Göran Malmberg, Mentice: Why Simulation Without Metrics Falls Short

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Göran Malmberg, Mentice: Why Simulation Without Metrics Falls Short

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Guest: Göran Malmberg, Group CEO and President of Mentice AB (Gothenburg, Sweden), the world leader in physics-based virtual reality simulation for endovascular therapiesHost: Professor Anthony G GallagherTopic: Why Simulation Without Metrics Falls Short, and the Unsettled Question of Who Owns Medical TrainingEpisode SummaryIn this episode, Professor Tony Gallagher is joined by Göran Malmberg, who has led Mentice since 2008 and built it into the global leader in physics-based VR simulation for endovascular therapies. Drawing on more than two decades at the meeting point of engineering, medical devices and clinical training, Göran and Tony confront an uncomfortable structural problem: training is still treated as a cost item rather than a driver of value, and no one can say clearly who owns the responsibility for proving that a clinician is ready to perform a procedure. They make the case that simulation without validated metrics is a suboptimal tool, that proficiency-based progression (PBP) is the route to structured skill, and that the next move belongs to whoever is willing to lead, whether that is a major device manufacturer, a regulator or a professional society.Key Topics Covered1. From High-Tech to High-Stakes — 0:00Göran's route into medical simulation from automotive and industrial B2B technologyWhy selling advanced technology is broadly similar across sectors, and what was genuinely new about medicineMentice and the early years of VR simulation in medicine2. Training as a Cost, Not a Value — 2:13Why structured training is rarely connected to return on investmentHow it has often depended on the goodwill and personal time of passionate cliniciansThe wider concern about a business ethos moving into academic medical centres, and where training and quality assurance fit3. Why Simulation Needs Metrics — 6:40Göran's agreement with Tony's central conclusion: any simulation without metrics is a suboptimal tool for procedure-based trainingThe difference between general-purpose simulation and structured training to a defined level of skillWhere proficiency-based progression fits4. The Hard Part: Defining and Validating Metrics — 7:26Why the biggest hurdle is getting device companies to define and validate metrics before they engage the simulation providerThe mechanical thrombectomy example, where clinicians pushed Mentice to build and subsequently patent a new deviceWho should own the metrics: industry, professional medicine, or departments of healthThe evidence that PBP-trained operators perform around 60% better in the clinical environmentPublication: Seymour NE, Gallagher AG, Roman SA, O'Brien MK, Bansal VK, Andersen DK, Satava RM. Virtual reality training improves operating room performance: results of a randomized, double-blinded study. Annals of Surgery. 2002;236(4):458-464. doi:10.1097/00000658-200210000-000085. The Misunderstood Cost of Physics-Based Simulation — 11:12Why a physics-based VR simulation is not a video gameThe months of programming, engineering and validation behind a credible simulatorHow to weigh that cost against the alternative cost of proctored real cases over three to six monthsEvidence that PBP simulation training can cost roughly a third of conventional training, and the question of why medicine has not collated thisPublication: Puliatti S, Rodriguez Peñaranda N, Amato M, De Groote R, Farinha R, Bunting B, van Cleynenbreugel B, Mottrie A, Gallagher AG. Randomised trial on the economic impact of proficiency-based progression versus conventional robotic surgical training. BJU International. 2026;137(3):493-501. doi:10.1111/bju.701306. The Evidence Industry Finds Hard to Hear — 18:00The Birkmeyer finding that suboptimal performance in experienced clinicians leads to worse outcomes, with a difference of roughly 50 to 80 per centThe Mascheroni IMPROF trial, run with Medtronic in Switzerland, where metrics-based training to proficiency produced markedly fewer intraoperative errors than traditional simulation training, and where Tony notes that none of the standard-trained group reached the proficiency benchmarkA Leuven PhD viva on a circular stapler, where PBP training removed the leak rate seen with standard instructions-for-use trainingPublication: Birkmeyer JD, Finks JF, O'Reilly A, Oerline M, Carlin AM, Nunn AR, Dimick J, Banerjee M, Birkmeyer NJO. Surgical skill and complication rates after bariatric surgery. New England Journal of Medicine. 2013;369(15):1434-1442. doi:10.1056/NEJMsa1300625Publication: Mascheroni J, Stockburger M, Patwala A, Mont L, Rao A, Retzlaff H, Garweg C, Verbelen T, Gallagher AG. Effect of Metrics-Based Simulation Training to Proficiency on Procedure Quality and Errors Among Novice Cardiac Device Implanters: The IMPROF Randomized Trial. JAMA Network Open. 2023;6(8):e2322750. doi:10.1001/jamanetworkopen.2023.227507. Whose Job Is It Anyway? — 22:40The sensitivity of telling a clinician they are not ready yet, and why the metrics come ...

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