Implementation of an interactive virtual-world simulation for structured surgeon assessment of clinical scenarios

A novel simulation technology has emerged through the use of online 3-dimensional virtual worlds in which it is feasible to create virtual patients. This study establishes the face, content and construct validity of online 3-dimensional virtual patients in Second Life (a 3-dimensional virtual world accessible via the Internet).

Sixty-three surgeons of the following grades participated in this study: intern (n = 20); junior resident (n = 15); senior resident (n = 18), and attending (n = 10). All subjects assessed a series of 3 virtual patients (level 1) with different surgical presentations, such as lower gastrointestinal bleeding, acute pancreatitis, and small bowel obstruction. The junior resident group managed an additional 3 cases (level 2) with the same presentation but of increasing complexity. The senior resident and attending groups completed a total of 9 cases (level 1 to 3). The primary outcomes measures were the face and content validity rated on a 7-point Likert scale and a performance score based on a performance rating.

The simulation demonstrated high face and content validity ratings. Eight of 9 cases, with the exception of the level 3 small bowel obstruction, demonstrated significant differences in performance among the user groups (p < 0.01). Additional subset analysis demonstrated that the attending group performed best for performance ratings.

This novel form of simulation demonstrated high face and content validity. Performance assessed in managing a series of virtual patients varies with different levels of surgical training. This simulation can be used to differentiate among these levels and can be implemented as a unique form of assessment.