Design and validation of a virtual reality trainer for ultrasound‐guided regional anaesthesia

Abstract

Virtual reality is a form of high-fidelity simulation that may be used to enhance the quality of medical education. We created a bespoke virtual reality trainer software using high resolution motion capture and ultrasound imagery to teach cognitive-motor needling skills necessary for the performance of ultrasound-guided regional anaesthesia. The primary objective of this study was to determine the construct validity between novice and experienced regional anaesthetists. Secondary objectives were: to create learning curves for needling performance; compare the virtual environment immersion with other high-fidelity virtual reality software; and compare cognitive task loads imposed by the virtual trainer compared with real-life medical procedures. We recruited 21 novice and 15 experienced participants, each of whom performed 40 needling attempts on four different virtual nerve targets. Performance scores for each attempt were calculated based on measured metrics (needle angulation, withdrawals, time taken) and compared between the groups. The degree of virtual reality immersion was measured using the Presence Questionnaire, and cognitive burden was measured using the NASA-Task Load Index. Scores by experienced participants were significantly higher than novices (p = 0.002) and for each nerve target (84% vs. 77%, p = 0.002; 86% vs. 79%, p = 0.003; 87% vs. 81%, p = 0.002; 87% vs. 80%, p = 0.003). Log-log transformed learning curves demonstrated individual variability in performance over time. The virtual reality trainer was rated as being comparably immersive to other high-fidelity virtual reality software in the realism, possibility to act and quality of interface subscales (all p > 0.06) but not in the possibility to examine and self-performance subscales (all p < 0.009). The virtual reality trainer created workloads similar to those reported in real-life procedural medicine (p = 0.53). This study achieved initial validation of our new virtual reality trainer and allows progression to a planned definitive trial that will compare the effectiveness of virtual reality training on real-life regional anaesthesia performance.

Research priorities in regional anaesthesia: an international Delphi study

“… 40 , 41 , 42 In addition, whilst augmented and virtual reality technologies offer the chance to support, improve, and reform traditional education and training in regional anaesthesia, more evidence is required to establish the potential role of these emerging tools. 32 , 42 , 43 , 44 …”

Envisioning gamification in anesthesia, pain management, and critical care: basic principles, integration of artificial intelligence, and simulation strategies

“…AI-based immersive technologies can be adopted for all these aims. For instance, Chuan et al [ 42 ] developed a custom VR training software utilizing advanced motion capture and ultrasound imagery at high resolution. Their software was designed to impart the cognitive-motor needling skills required for proficiently executing UGRA procedures.…”

Regional anaesthesia training in the UK – a national survey

“…However, despite the potential paradigm shift in training accompanying the introduction of new technologies such as artificial intelligence-assisted nerve recognition and noninvasive simulation and assessment equipment, there is currently little information on the delivery of regional anaesthesia training in the UK and the nature and number of blocks being undertaken by trainees. 8 , 9 , 10 , 11 Whether the 2021 RCoA curriculum objectives are being met, or are likely to be met in the future, is unknown.…”