The case for virtual reality in surgical education.

Supporting modern theories of learning, virtual reality serves as an adjunct to or replacement for traditional teaching. While more research needs to be done to correlate this new method of learning to real-world mastery, the data so far is promising.

The evolution of surgical education and training

Immersive Virtual Reality: A Paradigm Shift in Education and Training

Ryan Lohre, MD and Danny P. Goel, MD, MSC, FRCSC, AAOS Now, “Immersive Virtual Reality: A Paradigm Shift in Education and Training”, January 2020.

The training of both aspiring and established surgeons remains rooted in the historic model of mentorship coupled with direct learning on patients. Yet, beyond the classic Halstedian “see one, do one, teach one” method of learning, there are other well-researched learning methods that virtual reality supports. Applying computing power and modern, highly realistic graphics creates an immersive operating environment that affords repetition of procedures with infinite variability. Trainees test their skills, make mistakes, accept feedback, reflect, and then repeat until they achieve proficiency. This has the potential for more rapid and efficient learning gained through greater experience, creating an accelerated path to mastery.

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Virtual Reality in Spinal Endoscopy: a Paradigm Shift in Education to Support Spine Surgeons

Ryan Lohre, Jeffrey C. Wang, Kai-Uwe Lewandrowski, Danny P. Goel, J Spine Surg, “Virtual reality in spinal endoscopy: a paradigm shift in education to support spine surgeons,” January 2020

With technological advances in computer processing, the state of virtual reality simulation for training in neurosurgery and orthopedic surgery continues to improve. Its use has been endorsed by medical societies and organizations, and there is a growing body of support in the medical literature. A systematic review encompassed 38 separate studies that illustrate use of virtual reality, augmented reality and mixed-reality across a wide range of procedures. The studies found improvement in both technical skills and patient outcomes in short term follow-up.

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Competency-based surgical training

Eight-year Outcomes of a Competency-Based Residency Training Program in Orthopedic Surgery

Markku T. Nousiainen, Polina Mironova, Melissa Hynes, Susan Glover Takahashi, Richard Reznick, William Kraemer, Benjamin Alman, Peter Ferguson & The CBC Planning Committee (2018) Eight-year outcomes of a competency-based residency training program in orthopedic surgery, Medical Teacher, 40:10, 1042-1054, DOI: 10.1080/0142159X.2017.1421751

The use of simulation in training was a core element of a pilot residency training program begun in 2009 by the Division of Orthopaedic Surgery at the University of Toronto. It investigated the efficacy of a competency-based curriculum (CBC) for a subset of residents, compared to a strictly time-based approach. The modularized approach dramatically intensified the structured learning elements and assessment process. Eight of the 14 residents who participated completed their residency training in four years rather than the traditional five.As a result, the Division of Orthopaedic surgery made the decision to fully adopt the CBC as the sole mode of training and assessment in the residency training program in the 2013–14 academic year. That same year, the Royal College of Physicians and Surgeons of Canada mandated that all postgraduate specialty programs in Canada were to adopt a competency-based framework by the year 2022.

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Effectiveness of training with VR

Real Learning in a Virtual World: How VR Can Improve Learning and Training Outcomes

Deliotte Insights, Real learning in a virtual world: How VR can improve learning and training outcomes, 2018.

Those tasked with training individuals to perform in high-risk environments face a conundrum: How can they deliver the benefits of learning from experience without the costs and dangers of putting trainees in those experiences? The answer is to recreate them using virtual reality (VR). VR presents immersive, realistic situations over and over again, building the expertise to deal with those situations before facing them in the real world. Research has shown that virtual reality reduces the time to learn while increasing the amount learned, while also improving long-term knowledge retention. In scenarios from food processing to handing dangerous industrial gases, VR is proven to promote better and faster learning. But where it truly comes into a class of its own apart from other training methods is when the body of knowledge to attain is complex.

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The value of VR surgical training

The Value of Immersive Virtual Surgical Training in Orthopaedics

Pending Publication

Value in healthcare has traditionally been considered a relationship between the quality of the outcome for a condition balanced against the cost of care. Innovation that improves surgeon skills and reduces errors, at a reduced cost, is a direct way to improve value. Simulation technology has a positive impact on acquisition of both technical and non-technical skills, while reducing the need for costly operating room time. But the cornerstone of the value of immersive virtual reality is in translating learned skill to the real operating room. The enhanced value reaches all stakeholders. For surgeons: reduced time to learn new and variable skills versus traditional methods. For medical device manufacturers: reduced costs to bring new implants and technologies to market. For hospitals: less time in the OR, shorter surgical times and fewer errors. For patients: reduced errors and improved outcomes.

Improvement in Translational and Nontechnical Skills with VR

Pending Publication

A recent study investigated the validity and efficacy of immersive virtual reality training for orthopaedic resident education, via a multicenter, blinded, randomized controlled trial. A resident group of 10 senior orthopaedic residents and an expert group of fellowship-trained and experienced shoulder arthroplasty surgeons participated. The study compared immersive VR with traditional learning (via a technical journal article), using glenoid exposure as the test procedure. Training effectiveness was determined by Objective Structured Assessment of Surgical Skills (OSATS) scores, a laboratory metric, verbal answers, and task-completion time. Among the orthopedic residents, the immersive VR immersive VR group completed the learning activity and knowledge tests significantly faster for a reduction in learning time of 570%. Results among both resident and experts demonstrated the validity of immersive VR in terms of realism, the teaching content and construct applied, and skills transference.