Virtual Reality and Physical Models in Undergraduate Orthopaedic Education: A Modified Randomised Crossover Trial

Abstract

Background: Orthopaedic surgery is underrepresented in the United Kingdom medical school curriculum, with an average of less than 3 weeks of exposure over the five-year degree. This study evaluates the effectiveness of high-fidelity virtual reality (VR) and physical model simulation in teaching undergraduate orthopaedic concepts.

Methods: A modified randomised crossover trial was used. Forty-nine students were randomly allocated to two groups, with thirty-three finishing the six-week follow-up assessment. All undergraduate medical students were eligible for inclusion. Both groups were given introductory lectures, before completing a pre-test with questions on the principles of fracture fixation and osteotomy. Each group then received a lecture on these topics with the same content, but one was delivered with VR and the other with physical models. Both groups completed the post-course assessments. Knowledge was assessed by way of questionnaire immediately before, immediately after, and six-weeks after.

Results: In the VR group, participants improved their post-training score by 192.1% (U=32; p<0.00001). In the physical models group, participants improved their post-training scores by 163.1% (U=8.5; p<0.00001). Overall, there was no statistically significant difference in the total means of post-training test scores between the VR and the physical models study groups (U=260.5; p=0.4354).

Conclusion: Both VR and physical models represent valuable educational adjuncts for the undergraduate medical curriculum. Both have demonstrated improvements in immediate and long-term knowledge retention of key orthopaedic concepts.

Keywords: learning curve; orthopaedic surgery; simulation; surgical training; undergraduate; virtual reality.

Figure 1

Physical hand models.

Figure 2

Virtual-reality image of plating for fracture fixation.

Figure 3

3D printed osteotomy physical models.

Figure 4

Virtual-reality osteotomy model.

Figure 5

Median scores, upper and lower quartiles, and minimum and maximum scores for pre-test, post-test and 6-week follow-up tests for fracture fixation taught using virtual reality.

Figure 6

Median scores, upper and lower quartiles, and minimum and maximum scores for pre-test, post-test and 6-week follow-up tests for osteotomy taught using virtual reality.

Figure 7

Median scores, upper and lower quartiles, and minimum and maximum scores for pre-test, post-test and 6-week follow-up tests for fracture fixation taught using physical models.

Figure 8

Median scores, upper and lower quartiles, and minimum and maximum scores for pre-test, post-test and 6-week follow-up tests for osteotomy taught using physical models.