Tuggy M L
Swedish Family Medicine Residency, Seattle, WA 98104, USA.
J Am Board Fam Pract. 1998 Nov-Dec;11(6):426-33. doi: 10.3122/jabfm.11.6.426.
Flexible sigmoidoscopy, a core skill for the primary care physician, requires learned hand-eye skills that can be difficult to master during residency training. With recent advances in virtual reality simulation technology, simulated flexible sigmoidoscopes are available to family medicine residents for training before their initial and subsequent live patient examinations. The purpose of the study was to determine whether a virtual reality flexible sigmoidoscope simulator would improve the hand-eye skills and various performance parameters in a live patient.
Residents were assigned to a control (n = 5) or experimental group (n = 5) in which the experimental group trained on a virtual reality sigmoidoscopy simulator before their first sigmoidoscopies on live patient volunteers. After the initial live patient sigmoidoscopies, both control and experimental groups trained on the simulator so that it was possible to evaluate presimulator and postsimulator training effects on live patient performance and to compare speed and skill between the groups at different levels of training.
Training on the virtual reality simulator produced substantial improvements in examination times and hand-eye skill measures. After 6 to 10 hours of training on the simulator, the experimental group achieved significantly faster insertion times to 30 cm (119 versus 357 sec, P = 0.03), 40 cm (211 versus 518 sec, P = 0.03), and a shorter mean length of examination (323 versus 654 sec, P = 0.01). There was also significant improvement of hand-eye skill measures of the experimental group in directional errors (1.6 versus. 8.6, P < 0.01), percentage of colon visualized (79 versus 45 percent, P = 0.02), and viewing quality of examination when compared with the control group's initial performance on live patients. Resident survey findings after the study confirmed the trainee's perception of the benefit of the simulator training.
This study shows the value of virtual reality simulator training for accelerating the development of the hand-eye skills to perform adequate sigmoidoscopy.
可弯曲乙状结肠镜检查是初级保健医生的一项核心技能，需要通过学习掌握手眼协调技能，而这些技能在住院医师培训期间可能难以掌握。随着虚拟现实模拟技术的最新进展，现在有模拟可弯曲乙状结肠镜供家庭医学住院医师在首次及后续对真实患者进行检查之前进行培训。本研究的目的是确定虚拟现实可弯曲乙状结肠镜模拟器是否能提高在真实患者检查中的手眼技能和各种操作参数。
将住院医师分为对照组（n = 5）和实验组（n = 5），实验组在对真实患者志愿者进行首次乙状结肠镜检查之前，先在虚拟现实乙状结肠镜模拟器上进行培训。在首次对真实患者进行乙状结肠镜检查之后，对照组和实验组都在模拟器上进行培训，以便能够评估模拟器训练前后对真实患者操作的影响，并比较不同训练水平下两组之间的速度和技能。
在虚拟现实模拟器上进行培训后，检查时间和手眼技能指标有了显著改善。在模拟器上进行6至10小时的培训后，实验组插入至30厘米处（119秒对357秒，P = 0.03）、40厘米处（211秒对518秒，P = 0.03）的时间明显更快，平均检查长度也更短（323秒对654秒，P = 0.01）。与对照组在真实患者上的初始表现相比，实验组在手眼技能指标的方向误差（1.6对8.6，P < 0.01）、结肠可视化百分比（79%对45%，P = 0.02）以及检查的观察质量方面也有显著改善。研究后住院医师的调查结果证实了学员对模拟器培训益处的认知。
本研究表明虚拟现实模拟器培训对于加速手眼技能发展以进行充分的乙状结肠镜检查具有价值。
