Middleton Robert M, Alvand Abtin, Garfjeld Roberts Patrick, Hargrove Caroline, Kirby Georgina, Rees Jonathan L
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, England.
Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Biomedical Research Unit, University of Oxford, Oxford, England.
Arthroscopy. 2017 May;33(5):996-1003. doi: 10.1016/j.arthro.2016.10.021. Epub 2017 Jan 7.
To determine whether a virtual reality (VR) arthroscopy simulator or benchtop (BT) arthroscopy simulator showed superiority as a training tool.
Arthroscopic novices were randomized to a training program on a BT or a VR knee arthroscopy simulator. The VR simulator provided user performance feedback. Individuals performed a diagnostic arthroscopy on both simulators before and after the training program. Performance was assessed using wireless objective motion analysis and a global rating scale.
The groups (8 in the VR group, 9 in the BT group) were well matched at baseline across all parameters (P > .05). Training on each simulator resulted in significant performance improvements across all parameters (P < .05). BT training conferred a significant improvement in all parameters when trainees were reassessed on the VR simulator (P < .05). In contrast, VR training did not confer improvement in performance when trainees were reassessed on the BT simulator (P > .05). BT-trained subjects outperformed VR-trained subjects in all parameters during final assessments on the BT simulator (P < .05). There was no difference in objective performance between VR-trained and BT-trained subjects on final VR simulator wireless objective motion analysis assessment (P > .05).
Both simulators delivered improvements in arthroscopic skills. BT training led to skills that readily transferred to the VR simulator. Skills acquired after VR training did not transfer as readily to the BT simulator. Despite trainees receiving automated metric feedback from the VR simulator, the results suggest a greater gain in psychomotor skills for BT training. Further work is required to determine if this finding persists in the operating room.
This study suggests that there are differences in skills acquired on different simulators and skills learnt on some simulators may be more transferable. Further work in identifying user feedback metrics that enhance learning is also required.
确定虚拟现实（VR）关节镜模拟器或台式（BT）关节镜模拟器作为训练工具是否具有优越性。
将关节镜新手随机分为接受BT或VR膝关节镜模拟器训练的组。VR模拟器提供用户操作反馈。个体在训练计划前后分别在两个模拟器上进行诊断性关节镜检查。使用无线客观运动分析和整体评分量表评估操作表现。
两组（VR组8人，BT组9人）在基线时所有参数均匹配良好（P>.05）。在每个模拟器上进行训练均使所有参数的操作表现有显著改善（P<.05）。当在VR模拟器上对受训者进行重新评估时，BT训练使所有参数都有显著改善（P<.05）。相比之下，当在BT模拟器上对受训者进行重新评估时，VR训练并未使操作表现得到改善（P>.05）。在BT模拟器上进行最终评估时，接受BT训练的受试者在所有参数上的表现均优于接受VR训练的受试者（P<.05）。在最终的VR模拟器无线客观运动分析评估中，接受VR训练和BT训练的受试者在客观表现上没有差异（P>.05）。
两种模拟器均能提高关节镜操作技能。BT训练所获得的技能能够轻松转移到VR模拟器上。VR训练后获得的技能则不容易转移到BT模拟器上。尽管受训者从VR模拟器获得了自动的指标反馈，但结果表明BT训练在心理运动技能方面有更大的提升。需要进一步研究以确定这一发现是否在手术室中依然成立。
本研究表明，在不同模拟器上获得的技能存在差异，并且在某些模拟器上所学的技能可能更具可转移性。还需要进一步研究确定能够增强学习效果的用户反馈指标。
