title: Surgical experience correlates with performance on a virtual reality simulator for shoulder arthroscopy.
abstract: BACKGROUND
  The traditional process of surgical education is being increasingly challenged by economic constraints and concerns about patient safety. Sophisticated computer-based devices have become available to simulate the surgical experience in a protected environment. As with any new educational tool, these devices have generated controversy about the validity of the training experience.
  
  
  OBJECTIVE
  Performance on a virtual reality simulator correlates with actual surgical experience.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Forty-three test subjects of various experience levels in shoulder arthroscopy were tested on an arthroscopy simulator according to a standardized protocol. Subjects were evaluated for time to completion, distance traveled with the tip of the simulated probe compared with a computer-determined optimal distance, average probe velocity, and number of probe collisions with the tissues.
  
  
  RESULTS
  Subjects were grouped according to prior experience with shoulder arthroscopy. Comparing the least experienced with most experienced groups, the average time to completion decreased by 62% from 128.8 seconds to 49.2 seconds; path length and hook collisions were more than halved from 8.2 to 3.8 and 34.1 to 16.8, respectively; and average probe velocity more than doubled from 0.18 to 0.4 cm/second. There were no significant differences for any parameter tested between subjects with video game experience compared to those without.
  
  
  CONCLUSIONS
  The study demonstrated a close and statistically significant correlation between simulator results and surgical experience, thus confirming the hypothesis. Conversely, experience with video games was not associated with improved simulator performance. This indicates that the skill set tested may be similar to the one developed in the operating room, thus suggesting its use as a potential tool for future evaluation of surgical trainees.
  
  
  CONCLUSIONS
  The results have implications for the future of orthopaedic surgical training programs, the majority of which have not embraced virtual reality technology for physician education.
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA.
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Gomoll
authors.forename: Robert V
authors.initials: RV
authors.lastname: O'Toole
authors.forename: Joseph
authors.initials: J
authors.lastname: Czarnecki
authors.forename: Jon J P
authors.initials: JJ
authors.lastname: Warner
mesh_terms: D001182:Arthroscopy; D003198:Computer Simulation; D004501:Education, Medical / Q000379:methods; D006801:Humans; D008404:Massachusetts; D012782:Shoulder / Q000601:surgery*; D013647:Task Performance and Analysis