title: Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training.
abstract: BACKGROUND
  To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and practice of minimally invasive surgery (MIS) makes unique demands on surgical training programs. A decade ago Satava proposed virtual reality (VR) surgical simulation as a solution for this problem. Only recently have robust scientific studies supported that vision
  
  
  METHODS
  A review of the surgical education, human-factor, and psychology literature to identify important factors which will impinge on the successful integration of VR training into a surgical training program.
  
  
  RESULTS
  VR is more likely to be successful if it is systematically integrated into a well-thought-out education and training program which objectively assesses technical skills improvement proximate to the learning experience. Validated performance metrics should be relevant to the surgical task being trained but in general will require trainees to reach an objectively determined proficiency criterion, based on tightly defined metrics and perform at this level consistently. VR training is more likely to be successful if the training schedule takes place on an interval basis rather than massed into a short period of extensive practice. High-fidelity VR simulations will confer the greatest skills transfer to the in vivo surgical situation, but less expensive VR trainers will also lead to considerably improved skills generalizations.
  
  
  CONCLUSIONS
  VR for improved performance of MIS is now a reality. However, VR is only a training tool that must be thoughtfully introduced into a surgical training curriculum for it to successfully improve surgical technical skills.
authors.affiliation: Emory Endosurgery Unit, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA. aggallagher@comcast.net
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Gallagher
authors.forename: E Matt
authors.initials: EM
authors.lastname: Ritter
authors.forename: Howard
authors.initials: H
authors.lastname: Champion
authors.forename: Gerald
authors.initials: G
authors.lastname: Higgins
authors.forename: Marvin P
authors.initials: MP
authors.lastname: Fried
authors.forename: Gerald
authors.initials: G
authors.lastname: Moses
authors.forename: C Daniel
authors.initials: CD
authors.lastname: Smith
authors.forename: Richard M
authors.initials: RM
authors.lastname: Satava
mesh_terms: D001288:Attention; D002983:Clinical Competence; D003198:Computer Simulation; D005246:Feedback; D013502:General Surgery / Q000193:education*; D006801:Humans; D009873:Operating Rooms; D013647:Task Performance and Analysis; D014584:User-Computer Interface