Hogle Nancy J, Briggs William M, Fowler Dennis L
College of Physicians and Surgeons, Department of Surgery, Columbia University, New York, New York, USA.
J Surg Educ. 2007 Nov-Dec;64(6):424-30. doi: 10.1016/j.jsurg.2007.08.007.
Virtual reality simulators are a component of the armamentarium for training surgical residents. No one knows exactly how to incorporate virtual reality simulators into a curriculum. The purpose of this study was to document and show the learning curve and test-retest reliability of 2 tasks on a virtual reality-training simulator (LapSim; Surgical Science, Göteborg, Sweden) in laparoscopic surgery.
Twenty-nine medical students participated in 8 iterations of 7 virtual reality tasks ("camera navigation" (CN), "instrument navigation," "coordination," "grasping," "lifting and grasping" (LG), "cutting," and "clip applying") Learning curves for each outcome variable of the CN and LG tasks were generated. Using ANOVA, we evaluated the differences between each score from attempt number 7 to attempt number 8 to document test-retest reliability.
A plateau in the learning curve occurred within 8 sessions for CN misses, CN tissue damage, CN maximum damage, and LG maximum damage. Over the course of 8 sessions, a plateau in the learning curve was nearly reached for CN time, CN drift, CN path, CN angular path, and LG left and right path. The following variables had a downward trend to the mean learning curve over 8 sessions, but they did not reach a plateau: LG time, LG left and right miss, LG left and right angular path, and LG tissue damage.
Using the LapSim virtual reality simulator, we documented a learning curve and test-retest reliability for each outcome variable for CN and LG for rank novices. The modeling of the general learning curve is useful in designing training program. These results may be important in developing standards for technical evaluation in a surgical training curriculum.
虚拟现实模拟器是培训外科住院医师的一系列工具的组成部分。没有人确切知道如何将虚拟现实模拟器纳入课程体系。本研究的目的是记录并展示在腹腔镜手术的虚拟现实训练模拟器（LapSim；瑞典哥德堡外科科学公司）上两项任务的学习曲线和重测信度。
29名医学生参与了7项虚拟现实任务（“摄像头导航”（CN）、“器械导航”、“协调”、“抓持”、“提起和抓持”（LG）、“切割”和“夹闭应用”）的8轮训练。生成了CN和LG任务各结果变量的学习曲线。使用方差分析，我们评估了从第7次尝试到第8次尝试的每个分数之间的差异，以记录重测信度。
对于CN失误、CN组织损伤、CN最大损伤和LG最大损伤，学习曲线在8次训练内达到平稳期。在8次训练过程中，CN时间、CN漂移、CN路径、CN角路径以及LG左右路径的学习曲线几乎达到平稳期。以下变量在8次训练中向平均学习曲线呈下降趋势，但未达到平稳期：LG时间、LG左右失误、LG左右角路径和LG组织损伤。
使用LapSim虚拟现实模拟器，我们记录了新手级别CN和LG各结果变量的学习曲线和重测信度。一般学习曲线的建模有助于设计培训计划。这些结果对于制定外科培训课程中的技术评估标准可能很重要。
