Virtual Reality Skills Research Articles

An exploratory study on practising listening comprehension skills in high‐immersion virtual reality

AbstractHolding learners' attention is challenging, especially when they are asked to listen to long passages. High‐immersion virtual reality (VR) can immerse learners in listening tasks, even in such complex languages as Chinese. This exploratory study examined the effect of VR on 43 Chinese language learners' listening comprehension, enjoyment, sense of presence, and cognitive load. Participants were self‐selected into two groups without knowing the purpose of the study or the details of their activity. The experimental group (n1 = 23) experienced an interactive multimedia story in VR, and the comparison group (n2 = 20) watched a screencast video recording of the same story. Multivariate analysis of covariance (MANCOVA) indicated that VR may have a positive effect on the development of listening skills. Compared with the video group, the VR group had significantly higher listening comprehension scores, reported significantly more enjoyment and sense of presence, and reported experiencing less cognitive load. Thus, the findings suggest that VR could be used as a pedagogical tool to enhance foreign language listening skills.Practitioner notesWhat is already known about this topic Practising listening skills is key for language development. Virtual reality (VR) is motivational and engaging. Research on practising listening skills in VR is scarce. What this paper adds VR can be beneficial for practising listening skills. Language learners highly enjoy practising listening in VR. Interactivity can improve engagement and support listening comprehension. Implications for practice and/or policy Learners should be provided pretraining and scaffolding prior to using VR. The duration of VR activities should be considered. Interactivity in VR may increase its effectiveness in attending listening tasks.

Assessment of Basic Thoracic Ultrasound Skills in Immersive Virtual Reality: Gathering Validity Evidence

Background: Operator skills are essential for thoracic ultrasound (TUS) to ensure diagnostic accuracy. Immersive virtual reality (IVR) has shown potential within medical education but never to assess TUS skills.This study aimed to develop an IVR test for assessing TUS skills, gathering validity evidence, and establishing a pass/fail score.Methods: An expert panel developed a test based on the TUS protocol by the European Respiratory Society (ERS) including a tutorial and two clinical cases (pleural effusion and interstitial syndrome) using an IVR platform [VitaSim, Denmark]. Four anterior, four lateral, and six posterior zones were available for examination and decision of diagnosis. Each correct examination equalled one point. The contrasting groups’ method was used to set a pass/fail score.Results: Data was collected at the during the ERS Congress 2022. We included 13 novices (N, experience: 0 TUS), 22 intermediates (I, 1-50 TUS), and 11 experienced (E, >50 TUS). Cronbach's alpha was 0.86. The total mean point scores in case 1 (C1) were N: 5.0±2.7; I: 7.3±2.4; E: 8.7±1.3 and in case 2 (C2): N: 4.5±1.8; I: 6.7±2.3; E: 8.5±2.1. Significant differences were found between the N and I for C1 (p=0.007) and C2 (p=0.02), I and E for C1 (p= 0.04) and C2 (p=0.019), and N and E for C1 (p<0.001) and C2 (p<0.001). The pass/fail score was seven points in each case.Conclusion: We established an IVR test that can distinguish between operators with different TUS skills. This enables a standardized, objective, and evidence-based approach to assess TUS skills.

First Recorded Large-Scale Adoption of Virtual Reality as a Part of Curriculum

Virtual Reality (VR) has been gaining traction as a medium of training for medical students, with various studies finding a multitude of advantages. These developments have led to its inculcation into educational institutions and programs. This study intended to understand the impact of using VR training on Indian medical students. Over 200 students from KIMS were enrolled in a VR-integrated curriculum program consisting of 10 modules across an academic year (Aug 2021-June 2022). After completion of all modules in the guided and evaluation modes, each student was asked to fill out an online questionnaire. An objective analysis of the results suggested that it was an interesting form of learning (61% of students), one that was more effective than manikin training (47%), bringing an increased level of confidence post training (92%). Feedback on the modules included satisfactory learning points, room for improvement in the visual graphics, and positive opinions on the assessment aspect. Overall, this study found that medical students perceived VR training as a fun and effective way to not only educate but assess them on procedural skills. Limitations included the need for repeated practice and the need to develop more realism in the digital environment to bring greater immersion. Keywords: Virtual Reality, Healthcare Training, VR Skill Training, Medical Simulation, KIMS.

A Multi-institution Study on the Association of Virtual Reality Skills with Continence Recovery after Robot-assisted Radical Prostatectomy

BackgroundVirtual reality (VR) simulators are increasingly being used for surgical skills training. It is unclear what skills are best improved via VR, translate to live surgical skills, and influence patient outcomes. ObjectiveTo assess surgeons in VR and live surgery using a suturing assessment tool and evaluate the association between technical skills and a clinical outcome. Design, setting, and participantsThis prospective five-center study enrolled participants who completed VR suturing exercises and provided live surgical video. Graders provided skill assessments using the validated End-To-End Assessment of Suturing Expertise (EASE) suturing evaluation tool. Outcome measurements and statistical analysisA hierarchical Poisson model was used to compare skill scores among cohorts and evaluate the association of scores with clinical outcomes. Spearman’s method was used to assess correlation between VR and live skills. Results and limitationsTen novices, ten surgeons with intermediate expertise (median 64 cases, interquartile range [IQR] 6–80), and 26 expert surgeons (median 850 cases, IQR 375–3000) participated in this study. Intermediate and expert surgeons were significantly more likely to have ideal scores in comparison to novices for the subskills needle hold angle, wrist rotation, and wrist rotation needle withdrawal (p < 0.01). For both intermediate and expert surgeons, there was positive correlation between VR and live skills for needle hold angle (p < 0.05). For expert surgeons, there was a positive association between ideal scores for VR needle hold angle and driving smoothness subskills and 3-mo continence recovery (p < 0.05). Limitations include the size of the intermediate surgeon sample and clinical data limited to expert surgeons. ConclusionsEASE can be used in VR to identify skills to improve for trainee surgeons. Technical skills that influence postoperative outcomes may be assessable in VR. Patient summaryThis study provides insights into surgical skills that translate from virtual simulation to live surgery and that have an impact on urinary continence after robot-assisted removal of the prostate. We also highlight the usefulness of virtual reality in surgical education.

Implementing the creation of comics using information and communication technologies to enhance reading and writing skills strengthening the autonomous learning of the 11-2 section at marco tulio salazar nocturnal high school during the second Quarter of

The instruction of the four English skills was affected by the interruption of face-to-face classes during the pandemic and the lack of strategies to adequately assume virtuality. Given the situation, different investigations have shown that reading and writing have been the least developed skills in virtual reality. This research focused on the impact that the creation of comics using information and communication technologies and the autonomous learning of adult students from a night high school located in Costa Rica had on improving their reading and writing skills. The creation of comics was implemented as a new strategy to analyze the scope of the use of technologies in the learning process considering its role in current life. Autonomy was analyzed during the study using selected instrumentation to evaluate the actions carried out by the students before and after the implementation of the activities, as well as the improvement of reading and writing. The results obtained showed an improvement that went beyond reading and writing skills, the use of ICT and autonomy were positively affected, in addition to demonstrating that all the elements used worked complementing each other in the same strategy.

Pain education and pain management skills in virtual reality in the treatment of chronic low back pain: A multiple baseline single-case experimental design

Chronic lower back pain is a major health problem and current treatments do not always lead to adequate pain control. Virtual reality (VR) is an upcoming technology that has shown to be effective in reducing acute pain. However, the value of VR in reducing chronic pain is still unknown. Therefore, the current study focuses on the effects of a recently developed VR application ‘Reducept’ using a multiple baseline single-case experimental design in 8 patients (N = 8). Reducept is a VR-training program aiming to improve pain management skills and providing pain education in patients with (chronic lower) back pain. Results based on visual and statistical analyses indicated that Reducept has the potential to reduce chronic lower back pain, although its clinical relevance was small. This study is one of the first that focuses on the possible effects of Reducept using sophisticated visual and statistical analyses. Our study shows a detailed overview of individual changes in pain intensity over time. Further research is necessary to investigate the working mechanism of Reducept and its impact on chronic pain conditions.

Research on Training Mode of Virtual Reality Skill Talents with "Integration of Post Class Competition Certificate" as the Core

With the rapid development of modern science and technology, virtual reality technology has been applied in many fields, and more and more "core", the training of virtual reality application technology professionals has also caused more attention of the society. Under such circumstances, many universities in our country have set up virtual reality application technology major, and each has a characteristic in the construction of talent training mode. However, from the perspective of the quality of talent training, the application of new technology poses great challenges to professional teachers.

Limited transfer and retention of locomotor adaptations from virtual reality obstacle avoidance to the physical world

Locomotor training based in virtual reality (VR) is promising for motor skill learning, with transfer of VR skills in turn required to benefit daily life locomotion. This study aimed to assess whether VR-adapted obstacle avoidance can be transferred to a physical obstacle and whether such transfer is retained after 1 week. Thirty-two young adults were randomly divided between two groups. A control group (CG) merely walked on a treadmill and an intervention group (IG) trained crossing 50 suddenly-appearing virtual obstacles. Both groups crossed three physical obstacles (transfer task) immediately after training (T1) and 1 week later (T2, transfer retention). Repeated practice in VR led to a decrease in toe clearance along with greater ankle plantarflexion and knee extension. IG participants crossed physical obstacles with a lower toe clearance compared to CG but revealed significantly higher values compared to the VR condition. VR adaptation was fully retained over 1 week. For physical obstacle avoidance there were differences between toe clearance of the third obstacle at T1 and the first obstacle at T2, indicating only partial transfer retention. We suggest that perception–action coupling, and thus sensorimotor coordination, may differ between VR and the physical world, potentially limiting retained transfer between conditions.

The on-task Attention of Individuals with Autism Spectrum Disorder-An Eye Tracker Study Using Auticare

Introduction: Autism Spectrum Disorders (ASD) are characterized by atypical patterns of behaviors and impairments in social communication. Traditional intervention approaches often require extensive fund support and well-trained therapists to address core deficits. Hence, emerging technology such as virtual reality (VR) has the potential to offer useful technology-enabled intervention systems. In this paper, an innovative Extended reality, Artificial Intelligence, virtual reality-based skill training platform called Auticare was used. Aim/Objective: This study explores the on-task attention on two virtual reality-based cognitive scenarios of individuals with Autism spectrum disorder (ASD) and typically developing (TD) groups. Methodology: 220 participants (ASD = 200, TD = 20) took part in a series of attention tests, which involved ball picking and putting in a basket and an alphabet learning scenario. We captured four eye-gaze parameters, which includes time to first fixate, first fixation duration, average fixation duration, and the sum of fixation count. The eye tracking data were analyzed to determine the on-task attention of the user while performing VR-based cognitive scenarios. Performance data, eye tracking indices and physiological features indicated the on-task attention of the individuals with ASD. Results: In the results we observe the comparison in the eye tracking parameters of ASD and TD group. This gives insight into the attention patterns of the participants of the study in each cognitive VR scenario. Conclusion: It is concluded that virtual reality skill training is a promising medium for skill training of individuals with Autism.

Virtual Reality Skills Training Trends in Nurse Practitioner Education

Technology developments change education strategies. Incorporating virtual reality into lesson plans allows education to focus not only on learning knowledge but also on knowledge and skills integration. In simulation education, learning environments are designed to approximate actual clinical situations, allowing students to practice skills in virtual clinical situations continuously. In addition, clinical lecturers may observe the students' practice process and provide feedback. Furthermore, through experiencing and practicing clinical procedures, students gain critical clinical judgment, skills, and teamwork operation competences, which may be applied in the real world. In Taiwan, the majority of nurse practitioner training is implemented in hospitals, and clinical training is done using hands-on and face-to-face teaching strategies within a mentorship framework. Because of the ongoing COVID-19 pandemic, this hospital-based training model has been significantly challenged. However, this represents an opportunity to migrate the nurse practitioner training model toward technology-based simulation education. Developing more virtual-reality-based lesson plans centered on clinical situations may help students complete training that is normally conducted in hospital teaching environments. Through repetitive practice in virtual reality settings, students may obtain comprehensive knowledge and clinical skills that will help relieve the subsequent stress of clinical practicum work and promote care quality and patient safety.

A Review on Virtual Reality Skill Training Applications

This study aimed to discuss the research efforts in developing virtual reality (VR) technology for different training applications. To begin with, we describe how VR training experiences are typically created and delivered using the current software and hardware. We then discuss the challenges and solutions of applying VR training to different application domains, such as first responder training, medical training, military training, workforce training, and education. Furthermore, we discuss the common assessment tests and evaluation methods used to validate VR training effectiveness. We conclude the article by discussing possible future directions to leverage VR technology advances for developing novel training experiences.

Toward a framework for developing virtual reality skills training in human services

Virtual Reality (VR) is used increasingly for training in human services. A framework that can guide the development and implementation of VR training approaches in human services is needed if the promise of VR is to be realized. Toward this end, we provide design and development recommendations originating from work creating two VR training applications for the child welfare workforce. Our focus is on the training and practice of skills. We begin by providing a brief overview of VR training and the need for effective skills training approaches. Next, orienting information about the two applications is provided. Then, we discuss areas we believe need to be addressed to develop effective VR skills training approaches; namely, incorporating evidence-based learning theories, gaining and maintaining learner engagement using motivational strategies, and creating collaborative technology development teams. The article concludes with a discussion regarding ethical issues that should be considered when developing technology that will be used for training in human services.

Learning ultrasound rendering from cross-sectional model slices for simulated training

PurposeGiven the high level of expertise required for navigation and interpretation of ultrasound images, computational simulations can facilitate the training of such skills in virtual reality. With ray-tracing based simulations, realistic ultrasound images can be generated. However, due to computational constraints for interactivity, image quality typically needs to be compromised.MethodsWe propose herein to bypass any rendering and simulation process at interactive time, by conducting such simulations during a non-time-critical offline stage and then learning image translation from cross-sectional model slices to such simulated frames. We use a generative adversarial framework with a dedicated generator architecture and input feeding scheme, which both substantially improve image quality without increase in network parameters. Integral attenuation maps derived from cross-sectional model slices, texture-friendly strided convolutions, providing stochastic noise and input maps to intermediate layers in order to preserve locality are all shown herein to greatly facilitate such translation task.ResultsGiven several quality metrics, the proposed method with only tissue maps as input is shown to provide comparable or superior results to a state-of-the-art that uses additional images of low-quality ultrasound renderings. An extensive ablation study shows the need and benefits from the individual contributions utilized in this work, based on qualitative examples and quantitative ultrasound similarity metrics. To that end, a local histogram statistics based error metric is proposed and demonstrated for visualization of local dissimilarities between ultrasound images.ConclusionA deep-learning based direct transformation from interactive tissue slices to likeness of high quality renderings allow to obviate any complex rendering process in real-time, which could enable extremely realistic ultrasound simulations on consumer-hardware by moving the time-intensive processes to a one-time, offline, preprocessing data preparation stage that can be performed on dedicated high-end hardware.

The digital skills divide: evidence from the European tourism industry

PurposeThis paper aims to present the findings from a European study on the digital skills gaps in tourism and hospitality companies.Design/methodology/approachMixed methods research was adopted. The sample includes 1,668 respondents (1,404 survey respondents and 264 interviewees) in 5 tourism sectors (accommodation establishments, tour operators and travel agents, food and beverage, visitor attractions and destination management organisations) in 8 European countries (UK, Italy, Ireland, Spain, Hungary, Germany, the Netherlands and Bulgaria).FindingsThe most important future digital skills include online marketing and communication skills, social media skills, MS Office skills, operating systems use skills and skills to monitor online reviews. The largest gaps between the current and the future skill levels were identified for artificial intelligence and robotics skills and augmented reality and virtual reality skills, but these skills, together with computer programming skills, were considered also as the least important digital skills. Three clusters were identified on the basis of their reported gaps between the current level and the future needs of digital skills. The country of registration, sector and size shape respondents’ answers regarding the current and future skills levels and the skills gap between them.Originality/valueThe paper discusses the digital skills gap of tourism and hospitality employees and identifies the most important digital skills they would need in the future.

Exploring the experiences of nursing students in using immersive virtual reality to learn nursing skills

BackgroundIn recent years, virtual reality teaching applications exhibited exponential development in numerous fields. An increasing number of virtual reality application cases and modules have been developed in the nursing education field to verify their effectiveness. ObjectiveThe research objective is to understand the experience of nursing students in using virtual reality skill learning process. DesignThis study is a qualitative research that adopts focus group research methods. The participants were able to freely describe their subjective feelings toward the virtual reality skill learning process. Participants/settingsThis research was conducted in a nursing school in Taiwan. Purposive sampling was adopted to select 60 nursing students who participated in the Adult Nursing and Practice course. The participants were divided into six focus groups containing 10 participants each. MethodAside from learning with traditional practice equipment, the students also experienced the virtual reality nasogastric tube care skill learning system. Focus group interviews were held from March 25 to 27, 2019. During the interview, we inquired about the students' subjective feelings toward the virtual reality skill learning system and reflected on its influence on the students' learning process. ResultsAn analysis of the focus group interview content of 60 students, revealed that the students' experience toward the virtual reality skill learning process could be classified into five themes, namely “convenient to practice, but requires adaptation,” “fast skill learning process,” “stress-free learning environment,” “environmentally friendly,” and “lacks a sense of reality.” ConclusionsInstead of replacing conventional skill teaching methods, future applications of the virtual reality nursing skill education support system shall serve as a student self-learning supporting tool. Additionally, the research and development of the virtual reality nursing skill education support system should focus on its stereognosis aspect and include an interactive function to upgrade the system into a practical teaching and learning support material.

Web-based virtual reality to enhance behavioural skills training and weight loss in a commercial online weight management programme: The Experience Success randomized trial.

SummaryObjectiveCommercial online weight management programmes are popular and easily accessible but often lack training in empirically validated behaviour change strategies and produce suboptimal outcomes. This study evaluated the effects of a Web‐based virtual reality (VR) programme for enhancing behavioural skills training and weight loss when offered as an adjunct to a commercial online weight management programme.Methods N = 146 adults with overweight/obesity (body mass index [BMI] 27‐40 kg/m2) were randomized to 6 months of no‐cost access to the Weight Watchers (WW) online platform alone or enhanced with the Experience Success (WW + ES) programme, consisting of four Web‐based VR sessions for training in behavioural weight‐loss skills related to the home environment, the workplace, physical activity and social situations (i.e., a party at a friend's house). Weight was measured at the research centre at baseline, 3 and 6 months.ResultsBoth groups achieved statistically significant weight loss across the trial, with no difference in mean ± standard error (SE) weight loss between WW and WW + ES at 3 months (2.7 ± 1.1 kg vs. 4.2 ± 1.1 kg, respectively; P = .086) but greater weight loss in WW + ES at 6 months (2.6 ± 1.3 kg vs. 4.9 ± 1.3 kg, respectively; P = .042).ConclusionsThis study demonstrates the potential of Web‐based VR skills training to enhance outcomes of commercial online weight management programmes that are widely accessible. Compared with traditional didactic methods for online skills training, VR simulation provides opportunities to learn behavioural skills via modelling and experiment with skills in real‐world situations. More research is needed to identify specific behavioural mechanisms by which ES may improve outcomes.

Using Virtual Reality in the Classroom: Reflections of STEM Teachers on the Use of Teaching and Learning Tools

The purpose of the study was to determine teachers’ opinions about virtual reality (VR). Virtual Reality Interview Form (VRIF) administered to seven teachers after the implementation of VR practices. Teachers received three weeks of intensive training. Afterward, teachers applied VR for two months in their classrooms. Later, interviews held with them. Findings indicated that different VR practices, including Google Cardboard, were used in the classroom. According to the teachers, using virtual reality in the classroom captured students’ interest, increased their creativity, allowed students to take virtual trips, increased students’ motivation, improved students’ technology literacy, individualized learning; made students easier to understand difficult concepts. The potential problems of using VR were not asked the teachers; however, teachers mentioned that online safety and security, student access, and technology gaps were the problems they faced. The findings of this study suggest that the use of VR allows teachers to visualize abstract topics and enrich instruction. A VR orientation module would be provided teachers with opportunities to learn, practice, and apply their VR skills before being placed in the classroom.

Use of a Secure Web-Based Data Management Platform to Track Resident Operative Performance and Program Educational Quality Over Time

In surgery residency programs, Accreditation Council for Graduate Medical Education mandated performance assessment can include assessment in the operating room to demonstrate that necessary quality and autonomy goals are achieved by the conclusion of training. For the past 3 years, our institution has used The Ottawa Surgical Competency Operating Room Evaluation (O-SCORE) instrument to assess and track operative skills. Evaluation is accomplished in near real-time using a secure web-based platform for data management and analytics (Firefly). Simultaneous to access of the platform's case logging function, the O-SCORE instrument is delivered to faculty members for rapid completion, facilitating quality, and timeliness of feedback. We sought to demonstrate the platform's utility in detecting operative performance changes over time in response to focused educational interventions based on stored case log and O-SCORE data. Stored resident performance assessments for the most frequently performed laparoscopic procedures (cholecystectomy, appendectomy, inguinal hernia repair, ventral hernia repair) were examined for 3 successive academic years (2016-2019). During this time, 4 of 36 residents had received program-assigned supplemental simulation training to improve laparoscopic skills. O-SCORE data for these residents were extracted from peer data, which were used for comparisons. Assigned training consisted of a range of videoscopic and virtual reality skills drills with performance objectives. O-SCORE responses were converted to integers and autonomy scores for items pertaining to technical skill were compared before and after educational interventions (Student's t-tests). These scores were also compared to aggregate scores in the nonintervention group. Bayesian-modeled learning curves were used to characterize patterns of improvement over time. University of Massachusetts Medical School-Baystate Surgery Residency and Baystate Medical Center PARTICIPANTS: General surgery residents (n = 36) RESULTS: During the period of review, 3325 resident cases were identified meeting the case type criteria. As expected, overall autonomy increased with the number of cases performed. The 4 residents who had been assigned supplemental training (6-18 months) had preintervention score averages that were lower than that of the nonintervention group (2.25 ± 0.43 vs 3.57 ± 1.02; p < 0.0001). During the respective intervention periods, all 4 residents improved autonomy scores (increase to 3.40 ± 0.61; p < 0.0001). Similar improvements were observed for tissue handling, instrument handling, bimanual dexterity, visuospatial skill, and operative efficiency component skills. Postintervention scores were not significantly different compared to scores for the non-intervention group. Bayesian-modeled learning curves showed a similar pattern of postintervention performance improvement. The data management platform proved to be an effective tool to track responses to supplemental training that was deemed necessary to close defined skills gaps in laparoscopic surgery. This could be seen both in individual and in aggregated data. We were gratified that at the conclusion of the supplemental training, O-SCORE results for the intervention group were not different than those seen in the non-intervention group.

Fully Immersive Virtual Reality for Total Hip Arthroplasty: Objective Measurement of Skills and Transfer of Visuospatial Performance After a Competency-Based Simulation Curriculum.

Fully immersive virtual reality (VR) uses headsets to situate a surgeon in a virtual operating room to perform open surgical procedures. The aims of this study were to determine (1) if a VR curriculum for training residents to perform anterior approach total hip replacement (AA-THR) was feasible, (2) if VR enabled residents' performance to be measured objectively, and (3) if cognitive and motor skills that were learned with use of VR were transferred to the physical world. The performance of 32 orthopaedic residents (surgical postgraduate years [PGY]-1 through 4) with no prior experience with AA-THR was measured during 5 consecutive VR training and assessment sessions. Outcome measures were related to procedural sequence, efficiency of movement, duration of surgery, and visuospatial precision in acetabular component positioning and femoral neck osteotomy, and were compared with the performance of 4 expert hip surgeons to establish competency-based criteria. Pretraining and post-training assessments on dry bone models were used to assess the transfer of visuospatial skills from VR to the physical world. Residents progressively developed surgical skills in VR on a learning curve through repeated practice, plateauing, on average, after 4 sessions (4.1 ± 0.6 hours); they reached expert VR levels for 9 of 10 metrics (except femoral osteotomy angle). Procedural errors were reduced by 79%, assistive prompts were reduced by 70%, and procedural duration was reduced by 28%. Dominant and nondominant hand movements were reduced by 35% and 36%, respectively, and head movement was reduced by 44%. Femoral osteotomy was performed more accurately, and acetabular implant orientation improved in VR assessments. In the physical world assessments, experts were more accurate than residents prior to simulation, but were matched by residents after simulation for all of the metrics except femoral osteotomy angle. The residents who performed best in VR were the most accurate in the physical world, while 2 residents were unable to achieve competence despite sustained practice. For novice surgeons learning AA-THR skills, fully immersive VR technology can objectively measure progress in the acquisition of surgical skills as measured by procedural sequence, efficiency of movement, and visuospatial accuracy. Skills learned in this environment are transferred to the physical environment.

Prospective Cohort Study of Haptic Virtual Reality Laparoscopic Appendicectomy Learning Curve Trajectory.

Background: Simulation training is strongly advocated by 24/7 risk-rich professions because swift learning curve inflection point attainment delivers earlier competence; the left-shift effect. The aim of this study was to determine the value of haptic laparoscopic virtual reality simulation, by iterative benchmark exercise (n = 8), before simulated laparoscopic appendicectomy (SLA); the hypothesis was that favorable benchmark learning curve trajectories would be associated with improved SLA competence when compared with consultant expert performance. Methods: A 28-trainee cohort completed 1349 Laparoscopic Haptic Virtual Reality Skills (LHVRS) tasks, during which 19 ergonomic variables were assessed by virtual interface, including force feedback (Surgicalscience.com), before 153 SLAs. Primary outcome measure was SLA composite competence score related to six consultant trainer experts. Results: Of the eight LHVRS tasks, the three with the steepest learning curve trajectories correlated with better median overall SLA competence scores, namely tissue grasping/lifting (rho = 0.362, P = .049), fine dissection (rho = 0.388, P = .028), and camera navigation (rho = 0.518, P = .007); fine dissection was the only haptic laparoscopic virtual reality simulation task that predicted a SLA score within a Youden index defined, 70% of the consultant expert level (area under curve [AUC] = 0.803, P = .028). A significant SLA learning curve emerged, with a learning curve trajectory inflection point at the fourth SLA attempt (first SLA 30.5% versus fourth SLA score 76.0%, gradient 76°, P = .010). Conclusion: Learning curve trajectory can be measured, influenced, and accelerated significantly; a pronounced left-shift effect, with translational potential for enhanced shorter training time and improved patient safety.