title: Implementation of an interactive virtual-world simulation for structured surgeon assessment of clinical scenarios.
abstract: BACKGROUND
  A novel simulation technology has emerged through the use of online 3-dimensional virtual worlds in which it is feasible to create virtual patients. This study establishes the face, content and construct validity of online 3-dimensional virtual patients in Second Life (a 3-dimensional virtual world accessible via the Internet).
  
  
  METHODS
  Sixty-three surgeons of the following grades participated in this study: intern (n = 20); junior resident (n = 15); senior resident (n = 18), and attending (n = 10). All subjects assessed a series of 3 virtual patients (level 1) with different surgical presentations, such as lower gastrointestinal bleeding, acute pancreatitis, and small bowel obstruction. The junior resident group managed an additional 3 cases (level 2) with the same presentation but of increasing complexity. The senior resident and attending groups completed a total of 9 cases (level 1 to 3). The primary outcomes measures were the face and content validity rated on a 7-point Likert scale and a performance score based on a performance rating.
  
  
  RESULTS
  The simulation demonstrated high face and content validity ratings. Eight of 9 cases, with the exception of the level 3 small bowel obstruction, demonstrated significant differences in performance among the user groups (p < 0.01). Additional subset analysis demonstrated that the attending group performed best for performance ratings.
  
  
  CONCLUSIONS
  This novel form of simulation demonstrated high face and content validity. Performance assessed in managing a series of virtual patients varies with different levels of surgical training. This simulation can be used to differentiate among these levels and can be implemented as a unique form of assessment.
authors.affiliation: Division of Surgery, Imperial College, St Mary's Hospital, London, UK. v.patel20@imperial.ac.uk
authors.forename: Vishal
authors.initials: V
authors.lastname: Patel
authors.forename: Rajesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Daniel
authors.initials: D
authors.lastname: Cohen
authors.forename: Dave
authors.initials: D
authors.lastname: Taylor
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D020407:Internet; D007396:Internship and Residency; D008131:London; D008297:Male; D015203:Reproducibility of Results; D014584:User-Computer Interface