A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first year surgical residents’ simulation curriculum.

Mostafa H El-Beheiry, BSc, MSc, MD, Greig McCreery, BEsc, MD, Christopher M Schlachta, BSc, MDCM, FRCSC, FACS. CSTAR, London Health Sciences Centre and Department of Surgery, Western University, London, CANADA

INTRODUCTION: The objective of this study was to assess the effect of a serious game skills competition on voluntary usage of the laparoscopic virtual reality simulator among first year surgical residents’ standard simulation curriculum.

METHODS: With approval from the local research ethics board, all first year surgical residents attending the surgical foundations simulation training curriculum, between September 2013 and April 2015, at a university based, residency training program, provided informed consent to be included in this study. The class of 2013-14 served as the control cohort and followed the standard curriculum, which included mandatory use and demonstration of proficiency on a virtual reality laparoscopic trainer, peg transfer task. For the 2014-15 competition cohort, the only change introduced was the biweekly and monthly posting of a leader board consisting of the top three, fastest peg transfer times for the same mandated curriculum from the previous cohort. No additional incentive was given. Entry surveys were administered to both groups assessing attitudes towards simulation-based training and competition. Cohorts were each observed for a 5 month period, concluding with the annual deadline for achieving simulator proficiency.

RESULTS: There were 24 and 25 residents in the control and competition cohorts respectively. There were no differences in demographics. Half of residents in each cohort felt that simulation-based training was useful. The competition cohort overwhelmingly (76%) stated that they were not motivated to deliberate practice by competition. Median total simulator usage time was 140 minutes (IQR = 432) in the competition group compared to 96 (IQR = 189) in the control cohort and the competition cohort completed their course requirements significantly earlier than the control cohort (χ2=6.5, p=0.01). There was a significantly greater proportion of residents continuing to use the simulator voluntarily after completing their course requirements in the competition cohort (44% vs 4%; p=0.002). Residents in the competition cohort were significantly faster than the control group in skill task completion time (181 ± 71 vs 231 ± 54 sec; p=0.02) and significantly improved their completion time by 45 ± 63 sec (paired t-test, p=0.007) from first attempt to best attempt at the task.

CONCLUSION: A simple serious games skills competition increased voluntary usage and performance on a virtual reality laparoscopic simulator, this despite more than half the participants reporting that they are not motivated by a competitive environment. Future directions should endeavor to examine other serious gaming modalities to further engage trainees in simulated skills development.

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