Clinical surgery–American
Randomized controlled trial of virtual reality simulator training: transfer to live patients

https://doi.org/10.1016/j.amjsurg.2006.11.032Get rights and content

Abstract

Background

New Residency Review Committee requirements in general surgery require 50 colonoscopies. Simulators have been widely suggested to help prepare residents for live clinical experience. We assessed a computer-based colonoscopy simulator for effective transfer of skills to live patients.

Methods

A randomized controlled trial included general surgery and internal medicine residents with limited endoscopic experience. Following a pretest, the treatment group (n = 12) practiced on the simulator, while controls (n = 12) received no additional training. Both groups then performed a colonoscopy on a live patient. Technical ability was evaluated by expert endoscopists using previously validated assessment instruments.

Results

In the live patient setting, the treatment group scored significantly higher global ratings than controls (t(22) = 1.84, P = .04). Only 2 of the 8 computer-based performance metrics correlated significantly with previously validated global ratings of performance.

Conclusions

Residents trained on a colonoscopy simulator prior to their first patient-based colonoscopy performed significantly better in the clinical setting than controls, demonstrating skill transfer to live patients. The simulator’s performance metrics showed limited concurrent validity, suggesting the need for further refinement.

Section snippets

Study population

Institutional research ethics approval was obtained prior to the study’s implementation. Residents in postgraduate years 1 to 3 in the general surgery and internal medicine programs at the University of Toronto were invited to participate in this study. Prior to participation, all residents completed a questionnaire to determine their level of training and previous endoscopic experience. Residents with experience in endoscopy (defined as the primary endoscopist for greater than 3 procedures of

Baseline demographics and simulator pretest results

Twenty-eight residents entered the study. Four residents (2 in each group) were unable to complete the clinical phase because of scheduling difficulties, and their data were excluded from analyses. Thus, 24 residents completed the entire study, with 12 residents in each of the treatment and control groups. The demographic characteristics were not significantly different between groups, with similar proportions of gender, age, and postgraduate year level in each of the 2 groups. In addition, the

Comments

Despite the widespread use of simulation technology in surgical training, skill transfer from simulators—bench models or computer-based—to real patients has been objectively demonstrated for only a limited number of procedures, including laparoscopic surgery [20], [22], [23], bronchoscopy [24], and fiberoptic orotracheal intubation [19]. A number of papers describing similar efforts have failed to show clinical benefit with simulator training. For example, a study on intravenous catheter

Acknowledgments

The authors are above all grateful to the patients who volunteered for this study in the interest of process development to improve future training initiatives. We also thank the residents who participated in this study, the staff at the University of Toronto Surgical Skills Centre at Mount Sinai Hospital, and the administrative and nursing staff at the University Health Network, Toronto, Ontario. Supported by a research grant from the Royal College of Physicians and Surgeons of Canada. J.P.

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