High-fidelity Virtual Reality Simulator Research Articles

Teaching Otolaryngology skills through simulation

Over the last couple of decades, learning through simulation has become popularised for various reasons and is continuing to expand exponentially despite a lack of robust evidence that it actually improves outcomes for patients and learners. There has been a particular growth in the use of high-fidelity virtual reality simulators for surgical training as the technology has become more affordable. In the field of Otolaryngology, simulation appears to help teach simple procedural skills through to complex surgery of the temporal bone and paranasal sinuses. This is happening in an era when quality of care and patient safety are top of the agenda and cadaveric material is in short supply. In this article, we explore the history behind simulation, review the available evidence and discuss its applications within Otolaryngology.

Development and validation of a virtual reality transrectal ultrasound guided prostatic biopsy simulator

Surgical training has undergone some remarkable changes over the past 2 decades. No longer is the operating room the sole training ground for medical students and residents learning surgery. Basic skills, such as knot tying and laparoscopic suturing, can be practiced in the confines of a surgical skills laboratory.1 Studies have shown that ex-vivo surgical skills training can lead to significant improvement in actual intra-operative performance.2 Models used to teach learners have varied in fidelity, in terms of how realistic the model looks, from simple bench models to complex virtual reality (VR) model. However, a high fidelity or virtual reality model is not synonymous with an excellent teaching tool.3 The authors of this study have developed a VR model that captures the critical constructs of performing a transrectal ultrasound and biopsy (TRUS-BX).4 Targeting is the foundation of TRUS-BX and teaching a learner how to target is the focus of this simulator. The VR simulator developed by the University of Western Ontario group incorporates real patient 3D TRUS data to train and test a learner’s ability to target 12 virtual targets. The simulator calculates the accuracy of each of the biopsy taken and also records time. Face and content validity, through self-made questionnaire, showed this model to have a very realistic feel and simulation of a TRUS-BX. The VR TRUS-BX simulator was also able to discriminate performance between experts and novices. Furthermore, improvements were demonstrated while using this model. As the authors surmized, this VR simulator shows promise as a tool that can be used to train residents and serve a role in continuing professional development. We have seen great progress being made in surgical education research and advance in the science of technical skills assessment. However, there is also much more to be desired. As technology advances and increasingly more high fidelity VR simulators become available, there is a need for standardized methods in evaluating these new simulators. Measuring a simulators face and content validity needs to be more than experts’ opinion that “yes-this looks and feels like the real thing.” A stringent, reliable and accurate tool to measure face and content validity would allow meaningful comparison between simulator offerings from different companies. Measuring construct validity using subjects of varying experience has become a standard and acceptable method of simulator validation in the surgical education field. What would be highly desirable is a simulator with high predictive validity. Can the performance in the simulator predict the performance in the real-world? This would have significant implications on residency training and would introduce a high-stakes technical skills examination using simulator to attest to one’s competence. To achieve this goal, one needs to be able to measure technical performance in the operating room, which still remains the “holy grail” of surgical education. Ethical issues of live patients and the lack of unobtrusive and practical methods of intra-operative assessment remain impeding factors. Surgical education research remains a field that is evolving and it is encouraging to see well-thought simulators being designed and evaluated in a thorough manner.

The impact of constructive feedback on training in gastrointestinal endoscopy using high-fidelity virtual-reality simulation: a randomised controlled trial

BackgroundRecently, virtual reality computer simulators have been used to enhance traditional endoscopy teaching. Previous studies have demonstrated construct validity of these systems and transfer of virtual skills to the operating...

Development of a virtual reality training curriculum for laparoscopic cholecystectomy

Training within a proficiency-based virtual reality (VR) curriculum may reduce errors during real surgical procedures. This study used a scientific methodology for development of a VR training curriculum for laparoscopic cholecystectomy. Inexperienced (had performed fewer than ten laparoscopic cholecystectomies), intermediate (20-50) and experienced (more than 100) surgeons were recruited. Construct validity was defined as the ability to differentiate between the three levels of experience, based on simulator-derived metrics for nine basic skills, four procedural tasks and full laparoscopic cholecystectomy on a high-fidelity VR simulator. Inexperienced subjects performed ten repetitions for learning curve analysis. Proficiency measures were based on the performance of experienced surgeons. Thirty inexperienced, 11 intermediate and 16 experienced operators were recruited. Eight of nine basic skills and three of four procedural tasks were found to be construct valid. The full procedure revealed significant intergroup differences for time (1541, 673 and 816 s; P = 0.002), movements (1021, 595 and 638; P = 0.006) and path length (2038, 1235 and 1303 cm; P = 0.033). Learning curves plateaued between the second and ninth sessions. This study shows that it is possible to define and develop a whole-procedure VR training curriculum for laparoscopic cholecystectomy using structured scientific methodology.

Assessment of the Laparoscopic Training Validity of a Virtual Reality Simulator (LAP MentorTM

TM is a high-fidelity virtual reality simulator with haptic feedback that allows a trainee to practice 9 basic laparoscopic tasks including laparoscopic suturing. The purpose of this study was to evaluate the predictive validity of performance on the LAP Mentor before surgical simulators are incorporated into training programs. Materials and Methods: Eleven participants (6 medical students and 5 residents) underwent laparoscopic skills training on the virtual reality simulator LAP Mentor. Each participant was tested on 5 sets of 4 LAP Mentor basic laparoscopic tasks (grasping, cutting, clipping, and suturing) in a 3-week period. Total time and accuracy were measured for each task. Results: There was a significant difference between the initial session and the final session for total time and accuracy in both groups. Among the medical students, as they progressed through the training step by step, total time decreased for the grasping task, the cutting task, the clipping task, and the suturing task. At the same time, accuracy improved for the grasping task, the cutting task, the clipping task, and the suturing task, respectively. The residents group showed a similar progression. Conclusions: Basic skills straining on a LAP Mentor virtual reality simulator improves learning of the basic skills for laparoscopy. Education with virtual reality simulators, therefore, may provide an effective teaching method and lead to improved operating performance. (Korean J Urol