The Computer Module Farce: Healthcare’s Dirty Secret

Each year, 250,000 preventable deaths occur in the healthcare system. These tragedies are the result of inadequate training methods that prioritize theoretical knowledge over real-world skills. This startling number highlights a critical issue that demands urgent attention.

We go through annual or biennial compliance checks in healthcare. We are reminded by learning management systems in hospitals and other healthcare organizations that it is time to log into our account, go through a video module, and click through a quiz. We pass after multiple attempts and satisfy a compliance check. These compliance checks satisfy a regulatory aspect of one’s skills, but not actual skills. Competence means proven performance under pressure, not simply answering questions correctly. The cognitive aspect is there, but is competence really measured?

Completed, but competent?

This is an uncomfortable question, and the answer is even more daunting. The uncomfortable truth is that completion does not translate to competence because the methodology is flawed.

I have practiced cardiac surgery for over 25 years. During this time, I have performed over 10,000 procedures and have witnessed countless emergencies unfold in hospitals. What I have observed, time and again, mortifies me. When crises happen—when a patient codes, when seconds matter—I have watched certified professionals freeze, fumble, or simply not know what to do. Their papers say they are certified. Their badges say they are qualified. But their hands do not know the motions. Their minds have not rehearsed the chaos.

This is not their fault. These are intelligent, dedicated healthcare workers failed by a system that is not geared to provide a platform for skills. The system provides theoretical paper knowledge and calls it training. It measures attendance and calls it certification. And when the moment of truth arrives, that paper is worthless. Can a computer module and a quiz impart the necessary training? Does the act of watching actually demonstrate skills in that particular area? Does this translate to the delivery of care in a moment of crisis, or even under controlled circumstances? Is the mental impression strong enough to have the healthcare professional deploy those skills learned as theory when those skills require muscle memory? The modules only measure whether one attended the necessary and mandatory compliance requirements. Attendance, not ability.

Real patients are the practice courts. Real patients are the fields where we hone our skills. But before we meet them, we learn on fast screens. Fast screens show procedures flat on the screen. Real patients bear the brunt of our learning curve, and our mistakes are not just marks on a test. We learn on screens, but perform on patients. Theory, alone, is useless without practice. Practicing theory behind a screen feels like preparing for a swim by reading about it, then jumping into an ocean. It’s time we close the gap between theory and real preparation.

When a code blue happens, unless one has practiced a code a number of times, our minds wander under the stress of someone having a cardiac arrest. We are entrusted to perform life-saving skills that we have only rehearsed in theory, with no practice. We are exposed to stress that has not been inoculated. Research indicates that skill retention can drop by as much as 25% within three to six months without practice. We are required to perform under stress with practice only in sterile and calm environments. When we are called into action, all we have to fall back on is our video and computer module—theory, not skills.

This lack of training and practice leads to 250,000 deaths annually. These are preventable deaths. Preventable if we had training paradigms that did not certify attendance but verified competence. To put it into perspective, that’s almost 700 lives lost every day. These 250,000 deaths represent the third largest cause of death in the United States. We talk about heart disease. We talk about cancer. We do not talk about this.

When pilots are required to train on simulators under variable conditions that they can be confronted with in real life, when aviators are required to train and demonstrate competence, then why is healthcare so reluctant to follow the same standard? We deal with human lives on a minute-to-minute basis. Would you board a plane knowing that the pilot last practiced emergencies by watching videos online? This question highlights the need for a parallel level of training rigor in healthcare.

Pilots undergo extensive training in simulators before they ever sit in a cockpit with passengers. They practice engine failures, severe weather, system malfunctions, and emergency landings in environments designed to replicate the stress and variables of real flight. Even after certification, they must demonstrate every six months that their skills have not decayed, proving their competence under various conditions. The aviation industry understood decades ago that certification is not a one-time event. Continuous verification is essential. Since the implementation of mandatory simulations, the aviation industry has seen a dramatic drop in fatalities, becoming one of the safest in the world. Healthcare has yet to learn this lesson.

There is a path forward in which technology can provide the tools healthcare professionals need. They need real-life scenarios, such as virtual reality BLS training modules, to practice and learn the skills they will use with real patients. Performance-based verification of certification is not only feasible but also available. Immersive medicine has formed the basis of simulation and biometric certification of one’s capabilities and skill level. The infrastructure exists.

The solution is here. Immersive medicine provides the level of learning that can be achieved in high-frequency, low-dose environments, where skills are honed and stay current. Using medical simulation training, healthcare professionals can practice code scenarios, emergency responses, and critical procedures repeatedly—building the muscle memory and stress inoculation that no video module can provide. They can fail safely. They can learn from mistakes that do not cost lives.

And now, immersive medicine can even measure skill decay. This is something we have discussed theoretically for years, but implementation has remained out of reach until now. Previously, we knew that skills deteriorate without practice, but we lacked a method to quantify, track, or address this decline before it became significant. With recent advancements, we can now plot skill decay curves in real-time, offering a visual representation of competency erosion. This breakthrough allows us to identify when a healthcare professional’s skills have waned, enabling targeted retraining before they face a critical moment.

But the adoption gap is the bigger challenge. Healthcare is slow to shift the paradigm that paper certification does not mean competence. Privileging of healthcare professionals should not be based on a check mark or checking off a box. It should be based on actual demonstration of skills that are mentioned in the paper, actual measurement of hand motions, decision-making under stress that can be biometrically verified, and certified. Will credentialing bodies dare to change the checklist? What would change if we verified that healthcare workers can do what their certifications claim they can?

What is at stake is human lives lost. We cannot afford to lose more lives to human error borne by the very professionals entrusted to save lives. The farce must end.

Farzad Najam, MD, FACS, is the Founder and CEO of VRKure and a pioneer in Immersive Medicine.