Virtual reality simulation\u2014the future of orthopaedic training? A systematic review and narrative analysis

Elinor Clarke

doi:10.1186/s41077-020-00153-x

Abstract

BackgroundVirtual reality (VR) simulation provides users with an immersive, 3D experience that can be used to allow surgical trainees to practice skills and operations in a safe yet realistic environment. The field of orthopaedics is yet to include VR in core teaching, despite its advantages as a teaching aid, particularly against current simulation tools. This study aims to conduct a systematic review to investigate the efficacy of VR in orthopaedic training, against current methods.MethodsA systemic review of databases Medline, Embase and the Cochrane Library for randomized controlled trials focusing on VR training against conventional training in orthopaedic surgery was performed. Data synthesis was performed through narrative analysis due to the heterogeneous nature of the data.ResultsA total of 16 studies from 140 titles were identified, across 6 specialty areas. Four hundred and thirty-one participants were included. Control groups included VR, cadaver and benchtop simulators. Forty-seven outcomes were measured, focusing on skill and proficiency assessment. No outcomes focused on patient safety. Although significance between intervention and control was not always achieved, most studies found that the intervention outperformed the control.ConclusionVR provides a modern and immersive teaching tool that can develop skills and give confidence to trainees. This study demonstrates the potential for VR simulation as a training aid in orthopaedics and encourages its use alongside conventional teaching methods. However, long-term analysis of the results of VR training on surgical trainees has yet to be conducted. To provide conclusive justification for its inclusion in surgical training, this study recommends that future research follows trainees using VR into the operating room, to determine that VR teaches skills that are transferable onto actual surgeries, subsequently leading to better patient outcomes.

Highlights

Virtual reality (VR) simulation provides users with an immersive, 3D experience that can be used to allow surgical trainees to practice skills and operations in a safe yet realistic environment
Studies were excluded for a number of reasons, including a non-orthopaedic focus and using a simulator that would not be classed as VR
This result could lead to the conclusion that training in VR does lead to a greater positive effect on outcomes than standard training currently used in the orthopaedic curriculum

Summary

Introduction

Virtual reality (VR) simulation provides users with an immersive, 3D experience that can be used to allow surgical trainees to practice skills and operations in a safe yet realistic environment. The surgical field of orthopaedics has a wellestablished history in the area of simulation, and these tasks largely involve low-fidelity models, or the use of wet or dry labs for anatomical learning [1]. These models may not as accurately represent the surgical environment or require sufficient access to resources that may not always be freely available and, in some cases, can only be used once, i.e. human tissue. Beyond the rehearsal and refinement of procedures, VR lends itself to being an excellent teaching tool, providing trainees of all level access to a range of techniques that accurately replicate real-life environments, without risk to the patient or even a necessary need for supervision [4]

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