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Prospective, Randomized Assessment of Transfer of Training (ToT) and Transfer Effectiveness Ratio (TER) of Virtual Reality Simulation Training for Laparoscopic Skill Acquisition

Gallagher, Anthony G. PhD, DSc*; Seymour, Neal E. MD; Jordan-Black, Julie-Anne PhD; Bunting, Brendan P. PhD§; McGlade, Kieran MD; Satava, Richard Martin MD

doi: 10.1097/SLA.0b013e318284f658
Randomized Controlled Trials

Objectives: We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation. Concordance between simulated and in-vivo procedure performance was also assessed.

Design: Prospective, randomized, and blinded.

Participants: In Study 1, experienced laparoscopic surgeons (n = 195) and in Study 2 laparoscopic novices (n = 30) were randomized to either train on VR simulation before completing an equivalent real-world task or complete the real-world task only.

Results: Experienced laparoscopic surgeons and novices who trained on the simulator performed significantly better than their controls, thus demonstrating ToT. Their performance showed a TER between 7% and 42% from the virtual to the real tasks. Simulation training impacted most on procedural error reduction in both studies (32- 42%). The correlation observed between the VR and real-world task performance was r > 0·96 (Study 2).

Conclusions: VR simulation training offers a powerful and effective platform for training safer skills.

Transfer of training (ToT) and transfer effectiveness ratio (TER) of virtual reality (VR) laparoscopic simulation training was assessed in 2 prospective, randomized studies. ToT from VR to a real-world task was demonstrated in both studies and TER with high concordance (r > 0.96) was estimated to be approximately 26–42%.

*School of Medicine, University College Cork, Cork, Ireland

Department of Surgery, Tufts University School of Medicine, Springfield, MA

School of Psychology, Queen's University, Belfast, Northern Ireland, United Kingdom

§School of Psychology, University of Ulster, Derry, Northern Ireland, United Kingdom

School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, Northern Ireland, United Kingdom

Department of Surgery, University of Washington Medical Center, Seattle, WA.

Reprints: Anthony G. Gallagher, PhD, DSc, School of Medicine, Brookfield Health Sciences Complex, College Road, University College Cork, Ireland. E-mail:

Disclosure: The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.