Virtual reality simulators: Current status in acquisition and assessment of surgical skills

Medical technology is currently evolving so rapidly that its impact cannot be analysed. Robotics and telesurgery loom on the horizon, and the technology used to drive these advances has serendipitous side‐effects for the education and training arena. The graphical and haptic interfaces used to provide remote feedback to the operator – by passing control to a computer – may be used to generate simulations of the operative environment that are useful for training candidates in surgical procedures. One additional advantage is that the metrics calculated inherently in the controlling software in order to run the simulation may be used to provide performance feedback to individual trainees and mentors. New interfaces will be required to undergo evaluation of the simulation fidelity before being deemed acceptable. The potential benefits fall into one of two general categories: those benefits related to skill acquisition, and those related to skill assessment. The educational value of the simulation will require assessment, and comparison to currently available methods of training in any given procedure. It is also necessary to determine – by repeated trials – whether a given simulation actually measures the performance parameters it purports to measure. This trains the spotlight on what constitutes good surgical skill, and how it is to be objectively measured. Early results suggest that virtual reality simulators have an important role to play in this aspect of surgical training.

[1]  R L Helmreich,et al.  Anaesthetic simulation and lessons to be learned from aviation , 1997, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[2]  J. Cocks,et al.  Conservative management of perforated peptic ulcer. , 1990, Lancet.

[3]  J M Sackier,et al.  Is there a dilemma in adequately training surgeons in both open and laparoscopic biliary surgery? , 1994, The Surgical clinics of North America.

[4]  R. Payne,et al.  Heart rate as an indicator of stress in surgeons and anaesthetists. , 1986, Journal of psychosomatic research.

[5]  B. Tulloh Patterns of injury from major trauma in Victoria. , 1996, Australian and New Zealand Journal of Surgery.

[6]  S. Mayor UK helps refugee doctors to practise in NHS , 2000, BMJ : British Medical Journal.

[7]  Alan D. Lopez,et al.  Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study , 1997, The Lancet.

[8]  J. S. Røtnes,et al.  Digital trainer developed for robotic assisted cardiac surgery. , 2001, Studies in health technology and informatics.

[9]  T Matsumoto,et al.  The "learning curve" in the performance of laparoscopic cholecystectomy. , 1993, International surgery.

[10]  J. Cocks Perforated peptic ulcer--the changing scene. , 1992, Digestive diseases.

[11]  R. Gibberd,et al.  Quality in Australian Health Care Study , 1996, The Medical journal of Australia.

[12]  D A Rogers,et al.  A virtual reality module for intravenous catheter placement. , 1999, American journal of surgery.

[13]  K. Calman,et al.  Hospital doctors: training for the future , 1995, British journal of obstetrics and gynaecology.

[14]  Kirk Rm Teaching the craft of operative surgery. , 1996 .

[15]  Alan D. Lopez,et al.  Regional patterns of disability-free life expectancy and disability-adjusted life expectancy: Global Burden of Disease Study , 1997, The Lancet.

[16]  R. Woodman Surgeons should train like pilots , 1999 .

[17]  Alan D. Lopez,et al.  Mortality by cause for eight regions of the world: Global Burden of Disease Study , 1997, The Lancet.

[18]  H. Champion Trauma centres in the USA – past and present , 1999, The British journal of surgery.

[19]  A. Hasan,et al.  New surgical procedures: can we minimise the learning curve? , 2000, BMJ : British Medical Journal.

[20]  W. Geis,et al.  Sequential psychomotor skills development in laparoscopic colon surgery. , 1994, Archives of surgery.

[21]  R M Kirk Teaching the craft of operative surgery. , 1996, Annals of the Royal College of Surgeons of England.

[22]  S. Gottlieb Older surgeons lose more patients than younger colleagues , 2000, BMJ : British Medical Journal.

[23]  T. Treasure,et al.  Training surgeons and safeguarding patients. , 1996, Annals of the Royal College of Surgeons of England.

[24]  Shaun B. Jones,et al.  Preparing surgeons for the 21st century. Implications of advanced technologies. , 2000, The Surgical clinics of North America.

[25]  F CUNHA,et al.  The Edwin Smith surgical papyrus. , 1949, American journal of surgery.

[26]  J. Coelho,et al.  Twenty-four-hour ambulatory electrocardiographic monitoring of surgeons. , 1995, International surgery.

[27]  M. Patkin ERGONOMICS APPLIED TO THE PRACTICE OF MICROSURGERY1 , 1977 .

[28]  J. Shea,et al.  Effects of Relative Frequency of Knowledge of Results on Retention of a Motor Skill , 1978, Perceptual and motor skills.

[29]  M. McDonough,et al.  Stresses affecting surgical performance and learning. I. Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes. , 1972, The Journal of surgical research.

[30]  John N. Walton The Making of a Doctor. Medical Education in Theory and Practice. , 1994 .

[31]  K. Rigg,et al.  Conservative management of perforated peptic ulcer , 1990, The Lancet.

[32]  A. Wall,et al.  Book ReviewTo Err is Human: building a safer health system Kohn L T Corrigan J M Donaldson M S Washington DC USA: Institute of Medicine/National Academy Press ISBN 0 309 06837 1 $34.95 , 2000 .

[33]  T. Krummel,et al.  Simulation and virtual reality in surgical education: real or unreal? , 1999, Archives of surgery.

[34]  C H Organ,et al.  The impact of technology on surgery. , 1999, Archives of surgery.

[35]  I. Taylor A structure for general surgery. , 1996, Annals of the Royal College of Surgeons of England.

[36]  R Goldsmith,et al.  Heart rates of surgeons in theatre. , 1983, Ergonomics.

[37]  A. de Costa Teaching gall bladder surgery: remembrance of things past, or defensive cholecystectomy revisited. , 1999, The Australian and New Zealand journal of surgery.

[38]  Lloyd Da Trauma centres in the USA--past and present. Trauma centres: a British perspective. , 1999 .

[39]  M. Patkin Ergonomics applied to the practice of microsurgery. , 1977, The Australian and New Zealand journal of surgery.

[40]  J. Cocks,et al.  Perforated peptic ulcer: a deliberative approach. , 2008, The Australian and New Zealand journal of surgery.

[41]  J. A. Martin Trainee selection for general surgery. , 1996, The Australian and New Zealand journal of surgery.

[42]  A. Leaman,et al.  Who is a surgeon? , 1995, The Lancet.

[43]  J. Hamdorf,et al.  Acquiring surgical skills , 2000, The British journal of surgery.