Abstract
Purpose
Training within a proficiency-based virtual reality (VR) curriculum may reduce errors during real surgical procedures. This study used a scientific methodology to develop a VR training curriculum for phacoemulsification surgery (PS).
Patients and methods
Ten novice-(n) (performed <10 cataract operations), 10 intermediate-(i) (50–200), and 10 experienced-(e) (>500) surgeons were recruited. Construct validity was defined as the ability to differentiate between the three levels of experience, based on the simulator-derived metrics for two abstract modules (four tasks) and three procedural modules (five tasks) on a high-fidelity VR simulator. Proficiency measures were based on the performance of experienced surgeons.
Results
Abstract modules demonstrated a ‘ceiling effect’ with construct validity established between groups (n) and (i) but not between groups (i) and (e)—Forceps 1 (46, 87, and 95; P<0.001). Increasing difficulty of task showed significantly reduced performance in (n) but minimal difference for (i) and (e)—Anti-tremor 4 (0, 51, and 59; P<0.001), Forceps 4 (11, 73, and 94; P<0.001). Procedural modules were found to be construct valid between groups (n) and (i) and between groups (i) and (e)—Lens-cracking (0, 22, and 51; P<0.05) and Phaco-quadrants (16, 53, and 87; P<0.05). This was also the case with Capsulorhexis (0, 19, and 63; P<0.05) with the performance decreasing in the (n) and (i) group but improving in the (e) group (0, 55, and 73; P<0.05) and (0, 48, and 76; P<0.05) as task difficulty increased.
Conclusion
Experienced/intermediate benchmark skill levels are defined allowing the development of a proficiency-based VR training curriculum for PS for novices using a structured scientific methodology.
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Acknowledgements
Emily Turton MSc (Research Assistant) for contributing towards statistical analysis. All running expenses funded privately.
This study has been previously presented at: The European Society of Cataract and Refractive Surgery (ESCRS) Annual Congress, Vienna, Austria on the 20th September 2011 where it was Winner of one of the Best of the Best at the Special Free Paper Session. The United Kingdom and Ireland Society of Cataract and Refractive Surgery (UKISCRS) Annual Congress, Southport, England, 14 October 2011* where it was voted Winner of the Best Cataract Surgery Paper. The study is being piloted at Regional Deanery level with a view to being implemented nationwide by the Royal College of Ophthalmologists as part of the training curriculum for all novice ophthalmic surgeons in the United Kingdom.
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Spiteri, A., Aggarwal, R., Kersey, T. et al. Development of a virtual reality training curriculum for phacoemulsification surgery. Eye 28, 78–84 (2014). https://doi.org/10.1038/eye.2013.211
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DOI: https://doi.org/10.1038/eye.2013.211
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