Randomized Trial of a Virtual Reality Tool to Teach Surgical Technique for Tibial Shaft Fracture Intramedullary Nailing

Abstract

Introduction: Active learning methods have accumulated popularity due to improved results in knowledge acquisition as opposed to passive learning methods. For surgical resident physicians with limited training opportunities outside of the operating room due to time constraints, virtual reality (VR) is a relatively inexpensive and time-efficient active training method for procurement of surgical skills. We conducted a simulated intramedullary nailing (IMN) of a tibia to demonstrate VR training programs as a more effective modality of learning orthopedic surgical techniques compared to passive learning tools such as a standard guide (SG) through trained novice medical students performing a SawBones simulation of intramedullary nail fixation. Materials and methods: First and second-year medical students without prior experience of procedure were recruited and randomized to SG or VR training. Participants were observed performing simulated tibia IMN procedure immediately after training and evaluated by a blinded attending surgeon using procedure-specific checklist and 5-point global assessment scale. Participants returned after 2-weeks for repeat training and evaluation. Results: 20 participants were recruited and randomized into VR (n = 10) and SG (n = 10) groups. All 20 participants completed the first phase and 17 completed the second phase of the study. Aggregate global assessment scores were significantly higher for VR than SG group (17.5 vs. 7.5, p < 0.001), including scores in all individual categories. The percentage of steps completed correctly was significantly higher in the VR group compared to the SG group (63% vs. 25%, p < 0.002). Average improvement between the first and second phases of the study were higher in the VR group compared to SG group across all 5-categories of the global assessment scale, and significantly higher for knowledge of instruments (50% vs. 11%, p, 0.01). Discussion: VR training was more effective than a passive SG in our model of simulated tibia IMN for novice medical students. Virtual reality training may be a useful method to augment orthopedic education.

Virtual reality simulation—the future of orthopaedic training? A systematic review and narrative analysis

“…The second most common area of focus was spinal pedicle screw placement (3 out of 16) [ 22 – 24 ]. Other procedures included tibial shaft fracture fixation [ 25 ], pre-surgery fracture carving [ 26 ], dynamic hip screw placement [ 27 ] and hip arthroplasty [ 28 ].…”

“…ArthroVR was used in 2 articles [ 17 , 18 ], as was insightArthro [ 13 , 16 ]. The remainder of the simulators were used in only 1 article each—Osso VR [ 25 ], Immersive Touch [ 22 ], Procedius [ 14 ], IVRSS-PSP [ 24 ], ORamaVR [ 28 ], VSTS [ 23 ], PrecisionOS [ 15 ], Virtual-Fracture-Carving-Simulator [ 26 ] and TraumaVision [ 27 ].…”

“…VR group performed SS better than benchtop in lab and on cadaver ( p = 0.02). Blumstein et al [ 25 ] 17 (all novices) Perform tibial shaft fracture IM nailing Read printed instructions on surgical technique for procedure Perform tibial shaft fracture IM nailing on benchtop model GRS and procedure-specific checklist SS higher GRS ( p = 0.001) and increase in correctly completed steps ( p = 0.008) in VR group. Cannon et al [ 19 ] 48 (all intermediates) Visualise, probe anatomical structures in the knee (must achieve level of proficiency to progress) No additional training Perform diagnostic arthroscopy on live patient, within 25 min GRS, procedure-specific checklist (visualisation scale and probing scale) VR group had SS higher scores in procedure-specific checklist ( p = 0.031), but not GRS ( p = 0.061).…”

“…The choice of task for the control group also varied. Seven studies chose to have their control group receive no additional learning to complete before assessment [ 13 , 14 , 17 – 20 , 28 ], 6 had their control groups receive didactic lectures or demonstrations, or read instruction manuals on the relevant surgical technique [ 15 , 16 , 22 , 23 , 25 , 26 ], 3 used SawBones—a benchtop simulator—as their control [ 18 , 21 , 26 ], and the remaining 2 had unique control group tasks, including using the same VR simulator as the intervention group for a much shorter amount of time [ 24 , 27 ].…”

Bright Ideas : Improving Clinicians' Experience with an In-House Virtual Reality Program

“…One of the reports came from the University of California, Los Angeles David Geffen School of Medicine. 2 The results from the study, which used the Osso VR surgical training platform, showed that VR training improved overall surgical performance by 230% compared with traditional training methods for a tibial shaft surgical procedure. Specifically, surgeons who used the Osso VR platform completed the procedure 20% faster than those not using the platform.…”