*Department of Surgery, University of Toronto; and †Department of Surgery, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Ann Surg. 2014 Mar;259(3):443-8. doi: 10.1097/SLA.0000000000000254.
OBJECTIVE: The purpose of this study was to investigate whether individualized deliberate practice on a virtual reality (VR) simulator results in improved technical performance in the operating room. BACKGROUND: Training on VR simulators has been shown to improve technical performance in the operating room (OR). Currently described VR curricula consist of trainees practicing the same tasks until expert proficiency is reached. It has yet to be investigated whether the individualized deliberate practice, where curricula tasks vary depending on prior levels of technical proficiency, would translate into the OR. METHODS: This single-blinded prospective trial randomized 16 novice surgical residents to a deliberate practice (DP) group and a conventional residency training group. Both groups performed a laparoscopic cholecystectomy in the OR that was video-recorded. Technical performance of DP group residents in the OR was assessed using 3 validated assessment tools. A score of less than 60% on any component of the assessment tool resulted in the trainee practicing a specific task on the VR simulator. The DP group practiced on the simulator as per their individualized schedule. Both groups then performed another laparoscopic cholecystectomy. A blinded expert assessed the OR recordings using a validated global rating scale. RESULTS: Although both groups had similar technical abilities preintervention [DP: median score, 13.5 (9.3-15.0); control: median score, 14.5 (9.3-17.8); P = 0.45], the DP residents had a superior technical performance postintervention [DP: median score, 17.0 (15.3-18.5); control: median score, 12.5 (7.5-14.0); P = 0.03]. Of 8 DP residents, 6 practiced 5 basic VR tasks (median 1 trial to pass), and 7 of 8 practiced 2 advanced tasks (median 4 trials to pass). CONCLUSIONS: A curriculum of deliberate individualized practice on a VR simulator improves technical performance in the OR. This has implications to greatly improve the feasibility of implementing simulation-based curricula in residency training programs, rather then having them being limited to research protocols.
目的：本研究旨在探讨在虚拟现实（VR）模拟器上进行个体化刻意练习是否会提高手术室的技术绩效。
背景：在 VR 模拟器上进行培训已被证明可提高手术室（OR）的技术绩效。目前描述的 VR 课程包括培训者练习相同的任务，直到达到专家熟练程度。尚未研究是否根据先前的技术熟练程度，将个体化刻意练习（课程任务因先前的技术熟练程度而异）转化为 OR。
方法：这项单盲前瞻性试验将 16 名新手外科住院医师随机分为刻意练习（DP）组和传统住院医师培训组。两组均在 OR 中进行腹腔镜胆囊切除术，并进行视频记录。使用 3 种经过验证的评估工具评估 DP 组居民在 OR 中的技术表现。评估工具的任何组成部分得分低于 60%，则培训生在 VR 模拟器上练习特定任务。DP 组按照个人时间表在模拟器上练习。然后，两组再次进行腹腔镜胆囊切除术。一位盲法专家使用经过验证的综合评分量表评估 OR 记录。
结果：尽管两组干预前的技术能力相似[DP：中位数评分，13.5（9.3-15.0）；对照组：中位数评分，14.5（9.3-17.8）；P=0.45]，但 DP 组居民干预后的技术表现更好[DP：中位数评分，17.0（15.3-18.5）；对照组：中位数评分，12.5（7.5-14.0）；P=0.03]。在 8 名 DP 居民中，有 6 名练习了 5 项基本 VR 任务（中位数 1 次尝试通过），有 7 名练习了 2 项高级任务（中位数 4 次尝试通过）。
结论：在 VR 模拟器上进行个体化刻意练习课程可提高 OR 中的技术绩效。这意味着在住院医师培训计划中实施基于模拟的课程的可行性大大提高，而不是将其限于研究方案。
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