Department of Surgery, University of Alabama at Birmingham, 1922 7th Avenue South, KB 428, Birmingham, AL 35294-0016, USA.
World J Surg. 2011 Feb;35(2):245-52. doi: 10.1007/s00268-010-0861-1.
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.
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.
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).
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.
虚拟现实（VR）模拟器和基于网络的教学视频是外科培训计划中非常有价值的补充培训资源，但目前尚不清楚如何将它们最佳地整合到微创外科培训中。
将医学生随机分为两组，通过两种不同方法接受 VR 腹腔镜和内镜模拟器的基于熟练度的培训：有监督的培训（自动模拟器反馈加人类专家反馈）或独立培训（仅模拟器反馈）。在达到模拟器熟练程度后，学员在活体猪模型中进行一系列腹腔镜和内镜任务。在进入动物实验室之前，所有学员都观看了该程序的教学视频，并在自己进行操作之前随机分配观察或不观察实际手术。使用 Cox 回归模型评估 VR 培训方法和程序观察对成功完成任务时间的联合影响。
32 名学生（16 名有监督，16 名独立）完成了 VR 培训。Cox 回归模型分析调整了相关协变量后，独立培训与有监督培训在成功完成任务的可能性方面没有显著差异[风险比（HR）1.28；95%置信区间（CI）0.96-1.72；p=0.09]。与仅观看教学视频的学员相比，观察实际手术的学员更有可能成功（HR 1.47；95% CI 1.09-1.98；p=0.01）。
与独立培训相比，有监督的 VR 培训在手术表现方面没有优势。因此，在 VR 培训期间进行耗时的人类专家反馈可能是不必要的。虽然教学视频很有用，但当学员学习微创手术程序时，它们可能无法替代实际观察。
