Virtual reality simulation in training endoscopic skills: A systematic review

To investigate the effect on final-product performance of a distributed, virtual reality (VR) simulation training program on cadaveric dissection performance and learning curves compared with standard VR simulation training during a temporal bone course. Educational interventional cohort study. The national Danish temporal bone courses of 2016 and 2017. Postgraduate year 2 to 5 residents in otorhinolaryngology. Nine participants volunteered for additional VR simulation training (intervention) before the temporal bone course, with training blocks distributed (i.e., separated). The remaining 28 participants received standard VR simulation training during the temporal bone course (control). VR simulation and cadaveric dissection final-product performances were analyzed by blinded raters using a 26-item modified Welling Scale. Distributed VR simulation training before the temporal bone course (intervention) significantly increased dissection final-product performance by 25% compared with standard VR simulation training during the course (control) (mean scores 12.8 points versus 10.3 points, p < 0.01). Distributed and repeated VR simulation practice markedly decreased drilling time. Guidance by the simulator-integrated tutor-function significantly increased final-product performance by 2.3 points compared with nontutored procedures but at the cost of increased drilling time. Skills acquired in a VR simulation environment translate to cadaveric dissection skills and repeated and distributed VR simulation can be used to further increase performance compared with standard VR simulation training during a temporal bone course. Further dissemination of inexpensive VR simulators would allow all future temporal bone course participants to train locally before attending future centralized courses.

Temporal bone surgery requires excellent surgical skills and simulation-based training can aid novices' skills acquisition. However, simulation-based training is challenged by early stagnation of performance after few performances. Structured self-assessment during practice might enhance learning by inducing reflection and engagement in the learning task. In this study, structured self-assessment was introduced during virtual reality (VR) simulation of mastoidectomy to investigate the effects on subsequent performance during cadaveric dissection. A prospective educational study with comparison with historical controls (reference cohort). At a temporal bone dissection course, eighteen participants performed structured self-assessment during 3h of VR simulation mastoidectomy training before proceeding to cadaver dissection (intervention cohort). At a previous course, eighteen participants received identical VR simulation training but without the structured self-assessment (reference cohort). Final products from VR simulation and cadaveric dissection were recorded and assessed by two blinded raters using a 19-point modified Welling Scale. The intervention cohort completed fewer procedures (average 4.2) during VR simulation training than the reference cohort (average 5.7). Nevertheless, the intervention cohort achieved a significantly higher average performance score both in VR simulation (11.1 points, 95% CI [10.6-11.5]) and subsequent cadaveric dissection (11.8 points, 95% CI [10.7-12.8]) compared with the reference cohort, who scored 9.1 points (95% CI [8.7-9.5]) during VR simulation and 5.8 points (95% CI [4.8-6.8]) during cadaveric dissection. Structured self-assessment is a valuable learning support during self-directed VR simulation training of mastoidectomy and the positive effect on performance transfers to subsequent cadaveric dissection performance.

The objective of this paper is to describe the current status, advantages, and disadvantages of Virtual Reality simulators as tools for training and assessment of laparoscopic skills. This is a review of publications about Virtual Reality simulators in laparoscopic training and assessment. Information was obtained through author’s experience and by search of MEDLINE using the keywords Virtual Reality simulation, training, assessment and laparoscopic surgery. The references cited in these studies were reviewed to find out whether any other trials fitted the selection criteria. There are several validated Virtual Reality systems that allow the transfer of skills from the virtual environment to the operating room and objective assessment of operative skills in laparoscopic surgery. In conclusion, Virtual Reality simulators are valid and objective tools in surgical education. Several systems are currently considered sufficiently validated and ready to be implemented in comprehensive educational curricula in minimally invasive surgery.

Operating room (OR) fires are rare but devastating events requiring immediate and effective response. Virtual Reality (VR) simulation training can provide a safe environment for practice of skills in such highly stressful situation. This study assessed interprofessional participants' ability to respond to VR-simulated OR fire scenarios, attitudes, numbers of attempt of the VR simulation do participants need to successfully respond to OR fires and does prior experience, confidence level, or professional role predict the number of attempts needed to demonstrate safety and pass the simulation. 180 surgical team members volunteered to participate in this study at Beth Israel Deaconess Medical Center, Boston, MA. Each participant completed five VR OR simulation trials; the final two trials incorporated AI assistance. Primary outcomes were performance scores, number of attempts needed to pass, and pre- and post-survey results describing participant confidence and experiences. Differences across professional or training role were assessed using chi-square tests and analyses of variance. Differences in pass rates over time were assessed using repeated measures logistic regression. One hundred eighty participants completed simulation testing; 170 (94.4%) completed surveys. Participants included surgeons (17.2%), anesthesiologists (10.0%), allied health professionals (41.7%), and medical trainees (31.1%). Prior to training, 45.4% of participants reported feeling moderately or very confident in their ability to respond to an OR fire. Eight participants (4.4%) responded safely on the first simulation attempt. Forty-three participants (23.9%) passed by the third attempt (VR only); an additional 97 participants (53.9%) passed within the 4-5th attempt (VR with AI assistance). Providers are unprepared to respond to OR fires. VR-based simulation training provides a practical platform for individuals to improve their knowledge and performance in the management of OR fires with a 79% pass rate in our study. A VR AI approach to teaching this essential skill is innovative, feasible, and effective.

Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care.

The effectiveness of virtual reality (VR) simulation training for improving robotic surgical skills is not firmly established. This systematic review and meta-analysis aimed to evaluate the impact of VR simulator training on surgeons' robotic surgical performance in the operating room (OR). To synthesize evidence regarding the association between VR-based robotic surgery training and subsequent technical performance inside the OR. A comprehensive literature search was conducted in PubMed, Scopus, Embase, and CINAHL databases, adhering to PRISMA 2020 guidelines. Studies evaluating VR simulator training for robotic surgeons with subsequent performance assessment in the OR were included. Risk of bias assessment was performed using the Medical Education Research Study Quality Instrument and the modified Newcastle-Ottawa Scale for Education (NOS-E), along with funding source appraisal. A total of 294 records were screened, resulting in 13 studies (281 participants) included in the systematic review, and 4 studies (72 participants) suitable for meta-analysis. Metaanalysis was conducted using a random-effects model to pool correlation coefficients between preand post-training performance. Of the included studies, nine reported positive evidence, three found no evidence, and one found negative evidence regarding VR training's role. The meta-analysis of before-after studies revealed a significant positive correlation ( r = 0.717, P < 0.05) between simulation performance and intraoperative outcomes. The small number of studies included in the meta-analysis and methodological heterogeneity may limit generalisability of results. VR simulator training is associated with improved robotic surgical performance in the OR. Incorporation of VR simulation into robotic surgical curricula is likely beneficial for skill acquisition and operative readiness.

Virtual reality (VR) offers the potential to provide a lifelike, safe, and interactive environment where healthcare providers can practice and refresh their skills. The Neonatal Resuscitation Program (NRP) is an evidence-based and standardized approach for training healthcare providers on the resuscitation of the newborn where VR can be applied. Here we describe a development study for a VR-NRP simulation. This contribution is relevant for researchers and developers in the health sector interested in the integration of VR and other extended reality (XR) technologies in medical education and training. For the implementation of the VR simulation, we used the Unity game engine, a VR-capable laptop, and an HTC Vive Pro Head-Mounted Display. We focused on the skill of positive pressure ventilation (PPV) using a bag and mask as the main scenario for the simulation since this is a foundational skill in NRP. To validate the prototype, we compared the VR-NRP simulation with 360° immersive VR videos in a crossover study involving 30 health-care providers and students, collecting various data through questionnaires and skill assessments by NRP instructors. We described in detail the creation process by which a highly realistic VR simulation was produced reflecting the visual elements and sounds of a Neonatal Intensive Care Unit in a hospital setting. In the crossover study, we found both VR technologies were positively viewed by healthcare professionals and performed very similarly. However, the VR simulation provided a significantly increased feeling of presence. Participants found the VR simulation more useful and reported higher confidence in NRP skills such as proper mask placement and newborn response evaluation, reflecting improved experiential learning outcomes. This research represents a step forward in understanding how VR technologies can be developed and applied for effective, immersive medical training, increasing the availability of NRP refresher sessions, and providing insights into similar applications.

An experimental comparison on the effectiveness of various levels of simulator fidelity on ab initio pilot training

Novice learners’ perspectives on obstetric airway crisis decision-making training using virtual reality simulation

Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme

Can virtual reality simulation be used for advanced bariatric surgical training?

Immersive virtual reality (VR) simulations are increasingly being used in diverse educational and training contexts to supplement traditional learning methods. The high versatility of virtual laboratories allows students to take advantage of many benefits, like experiencing dangerous reactions, time-consuming protocols, or expensive equipment without the necessity of a real science laboratory. However, little research is currently available to support the efficacy and efficiency of this new learning tool. In this context, the main objective of this study was to assess the influence of biotechnology training by using immersive VR technologies on the student’s motivational and learning outcomes as compared with learning with conventional methods only. To this aim we tested two diverse strategies, respectively VR simulations were used in place of or in addition to the teacher’s introductory lesson of a hands-on laboratory experience. Aligned questionaries were administered before and after the proposed activities to assess theoretical knowledge, self-efficacy, interest in biotechnology, and engagement of the participants. We found that when the introductory lesson to a biotechnology hands-on laboratory is replaced with an equivalent immersive VR simulation, the student’s learning outcomes are lower with respect to the traditional approach. On the contrary, when VR simulations are integrated as an additional tool to the existing learning methods, higher learning outcomes were observed demonstrating a deeper understanding of the learning contents. Furthermore, our study showed that learning with immersive VR simulations motivates students more than the traditional methods, thus, using this new technology in addition to the existing educational methods in biotechnology could be considered as a win-win strategy to raise the attention of the students while increasing the learning outcomes.

Development of three-dimensional visualisation technology of the aerodynamic environment in a greenhouse using CFD and VR technology, Part 2: Development of an educational VR simulator

Simulation is a key component of surgical training, enabling trainees to develop their skills in a safe environment. With simulators broadly grouped into physical models and virtual-reality (VR) simulators, it is important to evaluate the comparative effectiveness of the simulator types in terms of validity as well as cost. The review aims to compare the benefits and drawbacks of novel VR and physical simulators within the broader themes of endourology, laparoscopic and robotic operations, and other urological procedures. Key benefits of bench models include their comparatively lower cost, easy access and provision of haptic feedback, whereas VR simulators are generally self-sufficient, reusable and enable skills of haemostasis to be practised. The advent of perfused 3D printed simulators across a range of urological procedures may replace cadavers as the traditional gold-standard simulation modality. Although possessing differing strengths and downsides, VR and physical simulators when used together can have an additive effect due to skill transferability across the platforms. Further comparative studies are required to directly quantify the differences between physical models and VR simulators in terms of performance metrics and cost-effectiveness. There is lack of validated VR simulators for open and reconstructive procedures.

Minimally invasive laparoscopic surgery requires intensive training due to challenges such as loss of haptic feedback and depth perception. Traditional training methods include box trainers (BT), which offer realistic haptic feedback but lack objective performance assessment, and virtual reality (VR) simulators, which provide automated feedback but lack haptic feedback. This review, conducted at the Barts Cancer Institute, Queen Mary University, examines the learning outcomes of VRsimulators with haptic feedback compared to BT. A systematic review and meta-analysis was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines from December 2023 to April 2024. Research databases, such as PubMed, EMBASE, CINAHL, and Web of Science, were searched for randomized controlled trials (RCTs) comparing VR simulators with haptic feedback to BT in training medical students. Seven RCTs met the inclusion criteria, and four were included in the meta-analysis. The primary outcomes were learning curves and learning effectswhile secondary outcomes included skill transfer to a surgical environment. The review analysed data from 125 participants across the studies. Results indicated that BTs demonstrated a superior learning curve, with participants achieving proficiency faster than those using VR. Both simulators showed significant learning effects; however, BTs resulted in greater improvements across more performance parameters. Regarding skill transfer to surgical environments, there was no significant difference between the two groups, suggesting both approaches effectively support surgical skill transfer. Overall, BT has a more effective learning curve and marginally better performance in skill acquisition. While VR with haptic feedback offers enhanced realism, it does not fully replicate the natural haptic feedback provided by BT. Further studies are needed to improve VR haptic feedback and its integration into training programs to enhance learning outcomes.