Deconstructing laparoscopic competence in a virtual reality simulation environment

BackgroundVirtual reality (VR) simulators play a substantial role in modern medical education and have generated several performance parameters that are not always standardized and open to clear and easy interpretation. Consequently, our study objective was to investigate how these parameters contribute to the enhancement of key competencies in laparoscopic surgical skills.MethodsWe recruited 20 residents and 8 experienced surgeons to participate in this study. The residents were trained on 5 basic tasks (4 of them at two difficulty levels) using a commercially available VR simulator. Study participants also performed an additional 3 complex tasks before and after training for assessment purposes. The experienced surgeons served as controls and so only performed the assessment tasks. Performance parameters were grouped to reflect errors in dexterity, safety, and technical skill. These errors, as well as the parameters of time and instrument velocity, were analyzed during training and assessment.ResultsPerformance for training tasks demonstrated notable learning curves for most of the parameters that were measured (ie, plateaus varied between the second and seventh VR training session). Velocity was influenced least by the training (3 of the 5 tasks), while time and dexterity were influenced most (all 5 tasks and for both difficulty levels). In the assessment tasks, technical skill was improved (P < .05) for some study participants, but this improvement was not demonstrated in all of the complex procedures tested (eg, bowel suturing). There was a significant improvement in safety (all 3 tasks; P < .05), and time to completion and dexterity (both of them in 2 tasks; P < .05). Experienced surgeons scored at a greater level than VR-trained residents in terms of time (all tasks; P < .05), safety and technical skill (bowel suturing; P < .05), as well as dexterity (adhesiolysis and bowel suturing; P < .05).ConclusionVR simulation training contributed markedly to the enhancement of key surgical competencies of residents. The proposed mapping of the simulator parameters may help program directors and trainees evaluate important competency domains during VR-based surgical training.