Porcine transfer study: virtual reality simulator training compared with porcine training in endovascular novices.
OBJECTIVE
To compare the learning of endovascular interventional skills by training on pig models versus virtual reality simulators.


METHODS
Twelve endovascular novices participated in a study consisting of a pig laboratory (P-Lab) and a virtual reality laboratory (VR-Lab). Subjects were stratified by experience and randomized into four training groups. Following 1 hr of didactic instruction, all attempted an iliac artery stenosis (IAS) revascularization in both laboratories. Onsite proctors evaluated performances using task-specific checklists and global rating scales, yielding a Total Score. Participants completed two training sessions of 3 hr each, using their group's assigned method (P-Lab x 2, P-Lab + VR-Lab, VR-Lab + P-Lab, or VR-Lab x 2) and were re-evaluated in both laboratories. A panel of two highly experienced interventional radiologists performed assessments from video recordings. ANCOVA analysis of Total Score against years of surgical, interventional radiology (IR) experience and cumulative number of P-Lab or VR-Lab sessions was conducted. Inter-rater reliability (IRR) was determined by comparing proctored scores with the video assessors in only the VR-Lab.


RESULTS
VR-Lab sessions improved the VR-Lab Total Score (beta = 3.029, p = 0.0015) and P-Lab Total Score (beta = 1.814, p = 0.0452). P-Lab sessions increased the P-Lab Total Score (beta = 4.074, p < 0.0001) but had no effect on the VR-Lab Total Score. In the general statistical model, both P-Lab sessions (beta = 2.552, p = 0.0010) and VR-Lab sessions (beta = 2.435, p = 0.0032) significantly improved Total Score. Neither previous surgical experience nor IR experience predicted Total Score. VR-Lab scores were consistently higher than the P-Lab scores (Delta = 6.659, p < 0.0001). VR-Lab IRR was substantial (r = 0.649, p < 0.0008).


CONCLUSIONS
Endovascular skills learned in the virtual environment may be transferable to the real catheterization laboratory as modeled in the P-Lab.
Berry
Max
M
Department of Interventional Radiology, Sahlgrenska Hospital, Gothenburg, Sweden. max_berry@hotmail.com
Lystig
Ted
T
Beard
Jonathan
J
Klingestierna
Hans
H
Reznick
Richard
R
Lönn
Lars
L
D000328:Adult; D000800:Angioplasty, Balloon / Q000193:education*; D000818:Animals; D001157:Arterial Occlusive Diseases / Q000628:therapy*; D001291:Attitude of Health Personnel; D003198:Computer Simulation; D003479:Curriculum; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D007083:Iliac Artery; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional / Q000193:education*; D015607:Stents; D013552:Swine; D014584:User-Computer Interface