A Randomized Controlled Trial to Assess If Deliberate Practice on a Virtual Reality Simulator Can Achieve ‘Expert’ Surgical Performance

Daniel A Hashimoto, BA, Laura Beyer-Berjot, MD, Pramudith Sirimanna, MBBS, K. Anders Ericsson, PhD, Noel N Williams, MBBCh, FRCSI, Ara Darzi, KBE, PC, MD, FRCS, FACS, Rajesh Aggarwal, MD, MA, PhD, FRCS

Imperial College London, Perelman School of Medicine University of Pennsylvania, Florida State University

This study investigated whether deliberate practice (DP) leads to an increase in consistency of performance in virtual reality (VR) laparoscopic cholecystectomies (LC). Previous research has suggested that engaging in sustained DP – i.e. deliberately engaging in activities that improve and maintain high performance – is effective in surgical training.

Fifteen junior residents were randomized into deliberate practice (n=8) or control training (n=7). Both groups performed 10 sessions of two VR LCs (total of 20 VR LCs for each subject). For each session, the DP group was assigned 30 minutes of DP activities in between LCs while the control group viewed educational videos or read journal articles. Performance was assessed on speed and dexterity; quality was rated with global and procedure-specific rating scales. Performance between groups was compared using Mann-Whitney U test and within groups via Wilcoxon signed rank test. Consistency was compared using Levene’s test. Alpha was set to 0.05.

Groups were equivalent in speed, dexterity, and quality of performance at baseline. After 20 LCs, there were no differences in speed or dexterity; however, the DP group had significantly higher ratings for quality of surgical performance in both global (p=0.001) and procedure-specific rating scales (p=0.001). Both groups improved over 20 VR LCs in time (Control p=0.028; DP p=0.012), dexterity (Control p=0.018; DP p=0.012), and global rating scales (Control p=0.018; DP p=0.012). However, control group did not improve in procedure-specific rating scale over time (p=0.79) while DP group did (p=0.012). There was no significant difference in variance of the metrics between the groups across 20 LCs.

This study suggests DP leads to improvement in VR LC performance over multiple sessions and results in higher quality performance than standard training alone. Consistency of performance did not vary between DP and standard training; however, additional DP sessions may lead to improved, more consistent performance as suggested in sports and music training literature.

Session: Poster Presentation

Program Number: P137

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