Effectiveness of Immersive Virtual Reality on Orthopedic Surgical Skills and Knowledge Acquisition Among Senior Surgical Residents: A Randomized Clinical Trial.
Effectiveness of Immersive Virtual Reality on Orthopedic Surgical Skills and Knowledge Acquisition Among Senior Surgical Residents: A Randomized Clinical Trial.
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DOI：
10.1001/jamanetworkopen.2020.31217
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Goel DP
中科院分区：
文献类型：
--
作者：
Lohre R;Bois AJ;Pollock JW;Lapner P;McIlquham K;Athwal GS;Goel DP
对于使用沉浸式虚拟现实学习病理识别和复杂手术技能的外科学员来说，可量化的技能和知识转移是什么？在这项随机临床试验中，18名高级骨科手术住院医生，与接受技术视频指导的对照组相比，接受沉浸式虚拟现实培训的人在知识和程序指标方面表现出显着改善。转移效率比为0.79，表明沉浸式虚拟现实替代了47.4分钟的等效真实的手术室培训。这些研究结果表明，沉浸式虚拟现实可能在未来的手术培训中发挥重要作用，补充并可能增强传统教学，并有效减少早期手术学习曲线。这项随机临床试验评估了沉浸式虚拟现实是否能提高骨科手术住院医师进行反向肩关节成形术的学习效率。手术前的视频学习是学员和外科医生的常见做法，沉浸式虚拟现实（IVR）模拟器对手术培训越来越感兴趣。IVR与视频培训相比，在复杂技能获取方面的培训效果值得研究。评估IVR是否提高了外科受训者的学习效率，并通过与真实世界表现的相关性验证VR评级量表。这项区组随机、干预对照临床试验纳入了来自加拿大多家机构的骨科住院医师（即研究生4年级和5年级），他们参加了一次培训课程。进行意向治疗分析。数据收集时间为2020年1月30日至2月1日。IVR培训平台提供了一个基于病例的模块，用于治疗晚期肩袖撕裂关节病的反向肩关节成形术（RSA）。允许参与者无限期地重复该模块。主要结果指标是干预组和对照组的有效性能指标（技术技能客观结构化评估[OSATS]）。次要指标包括培训转移率（ToT）、转移效率比（TER）和IVR培训与对照组相比的成本效益比（CER）。其他次要指标包括IVR性能指标，采用新的评级量表与真实世界的性能进行比较。共有18名高级外科住院医师参与; 9名（50%）被随机分配到IVR组，9名（50%）被随机分配到对照组。参与者的人口统计学特征没有年龄差异（平均[SD]年龄：IVR组，31.1 [2.8]岁;对照组，31.0 [2.7]岁），性别（IVR组，8名[89%]男性;对照组，6名[67%]男性），手术经验（RSA的平均[SD]经验：IVR组，3.3 [0.9];对照组，3.2 [0.4]）或既往模拟器使用（有经验：IVR组6 [67%];对照组4 [44%]）。考虑到单次重复，IVR组完成训练的速度快了387%（IVR组的平均[SD]时间：4.1 [2.5]分钟;对照组的平均[SD]时间：16.1 [2.6]分钟;差异为12.0分钟; 95% CI，8.8-14.0分钟; P <0.001）。IVR组的平均（SD）OSATS评分显著优于对照组（15.9 [2.5] vs 9.4 [3.2];差异为6.9; 95% CI，3.3-9.7; P <0.001）。IVR组还表现出更高的平均（SD）口头提问评分（4.1 [1.0] vs 2.2 [1.7];差异，1.9; 95% CI，0.1-3.3; P = 0.03）。IVR评分（即，精度评分）与真实世界的OSATS评分（r = 0.74）和最终植入位置（r = 0.73）具有很强的相关性。基于OSATS评分，ToT为59.4%。毒性接触率为0.79，根据CER，该系统的成本效益是对照系统的34倍。在这项研究中，使用IVR的手术培训证明了上级学习效率、知识和技能转移。当IVR使用60分钟时，0.79的TER替代了47.4分钟的手术室时间。ClinicalTrials.gov标识符：NCT 04404010
What is the quantifiable skill and knowledge transfer for surgical trainees using immersive virtual reality to learn both pathology recognition and complex procedural skills? In this randomized clinical trial of 18 senior orthopedic surgery residents, those trained using immersive virtual reality demonstrated significant improvements in knowledge and procedural metrics compared with a control group receiving technical video instruction. A transfer effectiveness ratio of 0.79 was demonstrated, indicating that immersive virtual reality substituted for 47.4 minutes of equivalent real operating room training. These findings suggest that immersive virtual reality may play a significant role in the future of procedural training, supplementing and perhaps augmenting traditional teaching and effectively reducing early surgical learning curves. This randomized clinical trial evaluates whether immersive virtual reality improves learning effectiveness among orthopedic surgery residents performing reverse shoulder arthroplasty. 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. 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
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影响因子：
2.6
作者：
Choi, Sungwook;Bae, Jong-Hwan;Kang, Hyunseong
通讯作者：
Kang, Hyunseong
影响因子：
9
作者：
Gallagher, Anthony G.;Seymour, Neal E.;Satava, Richard Martin
通讯作者：
Satava, Richard Martin
影响因子：
3
作者：
Gallo, Robert A.;Gamradt, Seth C.;Warren, Russell F.
通讯作者：
Warren, Russell F.
DOI：
10.1016/j.jamcollsurg.2020.03.026
发表时间：
2020-06-01
影响因子：
5.2
作者：
Potts, John R., III
通讯作者：
Potts, John R., III
影响因子：
3.3
作者：
ROSCOE, SN
通讯作者：
ROSCOE, SN