Face and construct validation of a next generation virtual reality (Gen2-VR©) surgical simulator

Abstract

Introduction Surgical performance is affected by distractors and interruptions to surgical workflow that exist in the operating room. However, traditional surgical simulators are used to train surgeons in a skills lab that does not recreate these conditions. To overcome this limitation, we have developed a novel, immersive virtual reality (Gen2-VR©) system to train surgeons in these environments. This study was to establish face and construct validity of our system. Methods and Procedures The study was a within-subjects design, with subjects repeating a virtual peg transfer task under three different conditions: CASE I: traditional VR; CASE II: Gen2-VR© with no distractions and CASE III: Gen2-VR© with distractions and interruptions.. In Case III, to simulate the effects of distractions and interruptions, music was played intermittently, the camera lens was fogged for 10 seconds and tools malfunctioned for 15 seconds at random points in time during the simulation. At the completion of the study subjects filled in a 5-point Likert scale feedback questionnaire. A total of sixteen subjects participated in this study. Results Friedman test showed significant difference in scores between the three conditions (p < 0.0001). Post hoc analysis using Wilcoxon Signed Rank tests with Bonferroni correction further showed that all the three conditions were significantly different from each other (Case I, Case II, p < 0.001), (Case I, Case III, p < 0.001) and (Case II, Case III, p = 0.009). Subjects rated that fog (mean= 4.18) and tool malfunction (median = 4.56) significantly hindered their performance. Conclusion The results showed that Gen2-VR© simulator has both face and construct validity and it can accurately and realistically present distractions and interruptions in a simulated OR, in spite of limitations of the current HMD hardware technology.

Virtual Reality Simulation in Nontechnical Skills Training for Healthcare Professionals

“…Regarding sample size, the average number of participants was 39.69 (min = 10, max = 148, SD= 37.33). Looking more closely at their study design, 17 studies used an experimental design (pre-test/post-test, group comparisons or control/test group comparisons) (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) , nine were observational studies (18)(19)(20)(45)(46)(47)(48)(49)(50) , and one was based on qualitative interviews (51) .…”

“…Most of the studies include a range of professions: nurses feature in eight articles (19,20,32,37,38,40,48,49) , surgeons (33,35,38,39,43,45,46) in seven, and five articles mention other professionals (18,19,32,37,38) . With regard to students, 12 articles involve residents or postgraduate trainees (18,33,35,36,(38)(39)(40)42,(44)(45)(46)48) , ten concern health students regardless of their level or specialty (30,31,39,41,(44)(45)(46)(47)50,51) , and three articles mention trainees (29,34,38) .…”

“…In the studies selected for review, two technologies are equally represented: Screenbased VR simulators in 12 studies (29,30,33,34,36,(38)(39)(40)42,43,48,49) and virtual worlds in 12 articles (18)(19)(20)31,32,35,37,41,44,47,50,51) . Immersive virtual worlds are less common, as they are found in only three studies (39,45,46) .…”

A Framework for the Testing and Validation of Simulated Environments in Experimentation and Training

“…Collecting participant feedback regarding face validity is a commonly used approach in the field of surgical simulation. In this context, the opinions of expert surgeons are often sought about how the simulation looks and feels and is an important part of simulation validation (Sankaranarayanan et al, 2016;Roberts et al, 2017). A similar approach is also used in the development and testing of aircraft simulations with expert pilots (Perfect et al, 2014).…”

Designing the user interface of a virtual needle insertion trainer

“…Moreover, observation of experts during the task analysis showed that they usually keep the same head position when manipulating the needle. Finally, a recent study has shown that head tracking can disturb the users when performing a surgical task on a virtual simulator [29]. This led to the design decision to setup a fixed point of view for the user, i.e.…”