A systematic review of validation methods for virtual reality simulators

Ali N Bahsoun¹, Michael Mahgerefteh², Alice Lee², Jean Nehme³, Andre Chow³. ¹King’s College London, ²Imperial College London, ³Touch Surgery

Objective: To provide a structured overview on validation methods for surgical simulators as a basis for developing a unified validation process that can be used to establish evidence based training.

Background: In the current literature there are various methods used to assess the validity of surgical simulators. At present, validation is left to the authors’ discretion, as there is no standardised path that can be used by researchers as a framework for investigating the validity of simulators.

Methods: The authors performed a systematic literature review on PubMed to identify articles in the past 10 years that sought to validate a surgical simulator.

Results: A total of 84 articles were identified with 136 validation attempts and 2908 participants. The articles included 69 construct validation studies, 35 face validations, 22 content validations, and nine concurrent validation studies. Only one paper attempted predictive validation. Content of the papers showed little consistency between studies in several areas, including definitions of validation types, categorization of expertise levels, determination of appropriate participant numbers and even statistical tests used.

Conclusions: There is little consensus what on validation methods and even definitions between authors. There is also no guidance or recommendations from policy makers. A clear process needs to be set up for investigating surgical simulators prior to curricular integration.