Abstract
Background
Surgical simulators allow learner-focussed skills training, in controllable and reproducible environments suitable for assessment.
Aim
To research the face validity (extent to which the simulator resembles reality, determined subjectively by subjects), and construct validity, (ability to objectively differentiate between subjects with varying levels of arthroscopic experience) of a virtual reality arthroscopy simulator, to validate its effectiveness as an educational tool.
Methods
Using the simulator insightArthroVR®, 37 subjects were required to perform diagnostic knee arthroscopy, palpate anatomical landmarks and complete questionnaires. The simulator recorded objective data to assess proficiency: time to complete tasks, roughness in instrument handling, and path length covered by the arthroscope and palpation probe.
Results
The simulator succeeded in proving face validity: 86.4% participants agreed the simulator provided insight into arthroscopy.
Training met the expectations of 91.3% and showed improvement in novices in simulated diagnostic arthroscopy in completion time (p-value=0.036), roughness (p-value=0.026), and path length covered by the arthroscope (p-value=0.008).
Furthermore, the simulator was able to discriminate between experts, intermediates and novices, proving construct validity: time of completion (p-value=0.009), the path length covered by the arthroscope (p-value=0.02) and the probe (p-value=0.028).
Conclusions
Results demonstrate the simulator succeeds in emulating real arthroscopy and can discriminate between subjects according to arthroscopic experience, proving face and construct validity. Further research on transfer of skills to the operating room needs to be done.
With surgery constantly modernising and increasing time constraints with the EWTD, training must be efficient and assessable without compromising patient safety. Simulators could allow trainees earlier exposure to procedures, a wider range of pathologies in a compressed period, practice outside the OR, and an acceleration of the learning curve.
This study has taken a step forward in validating a VR simulator and thus a step towards the future of simulation becoming an indispensable adjunct to surgical training.
