426 Effect of Visuospatial Feedback Versus Numeric Scores on Neurosurgical Tumor Resection Skills Among Medical Students in Virtual Reality Simulation Randomized Control Trial

Abstract

INTRODUCTION: Virtual reality (VR) simulation can be implemented with various feedback modalities to optimize learners’ surgical skills acquisition. The systems can present benchmark scores as either a numeric report or a visuospatial performance assessment. In this context, the optimal feedback methodology to enhance learning remains undefined. METHODS: One hundred and twenty medical students (mean age [SD], 23.1 [3.6] years, 41% women) from four institutions were recruited to practice a simulated subpial tumor resection in five attempts. They were randomly assigned to receive one of four interventions between each attempt: (1) no feedback (n = 30), (2) numerical feedback (n = 30), (3) visual feedback (n = 29), or (4) visuospatial feedback (n = 31). Performance on the first task determined baseline. Skill was evaluated using previously established 14-expert performance benchmarks. The primary outcome was the number of performance benchmarks achieved throughout the five attempts. RESULTS: Participants in all feedback groups significantly improved their performance compared to baseline. Between-subjects comparison demonstrated a significant increase in the number of metrics achieved with visual (mean difference 1.80, p = 0.001) and visuospatial (mean difference 1.89, p < 0.001) feedback compared to control, and no significant increase with numeric assessment (mean difference 1.10, p = 0.093). In the third attempt, visual feedback was significantly superior to numeric assessment (mean difference 1.63, p = 0.016). CONCLUSIONS: Neurosurgical skill acquisition is enhanced with visual and visuospatial feedback in VR simulation training. These engaging modes of performance assessment result in more accelerated rate of benchmark acquisition compared to numerical scores alone. Further research is warranted to explore the potential benefits of visual and visuospatial feedback in other domains of surgical training.