title: Face and construct validation of a next generation virtual reality (Gen2-VR) surgical simulator.
abstract: BACKGROUND
  Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room. However, traditional surgical simulators are used to train surgeons in a skills laboratory that does not recreate these conditions. To overcome this limitation, we have developed a novel, immersive virtual reality (Gen2-VR) system to train surgeons in these environments. This study was to establish face and construct validity of our system.
  
  
  METHODS
  The study was a within-subjects design, with subjects repeating a virtual peg transfer task under three different conditions: Case I: traditional VR; Case II: Gen2-VR with no distractions and Case III: Gen2-VR with distractions and interruptions. In Case III, to simulate the effects of distractions and interruptions, music was played intermittently, the camera lens was fogged for 10 s and tools malfunctioned for 15 s at random points in time during the simulation. At the completion of the study subjects filled in a 5-point Likert scale feedback questionnaire. A total of sixteen subjects participated in this study.
  
  
  RESULTS
  Friedman test showed significant difference in scores between the three conditions (p < 0.0001). Post hoc analysis using Wilcoxon signed-rank tests with Bonferroni correction further showed that all the three conditions were significantly different from each other (Case I, Case II, p < 0.0001), (Case I, Case III, p < 0.0001) and (Case II, Case III, p = 0.009). Subjects rated that fog (mean 4.18) and tool malfunction (median 4.56) significantly hindered their performance.
  
  
  CONCLUSIONS
  The results showed that Gen2-VR simulator has both face and construct validity and that it can accurately and realistically present distractions and interruptions in a simulated OR, in spite of limitations of the current HMD hardware technology.
authors.affiliation: Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110 8th Street, JEC 2049, Troy, NY, 12180, USA. sankag@rpi.edu.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Sankaranarayanan
authors.affiliation: Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110 8th Street, JEC 2049, Troy, NY, 12180, USA.|School of Mechanical Engineering and Automation, Northeastern University, Shenyang, People's Republic of China.
authors.forename: Baichun
authors.initials: B
authors.lastname: Li
authors.affiliation: Cambridge Health Alliance, Cambridge, MA, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Manser
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Jones
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jones
authors.affiliation: Cambridge Health Alliance, Cambridge, MA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Schwaitzberg
authors.affiliation: Wright State University, Dayton, OH, USA.
authors.forename: Caroline G L
authors.initials: CG
authors.lastname: Cao
authors.affiliation: Center for Modeling, Simulation and Imaging in Medicine (CeMSIM), Rensselaer Polytechnic Institute, 110 8th Street, JEC 2049, Troy, NY, 12180, USA. des@rpi.edu.|Department of Mechanical, Aerospace and Nuclear Engineering, Rensselaer Polytechnic Institute, 110 8th Street, JEC 2049, Troy, NY, 12180, USA. des@rpi.edu.
authors.forename: Suvranu
authors.initials: S
authors.lastname: De
mesh_terms: D001288:Attention; D005246:Feedback; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000193:education*; D008297:Male; D000066908:Simulation Training / Q000379:methods*; D014584:User-Computer Interface
keywords: Cognitive simulator; Face and construct validation; Gen2-VR©; Head-mounted display; Immersive virtual reality; Surgery simulator