Previous Simulator Research Articles

Usefulness of a new polyvinyl alcohol hydrogel (PVA-H)-based simulator for endoscopic submucosal dissection training: a pilot study.

We developed a new endoscopic submucosal dissection (ESD) simulator and evaluated its efficacy and realism for use training endoscopists. An ESD simulator was constructed using polyvinyl alcohol hydrogel sheets and compared to a previous ESD simulator. Between March 1, 2020, and December 30, 2021, eight expert endoscopists from three different centers analyzed the procedure-related factors of the simulator. Five trainees performed gastric ESD exercises under the guidance of these experts. Although the two ESD simulators provided overall favorable outcomes in terms of ESD-related factors, the new simulator had several benefits, including better marking of the target lesion's limits (p<0.001) and overall handling (p<0.001). Trainees tested the usefulness of the new ESD simulator. The complete resection rate improved after 3 ESD training sessions (9 procedures), and the perforation rate decreased after 4 sessions (12 procedures). We have developed a new ESD simulator that can help beginners achieve a high level of technical experience before performing real-time ESD procedures in patients.

Transferability of robotic console skills by early robotic surgeons: a multi-platform crossover trial of simulation training

Robotic surgical training is undergoing a period of transition now that new robotic operating platforms are entering clinical practice. As this occurs, training will need to be adapted to include strategies to train across various consoles. These new consoles differ in multiple ways, with some new vendors using flat screen open source 3D enhanced vision with glasses and differences in design will require surgeons to learn new skills. This process has parallels with aviation credentialling across different aircraft described as type rating. This study was designed to test the hypothesis that technical robotic console operating skills are transferrable across different robotic operating platforms. Ten participants sequentially completed four Mimic®(Surgical Science) simulation exercises on two different robotic operating platforms (DaVinci®, Intuitive Surgical and HUGO™ RAS, Medtronic). Ethical approval and informed consent were obtained for this study. Groups were balanced for key demographics including previous robotic simulator experience. Data for simulation metrics and time to proficiency were collected for each attempt at the simulated exercise and analysed. Qualitative feedback on multi-platform learning was sought via unstructured interviews and a questionnaire. Participants were divided into two groups of 5. Group 1 completed the simulation exercises on console A first then repeated these exercises on console B. Group 2 completed the simulated exercises on console B first then repeated these exercises on console A. Group 1 candidates adapted quicker to the second console and Group 2 candidates reached proficiency faster on the first console. Participants were slower on the second attempt of the final exercise regardless of their allocated group. Quality and efficiency metrics and risk and safety metrics were equivalent across consoles. The data from this investigation suggests that console operating skills are transferrable across different platforms. Overall risk and safety metrics are within acceptable limits regardless of the order of progression of console indicating that training can safely occur across multiple consoles contemporaneously. This data has implications for the design of training and certification as new platforms progress to market and supports a proficiency-based approach.

Innovative learning - key question in teaching naval surgery

Simulation training plays an important role in the preparation of future naval surgeons. In this regard, nowadays in the department of naval surgery there is a training simulator, modernized on the model of the most modern diesel submarine. In contrast to the previous simulator it contains necessary devices for solving situational tasks with the use of telemedicine technologies. The simulator is equipped with sanitary stretchers and a tripod with medical melts. It allows to organize a military medical game with the introductory on transporting conditionally sick and injured both inside and outside the ship that improves the quality of preparing future naval surgeons.

Improved CPU Simulator for Use with Excel Online

I improved the CPU simulator so that it can be used with Excel online. In the previous simulator, the simulation was performed by using a VBA program. However, some students could not use the simulator because they could not use Excel due to differences in operating systems. Therefore, in order to make the simulator available to all students, the simulation is performed using Excel Online. However, VBA programs are not available in Excel Online. Therefore, I improved the CPU simulator so that it can be simulated using only cell functions. In the new simulator, repetitive structures are expanded and expressed as a program without repetitive structures. In this paper, I report on the CPU simulator realized with only cell functions.

External validation of a prostate biopsy simulator.

Simulation-based training has proven to be a promising option allowing for initial and continuous training while limiting the impact of the learning curve on the patient. The Biopsym simulator was developed as a complete teaching environment for the prostate biopsy procedure. This paper presents the results of an external validation of this simulator, involving urology residents recruited during a regional teaching seminar. Residents from 4 academic urology departments of the French Auvergne Rhône-Alpes region, who did not take part in the previous simulator validation studies, were enrolled. After a short presentation and standardized initiation session, residents carried out a simulated systematic 12-core biopsy procedure and were asked to fill in a questionnaire collecting their expectations and evaluation of the Biopsym simulator. The number of biopsies reaching each targeted sector, the total score provided by the simulator and the duration of the procedure were recorded. Twenty-three residents were recruited. The overall added value (/100) for learning was rated at a median of 100 (interquartile range 83-100), overall realism of the biopsy procedure at 80 (65-89). The median percentage of biopsies reaching the targeted sector was 66.7% (62-75). The median score provided by the simulator was 50% (37-60). For both, the difference between residents with or without prior biopsy experience was not statistically significant. The median duration of the simulated biopsy procedure was 4:58 (minutes: seconds) (3:49-6:00). Resident with prior experience required less time to complete the biopsy procedure 3:53 (3:39-4:56) vs. 5:10 (4:59-7:10), P=0.01. This external validation study confirms a high acceptance of the simulator by the target audience. To our knowledge, the Biopsym simulator is the only prostate biopsy simulator that demonstrated such validity as evaluated by clinicians, outside the center involved in its early development. 3.

The Development of a Cost-Effective Infant Intraosseous Infusion Simulator for Neonatal Resuscitation Program Training.

Simulation-based medical education (SBME) employs realistic simulators to allow physicians and medical students to learn and practice high acuity, low occurrence (HALO) skills such as the intraosseous (IO) infusion. Previous research was done to develop and evaluate a three-dimensional (3D)-printed adult proximal tibia IO simulator and was rated as a valuable and realistic medical education training tool. This report focuses on implementing this IO simulator for neonatal resuscitation program (NRP) training purposes, as well as to explain the process of redeveloping the previous adult IO simulator and the development of a stand, called the maxSIMbox, to hold the simulators, as well as the tools needed to perform an IO infusion. The feedback provided from stakeholders was helpful, with an emphasis on providing stability to both the infant IO simulator and the maxSIMbox. From this feedback, a functional and cost-effective simulator was developed to practice this HALO skill and is currently being used for NRP training.

More Anterior in vivo Contact Position in Patients With Fixed-Bearing Unicompartmental Knee Arthroplasty During Daily Activities Than in vitro Wear Simulator.

BackgroundWhile in vitro wear simulation of unicompartmental knee arthroplasty (UKA) showed outstanding long-term wear performance, studies reported that polyethylene (PE) wear was responsible for 12% fixed-bearing (FB) UKA failure. This paper aimed to quantify the in vivo 6-degrees-of-freedom (6-DOF) knee kinematics and contact positions of FB UKA during daily activities and compare with the previous results of in vitro wear simulator.MethodsFourteen patients following unilateral medial FB UKA received a CT scan and dual fluoroscopic imaging during level walking, single-leg deep lunge, and sit-to-stand motion for evaluating in vivo 6-DOF FB UKA kinematics. The closest point between surface models of the femoral condyle and PE insert was determined to locate the medial compartmental articular contact positions, which were normalized relative to the PE insert length. The in vivo contact area was compared with the in vitro wear region in previous simulator studies.ResultsThe in vivo contact positions during daily activities were more anterior than those in the previous in vitro wear simulator studies (p < 0.001). Significant differences in the femoral anteroposterior translation and tibial internal rotation during the stance phase were observed and compared with those in lunge and sit-to-stand motions (p < 0.05). The in vivo contact position located anteriorly and medially by 5.2 ± 2.7 and 1.8 ± 1.6 mm on average for the stance phase, 1.0 ± 2.4 and 0.9 ± 1.5 mm for the lunge, and 2.1 ± 3.3 and 1.4 ± 1.4 mm for sit-to-stand motion. The in vivo contact position was in the more anterior part during the stance phase (p < 0.05).ConclusionThe current study revealed that the contact position of FB UKA was located anteriorly and medially on the PE insert during in vivo weight-bearing activities and different from previous findings of the in vitro wear simulator. We should take in vivo 6-DOF knee kinematics and contact patterns of FB UKA into account to reproduce realistic wear performance for in vitro wear simulator and to improve implant design.

Take-over expectation and criticality in Level 3 automated driving: a test track study on take-over behavior in semi-trucks

With the introduction of advanced driving assistance systems managing longitudinal and lateral control, conditional automated driving is seemingly in near future of series vehicles. While take-over behavior in the passenger car context has been investigated intensively in recent years, publications on semi-trucks with professional drivers are sparse. The effects influencing expert drivers during take-overs in this context lack thorough investigation and are required to design systems that facilitate safe take-overs. While multiple findings seem to cohere in passenger cars and semi-trucks, these findings rely on simulated studies without taking environments as found in the real world into account. A test track study was conducted, simulating highway driving with 27 professional non-affiliated truck drivers. The participants drove an automated Level 3 semi-truck while a non-driving-related task was available. Multiple time critical take-over situations were initiated during the drives to investigate four main objectives regarding driver behavior. (1) With these results, comparison of reaction times and behavior can be drawn to previous simulator studies. The effect of situation criticality (2) and training (3) of take-over situations is investigated. (4) The influence of warning expectation on driver behavior is explored. Results obtained displayed very quick time to hands on steering and time to first reaction all under 2.4 s. Highly critical situations generate very quick reaction times M = 0.81 s, while the manipulation of expectancy yielded no significant variation in reaction times. These reaction times serve as a reference of what can be expected from drivers under optimal take-over conditions, with quick reactions at high speed in critical situations.

SCANNING FOR CRITICAL EVENTS DURING DRIVING: VISUAL SCANNING USING EYE TRACKING TECHNOLOGY ON A DRIVING SIMULATOR

This study explored age differences and scanning strategies for critical events using a driving simulator with eye-tracking technology. One critical skill in driving is to efficiently scan the environment. Ten young(M=26y) and 10 old(M=65y) healthy adults drove a wearing Tobii-Pro Glasses. The software analyzes areas of interest (AOI) for “percent time of fixation” as well as illustrative “heat maps” of duration of fixation. At a four-way-stop, the young fixated at the road ahead (25% fixation time), dashboard (29%), more often than left/right of their car (15%). The old fixed on the road ahead (21%) but spent more time outside the car (23%). At the hidden sign, older drivers fixated on the environment outside the road ahead more than younger drivers (26% versus 20%), but both had increased fixation to the right side of the vehicle (Y-23%, O-24%) with this event, likely looking for the sign. Heat maps of the hidden sign illustrate this, suggesting older drivers may more efficiently scan their environment. Other possibilities include the young trusting the simulator, young/old scan differently, or interference of previous simulator experience. Simulator outcomes showed age differences on gas-pedal-reaction times suggesting that older adults are more cautious, slowing down faster with critical events. Limitations include small sample and limited studies have used eye-tracking technology in driving. This study raises interesting questions, especially for medically-at-risk drivers with visual impairments. Using the eye-tracking may enhance targeting specific strategies for a variety of impairments as well as establishing a baseline of typical drivers’ visual scanning habits.

Subjectively estimated vs. objectively measured adaptation to driving simulators – Effects of age, driving experience, and previous simulator adaptation

ObjectiveThe present study aims to investigate whether drivers’ age and their experience with driving simulators could explain differences between a subjective estimation of system adaptation and a respective objective systematic measurement. BackgroundAssessing valid measurements in driving simulators causes concern because driving simulators are not yet as realistic as real on-road driving scenarios. Common methods like pre-defined training sessions and self-appraisals of simulator adaptation might therefore be insufficient to ensure actual valid data. Hence, influential variables on this discrepancy are investigated. MethodIn total, N = 203 drivers participated in a training session and a subsequent testing session in a close-to-production driving simulator. Subjective adaptation was estimated by the drivers and an objective adaptation value was gathered on the basis of driving accuracy. The discrepancy between these two measures was calculated and related to age, self-reported driving experience and occurrence of previous adaptation. ResultsSubjective adaptation was significantly faster than objective adaptation but neither drivers’ age, experience, nor previous adaptation could explain this discrepancy. DiscussionResults indicate that younger and older drivers likewise underestimate the time needed for adaptation. Measuring a subjective point of adaptation seems to be an insufficient measure to ensure simulator validity when assessing both older and younger drivers.

Quality Assurance During Brain Aneurysm Microsurgery—Operative Error Teaching

Quality assurance (QA) is a way to prevent mistakes in advance. Although it has been previously reported for surgical setup, there is no effective approach for minimizing microsurgical technical errors before an operation is done. Neurosurgery resident operative errors during brain aneurysm surgery could be foreseen by practicing in an exvivo hybrid simulator with microscopic fluorescein vessel flow image. Five vascular neurosurgeons and 8 junior/senior neurosurgical residents voluntarily joined this research initiative. The following methodology was adopted: 1) Identification of the 7 most-common resident operative performance errors during brain aneurysm surgery; 2) Design of exercises to prevent common mistakes in brain aneurysm microsurgery using a placenta simulator; and 3) Blinded staff neurosurgeon evaluation of resident performance during real brain aneurysm microsurgery. All key steps to perform such intervention were accomplished with a simulator that uses 2 placentas, a synthetic cranium, and microscopic fluorescein vessel flow image. Neurosurgery residents trained in this model had better surgical performance with fewer perioperative mistakes (P < 0.05). Fine microsurgical dissection of the arachnoid membrane and aneurysm sac were the most commonly improved tasks among the 7 common operative mistakes. Brain parenchyma traction with secondary bleeding was the only error not prevented after previous simulator training. There was a left-shift on the quality assurance line with residents who practiced brain aneurysm microsurgical errors in an exvivo model. A multicentric prospective study is necessary to confirm the hypothesis that real operative error could be reduced after training in a realistic simulator.

A Fast GPU-optimized 3D MRI Simulator for Arbitrary k-space Sampling.

Purpose:To develop a fast 3D MRI simulator for arbitrary k-space sampling using a graphical processing unit (GPU) and demonstrate its performance by comparing simulation and experimental results in a real MRI system.Materials and Methods:A fast 3D MRI simulator using a GeForce GTX 1080 GPU (NVIDIA Corporation, Santa Clara, CA, USA) was developed using C++ and the CUDA 8.0 platform (NVIDIA Corporation). The unique advantage of this simulator was that it could use the same pulse sequence as used in the experiment. The performance of the MRI simulator was measured using two GTX 1080 GPUs and 3D Cones sequences. The MRI simulation results for 3D non-Cartesian sampling trajectories like 3D Cones sequences using a numerical 3D phantom were compared with the experimental results obtained with a real MRI system and a real 3D phantom.Results:The performance of the MRI simulator was about 3800–4900 gigaflops for 128- to 4-shot 3D Cones sequences with 2563 voxels, which was about 60% of the performance of the previous MRI simulator optimized for Cartesian sampling calculated for a Cartesian sampling gradient-echo sequence with 2563 voxels. The effects of the static magnetic field inhomogeneity, radio-frequency field inhomogeneity, gradient field nonlinearity, and fast repetition times on the MR images were reproduced in the simulated images as observed in the experimental images.Conclusion:The 3D MRI simulator developed for arbitrary k-space sampling optimized using GPUs is a powerful tool for the development and evaluation of advanced imaging sequences including both Cartesian and non-Cartesian k-space sampling.

Fuzzy Logic Washout Algorithm Based on Serial Manipulator

The previous motion simulator is almost all built on the basis of parallel mechanism, and the most used and most mature is based on the six degree of freedom steward platform, and the simulator of the series mechanism has not been widely studied. Because the body organs can not accurately distinguish the degree of motion, the theory of fuzzy control is introduced to improve the classical wash out algorithm, and the motion error of the sensory organ of the vestibule of the human vestibule and the space of the motion platform are combined, and the fidelity of the motion simulation can be raised as much as possible under the limit of the non super motion platform.

The development of acoustic environment simulator for passenger’s train soundscape

The study of soundscape in laboratory usually conducted by reproducing acoustic environment recording or simulated acoustic environment. Different method has been developed to understand the soundscape in the laboratory using acoustic environment composition. The soundscape composition has been validated and implemented for outdoor urban soundscape but not the indoor soundscape. The previous soundscape simulator only considers the behaviour of sound sources (movement, and position in space) without considering the sound reflection. This study tries to develop an acoustic environment simulator for passenger train soundscape study. In the passenger train, there are some annoying sound source that cannot be removed such as the sound of bogie or the sound of buffers and chain coupler. The soundscape composition concept using acoustic environment simulator can be implemented to understand the existing soundscape, to fix the soundscape (by selecting different sound source for masking and adjust the sound level), and to evaluate the effect of the acoustic treatment inside the passenger train. The simulator can reproduce realistic acoustic environment using ambisonic reproduction concept. Furthermore, the reflection inside the passenger train simulated by using the concept of auralization.

Investigation of Time and Speed Perception using a Driving Simulator

Thirty-four drivers participated in a driving simulator experiment which investigated time and speed perception as it related to cognitive workload resulting from secondary tasks. Each participant drove the virtual drive twice, once with either an audio or a map task and again with no distractions as a control. Participants knew from a practice drive that they would be asked to estimate their speed and time duration of driving, thus this study used the prospective paradigm. Based on previous literature it was expected that there would be an underestimation of time and an overestimation of speed. The reverse occurred, participants overestimated time and underestimate their speed. This suggests that drivers may have found the drive unstimulating, despite the secondary tasks, and that the rural environmental may have impacted speed perception. In addition, a large group of participants, nine out of 34, crashed the virtual vehicle at a horizontal curve that was not problematic in previous simulator studies. When investigating these crashes further, it was found that drivers who crashed in the second drive had significantly worse time perception in the first drive as compared to drivers who did not crash in the second drive. This finding suggests that current time perception may be a predictor of future speed selection.

Novel Evaluation Systems for Compact In-Wheel Vehicles Considering Deviation of Load Torque between Left and Right Wheel

In-wheel vehicles driven by electrical energy are more efficient and emit less pollutant emissions than conventional vehicles powered by internal combustion engine. However, evaluation system for the in-wheel vehicles is not well established, the absence of the evaluation system for in-wheel vehicles is one of the major obstacles to commercialization of the in-wheel vehicles. In this study, we have suggested a new methodology of dynamometer test for in-wheel vehicle and devised simulators that can analyze the performance of in-wheel vehicles. In general, a new vehicle goes through the performance evaluation on dynamometer test which can simulate a straight motion of vehicles. Due to the characteristics of dynamometer test which simulates only a straight motion, it is not suitable for test for in-wheel vehicle. In the case of in-wheel vehicle, since driving motors on wheels are controlled independently, the stability of in-wheel vehicles during turning is important. Therefore, we have developed an in-wheel vehicle simulator to build a dynamometer test which can simulate turning motions of in-wheel vehicle. Using CarSim & Matlab/Simulink, we realized dynamic motion of a vehicle on a curved 3-demensional road. With this simulator, we could extract the load torque of each wheel during driving on the 3D virtual road. If the derived load torque is applied to motors of dynamometer test, it is possible to simulate driving on real road, through which the performance and the efficiency of in-wheel vehicles can be analyzed before the actual vehicle experiment. Also, we developed another simulator to evaluate the performance and the efficiency of in-wheel vehicles. This simulator allows us to evaluate the performance of in-wheel vehicles by using load torque derived from previous simulator. In this study, we developed two types of simulators to evaluate the performance of in-wheel vehicles in the simulation environment where the load torque for each wheel is different. One simulator derives load torque of each wheel and the other simulator evaluates the performance of in-wheel vehicles.

The UVA/Padova Type 1 Diabetes Simulator Goes From Single Meal to Single Day.

A new version of the UVA/Padova Type 1 Diabetes (T1D) Simulator is presented which provides a more realistic testing scenario. The upgrades to the previous simulator, which was accepted by the Food and Drug Administration in 2013, are described. Intraday variability of insulin sensitivity (SI) has been modeled, based on clinical T1D data, accounting for both intra- and intersubject variability of daily SI. Thus, time-varying distributions of both subject's basal insulin infusion and insulin-to-carbohydrate ratio were calculated and made available to the user. A model of "dawn" phenomenon based on clinical T1D data has been also included. Moreover, the model of subcutaneous insulin delivery has been updated with a recently developed model of commercially available fast-acting insulin analogs. Models of both intradermal and inhaled insulin pharmacokinetics have been included. Finally, new models of error affecting continuous glucose monitoring and self-monitoring of blood glucose devices have been added. One hundred in silico adults, adolescent, and children have been generated according to the above modifications. The new simulator reproduces the intraday glucose variability observed in clinical data, also describing the nocturnal glucose increase, and the simulated insulin profiles reflect real life data. The new modifications introduced in the T1D simulator allow to extend its domain of validity from "single-meal" to "single-day" scenarios, thus enabling a more realistic framework for in silico testing of advanced diabetes technologies including glucose sensors, new insulin molecules and artificial pancreas.

Cutting Force Simulation in Minute Time Resolution for Ball End Milling Under Various Tool Posture

A new cutting force simulator has been developed to predict cutting force in ball end milling. In this simulator, uncut chip thickness is discretely calculated based on fully voxel models representing both cutting edge and instantaneous workpiece shape. In the previous simulator, a workpiece voxel model was used to calculate uncut chip thickness under a complex change of workpiece shape. Using a workpiece voxel model, uncut chip thickness is detected by extracting the voxels removed per cutting tooth for the amount of material fed into the cutting edge. However, it is difficult to define the complicated shape of cutting edge, because the shape of cutting edge must be defined by mathematical expression. It is also difficult to model the voxels removed by the cutting edge when tool posture is nonuniformly changed. Therefore, a new method to detect uncut chip thickness is proposed, one in which both cutting edge and instantaneous workpiece shape are fully represented by a voxel model. Our new method precisely detects uncut chip thickness at minute tool rotation angles, making it possible to detect the uncut chip thickness between the complex surface shape of the workpiece and the particular shape of the cutting edge. To validate the effectiveness of our new method, experimental five-axis milling tests using ball end mill were conducted. Estimated milling forces for several tool postures were found to be in good agreement with the measured milling forces. Results from the experimental five-axis milling validate the effectiveness of our new method.

Simulated geomechanical responses to marine methane hydrate recovery using horizontal wells in the Shenhu area, South China Sea

Abstract The recovery of natural gas hydrate (NGH) from marine sediments faces challenging due to not only the gas productivity itself but also the possible geohazards, such as seafloor subsidence, submarine landslide, wellbore instability and possible sand production. The coupled thermal-hydrodynamic-mechanical (THM) processes during NGH recovery are generally complex, and numerical simulation tools are needed to assess related geomechanical responses. We have extended the Biot consolidation model in our previous simulator TOUGH2Biot, and incorporated into the existing TOUGH + hydrate code, resulting in a THM simulator for the NGH recovery. The THM simulator is used to assess the geomechanical responses to gas recovery from an unconfined hydrate-bearing sediment (HBS) in the Shenhu area, South China Sea. We investigated depressurization using constant bottom-hole pressure through a horizontal well. Results show that methane production quickly reaches a stabilized state and the water rate increases linearly. The drawdown of pore pressure around the well controls the increase in effective stress. Subsidence becomes significant after depressurization due to the quickly propagation of pore pressure. Depressurization in early stage could contribute to more than half of the total subsidence. The decreasing production pressure leads to an increase in the methane production rate but deterioration in subsidence. A decrease in intrinsic permeability of overlying and underlying layer is undesirable due to its decrease in methane production rate and the worse of subsidence. A balance between gas productivity and related geomechanical response must be achieved. The methods and preliminary results presented in this study could help us to understand the geomechanical behaviors during NGH recovery and to design trial production schemes under similar conditions.

A Comparison of Robotic Simulation Performance on Basic Virtual Reality Skills: Simulator Subjective Versus Objective Assessment Tools

Study ObjectiveTo answer the question of whether there is a difference between robotic virtual reality simulator performance assessment and validated human reviewers. Current surgical education relies heavily on simulation. Several assessment tools are available to the trainee, including the actual robotic simulator assessment metrics and the Global Evaluative Assessment of Robotic Skills (GEARS) metrics, both of which have been independently validated. GEARS is a rating scale through which human evaluators can score trainees' performances on 6 domains: depth perception, bimanual dexterity, efficiency, force sensitivity, autonomy, and robotic control. Each domain is scored on a 5-point Likert scale with anchors. We used 2 common robotic simulators, the dV-Trainer (dVT; Mimic Technologies Inc., Seattle, WA) and the da Vinci Skills Simulator (dVSS; Intuitive Surgical, Sunnyvale, CA), to compare the performance metrics of robotic surgical simulators with the GEARS for a basic robotic task on each simulator. DesignA prospective single-blinded randomized study. SettingA surgical education and training center. ParticipantsSurgeons and surgeons in training. InterventionsDemographic information was collected including sex, age, level of training, specialty, and previous surgical and simulator experience. Subjects performed 2 trials of ring and rail 1 (RR1) on each of the 2 simulators (dVSS and dVT) after undergoing randomization and warm-up exercises. The second RR1 trial simulator performance was recorded, and the deidentified videos were sent to human reviewers using GEARS. Eight different simulator assessment metrics were identified and paired with a similar performance metric in the GEARS tool. The GEARS evaluation scores and simulator assessment scores were paired and a Spearman rho calculated for their level of correlation. Measurements and Main ResultsSeventy-four subjects were enrolled in this randomized study with 9 subjects excluded for missing or incomplete data. There was a strong correlation between the GEARS score and the simulator metric score for time to complete versus efficiency, time to complete versus total score, economy of motion versus depth perception, and overall score versus total score with rho coefficients greater than or equal to 0.70; these were significant (p < .0001). Those with weak correlation (rho ≥0.30) were bimanual dexterity versus economy of motion, efficiency versus master workspace range, bimanual dexterity versus master workspace range, and robotic control versus instrument collisions. ConclusionOn basic VR tasks, several simulator metrics are well matched with GEARS scores assigned by human reviewers, but others are not. Identifying these matches/mismatches can improve the training and assessment process when using robotic surgical simulators.