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Ann Sofia Skou Skou Thomsen, Jens F Kiilgaard, Morten D De La Cour, Lars Konge; Investigating inter-procedural transfer of surgical skills using virtual-reality simulation. Invest. Ophthalmol. Vis. Sci. 2016;57(12):5827.
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© ARVO (1962-2015); The Authors (2016-present)
Inter-procedural transfer of surgical skills may be anticipated for related types of surgery but has never been investigated in ophthalmic surgery. We performed a randomized controlled trial to investigate the effect of cataract surgery ’pre-training’ on vitreoretinal (VR) surgical performance on a virtual-reality simulator (EyeSi™). In order to do so, we first examined the validity evidence of the EyeSi assessment.
Twelve ophthalmic residents (no intraocular surgical experience) were randomized to (1) only VR procedural training (novices) or (2) passing a previously validated test in cataract surgery prior to VR procedural training (cataract trainees). All residents and three experienced VR surgeons repeated the training program (including all VR modules) until flattening of their performance curve. Outcomes were total simulator test score and training time. To investigate the discriminative ability of the assessment, oneway ANOVA analysis (Bonferroni post hoc test) was carried out using first repetition score after allowing familiarization to the simulator. Two-tailed independent samples t-tests on plateau score and training time were calculated to investigate the effect of cataract surgery ‘pre-training’.
We found good inter-module reliability of the performance assessment, Cronbach’s Alpha= 0.73, and a significant discriminatory ability between experienced surgeons and novices (mean difference 226 (71), p=0.023), and experienced surgeons and cataract trainees (301 (71), p=0.003) but not between novices and cataract trainees (74 (58), p=0.667) on first repetition. We found no statistical significant difference in plateau score (805 vs 785, p=0.791) or training time (8.7 vs 10.7 hours, p=0.265) between novices and cataract trainees, respectively.
We found that a test on the EyeSi simulator contains evidence of validity and is a reliable method to assess VR competency in a virtual-reality environment. Unexpectedly, we found no significant transfer effect between two types of intraocular surgery: Cataract surgical ’pre-training’ did not have any effect on VR surgical performance when comparing initial score, plateau score or total training time. The results of this study indicate that we should not anticipate extensive inter-procedural transfer of surgical skills when planning surgical training programs.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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