Orthopedic residents and surgeons at NewYork-Presbyterian/
This new study on iVR shows that high fidelity type simulators, like iVR, are comparative in skill acquisition and validity to cadaver laboratory sessions, according to William K. Crockatt, MD, a third-year orthopedic resident at NewYork-Presbyterian/
Dr. Crockatt identified iVR as an innovative form of surgical training that never had been compared to cadaver training and designed the study that enabled NewYork-Presbyterian/
Residents selected for the 6-year Research Track in NewYork-Presbyterian/
“Immersive virtual reality, augmented reality, and mixed reality are all exciting new technologies that may one day become commonplace in the operating room,” says Dr. Levine. “However, there remains uncertainty as to whether the cost and increased time make the benefits outweigh the risks. Therefore, we wanted to understand the impact of immersive virtual reality compared to traditional didactic and cadaveric teaching with our faculty and residents.”
“Immersive virtual reality, augmented reality, and mixed reality are all exciting new technologies that may one day become commonplace in the operating room. However, there remains uncertainty as to whether the cost and increased time make the benefits outweigh the risks. Therefore, we wanted to understand the impact of immersive virtual reality compared to traditional didactic and cadaveric teaching with our faculty and residents.” — Dr. William Levine
Assessing iVR Versus Cadaveric Learning
Dr. Crockatt and the other authors aimed to compare the skill acquisition and cost-effectiveness of these two forms of surgical training. Fourteen junior orthopedic surgery residents at NewYork-Presbyterian/
Screenshot from the Zimmer Biomet Comprehensive Augmented Baseplate module to perform baseplate implantation of total shoulder arthroplasty.
Image courtesy of Dr. Crockatt.
The iVR training was delivered via a device worn on the head which delivers visual and auditory guidance, simulating an operating room environment, with hand controls as the haptic feature for the surgery. Residents followed the curriculum within the Zimmer Biomet Comprehensive Augmented Baseplate module to perform baseplate implantation of total shoulder arthroplasty (rTSA). This was directly compared to cadaver laboratory training, which, in this case, was fresh-frozen cadaveric shoulder specimens accompanied by materials to follow the steps of implantation of the augmented baseplate for rTSA.
A resident participating in iVR training.
Image courtesy of Dr. Crockatt.
The cadaver group was given one hour to train and learn the instruments and anatomy for rTSA. The iVR group was solely guided by the training module on the device. Dr. Jobin, who was the program director for this study, assisted in guidance for those in the cadaveric group.
Both groups were assessed using the Objective Structured Assessment of Technical Skill (OSATS) checklist and Global Rating Scale (GRS). They were scored on the accuracy of step completion for OSATS and GRS. Participants were also asked to complete a survey regarding the realism of their training tools and repeated the written knowledge test, administered originally before the training, to assess the change in the level of knowledge after iVR or cadaveric training.
When comparing the outcomes of the iVR training to cadaver training, there was no statistical significance difference in the written knowledge score, OSATS score, GRS score, time completion of assessment, or post-training written knowledge.
After evaluating the average cost of iVR hardware and the one-year software license to the average cost of a single cadaver laboratory training, it was proven that both iVR and cadaver laboratory training are both useful simulation tools and additionally, that one hour of iVR training saves one minute of time to task completion compared with cadaver training.
“iVR was really great to help them learn the steps of the case, but not all the specifics as far as handling tissues or actually holding the instrument in hand for a little bit, as they were pressing a button or a virtual reality controller,” says Dr. Crockatt.
Immersive Virtual Reality: The Next Gold Standard?
The future of iVR use in tandem with traditional orthopedic surgical training still has much to be discovered, and there are various ways it could be utilized for the benefit of residents in training or practicing physicians.
“The fact that we were able to show no real significant difference between the two methods in learning the steps of the procedure is important as may increase integration of iVR into surgical training curriculums and residency programs throughout the country,” says Dr. Crockatt.
He also emphasizes the importance of other implications for virtual reality; the costof iVR systems are a one-time purchase, with one-year subscriptions that allow unlimited access to training modules to residents whenever needed. There are other various ways to utilize iVR, such as implementing it as a sort of ‘mental rehearsal’ for practicing physicians before performing surgeries, or as a device to take home for additional training for residents. “iVR has the potential to become a new gold standard and will certainly provide another method that we can use to help supplement our everyday training,” says Dr. Crockatt.
“iVR has the potential to become a new gold standard and will certainly provide another method that we can use to help supplement our everyday training.” — Dr. William Crockatt
NewYork-Presbyterian/
