Development of a virtual reality training curriculum for phacoemulsification surgery.
OBJECTIVE
Training within a proficiency-based virtual reality (VR) curriculum may reduce errors during real surgical procedures. This study used a scientific methodology to develop a VR training curriculum for phacoemulsification surgery (PS).


METHODS
Ten novice-(n) (performed <10 cataract operations), 10 intermediate-(i) (50-200), and 10 experienced-(e) (>500) surgeons were recruited. Construct validity was defined as the ability to differentiate between the three levels of experience, based on the simulator-derived metrics for two abstract modules (four tasks) and three procedural modules (five tasks) on a high-fidelity VR simulator. Proficiency measures were based on the performance of experienced surgeons.


RESULTS
Abstract modules demonstrated a 'ceiling effect' with construct validity established between groups (n) and (i) but not between groups (i) and (e)-Forceps 1 (46, 87, and 95; P<0.001). Increasing difficulty of task showed significantly reduced performance in (n) but minimal difference for (i) and (e)-Anti-tremor 4 (0, 51, and 59; P<0.001), Forceps 4 (11, 73, and 94; P<0.001). Procedural modules were found to be construct valid between groups (n) and (i) and between groups (i) and (e)-Lens-cracking (0, 22, and 51; P<0.05) and Phaco-quadrants (16, 53, and 87; P<0.05). This was also the case with Capsulorhexis (0, 19, and 63; P<0.05) with the performance decreasing in the (n) and (i) group but improving in the (e) group (0, 55, and 73; P<0.05) and (0, 48, and 76; P<0.05) as task difficulty increased.


CONCLUSIONS
Experienced/intermediate benchmark skill levels are defined allowing the development of a proficiency-based VR training curriculum for PS for novices using a structured scientific methodology.
London Kent Surrey Sussex Deanery, London, UK.
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AV
Spiteri
Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
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R
Aggarwal
Hillingdon Hospital, Western Eye Hospital, London, UK.
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TL
Kersey
Queen Alexandra Hospital, Portsmouth, UK.
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M
Sira
1] Stoke Mandeville Hospital, Buckinghamshire, UK [2] Education Committee of the Royal College of Ophthalmologists, London, UK.
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L
Benjamin
Imperial College, Imperial College Hospital NHS Trust, Royal Marsden Hospital, Institute of Cancer Research, London, UK.
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AW
Darzi
The Hillingdon Hospital NHS Foundation Trust and The Western Eye Hospital (Imperial College NHS Trust), Imperial College School of Medicine, Middlesex University, London, UK.
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PA
Bloom
D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D018918:Phacoemulsification / Q000193:education*; D025321:Surgery, Computer-Assisted / Q000193:education* / Q000379:methods; D013663:Teaching / Q000379:methods; D014584:User-Computer Interface