title: Training effect of a virtual reality haptics-enabled dynamic hip screw simulator.
abstract: OBJECTIVE
  Virtual reality (VR) simulation offers a safe, controlled, and effective environment to complement training but requires extensive validation before it can be implemented within the curriculum. The main objective was to assess whether VR dynamic hip screw (DHS) simulation has a training effect to improve objective performance metrics.
  
  
  METHODS
  52 surgical trainees who were naïve to DHS procedures were randomized to 2 groups: the training group, which had 5 attempts, and the control group, which had only one attempt. After 1 week, both cohorts repeated the same number of attempts. Objective performance metrics included total procedural time (sec), fluoroscopy time (sec), number of radiographs (n), tip-apex distance (TAD; mm), attempts at guide-wire insertion (n), and probability of cut-out (%). Mean scores (with SD) and learning curves were calculated. Significance was set as p < 0.05.
  
  
  RESULTS
  The training group was 68% quicker than the control group, used 75% less fluoroscopy, took 66% fewer radiographs, had 82% less retries at guide-wire insertion, achieved a reduced TAD (by 41%), had lower probability of cut-out (by 85%), and obtained an increased global score (by 63%). All these results were statistically significant (p < 0.001). The participants agreed that the simulator provided a realistic learning environment, they stated that they had enjoyed using the simulator, and they recognized the need for the simulator in formal training.
  
  
  CONCLUSIONS
  We found a significant training effect on the VR DHS simulator in improving objective performance metrics of naïve surgical trainees. Patient safety, an important priority, was not compromised.
authors.affiliation: a 1 MSk Lab, Imperial College London, Charing Cross Hospital , Fulham.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sugand
authors.affiliation: b 2 Blizard Institute and Department of Trauma and Orthopaedics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, and Department of Orthopaedics, Barts Health NHS Trust , London, UK.
authors.forename: Kash
authors.initials: K
authors.lastname: Akhtar
authors.affiliation: a 1 MSk Lab, Imperial College London, Charing Cross Hospital , Fulham.
authors.forename: Chetan
authors.initials: C
authors.lastname: Khatri
authors.affiliation: a 1 MSk Lab, Imperial College London, Charing Cross Hospital , Fulham.
authors.forename: Justin
authors.initials: J
authors.lastname: Cobb
authors.affiliation: a 1 MSk Lab, Imperial College London, Charing Cross Hospital , Fulham.
authors.forename: Chinmay
authors.initials: C
authors.lastname: Gupte
mesh_terms: D001863:Bone Screws; D002983:Clinical Competence; D005260:Female; D005593:Fracture Fixation, Internal / Q000193:education* / Q000295:instrumentation; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D013997:Time Factors; D014584:User-Computer Interface; D055815:Young Adult