Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Mar 18;102(6):e26.
doi: 10.2106/JBJS.19.00982.

Improved Complex Skill Acquisition by Immersive Virtual Reality Training: A Randomized Controlled Trial

Ryan Lohre  1 , Aaron J Bois  2 , George S Athwal  3 , Danny P Goel  1 ; Canadian Shoulder and Elbow Society (CSES)
Collaborators, Affiliations
Randomized Controlled Trial

Improved Complex Skill Acquisition by Immersive Virtual Reality Training: A Randomized Controlled Trial

Ryan Lohre et al. J Bone Joint Surg Am. .

Abstract

Background: There has been limited literature on immersive virtual reality (VR) simulation in orthopaedic education. The purpose of this multicenter, blinded, randomized controlled trial was to determine the validity and efficacy of immersive VR training in orthopaedic resident education.

Methods: Nineteen senior orthopaedic residents (resident group) and 7 consultant shoulder arthroplasty surgeons (expert group) participated in the trial comparing immersive VR with traditional learning using a technical journal article as a control. The examined task focused on achieving optimal glenoid exposure. Participants completed demographic questionnaires, knowledge tests, and a glenoid exposure on fresh-frozen cadavers while being examined by blinded shoulder arthroplasty surgeons. Training superiority was determined by the outcome measures of the Objective Structured Assessment of Technical Skills (OSATS) score, a developed laboratory metric, verbal answers, and time to task completion.

Results: Immersive VR had greater realism and was superior in teaching glenoid exposure than the control (p = 0.01). The expert group outperformed the resident group on knowledge testing (p = 0.04). The immersive VR group completed the learning activity and knowledge tests significantly faster (p < 0.001) at a mean time (and standard deviation) of 11 ± 3 minutes than the control group at 20 ± 4 minutes, performing 3 to 5 VR repeats for a reduction in learning time of 570%. The immersive VR group completed the glenoid exposure significantly faster (p = 0.04) at a mean time of 14 ± 7 minutes than the control group at 21 ± 6 minutes, with superior OSATS instrument handling scores (p = 0.03). The immersive VR group scored equivalently in surprise verbal scores (p = 0.85) and written knowledge scores (p = 1.0).

Conclusions: Immersive VR demonstrated substantially improved translational technical and nontechnical skills acquisition over traditional learning in senior orthopaedic residents. Additionally, the results demonstrate the face, content, construct, and transfer validity for immersive VR.

Clinical relevance: This adequately powered, randomized controlled trial demonstrated how an immersive VR system can efficiently (570%) teach a complex surgical procedure and also demonstrate improved translational skill and knowledge acquisition when compared with a traditional learning method.

PubMed Disclaimer

References

    1. Stirling ERB, Lewis TL, Ferran NA. Surgical skills simulation in trauma and orthopaedic training. J Orthop Surg Res. 2014 Dec 19;9:126-1-10.
    1. Bilimoria KY, Chung JW, Hedges LV, Dahlke AR, Love R, Cohen ME, Hoyt DB, Yang AD, Tarpley JL, Mellinger JD, Mahvi DM, Kelz RR, Ko CY, Odell DD, Stulberg JJ, Lewis FR. National cluster-randomized trial of duty-hour flexibility in surgical training. N Engl J Med. 2016 Feb 25;374(8):713-1-10. Epub 2016 Feb 2.
    1. Saadat LV, Dahlke AR, Rajaram R, Kreutzer L, Love R, Odell DD, Bilimoria KY, Yang AD. Program director perceptions of surgical resident training and patient care under flexible duty hour requirements. J Am Coll Surg. 2016 Jun;222(6):1098-1-10. Epub 2016 Apr 4.
    1. Desai SV, Asch DA, Bellini LM, Chaiyachati KH, Liu M, Sternberg AL, Tonascia J, Yeager AM, Asch JM, Katz JT, Basner M, Bates DW, Bilimoria KY, Dinges DF, Even-Shoshan O, Shade DM, Silber JH, Small DS, Volpp KG, Shea JA; iCOMPARE Research Group. Education outcomes in a duty-hour flexibility trial in internal medicine. N Engl J Med. 2018 Apr 19;378(16):1494-1-10. Epub 2018 Mar 20.
    1. Blay E Jr, Hewitt DB, Chung JW, Biester T, Fiore JF, Dahlke AR, Quinn CM, Lewis FR, Bilimoria KY. Association between flexible duty hour policies and general surgery resident examination performance: a Flexibility In duty hour Requirements for Surgical Trainees (FIRST) trial analysis. J Am Coll Surg. 2017 Feb;224(2):137-1-10. Epub 2016 Nov 21.

Publication types

MeSH terms

LinkOut - more resources