Differentiating levels of surgical experience on a virtual reality temporal bone simulator.
OBJECTIVE
Virtual reality simulation is increasingly being incorporated into surgical training and may have a role in temporal bone surgical education. Here we test whether metrics generated by a virtual reality surgical simulation can differentiate between three levels of experience, namely novices, otolaryngology residents, and experienced qualified surgeons.


METHODS
Cohort study.


METHODS
Royal Victorian Eye and Ear Hospital.


METHODS
Twenty-seven participants were recruited. There were 12 experts, six residents, and nine novices. After orientation, participants were asked to perform a modified radical mastoidectomy on the simulator. Comparisons of time taken, injury to structures, and forces exerted were made between the groups to determine which specific metrics would discriminate experience levels.


RESULTS
Experts completed the simulated task in significantly shorter time than the other two groups (experts 22 minutes, residents 36 minutes, and novices 46 minutes; P = 0.001). Novices exerted significantly higher average forces when dissecting close to vital structures compared with experts (0.24 Newton [N] vs 0.13 N, P = 0.002). Novices were also more likely to injure structures such as dura compared to experts (23 injuries vs 3 injuries, P = 0.001). Compared with residents, the experts modulated their force between initial cortex dissection and dissection close to vital structures. Using the combination of these metrics, we were able to correctly classify the participants' level of experience 90 percent of the time.


CONCLUSIONS
This preliminary study shows that measurements of performance obtained from within a virtual reality simulator can differentiate between levels of users' experience. These results suggest that simulator training may have a role in temporal bone training beyond foundational training.
Zhao
Yi C
YC
Department of Otolaryngology, The University of Melbourne, East Melbourne, Victoria, Australia. yzhao@bionicear.org
Kennedy
Gregor
G
Hall
Richard
R
O'Leary
Stephen
S
D002102:Cadaver; D002983:Clinical Competence; D003198:Computer Simulation; D006801:Humans; D007396:Internship and Residency; D009048:Motor Skills / Q000502:physiology; D010036:Otolaryngology / Q000193:education*; D013517:Otorhinolaryngologic Surgical Procedures / Q000193:education*; D018709:Statistics, Nonparametric; D013701:Temporal Bone / Q000601:surgery*; D014584:User-Computer Interface