Use of a Virtual Reality Simulator for Tendon Repair Training: Randomized Controlled Trial

Abstract

Background Virtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality. Objective The aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field. Methods In this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the “Kessler tendon repair with 2 interrupted tendon repair knots” (KS) method and the “Bunnell tendon repair with figure 8 tendon repair” (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale. Results Of the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001). Conclusions Our study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice. Trial Registration Chinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180

A combined hypoxia and immune gene signature for predicting survival and risk stratification in triple-negative breast cancer

“…Accumulating evidence suggested that patients with PD-L1 expression in tumor cells and stromal immune cells are more likely to respond to chemotherapy and immunotherapy and exhibit better prognosis [9,[45][46][47]. Previous study showed that hypoxia could induce high expression of PD-L1 on MDSCs and macrophages in tumor microenvironment, then suppresses the immune system to evade immune attack [48][49][50]. In our study, the expression of immune checkpoint markers was notably decreased in the high-risk group, which meant that the hypoxia-immune status in tumor microenvironment may affect the response to the immune checkpoint inhibitors (ICIs) therapy.…”

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice

“…Despite the diversification of virtual simulators/platforms/systems used in undergraduate medical education, we found that 48 (52%) studies ( 18 , 22 , 23 , 27 – 31 , 33 – 35 , 37 – 39 , 42 , 44 – 48 , 50 , 52 , 54 , 57 – 67 , 71 , 72 , 75 , 78 , 81 – 84 , 93 , 96 , 99 , 101 , 103 , 105 ) reported the immersive VR application, which is characterized by the use of VR equipment consisting of head-mounted displays (headsets or goggles) and/or hand controllers. This finding suggested that VR might be a typical and popular representative of modern VS technology used in medical education.…”

“…From the 92 published studies, VS was reported to be applied in the educational practice involving undergraduate medical students across 25 countries including the United States [26 studies ( 15 – 40 )], the United Kingdom [9 studies ( 41 – 49 )], Germany [7 studies ( 50 – 56 )], China [6 studies ( 10 , 57 – 61 )], Denmark [6 studies ( 62 – 67 )], France [4 studies ( 68 – 71 )], Japan [4 studies ( 72 – 75 )], Sweden [3 studies ( 76 – 78 )], Canada [3 studies ( 79 – 81 )], Netherlands [3 studies ( 82 – 84 )], Spain [3 studies ( 85 – 87 )], Australia [2 studies ( 88 , 89 )], Singapore [2 studies ( 90 , 91 )], Korea [2 studies ( 92 , 93 )], Finland [1 study ( 94 )], Italy [1 study ( 95 )], Ireland [1 study ( 96 )], Colombia [1 study ( 97 )], Pakistan [1 study ( 98 )], Thailand [1 study ( 99 )], Iran [1 study ( 100 )], Poland [1 study ( 101 )], Mexico [1 study ( 102 )], Norway [1 study ( 103 )], Saudi Arabia [1 study ( 104 )], and Switzerland [1 study ( 105 )]. The distribution of included studies among different continents was shown in Figure 1 .…”

“…Of the included 92 papers, 38% (35 paper) reported the integration of VS in surgical training for medical undergraduates, among which 12 studies focused on the instructional application of virtual endoscopic [including laparoscopic ( 31 , 36 , 37 , 56 , 73 , 76 , 78 , 98 ), arthroscopic ( 26 , 47 , 48 ), and otoscopic ( 53 )] simulators; 7 studies were for learning procedures or concepts of orthopedic and bone surgery ( 32 , 33 , 35 , 45 , 57 , 66 , 70 ); 5 studies were based on VS system or platform as a primary mode of teaching neurosurgical procedures, neuroanatomy and pathologies ( 22 , 28 , 71 , 80 , 81 ); 4 papers ( 38 , 61 , 75 , 84 ) reported the exposure of medical undergraduates as novice surgeons to the robotic surgery simulators; 2 studies conducted by the same team ( 64 , 65 ) explored the VR simulation-based training in Cochlear Implant surgery; the other 2 were for learning basic motor skills in liver surgery ( 50 , 52 ); 1 in minimally invasive surgery ( 97 ), and 1 in vitreoretinal surgery ( 67 ). In addition, Fukuta et al ( 46 ) generated a virtual operating theater orientation to improve knowledge and confidence of medical undergraduates.…”

“…Currently, due to the excessive rapid change of VS technology, there are no standardized or well described VS design approaches ( 13 ). Continued back-and-forth collaboration among educators, clinicians and engineers in design and development teams is critical to advancing the establishment and implementation of VS-integrated undergraduate medical training ( 57 ). It had been estimated that at least 1 year need to be spent to achieve an acceptable VR simulator for medical undergraduates ( 57 ).…”