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La importancia del realismo en la realidad virtual

Article Summary

agosto 8, 2019

In This Article:

VR Medical Training

Many philosophers debate the topic of reality, and the components that make up what we perceive to be “real”. Although an interesting mental exercise, we’re more interested in the practical applications of reality today, which is more accurately defined as “realism”.  

El realismo se define como representar a una persona, cosa o situación con precisión o de una manera que sea fiel a la vida. En este artículo, buscamos comprender hasta qué punto se puede conocer esta definición de realismo en un entorno completamente simulado utilizando tecnología de realidad virtual, y cómo esto impacta en nuestro mundo. 

To understand the importance of realism in virtual reality, we must first look to what the technology is trying to achieve— a simulation. A simulation is defined as an approximate imitation of the operation of a process or system. There’s an important distinction in that definition, which is to mimic the operation of something rather than just the thing itself. A simulation is a place of action; and that intent is what separates a simulation from a static learning tool such as text, video, or presentations. Ultimately, a simulation bridges the gap between knowledge and high performing actions. 

Traditionally, a simulation would be run “live” in a simulated physical space. History tells us that live simulations have been used as a learning tool for centuries, dating back to clay and stone models being used to understand the anatomy of a person. In more modern applications, simulations have been used to train students and professionals to assist in learning—for example a medical student may practice in a room dressed up as an operating theatre, or they could be taken a step further and practice on-site in an actual operating theatre (also known as in-situ or in-situation) which was considered to have a higher degree of realism. The objects within that environment also benefit from being as real as possible, which could mean the difference between using mannequins or a paid actor to simulate a patient.

Simulations have more recently found a new environment in which to model themselves, known as “virtual”, where one would experience the imitation synthetically. Thanks to computer technology, virtual simulations have been able to imitate an operation without the need of costly physical environments and the challenging logistics of getting people to them. Virtual Reality (VR) specifically refers to synthetic imitations presented inside of a special headset, which enhances the immersion of a synthetic environment further by assuming the user’s entire field of vision rather than just on a two dimensional screen. 

Los cascos de realidad virtual han sido utilizados comercialmente por organizaciones como la NASA durante décadas y, a medida que disminuyó el costo de producción, la tecnología se volvió más viable para la compra del consumidor. Además, la potencia de procesamiento del hardware que se utiliza para ejecutar auriculares de realidad virtual ha dado lugar a simulaciones más realistas. Sin embargo, ¿hasta qué punto el realismo afecta la eficacia de una simulación, especialmente en situaciones de entrenamiento? 

To understand the efficacy of realism, we must look at a key variable that defines the perceived realism—fidelity.  Fidelity refers to how closely a simulation imitates or amplifies reality. The overall goal of high-fidelity simulations is to improve the performance of an action, or what a person actually does (rather than thinks). In 1990, Miller (1990) indicated that this action is built upon a person’s knowledge, competence, and performance. 

Generally speaking, a low fidelity simulation is good for building upon knowledge – it won’t feel real, but it will outline the basics and theory well enough. Medium fidelity is used to build competence through greater interaction, then high fidelity is where high performance action occurs. This model of traditional Fidelity can be viewed as a pyramid. Without the base level of knowledge, you can’t reach the top level of action. As you begin to improve your knowledge, competence, and performance, the action level of fidelity in a simulated environment increases too, agnostic of how the environment is actually presented. For example, the fidelity of a commercial flight simulator will be different for someone with no knowledge of aviation in comparison to someone who has spent years studying the theory. How will the person with little knowledge be able to know if the simulation is high-fidelity or not, if they don’t understand what to look for? Therefore, to some extent the concept of fidelity is subjective. 

This can be understood at a deeper level by examining the different components that make up fidelity, over and above the person experiencing it. At a conceptual level, the scenario at hand needs to make sense. For example, you would expect a flight simulator to have a high degree of conceptual fidelity if it flies through the air, rather than through Walmart. Physically, the simulation needs to reflect the actual physical properties of the real environment. The flight simulator wouldn’t have a high degree of physical fidelity if it used carrots for the levers. Emotionally, the simulation should try to capture the same feelings one would expect in the real environment. For example, a simulated emergency in the cockpit of a plane should feel naturally urgent to deal with, rather than casual and boring. New technology such as heart-rate monitors built into wearable devices have made it easier to test for emotional response, helping simulators find better ways to increase the degree of emotional fidelity. 

Sin embargo, este nivel de comprensión va un paso más allá de nuevo cuando se mira en el contexto de las simulaciones de realidad virtual. Hay una consideración importante cuando se trata de medir la fidelidad en un entorno de realidad virtual, especialmente en lo que respecta a las simulaciones de entrenamiento. Stone (2011) encontró que la idea errónea es que los avances tecnológicos conducen a mejores entornos de formación. Stone y su equipo de tecnologías de interfaz humana descubrieron que esto es mucho menos importante que el concepto de diseño centrado en el ser humano. Cuando el objetivo es maximizar la transferencia de tareas, conocimientos, habilidades y comportamientos simulados a aplicaciones del mundo real; la fidelidad psicológica es clave.  

La fidelidad psicológica es el grado en que las tareas simuladas pueden reproducir comportamientos requeridos en aplicaciones del mundo real. Esto, hasta cierto punto, combina las ideas tradicionales de fidelidad conceptual, física y emocional descritas; aunque normalmente uno consideraría la fidelidad en este contexto como una combinación de fidelidad física y psicológica.

It is through this definition that it also becomes obvious that pure technological advances aren’t a large part of that equation, but rather the technical advances make it more accessible and viable. The major drawback of new interfaces such as virtual reality is that of a human experience nature. Think back to the first few years of websites—every site was completely different with walls of text, hidden links, strange navigations, and unique layouts. It wasn’t until many years later that a standardized experience began to take shape that was more natural to the user, taking advantage of modern design principles, content structures, and human behaviour to deliver a seamless experience. Virtual reality is still in the early stages of exploring the best user interface, however it is far more complicated due to the additional dimension. It’s one thing to master the interface of a 2D screen with basic inputs, but quite another in a 3D environment. 

Stone desglosó aún más el concepto de fidelidad para las simulaciones de realidad virtual, de la siguiente manera:

  • Context Fidelity should seek to represent an appropriate background of sensory and behavioral detail—think background extras on a movie set. They don’t get in the way, but they add to the context of the scene.
  • La fidelidad de la tecnología interactiva es el grado en que los controles de entrada (piense en auriculares y controles manuales) representan las interfaces de la vida real. 
  • La hipo-fidelidad y la hiper-fidelidad miden la importancia de muy pocos o demasiados detalles sensoriales, detalles de comportamiento y sistemas de interacción.

Interestingly, many end-users already have a concept of fidelity in their head before entering a training simulation, a baseline of expectations based on what they’ve seen in other applications such as gaming and military applications. Now the complex web of what makes up a “high fidelity” training simulation begins to reveal itself. We know that at the highest level, the end-user needs a basic knowledge of the system and also a certain level of competence before reaching high-performance actions. However, simulations run in virtual reality require a balance of contextual sensory and behavioural details alongside realistic input characteristics; while catering to the potential expectation gap a user may have before entering the simulation. This is all impacted further by the challenges virtual reality face with regards to seamless interfaces that are not yet standardized or widely understood by users.

So, if a virtual reality simulation can have a high degree of psychological and physical fidelity, then it can be considered to be more realistic—assuming the user already has some knowledge and competence to be able to perceive it that way to begin with. However, this is all qualified by the ability for humans to actually use it, an idea often called human-centered design.

Ahora que entendemos la composición más amplia del realismo en una simulación, podemos usarlo a nuestro favor en aplicaciones de realidad virtual. Por ejemplo, la plataforma de entrenamiento quirúrgico Precision OS está diseñada para hacer uso de motores gráficos modernos para imitar el entorno físico, incluidos detalles sensoriales y de comportamiento como herramientas, iluminación y maquinaria con un alto grado de fidelidad física. El paciente en la mesa de operaciones está configurado para mostrar los síntomas que requieren un procedimiento determinado, asegurando que la representación esté equilibrada para evitar la hipo o hiperfidelidad. Los controladores manuales están configurados para parecerse más a las herramientas quirúrgicas comunes de un procedimiento, con el objetivo de una mayor fidelidad de la tecnología interactiva. Finalmente, el procedimiento simulado es guiado en tiempo real con retroalimentación y tutoría, tanto visualmente como vía audio para simular el entorno psicológico como si estuviera entrenando con un cirujano senior. 

Students or staff have already completed many years of medical school which includes traditional learning tools and simulations, so they have a high degree of knowledge and competence. Therefore, a realistic virtual environment can help them train for advanced skillsets and enhanced confidence without having to practice on real patients—which can be both costly to the trainee, the patient, their family, and the hospital; not to mention challenging to find appropriate training patients and matching them with trainees on a repeating basis. A un nivel más amplio, esto finalmente significa mejores cirujanos y una mayor tasa de éxito para los pacientes. 

The future of realism in virtual reality looks promising. Already, we’ve seen physical feedback in VR hand controllers which has been proven to enhance the perception of interactive technology fidelity (Hoffman, 2011), and this technology is expanding to full haptic-feedback suits. As other fields of technology such as biotech begin to crossover with virtual reality, we’ll see even more integration and immersion. For example, the user may be able to control their virtual environment using just their thoughts, or be able to connect sensors directly to nerve endings for realistic feedback. 

As the technology improves, so too does the perceived realism of our virtual environments—and as we’ve seen, this will further engage our world’s future students and professionals to perform at a higher level. The result in many years’ time will be a safer, more productive world to live in, and we can’t wait to stake our hand in the efforts. 

Fuentes: 

https://pdfs.semanticscholar.org/1bba/11bf001e17ec4643f63943fb1dffef008299.pdf
http://nursingeducation.lww.com/blog.entry.html/2018/09/19/increasing_fidelity-zEj0.html
https://www.docketalarm.com/cases/International_Trade_Commission/337-770/Certain_Video_Game_Systems_and_Wireless_Controller_and_Components_Thereof/446916/49/

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Preguntas frecuentes

Is there a step-by-step "Quick Start" guide for residents?

Yes—The Onboarding Course is your fastest path to proficiency. It walks you through account syncing, procedure selection, and your first virtual rehearsal step-by-step, ensuring you are “OR Ready” before you pick up the controllers.

Action: Follow the guided video path to standardize your learning experience.

Yes. PrecisionOS is compatible with Meta Quest 3, and 3s. If you already own a headset, you simply need to download the PrecisionOS Launcher from the App Store and sign in with your institution email and membership credentials.

Action: Download the launcher and log in.

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Hospital networks will often require a MAC address for device white-listing. You can find this in your Meta Quest headset settings under About > MAC Address.

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Both the headset firmware and the PrecisionOS app must be up to date to prevent technical glitches. Go to Settings > Software Update on your Quest and check the Launcher for app updates.

Action: Enable “Auto-updates” in your headset settings.

About The Author

Imagen de Danny P. Goel, MD

Danny P. Goel, médico

Is the CEO of PrecisionOS and is a practicing surgeon and surgical educator. Dr. Goel currently practices in the Vancouver, B.C. area and also serves on the University of British Columbia’s Faculty of Medicine in the Department of Orthopedic Surgery.

He received his medical degree from the University of Manitoba, pursued his residency training in orthopedic surgery at the University of Calgary, and completed fellowship training in shoulder surgery at the University of Western Ontario and Harvard University.

Goel has co-authored more than 30 publications, and is widely sought as a presenter on surgical techniques.

21 Months of Automated VR Data

MAJOR ACADEMIC ORTHOPAEDIC RESIDENCY PROGRAM

How self-directed VR practice fills the seams of the clinical day and produces measurable learning trajectories—completely automatically.

Executive Summary:

Over a 21-month period, 30 orthopaedic residents integrated immersive VR into their training curriculum. With a simple, weekly requirement for residents to practice in headset, the platform seamlessly captured over 88,000 structured data points across 2,566 practice sessions. The resulting data proved that when residents have access to high-fidelity, frictionless simulation and are motivated, they will hone their skills and demonstrate clear performance improvements.

Frictionless Adoption: Practice doesn't compete with clinical time. The data revealed that 45% of all sessions happened organically during lunch breaks or on weekends.

Comprehensive Coverage: Usage wasn't limited to a single subspecialty. Residents attempted 61 distinct cases across 27 procedure modules, proving active engagement from Foundations & Anatomy to Complex Trauma.

Measurable Improvement: The platform didn't just track usage; it tracked skill acquisition. Across 288 scored playthroughs, longitudinal data showed a clear performance signal, with residents demonstrating an average positive learning delta of +0.36 over time.

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Dr. Andrew Maeso

Orthopedic resident

From Uncertainty to Execution

“You already have a plan, now you’re just executing it.”

The Story: Bridging the "Intern Gap"

Dr. Andrew Maeso recognizes the steep reality of residency: “As an intern, you are thrown into the fire.” For him, the hurdle wasn’t just the surgery—it was the invisible mechanics (positioning, X-ray angles, and workflow) that move too fast to learn in a high-pressure OR.

The Solution: Access Over Policy

By bringing the PrecisionOS ecosystem home, Dr. Maeso replaced passive YouTube watching with active mental rehearsal. This allowed him to arrive in the OR with the “steps” already hard-coded into his muscle memory.

The Game Changer: Personal headsets issued for at-home, 24/7 training.

Clinical Focus: Mastery of Antegrade Femoral Nails and Shoulder Arthroscopy.

Program Growth: Experience led to secured funding for all incoming residents.

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Roberto Oliveira

Founder

Over his 25 years in the gaming industry, Roberto Oliveira has been known for bringing stunning realism and high fidelity to interactive experiences.

He combines an art director’s artistic vision with solid business leadership, including experience in building art teams, creative team management, project planning, project management and business development.

Over the years, his talents have been showcased in projects for major publishers including Sony, Activision, Disney and Electronic Arts.

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Dr. Ryan Lohre

MGH Staff Surgeon

From Resident to MGH Staff Surgeon

“Prepare like it matters. Because in the OR—it does.”

The Story: The Currency of Trust

Dr. Ryan Lohre’s trajectory changed during a complex pediatric case that had already seen two failed attempts by tenured surgeons. While textbooks offered the theory, Dr. Lohre used VR to master the 3D spatial intelligence required to build a mental model of the deformity and navigate C-arm imagery in real-time.

The Solution: The 18-Minute Sandbox

The night before surgery, Dr. Lohre rehearsed the procedure four times in VR from his own home. This high-fidelity rehearsal allowed him to arrive in the OR functioning at 80-90% proficiency, compared to the typical 10-20% for a resident facing a new, complex procedure.

The Game Changer: 18 minutes of at-home VR prep for a complex pediatric case.

Clinical Focus: Spatial intelligence for C-arm interpretation and screw trajectory.

Program Growth: Transitioned from trainee to Staff Surgeon at Mass General.

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Dr. Barry McDonough

Program Director

Teaching with Surgical Efficiency

“I let the junior resident do more than ever before—and still finished on time.”

The Story: Reclaiming the OR

While at West Virginia University (WVU), Dr. Barry McDonough faced a universal challenge: balancing resident education with strict OR efficiency. By the time residents step into the OR, foundational skills like camera handling and triangulation should be second nature—not a distraction that slows down the case.

The Solution: Independent Preparation

Residents were assigned just 10 minutes of asynchronous VR training per week. This allowed them to master the “invisible” basics of arthroscopy on their own time. With an average of 17 sessions completed during the pilot, residents arrived with a mental roadmap that translated into immediate technical fluency.

The Game Changer: Asynchronous prep—residents train independently at home.

Clinical Focus: Mastery of triangulation, scope control, and anchor placement.

Program Growth: Model expanded across trauma, spine, and upper extremity.

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Dr. Charlie Spieser

Orthopedic Resident

Mastering the Visuo-Spatial Gap

“VR practice shifts questioning from case generalizations to technique refinement.”

The Story: From Application to Confidence

Charlie Spieser highlights a universal resident hurdle: the high-stress transition from “book knowledge” to real-world execution. Early in training, the fear of making irreversible decisions can lead to hesitation. To bridge this gap, Charlie utilized VR as a daily resource for kinetic learning and anatomical association.

The Solution: Refining Spatial Intelligence

Unlike textbooks or passive videos, PrecisionOS allowed Charlie to practice high-stakes approaches—such as the anterior total hip—in a guided, 3D environment. This repetition provided a “safe sandbox” to identify why errors occurred, building the visuo-spatial confidence required to navigate complex anatomy before ever entering the OR.

The Game Changer: Daily Integration—normalized as an expected program resource.

Clinical Focus: Anterior Total Hip and Deltopectoral surgical approaches.

Program Growth: Nuanced Mentorship—shifting focus to specific faculty preferences.

Orthopaedic virtual reality training for junior residents in surgery.

Immersive Virtual Reality Training for a Junior Orthopaedic Surgery Resident

Andres D Maeso, DO, Michael R McDermott, DO, Jerrod A Steimle, DO

How consistent iVR training accelerates technical fluency and attending trust for first-year residents.

Executive Summary: This case study follows a first-year resident’s integration of immersive VR (iVR) into their surgical curriculum. By dedicating consistent training time to virtual modules, the resident was able to master procedural steps and receive real-time feedback in a risk-free environment before ever stepping into the operating room. The study highlights that this deliberate practice led to a “noticeable improvement in overall efficiency” and significantly increased the attending’s trust and confidence in the resident’s intraoperative capabilities.

Source Attribution: Immersive Virtual Reality Training for a Junior Orthopaedic Surgery Resident, Journal of Orthopaedic Experience & Innovation (2025).

Muscle Memory Development: The repetitive nature of immersive VR (iVR) training, combined with constant real-time feedback, allows technical surgical steps to become deep-seated muscle memory.

Measurable Efficiency Gains: Residents utilizing the platform observe a "noticeable improvement" in overall efficiency and technical proficiency when performing complex orthopedic procedures.

Accelerated Attending Trust: Preoperative rehearsal in a virtual environment significantly increases attending surgeon confidence, directly leading to increased autonomy for the resident in the operating room.

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Danny P. Goel, médico

Director ejecutivo

A practicing surgeon and surgical educator, Dr. Goel currently practices in the Vancouver, B.C. area and also serves on the University of British Columbia’s Faculty of Medicine in the Department of Orthopedic Surgery.

He received his medical degree from the University of Manitoba, pursued his residency training in orthopedic surgery at the University of Calgary, and completed fellowship training in shoulder surgery at the University of Western Ontario and Harvard University.

Goel has co-authored more than 30 publications, and is widely sought as a presenter on surgical techniques.

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Colin O'Connor

Founder

Colin O’Connor brings a proven track record as a business leader and entrepreneur, as well as expertise at developing cutting-edge technology to create immersive, high-fidelity experiences.

He has overseen and played key leadership roles in the highest echelons of the video game industry, founding companies and taking more than 16 top-tier titles to market.

He has worked at the forefront in innovating new rendering technologies in the areas of lighting, motion, particle graphics and shading that bring unprecedented realism to interactive experiences.

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