To the Editor:
We were pleased to see the article by Schirmer et al1 because it represents an update to our original concept from 20002 with enhanced modernized haptics and fidelity. The authors have updated our original model with an immersive environment and better 3-D representation.
It is conceptually similar in terms of the procedural steps modeled, and their assessment of our simulator from 2000. We have updated our simulator to run on the iPad since this article was submitted https://itunes.apple.com/gb/app/vcath/id568887198?mt=8.3
This is quite a simple App; however, it lacks haptic feedback, but it makes up for it in terms of accessibility and low cost. It has inbuilt evaluation of the procedural steps.
We have concentrated on educational content and concepts rather than fidelity of procedural accuracy. Improvements in procedural fidelity are very resource intense and seem, over the years since our original model, to have had limited success.
The authors describe and illustrate some of the problems of validation of surgical simulators. We perceive a tendency to demonstrate that the simulator shows improvement in learning the simulator rather than in learning an actual procedure. The authors have rightly used alternative methods of didactic teaching to counter this. The gold standard of validation has to be that performance in the actual procedure is enhanced by the simulator. A focus on the educational aspects of the simulator seems as important as the focus on modeling procedural fidelity.
The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article.
1. Schirmer CM, Elder JB, Roitberg B, Lobel DA. Virtual reality-based simulation training for ventriculostomy: an evidence-based approach. Neurosurgery. 2013;73(suppl 4):66–73. doi: 10.1227/NEU.0000000000000074.
2. Phillips NI, John NW. Web-based surgical simulation for ventricular catheterization. Neurosurgery. 2000;46(4):933–936; discussion 936-937.
3. Cenydd LA, John NW, Phillips NI, Gray WP. VCath: a tablet-based neurosurgery training tool. Stud Health Technol Inform. 2013;184:20–23.