in virtual reality (VR) simulation training by green lighting is a common learning support in simulation-based temporal bone surgical training. However, tutoring
overreliance can negatively affect learning. We therefore wanted to investigate the effects of simulator-integrated tutoring
on performance and learning.
A prospective, educational cohort study of a learning intervention (simulator-integrated tutoring
) during repeated and distributed VR simulation training for directed, self-regulated learning of the mastoidectomy
procedure. Two cohorts of novices (medical students) were recruited: 16 participants were trained using the intervention program (intermittent simulator-integrated tutoring
) and 14 participants constituted a nontutored reference cohort. Outcomes were final-product performance assessed by 2 blinded raters and simulator-recorded metrics.
had a large and positive effect on the final-product performance while turned on (mean difference = 3.8 points, P
< 0.0001). However, this did not translate to a better final-product performance in subsequent nontutored procedures. The tutored cohort had a better metrics-based score, reflecting higher efficiency of drilling (mean difference = 3.6%, P
= 0.001). For the individual metrics, simulator-integrated tutoring
had mixed effects both during procedures and on the tutored cohort in general (learning effect).
by green lighting did not induce a better final-product performance but increased efficiency. The mixed effects on learning could be caused by tutoring
overreliance, resulting from a lack of cognitive engagement when the tutor function is on. Further learning strategies such as feedback should be explored to support novice learning and cognitive engagement.