Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada.
JAMA Netw Open. 2020 Dec 1;3(12):e2031217. doi: 10.1001/jamanetworkopen.2020.31217.
Video learning prior to surgery is common practice for trainees and surgeons, and immersive virtual reality (IVR) simulators are of increasing interest for surgical training. The training effectiveness of IVR compared with video training in complex skill acquisition should be studied.
To evaluate whether IVR improves learning effectiveness for surgical trainees and to validate a VR rating scale through correlation to real-world performance.
DESIGN, SETTING, AND PARTICIPANTS: This block randomized, intervention-controlled clinical trial included senior (ie, postgraduate year 4 and 5) orthopedic surgery residents from multiple institutions in Canada during a single training course. An intention-to-treat analysis was performed. Data were collected from January 30 to February 1, 2020.
An IVR training platform providing a case-based module for reverse shoulder arthroplasty (RSA) for advanced rotator cuff tear arthropathy. Participants were permitted to repeat the module indefinitely.
The primary outcome measure was a validated performance metric for both the intervention and control groups (Objective Structured Assessment of Technical Skills [OSATS]). Secondary measures included transfer of training (ToT), transfer effectiveness ratio (TER), and cost-effectiveness (CER) ratios of IVR training compared with control. Additional secondary measures included IVR performance metrics measured on a novel rating scale compared with real-world performance.
A total of 18 senior surgical residents participated; 9 (50%) were randomized to the IVR group and 9 (50%) to the control group. Participant demographic characteristics were not different for age (mean [SD] age: IVR group, 31.1 [2.8] years; control group, 31.0 [2.7] years), gender (IVR group, 8 [89%] men; control group, 6 [67%] men), surgical experience (mean [SD] experience with RSA: IVR group, 3.3 [0.9]; control group, 3.2 [0.4]), or prior simulator use (had experience: IVR group 6 [67%]; control group, 4 [44%]). The IVR group completed training 387% faster considering a single repetition (mean [SD] time for IVR group: 4.1 [2.5] minutes; mean [SD] time for control group: 16.1 [2.6] minutes; difference, 12.0 minutes; 95% CI, 8.8-14.0 minutes; P < .001). The IVR group had significantly better mean (SD) OSATS scores than the control group (15.9 [2.5] vs 9.4 [3.2]; difference, 6.9; 95% CI, 3.3-9.7; P < .001). The IVR group also demonstrated higher mean (SD) verbal questioning scores (4.1 [1.0] vs 2.2 [1.7]; difference, 1.9; 95% CI, 0.1-3.3; P = .03). The IVR score (ie, Precision Score) had a strong correlation to real-world OSATS scores (r = 0.74) and final implant position (r = 0.73). The ToT was 59.4%, based on the OSATS score. The TER was 0.79, and the system was 34 times more cost-effective than control, based on CER.
In this study, surgical training with IVR demonstrated superior learning efficiency, knowledge, and skill transfer. The TER of 0.79 substituted for 47.4 minutes of operating room time when IVR was used for 60 minutes.
ClinicalTrials.gov Identifier: NCT04404010.
重要性：手术前观看视频是学员和外科医生的常见做法，沉浸式虚拟现实 (IVR) 模拟器也越来越受到手术培训的关注。应研究 IVR 与视频培训在复杂技能习得方面的培训效果。
目的：评估 IVR 是否能提高外科学员的学习效果，并通过与实际表现相关联来验证 VR 评分量表的有效性。
设计、地点和参与者：这是一项随机、干预对照的临床试验，纳入了来自加拿大多个机构的高级（即研究生 4 年级和 5 年级）骨科住院医师，在单一培训课程中进行。采用意向治疗分析。数据收集于 2020 年 1 月 30 日至 2 月 1 日。
干预：提供用于先进肩袖撕裂性关节炎的反向肩关节置换术 (RSA) 的基于案例的模块的 IVR 培训平台。参与者可以无限次重复该模块。
主要结果和措施：主要结局指标是干预组和对照组（客观结构化手术技能评估 [OSATS]）的经过验证的绩效指标。次要测量指标包括与对照组相比，IVR 训练的转移培训 (ToT)、转移效果比 (TER) 和成本效益比 (CER)。其他次要措施包括与实际表现相比，在新的评分量表上测量的 IVR 绩效指标。
结果：共有 18 名高级外科住院医师参加了研究；9 名（50%）随机分配到 IVR 组，9 名（50%）分到对照组。参与者的年龄（IVR 组平均[SD]年龄：31.1[2.8]岁；对照组：31.0[2.7]岁）、性别（IVR 组：8[89%]名男性；对照组：6[67%]名男性）、手术经验（IVR 组平均[SD] RSA 经验：3.3[0.9]；对照组：3.2[0.4]）或之前的模拟器使用情况（有经验：IVR 组 6[67%]；对照组：4[44%]）均无差异。考虑到单次重复，IVR 组的培训时间快了 387%（IVR 组平均[SD]时间：4.1[2.5]分钟；对照组平均[SD]时间：16.1[2.6]分钟；差异：12.0 分钟；95%置信区间：8.8-14.0 分钟；P<0.001）。IVR 组的 OSATS 评分明显高于对照组（15.9[2.5]与 9.4[3.2]；差异：6.9；95%置信区间：3.3-9.7；P<0.001）。IVR 组的口头提问评分也更高（4.1[1.0]与 2.2[1.7]；差异：1.9；95%置信区间：0.1-3.3；P=0.03）。IVR 分数（即精度分数）与实际 OSATS 分数（r=0.74）和最终植入物位置（r=0.73）有很强的相关性。根据 OSATS 评分，ToT 为 59.4%。TER 为 0.79，与对照组相比，该系统的成本效益高 34 倍。
结论和相关性：在这项研究中，IVR 手术培训显示出更高的学习效率、知识和技能转移。当 IVR 用于 60 分钟时，TER 为 0.79，可替代 47.4 分钟的手术室时间。
试验注册：ClinicalTrials.gov 标识符：NCT04404010。
