a feature would have been during education on the Ebola outbreak, amongst other uses.

Q: What other applications of SimX do you foresee, outside of medicine?

Ryan: We have certainly thought of other applications, as SimX is fundamentally a case education system in a 3D VR environment. It’s very transferrable to other fields, from doctors to nurses to EMS personnel to firefighters, then to police, and so. You can easily make very detailed simulations, with overturned vehicles, emergencies with fires, etc.. A lot of firefighter training utilizes actual buildings on fire-obviously there will always be a place for this, but doing initial training in a simulated environment would be helpful too. Even car mechanics could benefit from such a training simulator.  I think there are a lot of possibilities, and that’s why we are named SimX, not MedX or MedSim.

Q: What do you think the next 5 years hold for AR and VR?

Ryan: I think medical simulation will really move into both AR and VR. There’s not much more room for mannequins or other forms of physical simulation to improve. I think both AR and VR are the next big things for medical simulation. We’ll probably see more of what’s called tactile displays, with haptic feedback, allowing you to feel skin and other sensations in simulation. These existed in the past, but were prohibitively expensive. I estimate it’s probably between 5-10 years out from now, with a comprehensive sense of touch, such as with a virtual scalpel cutting virtual skin in surgical training. It’s going to be huge!

Q: Finally, Ryan, what should we expect from SimX in the near future?

Ryan: We are very close to a full scale launch at SimX. We’ve already partnered with a select few institutions to pre-launch with them on our initial product. Frankly, our V1 is basically ready for public release. We are in talks with distributors worldwide, not just in the USA, to get this tech out more widely. We are excited about SimX and ready for it to be released very soon!