Wellcome Leap Program: Surgery – Assess, Validate, Expand (SAVE)

Scheme to address the shortfall in the global surgical workforce through the development of new models for surgical skills acquisition and patient recovery and/or deterioration detection systems.

Founded in 1936, the Wellcome Trust is an independent foundation that seeks to improve health by supporting researchers and addressing big health challenges. The Wellcome Leap Program aims to deliver breakthroughs in human health by providing funding at scale and within short timeframes.

Wellcome Leap’s seventh funding initiative is Surgery – Assess, Validate, Expand (SAVE). The focus of the scheme is on addressing the shortage within the surgical workforce, particularly within abdominal and pelvic surgery. SAVE aims to double the number of surgical providers per year to an additional 100,000 within a decade, thus increasing the provisioning of minimally invasive abdominal operations by 30 million and simultaneously reducing global postoperative deaths by 1 million.

Every year 313 million operations are performed around the world and surgery is an indispensable part of healthcare. 60% of all surgery is conducted in high income countries where the infrastructure, financing and highly skilled human resources are concentrated, but where only 15% of the population live. An additional 143 million operations are needed annually to meet basic health needs, most urgently in low resource settings, but also to achieve equity across communities in all countries. It is estimated that the lack of access to essential and emergency surgery results in at least 1.5 million deaths each year.

Over a third of the world’s population lives in regions without a sufficient surgical workforce. In parts of Asia and Africa, the surgical workforce needs to be expanded 10-100x to meet basic needs. At the same time, healthcare staffing shortages are increasing worldwide. In Europe, 40% of medical doctors (MDs) will be retiring within the next decade. In the UK, 52% of staff posts remain unfilled in the National Health Service. In the United States, the current surgical workforce only meets 75% of demand in rural and suburban areas, with a projected shortage of over 16,000 surgical specialists in the next decade.

Of the 143 million ‘missing’ operations required to save lives and prevent disability, Wellcome Leap estimates that up to 30 million involve abdominal and pelvic conditions that could be treated using minimally invasive techniques. To date, laparoscopic surgery has improved the ability to deliver such operations while simultaneously reducing postoperative infections, length of stay, postoperative pain and long-term complications (eg internal scarring). It also lends itself to advanced simulation, quantitative assessment and validation that could dramatically expand the number of surgeons available.

To deliver 30 million abdominal and pelvic operations will require training an additional 100,000 surgeons. At current rates of training, this is unachievable. The number of MDs as a proportion of the population has remained essentially the same for the last 30 years, and in low and middle-income countries the number is inadequate.

The programme goals are:

• Demonstrate the capability to train non-MD practitioners to deliver routine laparoscopic surgery with equivalent outcomes to MD surgeons using a next-generation simulation, validation and certification programme of three years or less.
• Shorten the timeline needed to train MD surgeons by a full year through the use of new tools that accelerate skills acquisition of minimally invasive techniques and enable objective quantification of competence.
• Reduce postoperative complications and mortality by >50% through advanced sensing, monitoring and pattern recognition strategies, especially during periods of rapid expansion of services, thus increasing the confidence of surgeons, hospitals, patients and families.

There are two reasons why this is possible now:

• Minimally invasive surgical techniques have dramatically changed the delivery of abdominal surgery and enable immersive simulation training environments, objective assessment of skills, and virtual augmentation and overlays to assist visualisation and anatomic identification during surgery. This has created new options for scaling the workforce.
• New sensing and algorithmic approaches have changed the ability to predict perioperative patient trajectories earlier and with greater accuracy.

To achieve the programme goals, the following objectives will be fulfilled:

• Create and deploy new models for minimally invasive abdominal surgery skills acquisition and objective assessment, supported by instruments tailored for this task. These new models should support the ability to:
  • Identify and screen innate capabilities in non-MD practitioners and provide surgical training with validation of skills and certifiably comparable outcomes.
  • Decrease training time for MD surgeons.
• Produce new patient recovery or deterioration detection systems that utilise patterns from inputs as wide ranging as caregiver interactions, existing and new sensing methods, and novel biomarkers, to evaluate patient condition and predict recovery or deterioration following surgery.
• Validate the impact of these programmes through a demonstration at the health system, state/province or national level.

Proposals are required for work in one or more of the following thrust areas.

• Thrust Area 1: Create and deploy new models for surgical skills acquisition and quantification for MDs and non-MDs alike.
• Thrust Area 2: Produce new patient recovery and/or deterioration detection systems that utilise patient-level inputs to assess patient condition and predict recovery or deterioration.
• Thrust Area 3: Develop an end-to-end system demonstration of successful implementation of developments from Thrust Areas 1 and 2.

Projects are required to develop the simulation platform, develop the technologies or demonstrate the impact of implementing these advances. Proposers should clearly relate work in the thrust areas to the programme goals and objectives, but are not required to provide both platform technologies and end-to-end demonstrations.

Funding body	Wellcome Trust
Maximum value	Discretionary
Reference ID	S24339
Category	Medical Research
Fund or call	Fund