J. Matzke2, C. Ziegler1, S. Crawford1, K. Martin1, E. Sutton1 1University Of Louisville,Hiram C. Polk, Jr. Department Of Surgery,Louisville, KY, USA 2Eureka College,Eureka, ILLINOIS, USA
Introduction: This study evaluates if undergraduate medical trainees’ laparoscopic skills acquisition could be monitored and assessed using a virtual reality (VR) simulator and how the resultant metrics correlate with actual performance of Fundamentals of Laparoscopic Surgery™ (FLS) tasks. A central tenet in creating competency-based curricula in undergraduate medical education is the development of meaningful assessments of medical student performance. Therefore, we studied the use of VR to characterize and assess the laparoscopic skills attained in a competency-based curriculum designed for graduating medical students applying for general surgery residency. Our overall goal is to integrate the milestone competencies for surgery across the educational continuum and document trainee progress toward proficiency.
Methods: Seventeen fourth year medical students applying for surgical residency completed a monitored VR training curriculum comprised of camera navigation (CN), hand eye coordination (HEC) and FLS tasks: circle cutting (CC), ligating loop (LL), peg transfer (PT), and intracorporeal knot tying (IKT). Students completed the curriculum at their own pace over eight weeks. Performance goals were those of the simulator for CN and HEC tasks and the standard goals given in the FLS instruction manual. After 8 weeks, students were observed performing FLS tasks. The best VR performance for each FLS task and the observed performance of the FLS tasks were scored by assigning penalties as described in the FLS instruction manual. The ability of the VR simulator to detect penalties in each of the FLS tasks and correlations of time taken to complete tasks are reported. Additional metrics from the VR simulator were examined for correlation to the commission of penalties.
Results: Sixteen students trained in 100% of the curriculum, though no student achieved proficiency in all of the VR modules within eight weeks. All students were proficient in CN and HEC tasks. Proficiency was achieved in CC, LL PT and IKT by 15, 12, 15, and 1 student respectively. VR simulation showed high specificity for predicting zero penalties on the observed CC, LL, and PT tasks (84%, 81%, and 75%). VR consistently underestimates time for CC, LL, and PT tasks. The interrater reliability of manual and VR times was highest for PT (r=0.508, p=0.014). The number of movements and dominant hand path length positively correlated with the commission of penalties. Needle drops, passes, loading time and time needle is out of view did not correlate with penalties for any task.
Conclusion: VR can be used to monitor and assess medical student acquisition of laparoscopic skills. The absence of penalties in the simulator reasonably predicts the absence of penalties in manual demonstration of CC, LL and PT skills, but not IKT. The documented skills acquired by trainees can be transferred to a graduate medical education program for further monitoring of progress toward proficiency.