Article Text

0202 Insight Into Performance On Virtual Reality Simulation Of Dynamic Hip Screw Fixation
  1. Kapil Sugand,
  2. Kash Akhtar,
  3. Chetan Khatri,
  4. Chinmay Gupte
  1. MSk Lab, Imperial College, London, UK


Introduction Orthopaedic training comprises of unstandardised subjective feedback. Trainees rely on personal reflection and self-assessment to gauge performance and to improve future practice. An objective and standardised means of measuring performance metrics to achieve competency is required.

Objectives To correlate the accuracy of subjective self-assessment of performance against clinially pertinent objective metrics on a virtual reality (VR) haptic DHS fixation simulator.

Methods 52 medical students (naïve to DHS procedures and VR simulation) were recruited and randomised to two groups. Group 1 (training) performed 5 attempts whilst Group 2 (control) performed only once. After a week, both cohorts repeated the same number of attempts as the week before. Objective measurements for total procedural time (seconds), TAD (mm) and automated global score (out of 39 weighted on 17 objective performance metrics) were recorded. Post-procedure participants were asked to subjectively rate how they performed using a seven-point Likert scale. The mean score (with standard deviation), Mann-Whitney U-test to determine significance (p < 0.05) and Pearson correlation coefficient (r2) were calculated between metrics.

Results Group 1 outperformed Group 2 in total procedural time by 68% (p < 0.001), reduced tip-apex distance (TAD) by 41% (p < 0.001) and improved global score 63% (p < 0.001). Group 1 identified that they performed better than Group 2 (p = 0.001). However, no substantial correlation was found between self-reported performance (r2 = 0.28).

Conclusions Although participants correctly recognised an improvement in self-performance, they could not do so accurately against validated objective metrics including total procedural time, TAD and global score. Hence, the VR haptic DHS simulator has demonstrated its significance in objectively measuring validated metrics as part of the formal assessment which ought to be implemented within formal training programmes. Feedback from VR simulator, in conjunction with validated VR global rating scores, has the potential to standardise formal performance feedback for the very first time in orthopaedics.


  1. Blyth P, Anderson IA, Stott NS. Virtual reality simulators in orthopedic surgery: what do the surgeons think? J Surg Res 2006;131(1):133–9; discussion 140–2

  2. Froelich JM, Milbrandt JC, Novicoff WM, et al. Surgical simulators and hip fractures: a role in residency training? J Surg Educ 2011;68(4):298–302

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.