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Type: Journal article
Title: Development of a proficiency-based virtual reality simulation training curriculum for laparoscopic appendicectomy
Author: Siramanna, P.
Gladman, M.
Citation: ANZ Journal of Surgery, 2017; 87(10):760-766
Publisher: Wiley-Blackwell
Issue Date: 2017
ISSN: 1445-1433
Statement of
Pramudith Sirimanna and Marc A. Gladman
Abstract: Background: Proficiency-based virtual reality (VR) training curricula improve intraoperative performance, but have not been developed for laparoscopic appendicectomy (LA). This study aimed to develop an evidence-based training curriculum for LA. Methods: A total of 10 experienced (>50 LAs), eight intermediate (10–30 LAs) and 20 inexperienced (<10 LAs) operators performed guided and unguided LA tasks on a high-fidelity VR simulator using internationally relevant techniques. The ability to differentiate levels of experience (construct validity) was measured using simulator-derived metrics. Learning curves were analysed. Proficiency benchmarks were defined by the performance of the experienced group. Intermediate and experienced participants completed a questionnaire to evaluate the realism (face validity) and relevance (content validity). Results: Of 18 surgeons, 16 (89%) considered the VR model to be visually realistic and 17 (95%) believed that it was representative of actual practice. All ‘guided’ modules demonstrated construct validity (P < 0.05), with learning curves that plateaued between sessions 6 and 9 (P < 0.01). When comparing inexperienced to intermediates to experienced, the ‘unguided’ LA module demonstrated construct validity for economy of motion (5.00 versus 7.17 versus 7.84, respectively; P < 0.01) and task time (864.5 s versus 477.2 s versus 352.1 s, respectively, P < 0.01). Construct validity was also confirmed for number of movements, path length and idle time. Validated modules were used for curriculum construction, with proficiency benchmarks used as performance goals. Conclusion: A VR LA model was realistic and representative of actual practice and was validated as a training and assessment tool. Consequently, the first evidence-based internationally applicable training curriculum for LA was constructed, which facilitates skill acquisition to proficiency.
Keywords: Laparoscopic appendicectomy; proficiency training; surgical education; technical skills curriculum; virtual reality simulation
Description: This paper was presented at the 10th Annual Academic Surgical Congress (ASC), 3–5 February 2015 in Las Vegas, NV, USA.
Rights: © 2017 Royal Australasian College of Surgeons
DOI: 10.1111/ans.14135
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