Validation of virtual reality temporal bone simulators in otolaryngology training

© 2010 Dr. Yi Chen ZhaoBackground: The training of surgeons is a critically important issue for the health care system. While the traditional method of surgical training continues to serve the health care system well, there are many forces both within surgery and in society that are seeking to improve the training of surgeons of the future. Virtual reality simulations have played a major part in the training of the airline industry and the military but its use in otology surgical training has not been fully elucidated. This thesis aims to investigate the role of virtual reality simulation in temporal bone surgical training by testing i) its construct validity, ii) the transferability of skills, iii) to develop an “intelligent” tutor in the virtual reality simulation and iv) to compare self-directed virtual reality simulation training to traditional teaching methods on the performance of cadaver temporal bone dissection. Results: It was found that the University of Melbourne virtual reality temporal bone simulator had construct validity and was able to differentiate not only between experts and novices participants but also intermediate residents. Using it as a teaching tool by a senior otologist it was demonstrated that participants perform better in cadaver temporal bone dissection compared with traditional teaching methods in a randomized control trial. Finally, it was found that the simulator could be used as an “intelligent tutor” independent of expert supervision to teach novice trainees the fundamentals of temporal bone surgery. Once again in a randomized control trial, it was found that training on the VR simulator improved cadaveric temporal bone dissection compared with traditional teaching methods. Conclusion: Virtual reality temporal bone simulators could have a significant role in the education of temporal bone dissection. It’s most significant contribution would be towards novice surgical training by allowing early education to occur on a virtual reality simulator independent of consultant supervision. This would provide a more efficient use of the precious educational resources of cadaver temporal bone as well as time needed from consultant surgeons to teach and supervise junior trainees. While there are queries regarding the fidelity of the virtual reality simulation environment, it is important to remember that appropriate fidelity for the designed task is more important than absolute comparison to reality. In this regard the current virtual reality temporal bone simulator has sufficient realism to teach novice trainees the fundamental basic of temporal bone dissection. Future research direction would focus on determining the transfer of skills and knowledge from the virtual reality simulator to operating room performance as well as broadening the use of the virtual reality simulator to other areas such as technical skills assessment and surgical rehearsal