Visuospatial and psychomotor aptitude predicts endovascular performance of inexperienced individuals on a virtual reality simulator.

OBJECTIVES This study evaluated virtual reality (VR) simulation for endovascular training of medical students to determine whether innate perceptual, visuospatial, and psychomotor aptitude (VSA) can predict initial and plateau phase of technical endovascular skills acquisition. METHODS Twenty medical students received didactic and endovascular training on a commercially available VR simulator. Each student treated a series of 10 identical noncomplex renal artery stenoses endovascularly. The simulator recorded performance data instantly and objectively. An experienced interventionalist rated the performance at the initial and final sessions using generic (out of 40) and procedure-specific (out of 30) rating scales. VSA were tested with fine motor dexterity (FMD, Perdue Pegboard), psychomotor ability (minimally invasive virtual reality surgical trainer [MIST-VR]), image recall (Rey-Osterrieth), and organizational aptitude (map-planning). VSA performance scores were correlated with the assessment parameters of endovascular skills at commencement and completion of training. RESULTS Medical students exhibited statistically significant learning curves from the initial to the plateau performance for contrast usage (medians, 28 vs 17 mL, P < .001), total procedure time (2120 vs 867 seconds, P < .001), and fluoroscopy time (993 vs. 507 seconds, P < .001). Scores on generic and procedure-specific rating scales improved significantly (10 vs 25, P < .001; 8 vs 17 P < .001). Significant correlations were noted for FMD with initial and plateau sessions for fluoroscopy time (r(s) = -0.564, P = .010; r(s) = -.449, P = .047). FMD correlated with procedure-specific scores at the initial session (r(s) = .607, P = .006). Image recall correlated with generic skills at the end of training (r(s) = .587, P = .006). CONCLUSIONS Simulator-based training in endovascular skills improved performance in medical students. There were significant correlations between initial endovascular skill and fine motor dexterity as well as with image recall at end of the training period. In addition to current recruitment strategies, VSA may be a useful tool for predictive validity studies.

[1]  EVAR trial participants,et al.  Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial , 2005, The Lancet.

[2]  S. Wilson,et al.  Increased endovascular interventions decrease the rate of lower limb artery bypass operations without an increase in major amputation rate. , 2008, Annals of vascular surgery.

[3]  Richard Reznick,et al.  Assessment of a Virtual Interventional Simulator Trainer , 2006, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[4]  A Darzi,et al.  Validation of video-based skill assessment in carotid artery stenting. , 2009, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[5]  R. McCarthy,et al.  The increasing role of percutaneous transluminal angioplasty in the primary management of critical limb ischaemia. , 2002, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[6]  Rajesh Aggarwal,et al.  Cognitive training improves clinically relevant outcomes during simulated endovascular procedures. , 2008, Journal of vascular surgery.

[7]  D. Gould,et al.  Simulators in interventional radiology training and evaluation: a paradigm shift is on the horizon. , 2006, Journal of vascular and interventional radiology : JVIR.

[8]  N. Laird,et al.  Polymorphism in maternal LRP8 gene is associated with fetal growth. , 2006, American journal of human genetics.

[9]  R. Reznick,et al.  Teaching surgical skills--changes in the wind. , 2006, The New England journal of medicine.

[10]  A Darzi,et al.  Identification of skills common to renal and iliac endovascular procedures performed on a virtual reality simulator. , 2007, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[11]  James R Korndorffer,et al.  Psychomotor testing predicts rate of skill acquisition for proficiency-based laparoscopic skills training. , 2006, Surgery.

[12]  S Weghorst,et al.  Identifying and reducing errors with surgical simulation , 2004, Quality and Safety in Health Care.

[13]  A. Darzi,et al.  Experienced endovascular interventionalists objectively improve their skills by attending carotid artery stent training courses. , 2008, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[14]  Daniel B. Jones,et al.  Assessment of basic human performance resources predicts operative performance of laparoscopic surgery. , 2003, Journal of the American College of Surgeons.

[15]  Rajesh Aggarwal,et al.  An Evidence-Based Virtual Reality Training Program for Novice Laparoscopic Surgeons , 2006, Annals of surgery.

[16]  B. Arthurs,et al.  Consent to cataract surgery performed by residents. , 2005, Canadian journal of ophthalmology. Journal canadien d'ophtalmologie.

[17]  R. Reznick,et al.  Objective structured assessment of technical skill (OSATS) for surgical residents , 1997, The British journal of surgery.

[18]  David L Waldman,et al.  Use of computer simulation for determining endovascular skill levels in a carotid stenting model. , 2004, Journal of vascular surgery.

[19]  W. Gantert,et al.  Can skills assessment on a virtual reality trainer predict a surgical trainee’s talent in laparoscopic surgery? , 2006, Surgical Endoscopy And Other Interventional Techniques.

[20]  Feng Gao,et al.  Retrospective motion correction protocol for high‐resolution anatomical MRI , 2006, Human brain mapping.

[21]  A. Almudevar,et al.  Simulator assessment of innate endovascular aptitude versus empirically correct performance. , 2006, Journal of vascular surgery.

[22]  Adam Dubrowski,et al.  Teaching Surgical Skills: What Kind of Practice Makes Perfect?: A Randomized, Controlled Trial , 2006, Annals of surgery.

[23]  S. Hamstra,et al.  Effect of visual-spatial ability on learning of spatially-complex surgical skills , 2002, The Lancet.

[24]  Pardis C Sabeti,et al.  Positive Selection of a Pre-Expansion CAG Repeat of the Human SCA2 Gene , 2005, PLoS genetics.

[25]  E. Minar,et al.  Procedure-Related Complications and Early Neurological Adverse Events of Unprotected and Protected Carotid Stenting: Temporal Trends in a Consecutive Patient Series , 2005, Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists.

[26]  Rajesh Aggarwal,et al.  Virtual reality simulation objectively differentiates level of carotid stent experience in experienced interventionalists. , 2007, Journal of vascular surgery.

[27]  J. Birkmeyer,et al.  Simulation Improves Resident Performance in Catheter-Based Intervention: Results of a Randomized, Controlled Study , 2006, Annals of surgery.

[28]  Jun Soo Kwon,et al.  Clinical and empirical applications of the Rey–Osterrieth Complex Figure Test , 2006, Nature Protocols.

[29]  R. Satava,et al.  Virtual Reality Simulation for the Operating Room: Proficiency-Based Training as a Paradigm Shift in Surgical Skills Training , 2005, Annals of surgery.

[30]  Ara Darzi,et al.  Virtual reality simulation training can improve inexperienced surgeons' endovascular skills. , 2006 .

[31]  R. Reznick,et al.  Setting Up a Surgical Skills Center , 2008, World Journal of Surgery.

[32]  R. Reznick,et al.  Teaching and testing technical skills. , 1993, American journal of surgery.

[33]  R. Satava,et al.  Virtual Reality Training Improves Operating Room Performance: Results of a Randomized, Double-Blinded Study , 2002, Annals of surgery.

[34]  P. Lamont,et al.  The impact of shortened training times on the discipline of vascular surgery in the United Kingdom. , 2005, American journal of surgery.