Immersive Mixed Reality Training Enhances Pedicle Screw Placement Skills in Undergraduate Medical Students: A Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND Amidst a growing need for improved surgical training, the conventional "see one, do one, teach one" model falls short, particularly for complex procedures like pedicle screw placement. This study introduces an Immersive Mixed Reality Training Framework (IMR-STF) designed to bridge this gap by integrating advanced mixed reality technologies with traditional surgical training to provide comprehensive, hands-on experience without the logistical constraints and ethical concerns of traditional methods. OBJECTIVE With the increasing constraints in surgical training, this study aimed to propose a novel Immersive Mixed Reality Surgical Training Framework(IMR-STF) to facilitate surgical skill development among medical students and evaluate its efficacy. Under IMR-STF, the authors developed the Immersive Mixed Reality Surgical Self-Training System(IMR-SS) for pedicle screw placement, seeking to overcome the limitations of traditional training by providing an immersive, interactive, and high-fidelity training environment METHODS A conceptual Immersive Mixed Reality Surgical Training Framework (IMR-STF) was proposed, under which a self-training system was prototyped as IMR-SS for pedicle screw placement for validation. The system integrates 3D-printed models, real surgical instruments, and IMR technology to provide an immersive learning experience and high-fidelity haptic feedback. A randomized controlled trial was conducted with 32 undergraduate medical students from two centers. Participants were randomly assigned to either the IMR Group(using IMR-SS) or the Control Group (using a digital textbook). Both groups underwent theoretical and practical training, followed by identical assessments. RESULTS The IMR Group demonstrated significantly higher completion rates (0.99±0.02 vs. 0.87±0.11, p=0.000) and fewer errors(0.06±0.25 vs. 2.13±1.54, p=0.000) compared to the Control Group. Additionally, the IMR Group showed better performance in screw placement angles(13.88°±6.98° vs. 20.89°±11.59°, p=0.049) and more stable performance with smaller variances. No cortical bone breaches were observed in the IMR Group, while the Control Group had breaches in 4 out of 16 cases during the exercise session (p=0.051). The theoretical assessment showed no significant difference between the groups, indicating equivalent baseline knowledge. The IMR Group reported higher satisfaction and confidence in learning outcomes. CONCLUSIONS The IMR-SS is a feasible and effective method for enhancing surgical education for novice medical students, providing superior hands-on training experiences, and improving practical skills. Future research should focus on long-term learning curve validation, skill transferability, and developing curricula for more surgeries for generalizability validation. CLINICALTRIAL This study was deemed exempt by the Peking Union Medical College Hospital(K5533-K24C0630) and The First Affiliated Hospital of Xi'an Jiaotong University(XJTU1AF2024LSYY-097).