title: Mapping the plateau of novices in virtual reality simulation training of mastoidectomy.
abstract: To explore why novices' performance plateau in directed, self-regulated virtual reality (VR) simulation training and how performance can be improved.
  
  
  
  Prospective study.
  
  
  
  Data on the performances of 40 novices who had completed repeated, directed, self-regulated VR simulation training of mastoidectomy were included. Data were analyzed to identify key areas of difficulty as well as the procedures terminated without using all the time allowed.
  
  
  
  Novices had difficulty in avoiding drilling holes in the outer anatomical boundaries of the mastoidectomy and frequently made injuries to vital structures such as the lateral semicircular canal, the ossicles, and the facial nerve. The simulator-integrated tutor function improved performance on many of these items, but overreliance on tutoring was observed. Novices also demonstrated poor self-assessment skills and often did not make use of the allowed time, lacking knowledge on when to stop or how to excel.
  
  
  
  Directed, self-regulated VR simulation training of mastoidectomy needs a strong instructional design with specific process goals to support deliberate practice because cognitive effort is needed for novices to improve beyond an initial plateau.
  
  
  
  N/A. Laryngoscope, 127:907-914, 2017.
authors.affiliation: Department of Otorhinolaryngology-Head ad Neck Surgery, Rigshospitalet, Denmark.
authors.forename: Steven A W
authors.initials: SA
authors.lastname: Andersen
authors.affiliation: Copenhagen Academy for Medical Education and Simulation, Centre for HR, the Capital Region of Denmark, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
authors.affiliation: Computer Graphics Lab, the Alexandra Institute, Aarhus, Denmark.
authors.forename: Peter Trier
authors.initials: PT
authors.lastname: Mikkelsen
authors.affiliation: Department of Otorhinolaryngology-Head ad Neck Surgery, Rigshospitalet, Denmark.
authors.forename: Per
authors.initials: P
authors.lastname: Cayé-Thomasen
authors.affiliation: Department of Otorhinolaryngology-Head ad Neck Surgery, Rigshospitalet, Denmark.
authors.forename: Mads Sølvsten
authors.initials: MS
authors.lastname: Sørensen
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002983:Clinical Competence; D015331:Cohort Studies; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods; D005260:Female; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D008416:Mastoid / Q000601:surgery*; D010036:Otolaryngology / Q000193:education*; D011446:Prospective Studies; D012647:Self-Assessment; D000066908:Simulation Training / Q000379:methods*; D014584:User-Computer Interface
keywords: Virtual reality simulation; directed self-regulated learning; self-assessment; surgical training; temporal bone surgery