Gallagher AG, Ritter EM, Champion H, et al. Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training

Emory Endosurgery Unit, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Annals of Surgery (Impact Factor: 8.33). 03/2005; 241(2):364-72. DOI: 10.1002/bjs.1800840237
Source: PubMed


To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and practice of minimally invasive surgery (MIS) makes unique demands on surgical training programs. A decade ago Satava proposed virtual reality (VR) surgical simulation as a solution for this problem. Only recently have robust scientific studies supported that vision
A review of the surgical education, human-factor, and psychology literature to identify important factors which will impinge on the successful integration of VR training into a surgical training program.
VR is more likely to be successful if it is systematically integrated into a well-thought-out education and training program which objectively assesses technical skills improvement proximate to the learning experience. Validated performance metrics should be relevant to the surgical task being trained but in general will require trainees to reach an objectively determined proficiency criterion, based on tightly defined metrics and perform at this level consistently. VR training is more likely to be successful if the training schedule takes place on an interval basis rather than massed into a short period of extensive practice. High-fidelity VR simulations will confer the greatest skills transfer to the in vivo surgical situation, but less expensive VR trainers will also lead to considerably improved skills generalizations.
VR for improved performance of MIS is now a reality. However, VR is only a training tool that must be thoughtfully introduced into a surgical training curriculum for it to successfully improve surgical technical skills.

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Available from: Richard Satava, Jan 17, 2014
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    • "Rather, students end up spending a significant portion of their training time carrying out unsupervised practice. Furthermore, medical schools have little choice but to set requirements for surgical curricula in terms of amount of training time spent rather than in terms of level of proficiency achieved [1]. Even when assessment is carried out, it is by nature subjective, lacking sufficient standardization. "
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    ABSTRACT: Recognizing clinical style is essential for generating intelligent guidance in virtual reality simulators for dental skill acquisition. The aim of this study was to determine the potential of Dynamic Time Warping (DTW) in matching novices’ tooth cutting sequences with those of experts. Forty dental students and four expert dentists were enrolled to perform access opening to the root canals with a simulator. Four experts performed in manners that differed widely in the tooth preparation sequence. Forty students were randomly allocated into four groups and were trained following each expert. DTW was performed between each student’s sequence and all the expert sequences to determine the best match. Overall, the accuracy of the matching was high (95%). The current results suggest that the DTW is a useful technique to find the best matching expert for a student so that feedback based on that expert’s performance can be given to the novice in clinical skill training.
    15th World Congress on Health and Biomedical Informatics (MEDINFO 2015), São Paulo; 08/2015
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    • "One possible reason for that is that despite proctored VR training the actual simulator training was not structured in that sense that no benchmarked proficiency level was reached before performing CA on patients. Proficiency-based pretest training has been a common denominator in VR studies demonstrating transferability and proposed to be the paradigm shift in VR skills training [9,25]. However, by the time for these simulator-based CA courses the expert proficiency level in the simulator was not known. "
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    BMC Medical Education 03/2014; 14(1):49. DOI:10.1186/1472-6920-14-49 · 1.22 Impact Factor
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    • "This also depends on the level of interactivity, dimensionality, accuracy, fidelity, and sensory input and output (Satava, 1993). When these features are addressed, simulation can be used as a performance tool to explore and study specific behaviors and as an educational tool to acquire and practice skills (Gallagher et al., 2005; Axelrod, 2007). Thus far, successful application of virtual training environments has been shown in studies addressing fears of heights, flying, spiders, and public speaking. "
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