Article Text

4 A virtual reality fundamentals of arthroscopic surgery training programme improves knee arthroscopy performance
  1. Kalpesh Vaghela,
  2. J Lee,
  3. K Akhtar
  1. Royal London Hospital, UK


Introduction The acquisition of arthroscopic skills can be challenging and often requires years of experiential learning. The Fundamentals of Arthroscopic Surgery Training (FAST) programme was developed to break down arthroscopy into its basic psychomotor tasks and provide a standardised, repeatable and safe method of skills acquisition. The purpose of this study was to determine whether a virtual reality (VR) FAST programme can improve performance in simulated knee arthroscopy using simulator metrics and validated global rating scales as outcome measures.

Methods 60 participants including experts(orthopaedic consultants n = 10), intermediates (orthopaedic registrars n = 30) and novices (medical students n = 20) completed an diagnostic knee arthroscopy on a VR simulator. All participants then completed 21 FAST modules including camera manipulation and instrumented bimanual dexterity tasks. All participants repeated the diagnostic knee arthroscopy. The pre and post FAST diagnostic knee arthroscopies were recorded anonymously using dual camera feeds from the simulator display and the participants hand movements. The recordings were assessed using the Arthroscopic Surgical Skills Evaluation Tool (ASSET) global rating scale by two independent consultant arthroscopic surgeons. Simulator metrics including time to completion (seconds) and economy of camera movement (path length in centimetres) were used to assess transfer validity.

Results Novice participants demonstrated a statistically significant improvement in performance in diagnostic knee arthroscopy following completion of the VR FAST programme in terms of their mean ASSET pre:post score 12:26 (P < 0.01). Simulator metrics also significantly improved in terms of mean time taken pre:post 465:260 seconds (P < 0.01) and mean economy of camera movement pre/post 210:115 centimetres (P < 0.01). There was no statistically significant difference in ASSET scores between the two expert raters, thus demonstrating a high inter-rater reliability(P = 0.95).

Conclusion This study demonstrates that a VR FAST programme is able to improve novice and intermediates diagnostic knee arthroscopy performance which suggests it is most effective at the early stage of acquisition of arthroscopic surgical skills.

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