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Comparison of the Efficacy and Efficiency of the Use of Virtual Reality Simulation With High-Fidelity Mannequins for Simulation-Based Training of Fiberoptic Bronchoscope Manipulation

Jiang, Bailin, MD; Ju, Hui, MD; Zhao, Ying, MD; Yao, Lan, MD; Feng, Yi, MD

doi: 10.1097/SIH.0000000000000299
Empirical Investigations

Introduction This study compared the efficacy and efficiency of virtual reality simulation (VRS) with high-fidelity mannequin in the simulation-based training of fiberoptic bronchoscope manipulation in novices.

Methods Forty-six anesthesia residents with no experience in fiberoptic intubation were divided into two groups: VRS (group VRS) and mannequin (group M). After a standard didactic teaching session, group VRS trained 25 times on VRS, whereas group M performed the same process on a mannequin. After training, participants' performance was assessed on a mannequin five consecutive times. Procedure times during training were recorded as pooled data to construct learning curves. Procedure time and global rating scale scores of manipulation ability were compared between groups, as well as changes in participants' confidence after training.

Results Plateaus in the learning curves were achieved after 19 (95% confidence interval = 15–26) practice sessions in group VRS and 24 (95% confidence interval = 20–32) in group M. There was no significant difference in procedure time [13.7 (6.6) vs. 11.9 (4.1) seconds, t′ = 1.101, P = 0.278] or global rating scale [3.9 (0.4) vs. 3.8 (0.4), t = 0.791, P = 0.433] between groups. Participants' confidence increased after training [group VRS: 1.8 (0.7) vs. 3.9 (0.8), t = 8.321, P < 0.001; group M = 2.0 (0.7) vs. 4.0 (0.6), t = 13.948, P < 0.001] but did not differ significantly between groups.

Conclusions Virtual reality simulation is more efficient than mannequin in simulation-based training of flexible fiberoptic manipulation in novices, but similar effects can be achieved in both modalities after adequate training.

From the Department of Anesthesiology (B.J., H.J., Y.Z., Y.F.), Peking University People's Hospital; and Peking University International Hospital (L.Y.), Beijing, China.

Reprints: Hui Ju, MD, Department of Anesthesiology, Peking University People's Hospital, 11 Xizhimen S St, Beijing, 100044, China (e-mail:

The authors declare no conflict of interests.

The work should be attributed to the Department of Anesthesiology, Peking University People's Hospital, Beijing, China. This work was supported by the Education Reform Fund of Peking University People's Hospital [Grant Numbers 2014(RD-Edu-201419), 2016(RD-Edu-201606)] and the Education and Teaching Fund of Peking University Health Science Center in 2014.

© 2018 Society for Simulation in Healthcare