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Effects of Virtual Reality Simulator Training Method and Observational Learning on Surgical Performance

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Abstract

Background

Virtual reality (VR) simulators and Web-based instructional videos are valuable supplemental training resources in surgical programs, but it is unclear how to optimally integrate them into minimally invasive surgical training.

Methods

Medical students were randomized to proficiency-based training on VR laparoscopy and endoscopy simulators by two different methods: proctored training (automated simulator feedback plus human expert feedback) or independent training (simulator feedback alone). After achieving simulator proficiency, trainees performed a series of laparoscopic and endoscopic tasks in a live porcine model. Prior to their entry into the animal lab, all trainees watched an instructional video of the procedure and were randomly assigned to either observe or not observe the actual procedure before performing it themselves. The joint effects of VR training method and procedure observation on time to successful task completion were evaluated with Cox regression models.

Results

Thirty-two students (16 proctored, 16 independent) completed VR training. Cox regression modeling with adjustment for relevant covariates demonstrated no significant difference in the likelihood of successful task completion for independent versus proctored training [Hazard Ratio (HR) 1.28; 95% Confidence Interval (CI) 0.96–1.72; p = 0.09]. Trainees who observed the actual procedure were more likely to be successful than those who watched the instructional video alone (HR 1.47; 95% CI 1.09–1.98; p = 0.01).

Conclusions

Proctored VR training is no more effective than independent training with respect to surgical performance. Therefore, time-consuming human expert feedback during VR training may be unnecessary. Instructional videos, while useful, may not be adequate substitutes for actual observation when trainees are learning minimally invasive surgical procedures.

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Acknowledgments

The authors acknowledge Joshua L. Argo and Wai M. A. Yeung for their assistance with data acquisition. They are also grateful to Olympus of America and Covidien for equipment donation and technical assistance. The study received no external funding, although Christopher W. Snyder received salary support under an educational grant from Olympus America Inc.

Conflict of interest

Dr. Snyder received salary support under an educational grant from Olympus America Inc. Drs. Vandromme, Argo, Yeung, Porterfield, Clements, and Hawn have no conflicts of interest or financial ties to disclose. Ms. Tyra has no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Alabama at Birmingham, 1922 7th Avenue South, KB 428, Birmingham, AL, 35294-0016, USA

    Christopher W. Snyder & Marianne J. Vandromme

  2. Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    Sharon L. Tyra, John R. Porterfield Jr., Ronald H. Clements & Mary T. Hawn

  3. Center for Surgical, Medical Acute Care Research and Transitions, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    Mary T. Hawn

Authors
  1. Christopher W. Snyder
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  2. Marianne J. Vandromme
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  3. Sharon L. Tyra
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  4. John R. Porterfield Jr.
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  5. Ronald H. Clements
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  6. Mary T. Hawn
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Corresponding author

Correspondence to Mary T. Hawn.

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Snyder, C.W., Vandromme, M.J., Tyra, S.L. et al. Effects of Virtual Reality Simulator Training Method and Observational Learning on Surgical Performance. World J Surg 35, 245–252 (2011). https://doi.org/10.1007/s00268-010-0861-1

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  • DOI: https://doi.org/10.1007/s00268-010-0861-1

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