Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
David Geffen School of Medicine at UCLA, Los Angeles, California.
J Surg Educ. 2020 Jul-Aug;77(4):969-977. doi: 10.1016/j.jsurg.2020.01.002. Epub 2020 Feb 5.
Active learning methods have accumulated popularity due to improved results in knowledge acquisition as opposed to passive learning methods. For surgical resident physicians with limited training opportunities outside of the operating room due to time constraints, virtual reality (VR) is a relatively inexpensive and time-efficient active training method for procurement of surgical skills. We conducted a simulated intramedullary nailing (IMN) of a tibia to demonstrate VR training programs as a more effective modality of learning orthopedic surgical techniques compared to passive learning tools such as a standard guide (SG) through trained novice medical students performing a SawBones simulation of intramedullary nail fixation.
First and second-year medical students without prior experience of procedure were recruited and randomized to SG or VR training. Participants were observed performing simulated tibia IMN procedure immediately after training and evaluated by a blinded attending surgeon using procedure-specific checklist and 5-point global assessment scale. Participants returned after 2-weeks for repeat training and evaluation.
20 participants were recruited and randomized into VR (n = 10) and SG (n = 10) groups. All 20 participants completed the first phase and 17 completed the second phase of the study. Aggregate global assessment scores were significantly higher for VR than SG group (17.5 vs. 7.5, p < 0.001), including scores in all individual categories. The percentage of steps completed correctly was significantly higher in the VR group compared to the SG group (63% vs. 25%, p < 0.002). Average improvement between the first and second phases of the study were higher in the VR group compared to SG group across all 5-categories of the global assessment scale, and significantly higher for knowledge of instruments (50% vs. 11%, p, 0.01).
VR training was more effective than a passive SG in our model of simulated tibia IMN for novice medical students. Virtual reality training may be a useful method to augment orthopedic education.
与被动学习方法相比，主动学习方法在知识获取方面的效果得到了改善，因此越来越受欢迎。对于手术室外由于时间限制而培训机会有限的外科住院医师来说，虚拟现实（VR）是一种相对便宜且高效的主动培训方法，可以获取手术技能。我们进行了模拟髓内钉（IMN）胫骨手术，以证明 VR 培训计划是一种比被动学习工具（如标准指南（SG））更有效的学习骨科手术技术的方式，通过接受过培训的新手医学生进行骨髓内钉固定的 SawBones 模拟来进行。
招募了没有该手术程序经验的一年级和二年级医学生，并将他们随机分为 SG 或 VR 培训组。参与者在培训后立即观察模拟胫骨 IMN 手术，并由一名盲法主治外科医生使用特定于程序的检查表和 5 分制总体评估量表进行评估。参与者在 2 周后返回进行重复培训和评估。
共招募了 20 名参与者，并将其随机分为 VR（n=10）和 SG（n=10）组。所有 20 名参与者均完成了第一阶段的研究，其中 17 名参与者完成了第二阶段的研究。VR 组的总体评估分数明显高于 SG 组（17.5 对 7.5，p<0.001），包括所有单项评分。VR 组完成正确步骤的比例明显高于 SG 组（63%对 25%，p<0.002）。与 SG 组相比，VR 组在全球评估量表的所有 5 个类别中，第一阶段和第二阶段之间的平均改善程度都更高，在仪器知识方面的改善程度也明显更高（50%对 11%，p，0.01）。
在我们的新手医学生模拟胫骨 IMN 模型中，VR 培训比被动 SG 更有效。虚拟现实培训可能是骨科教育的一种有用方法。
