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Le rôle de la confiance dans la performance

Article Summary

avril 6, 2019

In This Article:

Orthopedic Surgery

What do the world’s elite athletes have in common with orthopedic surgeons?

They’re both expected to perform at an expert level and they have both trained for years to hone their skills – but more importantly, they rely on a strong sense of confidence to perform at their optimal level. In the case of athletes, optimal performance may be the difference between a gold medal and a silver. In the case of chirurgiens, optimal performance may be the difference between life and death – these are high stakes that warrant dissecting the idea of confidence and how it can impact performance.

Confidence is generally defined as “the feeling or belief that one can rely on someone or something; firm trust”, whereas performance is defined as “the action or process of carrying out or accomplishing an action, task, goal, or function.” When looked at together, one believes that they can rely on their ability to accomplish a goal – but where does this belief stem from?

This belief is often conceptualized as one’s ability to forecast their chances of success in the future. The majority of academia suggests that the essence of this forecast lies in a complex web of self-persuasion, which is built upon several sources of “confidence information”. This information could be in the form of prior performances, social observation, verbal feedback, or physiological states. It is generally accepted that the leading source of confidence information comes from prior performances as they are based on personal experience – however, the value of this is largely dependent on whether one is satisfied or dissatisfied with their prior performances.

A history of unsatisfactory, or a lack of, performances will rely more heavily on the other sources of confidence information to build a stronger case for optimal performance. The observation of credible actors such as coaches, trainers, and instructors will become a higher priority in the absence of personal experience – it’s easier for us to mimic a performance in front of us than to conceptualize one. Similarly, research shows that positive feedback about performance is more likely to heighten one’s perception of confidence than no feedback at all. This was exemplified in a study where the participants were given a “screening” test before the full test. After the screening test, half of the participants were told they were “above average” and the other half were told nothing. The results showed that the participants with positive affirmation before the test performed better than those without.

Given the dynamic nature of confidence information down to the physiological state at the time of performance, one can quickly begin to see how confidence can be a fleeting perception unless it’s solidified and honed.

Le lien entre la confiance et la performance

A look into professional sports can reveal insights that explore the relationship between confidence and performance and how it may be strengthened. The world’s leading coaches often proclaim that one doesn’t achieve the levels of confidence required for expert performances without at least 10 years of deliberate practice on their field of competency. For example, a professional basketball player may lose confidence as it’s modified by their physiological state on the day – they may have woken up feeling tired, or the seats in the crowd might be empty which affects their level of arousal. They might then miss a few shots in the game and use that ‘past performance’ as an indicator for future performance and continue to miss. A professional basketball player with 10 or more years of experience is likely to have experienced most of these physiological states already and is therefore prepared to deal with them properly. They have a larger window of time from which to draw past performance information and have experienced a higher volume of both observational and verbal information over that period. In culmination, this greater set of information allows a more central locus of control; where performances are less often left to the uncontrollable states surrounding them and more often cognitively processed.

Dans le cadre d'un chirurgien orthopédique, one can’t afford to “miss a few shots” in the OR, for the consequences could become catastrophic. They rely on the same sources of information as professional sports players, yet they’re expected to perform at the optimal level every single time. In this context, the idea of “movement confidence” proposed by Giffin and Keogh (1982) has proven helpful. Movement confidence is a model of confidence that considers three components: perceived competence, sensations of enjoyment, and fear of harm. Put simply, the model suggests that the contributions from each component would lead to a given level of confidence where physical movement is involved.

Comment la formation VR améliore la confiance et les résultats

Surgeons already have a high base level of competency as they’re unable to enter an operating room without extensive study and training, and it’s no stretch to assume they have a higher fear of harm until they have successfully operated procedures for at least 10 years. Former des chirurgiens use cadavers to practice their procedures where fear of harm is falsely eliminated, which endangers real surgery as that component suddenly becomes a large contributing factor to confidence in the OR. That’s why recent advances in technologie telle que la réalité virtuelle ont permis une nouvelle méthode d'entraînement à la confiance dans le mouvement. L'environnement simulé repose toujours sur le mouvement physique pour accomplir les tâches, un retour verbal et visuel est donné en temps réel, l'historique des performances et les données sont vastes et la peur du mal est faussement augmentée en raison de la fidélité de l'environnement.

It’s easy to conclude that confidence and its tenuous link to performance is too complex to be treated as simple practice and positive reinforcement. When deconstructing the elements of confidence, one can identify sources of confidence information more readily and prepare for scenarios in which those sources are lacking or unavailable. In this way, one can former leur confiance like a skill over time. When combined with profession or competence training (ideally in simulated or real environments), the link between confidence and performance can be strengthened. When surgery could mean life or death, it’s too important to ignore.

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À propos de PrecisionOS

PrecisionOS is a leader in virtual reality-enabled surgical education. Trusted by top academic medical centers, health systems, and professional societies worldwide, the company delivers an immersive, scalable training ecosystem designed by surgeons for residents and the next generation of healthcare professionals. By combining high-fidelity VR cadaver labs with on-the-go access via the Approaches mobile module and AI-driven performance reporting, PrecisionOS ensures surgeons are ready for the OR, today.

Questions fréquemment posées

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.

Your Individual Membership is a month-to-month subscription ($99/mo) designed for residents who want 24/7 access to surgical rehearsal without a long-term contract.  Reach out for information about an institutional membership.

Action: Your card is billed every 30 days from the date of signup.

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.

Action: Reach out to provide your IT department with the MAC address found in your headset settings.

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

Image de Danny P. Goel, MD

Danny P. Goel, MD

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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Own Your Progress.

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Step #1

State Your Intent

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Step #2

Get Practice Recommendations

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Step #3

Queue Apps In VR

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Step #4

Learn From Experts

Access the video library for expert-led Virtual Grand Rounds and discover surgical pearls from industry leaders and device experts.

Step #4

Practice With A Plan

Go through the recommended VR apps to gain the skills and repetition needed for success. 

Step #5

Review Performance Insights

After your VR session, review your personalized performance insight on your phone to maximine your OR success. 

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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.

Smiling man wearing glasses and checkered shirt in an office setting.

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.

Professional man in business attire for PrecisionOS.

Danny P. Goel, MD

Chef de la direction

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.

Professional man smiling in a blue shirt for PrecisionOS About Us page.

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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