Virtual Reality Temporal Bone Simulator Research Articles

Trainee-perceived benefits of a virtual temporal bone competition.

To assess the perceived benefits of a novel educational approach for otolaryngology trainees: a virtual reality temporal bone simulator drilling competition. Regional otolaryngology trainees participated in the competition. Drilling activities using the Voxel-Man TempoSurg simulator were scored by experts. Questionnaires that contained questions covering motivators for attending, perceived learning and enjoyment were sent to participants. Agreement with statements was measured on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree). Eighteen trainees participated. The most cited reason for attending was for learning and/or education (61 per cent), with most attendees (72 per cent) believing that competition encourages more reading and/or practice. Seventeen attendees (94 per cent) believed Voxel-Man TempoSurg-based simulation would help to improve intra-operative performance in mastoidectomy (mean 7.83 ± 1.47, p < 0.001) and understanding of anatomy (mean 8.72 ± 1.13, p < 0.001). All participants rated the competition as 'fun' and 83 per cent believed the competitive element added to this. The virtual reality temporal bone competition is a novel educational approach within otolaryngology that was positively received by otolaryngology trainees.

Automated assessment of cortical mastoidectomy performance in virtual reality.

Cortical mastoidectomy is a core skill that Otolaryngology trainees must gain competency in. Automated competency assessments have the potential to reduce assessment subjectivity and bias, as well as reducing the workload for surgical trainers. This study aimed to develop and validate an automated competency assessment system for cortical mastoidectomy. Data from 60 participants (Group 1) were used to develop and validate an automated competency assessment system for cortical mastoidectomy. Data from 14 other participants (Group 2) were used to test the generalisability of the automated assessment. Participants drilled cortical mastoidectomies on a virtual reality temporal bone simulator. Procedures were graded by a blinded expert using the previously validated Melbourne Mastoidectomy Scale: a different expert assessed procedures by Groups 1 and 2. Using data from Group 1, simulator metrics were developed to map directly to the individual items of this scale. Metric value thresholds were calculated by comparing automated simulator metric values to expert scores. Binary scores per item were allocated using these thresholds. Validation was performed using random sub-sampling. The generalisability of the method was investigated by performing the automated assessment on mastoidectomies performed by Group 2, and correlating these with scores of a second blinded expert. The automated binary score compared with the expert score per item had an accuracy, sensitivity and specificity of 0.9450, 0.9547 and 0.9343, respectively, for Group 1; and 0.8614, 0.8579 and 0.8654, respectively, for Group 2. There was a strong correlation between the total scores per participant assigned by the expert and calculated by the automatic assessment method for both Group 1 (r=.9144, P<.0001) and Group 2 (r=.7224, P<.0001). This study outlines a virtual reality-based method of automated assessment of competency in cortical mastoidectomy, which proved comparable to the assessment provided by human experts.

The impact of virtual reality temporal bone simulator on the development of the surgical skill of identifying the surgical landmarks of mastoidectomy among the third-year Otolaryngology residents

The impact of virtual reality temporal bone simulator on the development of the surgical skill of identifying the surgical landmarks of mastoidectomy among the third-year Otolaryngology residents

The Melbourne Mastoidectomy Scale: Validation of an end-product dissection scale for cortical mastoidectomy.

Cortical mastoidectomy is a common otolaryngology procedure and represents a compulsory part of otolaryngology training. As such, a specific validated assessment score is needed for the progression of competency-based training in this procedure. Although multiple temporal bone dissection scales have been developed, they have all been validated for advanced temporal bone dissection including posterior tympanotomy, rather than the task of cortical mastoidectomy. The Melbourne Mastoidectomy Scale, a 20-item end-product dissection scale to assess cortical mastoidectomy, was developed. The scale was validated using dissections by 30 participants (10 novice, 10 intermediate and 10 expert) on a virtual reality temporal bone simulator. All dissections were assessed independently by three blinded graders. Additionally, all procedures were graded with an abbreviated Welling Scale by one grader. There was high inter-rater reliability between the three graders (r=.9210, P<.0001). There was a significant difference in scores between the three groups (P<.0001). Additionally, there was a large effect size between all three groups: the differences between the novice group and both the intermediate group (P=.0119, η2 =0.2482) and expert group (P<.001, η2 =0.6356) were significant. The difference between the intermediate group and expert group again had a large effect size (η2 =0.3217), but was not significant. The Melbourne Mastoidectomy Scale correlated well with an abbreviated Welling Scale (r=.8485, P<.0001). The Melbourne Mastoidectomy Scale offers a validated score for use in the assessment of cortical mastoidectomy.

Understanding the effects of structured self-assessment in directed, self-regulated simulation-based training of mastoidectomy: A mixed methods study

ObjectiveSelf-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance. This study aims to explore the mechanisms underlying the positive effects of a structured self-assessment intervention during simulation-based training of mastoidectomy. MethodsA prospective, educational cohort study of a novice training program consisting of directed, self-regulated learning with distributed practice (5x3 procedures) in a virtual reality temporal bone simulator. The intervention consisted of structured self-assessment after each procedure using a rating form supported by small videos. Semi-structured telephone interviews upon completion of training were conducted with 13 out of 15 participants. Interviews were analysed using directed content analysis and triangulated with quantitative data on secondary task reaction time for cognitive load estimation and participants’ self-assessment scores. ResultsSix major themes were identified in the interviews: goal-directed behaviour, use of learning supports for scaffolding of the training, cognitive engagement, motivation from self-assessment, self-assessment bias, and feedback on self-assessment (validation). Participants seemed to self-regulate their learning by forming individual sub-goals and strategies within the overall goal of the procedure. They scaffolded their learning through the available learning supports. Finally, structured self-assessment was reported to increase the participants’ cognitive engagement, which was further supported by a quantitative increase in cognitive load. ConclusionsStructured self-assessment in simulation-based surgical training of mastoidectomy seems to promote cognitive engagement and motivation in the learning task and to facilitate self-regulated learning.

Effect of Surgical Training Using a Virtual Reality Temporal Bone Simulator in Medical Education

Effect of Surgical Training Using a Virtual Reality Temporal Bone Simulator in Medical Education

Supporting skill acquisition in cochlear implant surgery through virtual reality simulation

Objectives: To evaluate the effectiveness of a virtual reality (VR) temporal bone simulator in training cochlear implant surgery.Methods: We compared the performance of 12 otolaryngology registrars conducting simulated cochlear implant surgery before (pre-test) and after (post-tests) receiving training on a VR temporal bone surgery simulator with automated performance feedback. The post-test tasks were two temporal bones, one that was a mirror image of the temporal bone used as a pre-test and the other, a novel temporal bone. Participant performances were assessed by an otologist with a validated cochlear implant competency assessment tool. Structural damage was derived from an automatically generated simulator metric and compared between time points.Results: Wilcoxon signed-rank test showed that there was a significant improvement with a large effect size in the total performance scores between the pre-test (PT) and both the first and second post-tests (PT1, PT2) (PT-PT1: P = 0.007, r = 0.78, PT-PT2: P = 0.005, r = 0.82).Conclusion: The results of the study indicate that VR simulation with automated guidance can effectively be used to train surgeons in training complex temporal bone surgeries such as cochlear implantation.

Notes From the Field: Secondary Task Precision for Cognitive Load Estimation During Virtual Reality Surgical Simulation Training.

Cognitive load (CL) theory suggests that working memory can be overloaded in complex learning tasks such as surgical technical skills training, which can impair learning. Valid and feasible methods for estimating the CL in specific learning contexts are necessary before the efficacy of CL-lowering instructional interventions can be established. This study aims to explore secondary task precision for the estimation of CL in virtual reality (VR) surgical simulation and also investigate the effects of CL-modifying factors such as simulator-integrated tutoring and repeated practice. Twenty-four participants were randomized for visual assistance by a simulator-integrated tutor function during the first 5 of 12 repeated mastoidectomy procedures on a VR temporal bone simulator. Secondary task precision was found to be significantly lower during simulation compared with nonsimulation baseline, p < .001. Contrary to expectations, simulator-integrated tutoring and repeated practice did not have an impact on secondary task precision. This finding suggests that even though considerable changes in CL are reflected in secondary task precision, it lacks sensitivity. In contrast, secondary task reaction time could be more sensitive, but requires substantial postprocessing of data. Therefore, future studies on the effect of CL modifying interventions should weigh the pros and cons of the various secondary task measurements.

The effect of fidelity: How expert behavior changes in a virtual reality environment

We compare the behavior of expert surgeons operating on the "gold standard" of simulation-the cadaveric temporal bone-against a high-fidelity virtual reality (VR) simulation. We aim to determine whether expert behavior changes within the virtual environment and to understand how the fidelity of simulation affects users' behavior. Five expert otologists performed cortical mastoidectomy and cochleostomy on a human cadaveric temporal bone and a VR temporal bone simulator. Hand movement and video recordings were used to derive a range of measures, to facilitate an analysis of surgical technique, and to compare expert behavior between the cadaveric and simulator environments. Drilling time was similar across the two environments. Some measures such as total time and burr change count differed predictably due to the ease of switching burrs within the simulator. Surgical strokes were generally longer in distance and duration in VR, but these measures changed proportionally to cadaveric measures across the stages of the procedure. Stroke shape metrics differed, which was attributed to the modeling of burr behavior within the simulator. This will be corrected in future versions. Slight differences in drill interaction between a virtual environment and the real world can have measurable effects on surgical technique, particularly in terms of stroke length, duration, and curvature. It is important to understand these effects when designing and implementing surgical training programs based on VR simulation--and when improving the fidelity of VR simulators to facilitate use of a similar technique in both real and simulated situations.

Virtual reality case-specific rehearsal in temporal bone surgery: A preliminary evaluation

Objectives1. To investigate the feasibility of performing case-specific surgical rehearsal using a virtual reality temporal bone simulator. 2. To identify potential clinical applications in temporal bone surgery. DesignProspective assessment study. SettingSt Mary's Hospital, Imperial College NHS Trust, London UK. ParticipantsSixteen participants consisting of a trainer and trainee group. MethodTwenty-four cadaver temporal bones were CT-scanned and uploaded onto the Voxelman simulator. Sixteen participants performed a 90-min temporal bone dissection on the generic simulation model followed by 3 dissection tasks on the case simulation and cadaver models. Case rehearsal was assessed for feasibility. Clinical applications and usefulness were evaluated using a 5-point Likert-type scale. ResultsThe upload process required a semi-automated system. Average time for upload was 20 min. Suboptimal reconstruction occurred in 21% of cases arising when the mastoid process and ossicular chain were not captured (n = 2) or when artefact was generated (n = 3). Case rehearsal rated highly (Likert score >4) for confidence (75%), facilitating planning (75%) and training (94%). Potential clinical applications for case rehearsal include ossicular chain surgery, cochlear implantation and congenital anomalies. Case rehearsal of cholesteatoma surgery is not possible on the current platform due to suboptimal soft tissue representation. ConclusionThe process of uploading CT data onto a virtual reality temporal bone simulator to perform surgical rehearsal is feasible using a semi-automated system. Further clinical evaluation is warranted to assess the benefit of performing patient-specific surgical rehearsal in selected procedures.

Evaluation of a haptics-based virtual reality temporal bone simulator for anatomy and surgery training

IntroductionVirtual reality simulation training may improve knowledge of anatomy and surgical skills. We evaluated a 3-dimensional, haptic, virtual reality temporal bone simulator for dissection training. MethodsThe subjects were 7 otolaryngology residents (3 training sessions each) and 7 medical students (1 training session each). The virtual reality temporal bone simulation station included a computer with software that was linked to a force-feedback hand stylus, and the system recorded performance and collisions with vital anatomic structures. Subjects performed virtual reality dissections and completed questionnaires after the training sessions. ResultsResidents and students had favorable responses to most questions of the technology acceptance model (TAM) questionnaire. The average TAM scores were above neutral for residents and medical students in all domains, and the average TAM score for residents was significantly higher for the usefulness domain and lower for the playful domain than students. The average satisfaction questionnaire for residents showed that residents had greater overall satisfaction with cadaver temporal bone dissection training than training with the virtual reality simulator or plastic temporal bone. For medical students, the average comprehension score was significantly increased from before to after training for all anatomic structures. Medical students had significantly more collisions with the dura than residents. The residents had similar mean performance scores after the first and third training sessions for all dissection procedures. DiscussionThe virtual reality temporal bone simulator provided satisfactory training for otolaryngology residents and medical students.

Surgeon Behavior in a New Virtual Reality Temporal Bone Simulator Compared to Cadaveric Dissection

Objectives: The gold standard for teaching otologic surgery is cadaveric temporal bone (TB) dissection. However, learning may be enhanced by virtual reality (VR) simulation, which improves access and allows reproducibility. The main criticism of VR has been its lack of fidelity. The objectives of this study were to 1) assess the fidelity of a novel VR TB simulator, and 2) compare surgeon behavior to that in cadaveric TB dissection. Methods: A new 3D high-fidelity force-feedback VR simulator was developed for otologic procedures. Using prospective paired comparisons conducted in June 2012, 6 surgeons each performed a mastoidectomy, facial recess dissection, and a cochleostomy on a human cadaveric TB and in the VR simulator. Drill movements were then compared between cadaveric and VR trials. Results: Stroke number ( P = 0.69), speed ( P = 0.08), and rate ( P = 0.74) did not differ significantly between VR and cadaveric environments for all 3 stages. Compared to cadaveric dissection, subjects in the VR simulator spent less time completing each stage (236s vs. 698s; P = 0.01); spent a greater percentage of time drilling (69.5% vs. 30.4%; P = 0.002); and used a larger percentage of long strokes (39.8% vs. 6.9%; P &lt; 0.001). Conclusions: Drill stroke characteristics among surgeons in the VR simulator were similar to those in the cadaveric dissection. This suggests that real-life drilling behavior was replicated in VR and that it may be a useful adjunct to traditional TB dissection.

Objective Skills Assessment and Construct Validation of a Virtual Reality Temporal Bone Simulator

To evaluate construct validity of the Voxelman TempoSurg Virtual Reality (VR) temporal bone simulator by determining whether generated objective metrics can distinguish experienced otologic surgeons from intermediate and novice surgeons. Prospective assessment study. Two university-affiliated teaching hospitals. Sixty-five participants were recruited; 40 novice surgeons, 15 trainees in otolaryngology, and 10 experienced otolaryngology consultants with a specialist interest in otology were individually assessed on a standardized simulated temporal bone task. The task involved identification and delineation of the sigmoid sinus in a virtual left-sided temporal bone. Objective data were produced using a scoring matrix incorporated into the VOXEL MAN TempoSurg software. The simulator measured the total time taken to complete the task, the volume and efficiency of bone removal and error data for excessive force or injury to the facial nerve, dura, and sigmoid sinus. Experts and intermediates outperformed novices with respect to the total time taken to complete the task (expert versus novice: p < 0.001; intermediate versus novice: p < 0.001), total volume of bone removed (p < 0.001 and p = 0.03), efficiency of bone removal (p < 0.001 and p < 0.001), time spent with the drill tip obscured (p = 0.002 and p < 0.001), and number of injuries to the sigmoid sinus (p < 0.001 and p < 0.001). The intermediate group injured the sigmoid sinus on more occasions than the experts (p = 0.008) and were less efficient than experienced surgeons (p = 0.005). Simulator-generated objective metrics can be used to differentiate individuals of differing levels of experience using a standardized temporal bone task. VR simulation has potential as a training tool and may have a role in both formative and summative assessment.

Case‐Specific Simulation in Temporal Bone Surgery

Objective: 1) To investigate the feasibility of performing case specific surgical rehearsal (CSSR) using a virtual reality (VR) temporal bone simulator. 2) To identify potential clinical applications in temporal bone surgery. Method: Preclinical study conducted in a London teaching hospital. Twenty-four cadaver temporal bones were CT scanned and uploaded onto the Voxelman simulator. Sixteen participants (trainer and trainee group) performed 3 dissection tasks on VR and cadaver models. CSSR was assessed for feasibility and clinical applications using a 5-point Likert scale. Results: The upload process required a semi-automated system. The average time for each upload was 15 minutes. Suboptimal reconstruction occurred (n = 4) when the mastoid process and ossicular chain were not captured. CSSR rated highly among both groups (Likert score &gt;4) for surgical anatomy (75%), facilitating surgical planning (75%), and training (94%). Both groups reported suboptimal realism compared to cadaver models due to poor depth perception. The most relevant clinical procedures for CSSR were ossicular chain surgery, pediatric cochlear implantation, and congenital anomalies. CSSR involving the facial nerve and cholesteatoma surgery were not feasible due to suboptimal soft tissue VR representation. Conclusion: The process of uploading CT data onto a temporal bone simulator to perform CSSR is feasible using a semi-automated system. It represents a promising application for selected clinical procedures. Further clinical evaluation is warranted to assess the potential benefit.

Technical skills improve after practice on virtual‐reality temporal bone simulator

To assess whether practice on a virtual-reality (VR) temporal bone simulator improves acquisition of technical skills in mastoid surgery. Prospective blinded study. Using a previously validated objective structured assessment of technical skills (OSATS) tool, performance was assessed in 12 residents for two tasks of cortical mastoidectomy: 1) identifying and defining the tegmen and 2) defining the sigmoid sinus and sinodural angle. These surgical tasks were chosen as key steps in mastoid dissection because they were of intermediate complexity. Videos of virtual dissections were captured at baseline and again after practicing each task four to six times. OSATS scores for the tegmen task increased from 2.125 ± 1.25 to 3.1 ± 0.85 (P = .026), whereas for the sigmoid task scores increased from 2 ± 0.45 to 2.75 ± 1.125 (P = .0098). The time to complete the tasks decreased from 8.37 ± 4.78 minutes to 5.39 ± 3.06 minutes (P = .018) for the tegmen task and from 8.99 ± 6.7 minutes to 8.68 ± 5.98 minutes (P = .594) for the sigmoid task. There was a decline in number of injuries from 0.5 ± 1.5 to 0 ± 0.5 (P = .594) for the tegmen task and from 2.5 ± 4 to 0.5 ± 1 (P = .029) for the sigmoid task. Technical skills in mastoidectomy surgery can be acquired during even brief practice on the VR temporal bone simulator. It is anticipated that longer periods of practice presented within the fundamentals of comprehensive curriculum will facilitate procedural learning. Further studies are required to elucidate evidence of transference of these skills to the operating room and to procedures of greater complexity.

Face and Content Validation of a Virtual Reality Temporal Bone Simulator

To validate the VOXEL-MAN TempoSurg simulator for temporal bone dissection. Prospective international study. Otolaryngology departments of 2 academic health care institutions in the United Kingdom and United States. Eighty-five subjects were recruited consisting of an experienced and referent group. Participants performed a standardized familiarization session and temporal bone dissection task. Realism, training effectiveness, and global impressions were evaluated across 21 domains using a 5-point Likert-type scale. A score of 4 was the minimum threshold for acceptability. The experienced group comprised 25 otolaryngology trainers who had performed 150 mastoid operations. The referent group comprised 60 trainees (mean otolaryngology experience of 2.9 years). Familiarization took longer in the experienced group (P = .01). User-friendliness was positively rated (mean score 4.1). Seventy percent of participants rated anatomical appearance as acceptable. Trainers rated drill ergonomics worse than did trainees (P = .01). Simulation temporal bone training scored highly (mean score 4.3). Surgical anatomy, drill navigation, and hand-eye coordination accounted for this. Trainees were more likely to recommend temporal bone simulation to a colleague than were trainers (P = .01). Transferability of skills to the operating room was undecided (mean score 3.5). Realism of the VOXEL-MAN virtual reality temporal bone simulator is suboptimal in its current version. Nonetheless, it represents a useful adjunct to existing training methods and is particularly beneficial for novice surgeons before performing cadaveric temporal bone dissection. Improvements in realism, specifically drill ergonomics and visual-spatial perception during deeper temporal bone dissection, are warranted.

Using a Virtual Reality Temporal bone Simulator to Enhance Surgical Competency in Procedural Tasks: A Pilot Study

The LaryngoscopeVolume 121, Issue S4 p. S186-S186 Triological Society 2011 Combined Sections Meeting Posters Using a Virtual Reality Temporal bone Simulator to Enhance Surgical Competency in Procedural Tasks: A Pilot Study Mohammad U. Malik MD, Mohammad U. Malik MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorDavid A. Diaz Voss Varela MD, David A. Diaz Voss Varela MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorHoward W. Francis MD, Howard W. Francis MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorVinciya Pandian PhDc, CRNP, Vinciya Pandian PhDc, CRNP Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorWade W. Chien MD, Wade W. Chien MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorYuri Agrawal MD, Yuri Agrawal MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorJohn K. Niparko MD, John K. Niparko MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorNasir I. Bhatti MD, Nasir I. Bhatti MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this author Mohammad U. Malik MD, Mohammad U. Malik MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorDavid A. Diaz Voss Varela MD, David A. Diaz Voss Varela MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorHoward W. Francis MD, Howard W. Francis MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorVinciya Pandian PhDc, CRNP, Vinciya Pandian PhDc, CRNP Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorWade W. Chien MD, Wade W. Chien MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorYuri Agrawal MD, Yuri Agrawal MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorJohn K. Niparko MD, John K. Niparko MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this authorNasir I. Bhatti MD, Nasir I. Bhatti MD Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, MDSearch for more papers by this author First published: 28 June 2011 https://doi.org/10.1002/lary.22068Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume121, IssueS4Supplement: Triological Society 2011 Combined Sections Meeting Posters2011Pages S186-S186 RelatedInformation

Improving Temporal Bone Dissection Using Self‐Directed Virtual Reality Simulation

A significant benefit of virtual reality (VR) simulation is the ability to provide self-direct learning for trainees. This study aims to determine whether there are any differences in performance of cadaver temporal bone dissections between novices who received traditional teaching methods and those who received unsupervised self-directed learning in a VR temporal bone simulator. Randomized blinded control trial. Royal Victorian Eye and Ear Hospital. Twenty novice trainees. After receiving an hour lecture, participants were randomized into 2 groups to receive an additional 2 hours of training via traditional teaching methods or self-directed learning using a VR simulator with automated guidance. The simulation environment presented participants with structured training tasks, which were accompanied by real-time computer-generated feedback as well as real operative videos and photos. After the training, trainees were asked to perform a cortical mastoidectomy on a cadaveric temporal bone. The dissection was videotaped and assessed by 3 otologists blinded to participants' teaching group. The overall performance scores of the simulator-based training group were significantly higher than those of the traditional training group (67% vs 29%; P < .001), with an intraclass correlation coefficient of 0.93, indicating excellent interrater reliability. Using other assessments of performance, such as injury size, the VR simulator-based training group also performed better than the traditional group. This study indicates that self-directed learning on VR simulators can be used to improve performance on cadaver dissection in novice trainees compared with traditional teaching methods alone.

Differentiating levels of surgical experience on a virtual reality temporal bone simulator

ObjectiveVirtual reality simulation is increasingly being incorporated into surgical training and may have a role in temporal bone surgical education. Here we test whether metrics generated by a virtual reality surgical simulation can differentiate between three levels of experience, namely novices, otolaryngology residents, and experienced qualified surgeons.Study DesignCohort study.SettingRoyal Victorian Eye and Ear Hospital.Subjects and MethodsTwenty‐seven participants were recruited. There were 12 experts, six residents, and nine novices. After orientation, participants were asked to perform a modified radical mastoidectomy on the simulator. Comparisons of time taken, injury to structures, and forces exerted were made between the groups to determine which specific metrics would discriminate experience levels.ResultsExperts completed the simulated task in significantly shorter time than the other two groups (experts 22 minutes, residents 36 minutes, and novices 46 minutes; P = 0.001). Novices exerted significantly higher average forces when dissecting close to vital structures compared with experts (0.24 Newton [N] vs 0.13 N, P = 0.002). Novices were also more likely to injure structures such as dura compared to experts (23 injuries vs 3 injuries, P = 0.001). Compared with residents, the experts modulated their force between initial cortex dissection and dissection close to vital structures. Using the combination of these metrics, we were able to correctly classify the participants’ level of experience 90 percent of the time.ConclusionThis preliminary study shows that measurements of performance obtained from within a virtual reality simulator can differentiate between levels of users’ experience. These results suggest that simulator training may have a role in temporal bone training beyond foundational training.

Differentiating levels of surgical experience on a virtual reality temporal bone simulator

Objective Virtual reality simulation is increasingly being incorporated into surgical training and may have a role in temporal bone surgical education. Here we test whether metrics generated by a virtual reality surgical simulation can differentiate between three levels of experience, namely novices, otolaryngology residents, and experienced qualified surgeons. Study Design Cohort study. Setting Royal Victorian Eye and Ear Hospital. Subjects and Methods Twenty-seven participants were recruited. There were 12 experts, six residents, and nine novices. After orientation, participants were asked to perform a modified radical mastoidectomy on the simulator. Comparisons of time taken, injury to structures, and forces exerted were made between the groups to determine which specific metrics would discriminate experience levels. Results Experts completed the simulated task in significantly shorter time than the other two groups (experts 22 minutes, residents 36 minutes, and novices 46 minutes; P = 0.001). Novices exerted significantly higher average forces when dissecting close to vital structures compared with experts (0.24 Newton [N] vs 0.13 N, P = 0.002). Novices were also more likely to injure structures such as dura compared to experts (23 injuries vs 3 injuries, P = 0.001). Compared with residents, the experts modulated their force between initial cortex dissection and dissection close to vital structures. Using the combination of these metrics, we were able to correctly classify the participants' level of experience 90 percent of the time. Conclusion This preliminary study shows that measurements of performance obtained from within a virtual reality simulator can differentiate between levels of users' experience. These results suggest that simulator training may have a role in temporal bone training beyond foundational training.