Role of Virtual Reality Simulation in Teaching and Assessing Technical Skills in Endovascular Intervention

doi:10.1016/j.jvir.2009.09.019

Journal of Vascular and Interventional Radiology

Volume 21, Issue 1, January 2010, Pages 55-66

https://doi.org/10.1016/j.jvir.2009.09.019 Get rights and content

Training in endovascular intervention ultimately aims to produce interventionalists who demonstrate competence in technical skills. Herein, the authors investigate the rationale for simulation-based training by providing an overview of the psychological theories underpinning acquisition of technical skills, training and assessment history, recent advances in simulation technology, and a critical appraisal of their role in training and assessment in endovascular intervention. Simulators have potential for training and assessment and promise solution to many shortcomings of traditional ‘apprenticeship’ training models. Before inclusion into the curriculum, further work is needed regarding fidelity, validity, reliability, and design of simulators to ensure accurate transfer of acquired endovascular skills from simulator to patient.

Section snippets

Psychological Basis of Skill Acquisition

Technical proficiency has been considered to be one of the most important skills of an interventionalist (4). Various theories of cognitive motor learning to enable skill acquisition have been described in the literature, including Kopta's theory, Schmidt's schema theory, the cognitive apprenticeship model, and Ericsson's rationale for the acquisition of expertise (5).

Kopta's theory highlights the importance of observation followed by practice. It involves three phases of acquisition of motor

History of Training and Assessment of Technical Skills in Craft Specialities

When considering the history of methods of medical training and assessment of technical skills in craft specialties such as endovascular intervention, authors begin with Sushutra from ancient India and Halstead from the early 19th century (10, 11), who described the concept of clinical training based on the practice of inanimate objects—the so-called “see one, do one, teach one approach.” Today, Sacks (12) eloquently describes the vision for simulators as “practice a whole bunch on a simulator

Role of Simulation in Skills Training

Simulators are instruments that reproduce, under artificial conditions, components of clinical tasks that are likely to occur under normal circumstances (40). Simulation, originally developed in aviation, allows training and practice of complex procedures to a proved proficiency before performance at the workplace. With further advances in simulation technology, simulation is likely to shift training away from patients to a low-risk environment (41). Currently, there is an increasing trend

Transferability of Skills From VR Models to Real Patients

Transferability of endovascular skills acquired from VR to animals and human patients has been demonstrated by various authors. Transfer of skills to a pig model from VIST has been shown by Berry et al (51) using the observational parameters (global assessment by an assessor) of assessment. Chaer et al (37) performed a randomized trial examining transfer of VR endovascular training (iliofemoral angioplasty) to the human model. In that study, training (VR and didactic) compared with the control

Assessment of Technical Skills

Assessment can be defined as the process of documenting, usually in measurable terms, knowledge, skills, attitudes, and beliefs (59). In 1990, psychologist George Miller proposed a pyramidal framework for the assessment of clinical competence. At the bottom of the pyramid is knowledge (“knows”), followed by competence (“knows how”), performance (“shows how”), and action (“does”). “Action” in this pyramid focuses on what happens in real life (60). The target of assessment in healthcare is this

Discussion

Training effectiveness of simulators requires validity of the content for all possible procedural steps and that these are replicated with suitable fidelity (realism) and in an environment with appropriate face validity. For simulation-based assessment, steps that are considered crucial for the safe completion of the target procedure must be present (a part of face and content validation) and must also be correctly assessed with a weighting as to their critical nature. To date, no ideal tool

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: None of the authors have identified a conflict of interest.

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Review articleRole of Virtual Reality Simulation in Teaching and Assessing Technical Skills in Endovascular Intervention

Section snippets

Psychological Basis of Skill Acquisition

History of Training and Assessment of Technical Skills in Craft Specialities

Role of Simulation in Skills Training

Transferability of Skills From VR Models to Real Patients

Assessment of Technical Skills

Discussion

Am J Surg

J Surg Res

Lancet

Nat Clin Pract Urol

J Vasc Interv Radiol

J Vasc Surg

J Vasc Surg

Appl Ergon

J Vasc Interv Radiol

J Vasc Surg

J Vasc Interv Radiol

J Vasc Surg

J Vasc Interv Radiol

J Vasc Interv Radiol

Eur J Vasc Endovasc Surg

J Vasc Surg

Am J Surg

J Vasc Surg

J Am Coll Cardiol

J Vasc Surg

Eur J Vasc Endovasc Surg

J Am Coll Surg

J Vasc Interv Radiol

J Vasc Surg

J Vasc Interv Radiol

Am J Surg

J Vasc Interv Radiol

J Vasc Interv Radiol

J Vasc Interv Radiol

New surgical procedures: can our patients benefit while we learn?

Am J Obstet Gynecol

The development of motor skills in orthopaedic education

Clin Orthop Relat Res

A schema theory of discrete motor skill learning

Psychol Rev

Cognitive apprenticeship: teaching the crafts of reading, writing, and mathematics

The acquisition of expert performance: an introduction to some of the issues

The training of the surgeon

Bull Johns Hopkins Hosp

The Far East

Ventilatory efficacy of mouth-to-mouth artificial respiration; airway obstruction during manual and mouth-to-mouth artificial respiration

J Am Med Assoc

A computer-controlled patient simulator

JAMA

Virtual reality permanent pacing: validation of a novel computerized permanent pacemaker implantation simulator

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Regulations relating to the examinations for the diploma of fellow

Quarterly council, 1946

The ADA chalk carving test

J Dent Educ

The selection of dental studentsa pilot study of an assessment of potential manula ability by psychometric tests

Br Dent J

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Review article
Role of Virtual Reality Simulation in Teaching and Assessing Technical Skills in Endovascular Intervention