Background: Contemporary immersive virtual reality (iVR) simulators have shown validity in surgical training. Measures of training effectiveness compared to traditional training modalities as pioneered in aviation and military training must be determined.
Hypothesis: Can iVR improve learning effectiveness compared to traditional media teaching measured through transfer of training (ToT) and transfer effectiveness ratio (TER)?
Methods: Eighteen orthopaedic surgery residents (PGY4-5) from multiple institutions were recruited for a randomized, intervention-control study. Randomized residents received iVR training (experimental group; n=9) on reverse total shoulder arthroplasty (RTSA) with augmented baseplate for rotator cuff tear arthropathy, or technical instructional video training (control group; n=9). Residents completed baseline demographic questionnaires, followed by a written knowledge test after training sessions. Residents were individually evaluated by blinded expert shoulder surgeons on performing a RTSA on fresh-frozen cadavers using Objective Structured Assessment of Technical Skills (OSATS) and Global Ratings Scale (GRS) metrics.
Results: Participant experience with RTSA (p=0.73), simulator (p=1.0), or VR (p=1.0) did not significantly differ. The VR group outperformed the control in OSATS scoring (p=0.0006). GRS “quality of performance” (p=0.49) and “quality of final product” (p=0.47) domains had higher scores for the VR group. The VR group completed training approximately 155% faster (p=0.008) with an average of two module repetitions and equivalent written scores (p=1.0). The ToT was 32.5% - 59.4% based on comparative completion time and OSATS scores, respectively. The TER was 0.79.
Conclusion: Training senior surgical residents with iVR demonstrated superior learning efficiency and skill transfer measured by ToT. Based on published RTSA learning curves, the iVR module can provide the equivalent of 12-23 operative cases. The TER of 0.79 is higher than prominent surgical simulators and average flight simulators, providing 47.4 minutes of saved OR time for 60 minutes of VR training. Immersive VR should be considered an efficient and effective means of training medical personnel.