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Virtual Reality Simulation for the Operating Room: Proficiency-Based Training as a Paradigm Shift in Surgical Skills Training

Gallagher, Anthony G. PhD*; Ritter, E Matt MD; Champion, Howard MD; Higgins, Gerald PhD§; Fried, Marvin P. MD; Moses, Gerald PhD; Smith, C Daniel MD*; Satava, Richard M. MD

doi: 10.1097/01.sla.0000151982.85062.80
Original Articles

Summary Background Data: To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and practice of minimally invasive surgery (MIS) makes unique demands on surgical training programs. A decade ago Satava proposed virtual reality (VR) surgical simulation as a solution for this problem. Only recently have robust scientific studies supported that vision

Methods: A review of the surgical education, human-factor, and psychology literature to identify important factors which will impinge on the successful integration of VR training into a surgical training program.

Results: VR is more likely to be successful if it is systematically integrated into a well-thought-out education and training program which objectively assesses technical skills improvement proximate to the learning experience. Validated performance metrics should be relevant to the surgical task being trained but in general will require trainees to reach an objectively determined proficiency criterion, based on tightly defined metrics and perform at this level consistently. VR training is more likely to be successful if the training schedule takes place on an interval basis rather than massed into a short period of extensive practice. High-fidelity VR simulations will confer the greatest skills transfer to the in vivo surgical situation, but less expensive VR trainers will also lead to considerably improved skills generalizations.

Conclusions: VR for improved performance of MIS is now a reality. However, VR is only a training tool that must be thoughtfully introduced into a surgical training curriculum for it to successfully improve surgical technical skills.

Evidence has been published demonstrating the power of simulation for training surgical skills. Simulation training is more likely to produce better training outcomes if it is systematically integrated into the curriculum of a training program with proficiency-based progression founded on objective feedback with validated metrics proximate to performance.

From the *Emory Endosurgery Unit, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; †NCA Medical Simulation Center, Norman M. Rich Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland; ‡Department of Otolaryngology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York; §Federation of American Scientists, Washington, DC; ∥Telemedicine and Advanced Technology Research Center (TATRC), Fort Dietrick, Maryland; and the ¶Department of Surgery, University of Washington Medical Center, Seattle, Washington.

Reprints: Anthony G. Gallagher, PhD, Director of Research, Emory Endosurgery Unit, Emory University School of Medicine, 1364 Clifton Road NE, Suite H-122, Atlanta, GA 30322. E-mail

© 2005 Lippincott Williams & Wilkins, Inc.