Shafi Ahmed - Director Medical Realities at CopenX, September 2016

day or so. I'm glad to say that I've brought the British weather with me today. So I'm glad we brought the nice wet cold weather from the UK. Lovely weather outside. I want to talk a bit about VR and AR and also the background, the bigger picture about why we're doing this thing because we get immersed in technology but actually it's about clinical practice, clinical penetration, translation. That's the hard bit and that's where we struggle to work out how we're going to utilize these wonderful technologies in the future. I have a number of roles which will be relevant to this discussion. I'm a surgeon, I'm a cancer specialist, I do laparoscopic keyhole surgery for cancer patients. That's my day job I guess. I also teach, I'm an associate dean at a medical school. I'm pleased our medical school is ranked number two in the UK at the moment so we're pleased with our progression because we've introduced technology into the curriculum and about how we teach our next generation of students. I run a lot of international work for the college but also philanthropic work. That opens up my whole idea about its globalization of education, healthcare and how this interfaces with what we're seeing today. I also run a couple of tech companies in my spare time which we'll talk about. I'll be about myself very quickly in my background. This is the hospital I work in. It's St Bartholomew's Hospital. As you can see it's been around for a long time, a thousand years. We're one of the oldest hospitals in Europe and we have a whole history of innovation. A lot of things have happened like Parkinson's being diagnosed and college fractures. The names are endless, these eponymous syndromes. One key factor is William Harvey who was at our hospital 200 years ago. He looked at and discovered the circulation of blood. For me that's a pivotal moment because all your biosensors, your Fitbits, Apple watches, whatever, it's all based on circulation, oximetry. Actually William Harvey was the father of modern Apple technology I think and perhaps I should give him some shares in the Apple company or his family. The other hospital I work in is Royal London. They're both hospitals together. This is one of the biggest hospitals in Europe. We just had a major renovation which cost £1.2 billion. So it's a big, big hospital covering all specialties. We're at home to the London Air Transport Service. This is our hospital helicopter bringing in lots of trauma victims. We're one of the biggest trauma centres in the world. The background is really good because we have a lot of tradition and interest in clinical practice and innovation. Going back a few years, let me tell you my stories. When I was studying medicine a few years ago, I'm getting on a bit in my days, but in those days of course you're learning from books designed from papyrus in the past. Books became the embodiment, it's paper. You're learning from fairly old-fashioned technology. See where we've come today. I remember seeing this picture of Birroth. Birroth is a surgeon from Germany who I suppose operated on the stomach. He did gastrectomies for cancer, etc. This was what I aspired to be. When I decided I would become a surgeon, it was to become him. Surrounded by the great and good. You are wonderful, you're amazing. It's the majesty of being a surgeon. Just being in your, around you. People learn by osmosis because you're so wonderful. That's what I aspire to be like. However, I learned very quickly that modern youth and youngsters don't teach like that at all, sadly. Our junior doctors of course are going on strike constantly giving us much grief. But this was the picture. Imagine learning in this environment. We've not questioned this. This has been going for years because that's 1870. If you go forward 50 years, my hospital, Royal London, honestly, could you get anybody else into operating theatre if you tried? Unless you hang them from the rafters or squeeze them in somehow. So my view is how do you train people? How do you educate a medical student who has aspirations to do really well in life in environments such as this? We've been dogged with dogma and tradition. We don't challenge. And I felt that we need to do something different. I was asked the question, why is it that we don't adapt our own way of learning? When I spoke at Singularity last year, it's all about challenging healthcare, not accepting mediocrity, which we do just by definition. We're a race of people accept what we have. We don't challenge it enough apart from the early adopters and innovators. And those are pockets of innovation that go on. As healthcare as a whole, the standard isn't raised. There's pockets of areas that are good and bad. So my question for everybody in the healthcare is to challenge what they're doing. It's not good enough. How do we move on? How do we embrace technology and use it to the better good? So a thousand years ago, when our hospital was being built, at the same time, there was a chap called Al Zarawi in Andalusia in Spain. And he was a surgeon, but he was an innovator. And he wrote the first actual textbook of surgery back in 1000 AD. And this was translated to Latin called the Libor Theorica. That book became the embodiment of surgical teaching for not one year, not five years, for a thousand years. It didn't change, 600 years at least. That was the only textbook of lives that existed for all surgical personnel. So you can see how reluctant we are to change as a species, especially surgeons, although we do innovate anyway. But let's look at that. That was a thousand years ago. Where are we now? Let's just have a think about this. This is the world we live in. It's changed so dramatically over the last five, 10, 15, 20 years. This is what we have to accustom ourselves to. It's about connectivity. It's about all the things happening in life. This is a really exciting time to be in healthcare because we call it the fourth industrial revolution. I'm sure you've heard of this. The first one was production. Second one was electrification. Third one was computerization. The fourth one is a mixture of artificial intelligence, big data, big pharma, nanobio technology, injectables, injectables, VR, AR. It's all coming to a head as the fourth industrial revolution. And this is where we are. We're exciting times about how we go forward. But it does mean, of course, it's connecting the human race. So my whole vision about all of this is stepping back one second. So what are we trying to achieve here? It's about connectivity, connecting human beings around the world, making the world a better place, more equitable, more fair, and a social just society. About a year ago, 18 months or so, the Lancet Commission, a big obviously well-respected journal, produced its finding over three to five years of the state of surgical practice in the world. It found that five billion people out of a population of seven billion, two-thirds of the population, don't have access to safe and affordable surgery. We're not talking about robotics here or laparoscopic surgery that I do. It's simple things like cedar infections, appendectomies, fracture manipulations, things that will save people's lives, give them mobility, and restore their health. And so we've got a huge problem. To overcome that, of course, we have to have solutions. It's estimated we need to perform about 150 million extra operations per year to equalize health care globally. That requires manpower. And that manpower is estimated to require over two billion surgeons. So where do we get them from? So the question, that's fine. That's the problem. How do we solve some of these issues? Okay, let's talk about that very quickly. These are the areas that are not supported. You can see the penetration. It's the Africa, it's Asia, and parts of the other parts. Things that are predictable. It's the lower and middle income countries that don't have access to our health care that we have in Denmark or in the UK. So how do we make that more fair? We could design a health care delivery program that's much better. We could have big data to make good choices out of money and make it more efficient. We could put more money in, persuade governments to put more than their measly 8% of GDP into health care. Of course we could. Also, we could work on workforce training education, raising the system so that more people can get trained in shorter periods of time to allow the equitability of health care. So let's look at the big local companies. They are connecting people. Google, Project Loon, putting up clouds this year into the atmosphere, which will give high-speed Wi-Fi access to people around the world that don't have access to Wi-Fi, connecting human beings. What about Facebook? They can't be outdone by Google. They've got a big drone called Aquila coming out this year. It will fly around at 60,000 feet in the air on solar panels, giving high-speed Wi-Fi access for up to three months at a time. Suddenly they're thinking about connecting people. Mark Zuckerberg this week was in Nigeria looking at ways of monetization of economics. Facebook and Microsoft are now, forget the air, they're putting a cable from North America into Spain. Big cable, big data because of VRNAR. They know they have to transmit some of that information to make it work. Facebook are big protagonists of VR as a whole. They've got to do this to make the world connected. We all saw the refugee crisis and our hearts cried for Ayan Kurdin who died on the beach in Greece. But Facebook have promised every refugee in the world access to the internet because connectivity is king, knowledge is key for everybody. These are the people who can transform all of our lives. A year ago, when I was at Singularity, Peter Diamandis, who was the ex-Prize chairman, made a comment. He said, Shafi, he said to make a billion pounds or billion dollars, you need to have a billion people. I actually disagreed. I said really? I said Peter, actually it's about connecting people. If you want to save or help a billion people, we need to connect a billion people. That's the way. If your money comes out of it, that's fine. Our mission has to be to connect people to make this whole thing better. For a few seconds, I just want you to imagine something with me. Now imagine this scenario that you're a trainee surgeon or a medical student in Tanzania. You really want to be trained by the best people. You want to see what's going on in the world rather than your geographic location. Imagine, of course, you may be a surgeon or a trainee in Bangladesh, a population of 150 million people, all scattered around trying to squeeze their education and training. It's not uniform. It's needs updating. Can we do better with AR and VR and connecting people? All right, this predicament. I did a lot of work in the Palestine and Gaza. I've written a whole project plan to raise the standard in a difficult place because Gaza is unique for all of us, because it's barricaded. For me, it's the perfect expression of connecting people. They can't go in. You can't go out. It's difficult. Therefore, how do we overcome some of these barriers? Maybe AR and VR are connecting people. It's where we're freeing people away from political strife that we're all facing going forward. What about if you're a boy or a young girl who wants to study medicine or who wants to help the world do great things? Can you get out of the school that you're in? It's limited by education. Education is not free for all. It's not universally fair. Perhaps you can do something better and get trained by the right people. When we did the VR and OR, my live operation, we sent out boxes and Google headsets to school kids. We asked the teachers to write to us, why do you want to do this? Why would you want your children to watch live operation, et cetera? We got the most amazing 1,000 colleges and schools writing to us saying, please give us cardboard. We want to see this because we want to do something different with our children. Andy Walters said you're right. We shouldn't be constrained by geography. That was a really touching tweet that he sent to me and my account. Going back, this is the context. Back in April of this year, 14th, some of you may have been down, but I'm not sure that you experienced it. I invited the whole world into Bar Operating Theatre for a day in 360. I said, well, let's do something great. We got a 360 rig, we recorded it, open access to everybody, including patients, including the public, medical students and trainees to see where 360 VR was heading towards. Was it the right thing for us to do? This 360 camera rig allows immersion, people around the world using low cost technology, a simple VR headset, actually immerse themselves in operating theatre around the world. Was it that simple? Is it a smartphone? Is it a VR headset, Google Cardboard and an app that's free? Will it be so simple to suddenly connect people around the world? That was my mission, it has to be low cost, it can't be expensive, people won't buy it. It has to be the smartphone, that's ubiquitous, it has penetration of almost 100%. It's using existing things to suddenly make the world easier to connect to. So what I did was I actually persuaded, now I'm sure you realise our hospital and our NHS is starved of cash. We're poor, we have no money whatsoever, we're really desperate in need of cash. So if you have something to throw at us, feel welcome to support our NHS. I persuaded our hospital to part with £5,000, that's a lot of money right, to part with. I managed to buy every person in the hospital a Google Cardboard. How great was that? The porters, the cleaners, the nurses, the doctors, whoever wanted one. We then said okay we'll do an app, we've got an app ready, that's the app, VR in OR. It's two clicks, you click once, click twice, suddenly you're live in the operating theatre, immersed with me, around me, watching, learning, being trained. That's how it works. Put the headset, it'll send some VR on the Android store, on the Play Store. So suddenly it seemed to make sense. And a British surgeon turned an operating room into a global virtual reality experience. The idea is to allow medical students and others to stand in the shoes of an experienced surgeon. It's just the start of more technology making its way into the OR to educate others. This camera hovers high above the operating table at the Royal London Hospital, bringing the images of surgery to places far beyond the OR. It's the world's first operation to be streamed live in 360 degree video via a company called Medical Realities. Dr Shafi Ahmed hopes it'll transform medical training worldwide. Well I think in the past we've done 2D videos which are readily available. This is going to be 360 immersive. So people around the world using low cost technology with a Google Cardboard or headset and a smartphone and an app can access live operations and training. With students all over the whole world watching, the operation begins. Okay, we're live. The surgery to remove a tumor in the colon may be routine, but for those watching, it's anything but. Students using VR headsets and smartphones can view in any direction and zoom in on the operating theatre, as Dr Ahmed narrates live. They can even ask questions. I found it really great because I've been in theatres before and it's often really difficult to have a good view of what's going on. So often you're pushed to the background and you can't see anything. Dr Ahmed believes this technology, giving others the experience of what it's really like to be in the OR, is just the beginning. In time they'll be having feedback. You'll be wearing gloves for example or body suits. You can touch feel things in the virtual world and ultimately imagine in time we have a virtual surgeon. We pop into virtual theatre, in a virtual patient, virtual instruments, into a virtual operation before ever going to operate theatre fully. And that learning experience will be vital. It's the most immersive simulation we can think of. The surgery was a success and now the plan is to create a library of other surgeries shot with a 360 degree view. The patient, a 62 year old British man, says while it took some time to agree to it, he finally did, knowing the experience would benefit medical students around the world. So capture the imagination of the public as a whole because 55,000 people watched the operation live in 140 countries in 4,000 cities and 5 million people reached on Twitter because VR in a while went, it was trending on Twitter for a while. It seemed to capture the imagination but also the narrative made sense to a lot of people. And in fact we were covered in every news station around the world for that 24 hour period in every newspaper because it seemed the world was looking for something different and new and how to connect people. China, 1.2 billion people were logging in because they really wanted, because China's a big country, they understand technology, they know they've got vast expanses to uncover and this idea meant a lot to them. So we had a lot of publicity I think but in the right way, it was the right thing to do I think in hindsight. There's a plethora of headsets I've just seen outside and forward and things have become cheaper and easier and better as the course of time. I'm sure my next speaker will tell us all about that and by the way it's a privilege to be here before speaking for Mr Scoble because that's a real honor for me to be here with him today. And thank you, but also there's going to be increasing or better camera systems, be cheaper as you've seen already. Suddenly it's like smartphone, penetration will be much better, you know you've got Google Dreamer, all sorts of things coming out that are going to be much easier to access and what I've done already will just be the simple start of something new. Let's go back a couple of years to tell you the whole story in essence. So when I was looking for this whole idea of globalization, education, training, how we move things on, I managed to persuade Google to part with one of their glasses, Google Glass of course, we thought how do we use this device, AR I guess you'd call it, in the same manner. So my story started two years prior to all this and actually you can see what happens. Emmerdale continues tomorrow night at seven here on ITV, now though the ITV news at ten. The election day immigration numbers that embarrassed the Prime Minister, official figures show a rise despite a pledge by David Cameron with most coming from within the EU to work. Also on the program Putin's fury over Prince Charles as the foreign office rebuffs Russia. Why fear of the Taliban is fueling a polio epidemic in Pakistan. And the new technology giving medical students a surgeon's eye view. This is ITV news at ten with Mark Austin and Mary Nightingale. And finally medical students wanting a surgeon's eye view of an operation are to be helped by some cutting edge technology. They'll be able to look and learn wherever they are in the world thanks to new Google Glasses. They'll even be able to text the surgeon during an operation. Our health editor Catherine Jones has been taking a high-tech look. Seeing through a surgeon's eyes to teach the next generation of doctors. This operation today a world first by offering interactive online training to medical students across the globe. The first thing you'll notice is leaves of small bowels. The surgeon at the Royal London Hospital was wearing a Google Glass headset. Now this chap has a cancer. This is the view the device captured and streamed live on the internet. Students watching could type questions which were projected into the corner of the surgeon's field of vision so he could answer them while he worked. Those are the three structures that are commonly at risk during these procedures that one would worry about. Hopefully that answers the question. Operations like this are live streamed to lecture theatres and medical conferences for training. The difference here is that any medical student anywhere in the world can log in and learn. The simplicity and low cost of this approach means demonstrations of best practice like this would be available to surgeons at a much earlier stage of their training. They sing an operation live. They'll also be able to talk to me by the text messages coming up on my screen as we speak and getting the answers they need. So it is that although we have a lot of live operations, we don't often get that interactivity particularly at student level. Today's operation was followed live by 1900 students in more than 50 countries and the Royal College of Surgeons welcomed the event as a glimpse of the great potential of the technology. The patient they tuned in to see was Roy Pulfa who told me before the OP why he was keen to be involved. You see the only way that they can learn is by seeing somebody actually doing it rather than reading a book. So you don't mind that you're going to be broadcast around the world? No crimes at all. Roy's operation to remove a tumour was a success and more than that it showed the potential technology now has to better equip the surgeons of the future with the skills to save lives. Katherine Jones, ITV News. That operation when we looked at the Google Analytics at midnight because they come out later that day, I taught 14,000 medical students across the globe in about 118 countries and it just seemed that again it is a way of communicating with people and offering a level of education that's not been there before and people really liked it. We had a virtually unanimous 100% of people wanting this type of education to be available to all the medical schools and we're going to think about the globalisation, the bigger picture, how do we teach people in a different way and why can't people from say Ethiopia get trained by people from Harvard? Why not? Why not from Rome or UK London? So suddenly that connectivity happens, people are freer. Actually it's not about geography, boundaries are disappearing because of this type of technology. I remember the picture I showed you earlier from the Lancet Commission, the areas that were poorly penetrated from health. Look at that picture, if I go back, look at that simple wearable tech. Forget what's Google asked, it was a simple thing to define suddenly there's a solution. You're training people and teaching people where the Lancet Commission said we must go and train them. So maybe that's the answer. We often have, we often, a lot of us go abroad, I do a lot of philanthropic work in the poor countries, I go there for my own rewards and do things with them. It's inefficient, it's expensive, it's time wasted. You're much better here training people in a bigger way. We've got to get away from one individual and one person, it's about one individual and a huge amount of people. N doesn't equal one, N equals 14,000 in my opinion. So going forward we created a whole platform in our medical school so the surgeon and the leases were both wearing glasses, they could show the operation live and that is a great view of an operation for medical students. They had a chat box on the right hand column, peer-to-peer learning, they'll teach one another and some of those questions were going in the glass, I could teach them live. So that's the type of thing we've been doing with our medical school. So does anyone know who this person is? Anyone know who this is? Yeah absolutely, that's John Scully. John Scully was the CEO of Apple, he's the guy who sacked Steve Jobs and he's got a lot of work in India, he produces smartphones and everything else, collecting people. I taught a 70 year old man how to do simple suturing remotely using the Google Glass. I can say to you he wasn't bad, he was actually really good, he was better than some of my trainees I hasten to add. But it's just showing that actually it's about connecting those people using simple low-cost technology. What about training people remotely? We use the glass now to remote teach people. I could teach from here in Copenhagen, my trainee can be wearing that, I could tell him by mobile phone, indicate what's going on. Yeah, I can hear you. Oh good. So have you ligated the vessel? Yeah, I've ligated the vessel. What's next? Red circle, big no-no, there we are, okay, and then we save that. So imagine that, someone around the world could just pick up a glass and say can I get some experience or some advice, that's the way to do it isn't it? Rather than jump on a plane, go and help them, makes no sense to anybody. If you want to hear about the Google Glass story, go into TEDxTalk, you'll hear the background of the glass that we did a few years ago. The other thing I'll talk about is simulation. Simulation itself is really big, people like simulation, they think it's great for training. But my view about simulation and current models of simulation, they're obsolete already, they're not good enough, haptics isn't good enough, it's just a bit of vibration. It's a 2D interface and you're sitting and having a coffee on a 2D interface. That's not simulation of a real operating theatre, we've got noise, we've got immersion, you've got people around you making noises, it's the reaction times when things go wrong. That's simulation, that's surgery and we don't do that well enough. We teach about the technical skills, putting that bit to that. But actually what about the team picture where VR adds huge immersion? What's the nices doing? What happens when the blood pressure goes down? How are you behaving? What are you having complication? That's where VR and AR suddenly have huge advantage over and above old-fashioned standard teaching. So there's many things out there of course, I'm sure Rob will talk about haptics in the future. People are now producing exoskeletons, biofilms and body suits, all sorts of things to see if we can get to the next stage. Because VR or 360 video is nothing without the next step which is going to be touch. It just becomes immersion, has value. But actually what we need to be moving towards is the whole concept of virtual anything and that means all your senses apart from taste probably. That might come, you never know. But those are the things we need to develop over the next five, ten years and these people working on it already. This is our simulation of our own company looking at the anatomy. This is an interesting company I'm working with at the moment. This is the guy who invented radiofrequency ablation to destroy tumor cells in the liver and the lung. Actually he's produced a lovely gadget which allows you to feel. You can feel the hardness, the smoothness and it really feels quite realistic. But also it's got temperature control so you can pick up a cup of tea and actually feels hot. Really nice bit of kit that's really I think going to change things going forward. Last bit about the future, what I think is going to be and I sort of I pitched this idea from Ray Kurzweil. Ray Kurzweil was the director of engineering at Google and he talks about singularity, the point at which computers will overcome human beings and he sets that out 2030 maybe 10 years online. At what point do you think that surgeons can be replaced by robots? Robots, AI is the big buzzword isn't it at the moment. Huge money going to IBM Watson and all sorts of AI and big data. So my question which I posed at Wired Health a few months ago, I did intentionally to create some debate around the whole subject. When would you trust a robot to do your operation? Today, so I would rather of course he would. Now let's think about this. It created a lot of controversy on Twitter. People mention all sorts of things about I prefer to have someone real live human being who understands me, who gets me. Let's pull this apart. We all drive cars. Every car you've driven is built by a robot, most of it. You never think twice about getting to a car and not trusting it. Put the code on how you drive, 50 miles an hour. You trust implicitly because you've been conditioned. That's what we do. Over the course of time, patients will be conditioned where parts of the operation and treatment will be by AI. Your first point of contact will be AI machine. Going through a whole history of history examinations, that's what you need to do. And then hitting a doctor when you need it. That's coming in at some stage. What about surgery? So I said this and about a week later, I was really happy because we had the first autonomous operator. The robot that came out in America that could put two bits of bowel together. That's what I do. I'm a glorified plumber. And actually this robot just put the two bits of bowel together and more importantly, did it better than a human being. Less leak, better apposition of the tissues. So suddenly, although I raised the question, we were getting the answers fairly quickly afterwards. Ladies and gentlemen, one of the things that I have to really be is holding an NHS and our patients. This is one of my patients you can hear in the background. This would sound a bit weird, right? But she's watching her own operation in VR. Can you imagine that? I recorded it in 360 and she said, I really want to see this and her husband and her family. That's okay. I thought, well, what do we do? Go ahead. She watched it and she really enjoyed watching her operation, which I felt really weird about. More importantly, the guy on the right was the guy who I did live transmission on around the world that you saw a little earlier in the news. Interestingly, his family all watched the operation in real time in 360. Okay. And I said, as I came out the operating theatre that evening, they said, we just want to tell you something. All our sons have watched the operation. I've watched the operation, his wife. Thank you, because we feel better because we've seen what you do. He's in good hands. And normally, when you do an operation, we go away for five, six hours. We come back, we know what's going on. We come back for the answers. They could work out what's going on. They're happy things are progressing, et cetera. Okay. I felt really strange about the whole concept. I don't know what to say because actually, you know what? Why not? We have to challenge dogma. We have to challenge tradition that patients shouldn't seal this thing. It's their fundamental right. So that posed a lot of questions and answers. One of the things about AR, VR, innovation, whatever in the hospital workplace, it's a journey, a journey for the surgeon, but also a journey for the patients. One of the things that's really key about all of this is understanding how a healthcare system can implement innovation fairly quickly. Mitigating risk as it goes on, validating the work, understanding the limitations, but taking a whole system with it. That's the hard part. Okay. Our hospital, I'm really pleased to say, and our patients have been so supportive of trying new things in a controlled way and understand that we need to innovate going forward. My last slide very quickly, shameless plug. My good friend, John Loster, who Rob knows I'm sure really well, we are running a giant health event in the South Bank in London in November. This will be about everything, big data, AI, robots. It'll be about nanobio technology, AR, VR, whatever. It's the whole thing about healthcare transformation using modern technology. So if you're in London for a few days and you wish to come along, feel welcome. We'll welcome you along to that conference. Thank you very much. Thank you, Sophie. That was quite eye opening and mind blowing. Please, could you tell us, you talked a little about the VR, the robot doing the surgery. Would you give your job to a robot and then just sitting like here doing the surgery in VR? Yeah, so I think what we're, it's about facilitation. I'm not sure the robot could do the entire operation at the moment, maybe not for some time, but it facilitates. So we have fatigue, we make errors of judgment, we all know that we're human beings. Actually, robots are less biased. Think about what I'd do when I'd operate. I have a complication. I'll change my mind next time. I won't do that again. I'll do something else because I'm subjectively biased by my last complication. The robot would get all the information around the world and actually, no, you carry on because your results are pretty good. Don't think about subjective nonsense. Actually, in some ways, the robot will make better clinical decisions than us. You could ask, well, subjectivity is quite important and it probably is quite emotionally. I reckon there will be parts of the operation that can be replaced fairly easily and there'll be a time fashion where those parts will be put together since our operation has been done, but that's going to take a while. I'd be okay with that. Just the last one. AR, you just talked about VR. What about AI when you're operating? Isn't that the perfect thing? You have both the conversation and stuff like virtual things around the surgery. The mixed reality. It's mixed reality and AI. I think a lot of work's been done around planning of surgical operations. AR, the advantages, of course, you can overlay information. People are now overlaying anatomy, pathology, looking at scans in real time. That's coming out as we speak in small amounts, small possible innovation. Yes, absolutely. You can communicate with that. AR and VR are both healthy. They're both going to go forward in their own ways. AR adds information, which is essential, and the connectivity is better in terms of communication. That will come with VR as well. They both will survive long term. They both add different elements to an educational experience. Thank you, Rishi Fihamid.