Sirimanna Pramudith, Gladman Marc A
Academic Colorectal Unit, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
ANZ J Surg. 2017 Oct;87(10):760-766. doi: 10.1111/ans.14135. Epub 2017 Aug 13.
Proficiency-based virtual reality (VR) training curricula improve intraoperative performance, but have not been developed for laparoscopic appendicectomy (LA). This study aimed to develop an evidence-based training curriculum for LA.
A total of 10 experienced (>50 LAs), eight intermediate (10-30 LAs) and 20 inexperienced (<10 LAs) operators performed guided and unguided LA tasks on a high-fidelity VR simulator using internationally relevant techniques. The ability to differentiate levels of experience (construct validity) was measured using simulator-derived metrics. Learning curves were analysed. Proficiency benchmarks were defined by the performance of the experienced group. Intermediate and experienced participants completed a questionnaire to evaluate the realism (face validity) and relevance (content validity).
Of 18 surgeons, 16 (89%) considered the VR model to be visually realistic and 17 (95%) believed that it was representative of actual practice. All 'guided' modules demonstrated construct validity (P < 0.05), with learning curves that plateaued between sessions 6 and 9 (P < 0.01). When comparing inexperienced to intermediates to experienced, the 'unguided' LA module demonstrated construct validity for economy of motion (5.00 versus 7.17 versus 7.84, respectively; P < 0.01) and task time (864.5 s versus 477.2 s versus 352.1 s, respectively, P < 0.01). Construct validity was also confirmed for number of movements, path length and idle time. Validated modules were used for curriculum construction, with proficiency benchmarks used as performance goals.
A VR LA model was realistic and representative of actual practice and was validated as a training and assessment tool. Consequently, the first evidence-based internationally applicable training curriculum for LA was constructed, which facilitates skill acquisition to proficiency.
基于熟练度的虚拟现实（VR）培训课程可提高术中表现，但尚未针对腹腔镜阑尾切除术（LA）开发。本研究旨在为LA制定基于证据的培训课程。
共有10名经验丰富（>50例LA手术）、8名中级（10 - 30例LA手术）和20名经验不足（<10例LA手术）的操作者在高保真VR模拟器上使用国际相关技术执行有引导和无引导的LA任务。使用模拟器得出的指标来衡量区分经验水平的能力（结构效度）。分析学习曲线。由经验丰富的组的表现来定义熟练度基准。中级和经验丰富的参与者完成一份问卷以评估逼真度（表面效度）和相关性（内容效度）。
18名外科医生中，16名（89%）认为VR模型在视觉上逼真，17名（95%）认为它代表了实际操作。所有“有引导”模块均显示出结构效度（P < 0.05），学习曲线在第6至9次训练之间趋于平稳（P < 0.01）。将经验不足者与中级者及经验丰富者进行比较时，“无引导”LA模块在动作经济性（分别为5.00、7.17和7.84；P < 0.01）和任务时间（分别为864.5秒、477.2秒和352.1秒，P < 0.01）方面显示出结构效度。动作数量、路径长度和空闲时间的结构效度也得到了证实。经过验证的模块用于课程构建，将熟练度基准用作表现目标。
VR LA模型逼真且代表实际操作，并被验证为一种培训和评估工具。因此，构建了首个基于证据的适用于国际的LA培训课程，该课程有助于技能获取直至熟练掌握。
