Assessing Neurosurgical Psychomotor Performance: Role of Virtual Reality Simulators, Current and Future Potential

Abstract

Training surgeons is a dynamic process which is evolving towards more objective measures of assessing psychomotor technical skills. The current method for assessing neurosurgical trainees' technical skills is the in-training evaluation report (ITER). Despite the wide use of ITER in neurosurgical training programs, multiple authors have criticized its assessment validity. A number of other tools, designed and validated in the last two decades to assess the technical and cognitive skills of surgical procedures, will be discussed. Advances in computer-based technology have created significant opportunities for implementing new neurosurgical training paradigms focusing on improving neurosurgical bimanual psychomotor skill acquisition, better documenting surgical skills assessment and potentially enhancing procedural outcomes. A number of simulators have been developed for training residents involving a variety of neurosurgical purposes, ranging from simple procedures to full preoperative planning simulation. This communication will focus on our recent results utilizing the NeuroTouch virtual reality simulator platform which provides haptic feedback to investigate a series of questions that relate to the concept of surgical expertise.

The force pyramid: a spatial analysis of force application during virtual reality brain tumor resection

“…In previous studies, our group has demonstrated how changes in the visual and tactile characteristics of simulated tumors influence bimanual psychomotor performance. 3,4,6 In the present study, altering the visual and tactile components of tumors resulted in well-defined 3D force pyramid patterns consistent with these results. The appearance of maximum force application crescents in the Q4 and Q3 quadrants was consistent in all tumors assessed, confirming the importance of the ergonomics of hand position during tumor resection.…”

“…The previously described NeuroTouch (now known as NeuroVR) platform was used to conduct this study. [1][2][3][4][5][6][7]10,11,14,16,20,26 Tumor removal was accomplished with a simulated virtual ultrasonic aspirator held in the participant's dominant hand (Fig. 1A).…”

“…20,24,25 A number of publications have reviewed how virtual reality simulators may be used to augment neurosurgical training and resident selection. 3,15,26 Although this study focused on only one metric, the force pyramid, without the ability to use the information that simulators such as NeuroVR can provide to enhance resident operating room performance, their use will be limited. As with any other training and/or assessment tool, rigorous efforts are necessary to provide evidence for validation and effectiveness of a virtual reality system over traditional educational methods.…”

“…rics have been used in a series of studies to demonstrate face, content, and construct validity of the NeuroTouch/ NeuroVR platform. [1][2][3][4][5][6][7]14 The concept of the force pyramid was introduced as one of the Tier 3 metrics with the ability to display and assess the forces applied by any virtual instrument in any tumor region during the resection of 3D tumors. 6 A number of studies have equipped neurosurgery tools with force sensors or used robotic tools to make force measurements.…”

The Virtual Operative Assistant: An explainable artificial intelligence tool for simulation-based training in surgery and medicine

“…[35] Teaching in surgery is largely reliant on the apprenticeship model whereby the knowledge of a skill (know-how) is assumed to be learned through observation and graduated active responsibility in the operating room. [36] Therefore, a significant part of knowledge and skill acquisition also occurs through experiential learning. Trainees are often expected to learn a combination of complex skills to achieve expertise, without a comprehensive understanding of the individual components of holistic surgical competency.…”