Comparison of Three Virtual Reality Arthroscopic Simulators as Part of an Orthopedic Residency Educational Curriculum

Orthopedic education continues to move towards evidence-based curriculum in order to comply with new residency accreditation mandates. There are currently three high fidelity arthroscopic virtual reality (VR) simulators available, each with multiple instructional modules and simulated arthroscopic procedures. The aim of the current study is to assess face validity, defined as the degree to which a procedure appears effective in terms of its stated aims, of three available VR simulators.

Thirty subjects were recruited from a single orthopedic residency training program. Each subject completed one training session on each of the three leading VR arthroscopic simulators (ARTHRO mentor-Symbionix, ArthroS-Virtamed, and ArthroSim-Toltech). Each arthroscopic session involved simulator-specific modules. After training sessions, subjects completed a previously validated simulator questionnaire for face validity.

The median external appearances for the ARTHRO Mentor (9.3, range 6.7-10.0; p=0.0036) and ArthroS (9.3, range 7.3-10.0; p=0.0003) were statistically higher than for Arthro- Sim (6.7, range 3.3-9.7). There was no statistical difference in intraarticular appearance, instrument appearance, or user friendliness between the three groups. Most simulators reached an appropriate level of proportion of sufficient scores for each categor y (≥70%), except for ARTHRO Mentor (intraarticular appearance-50%; instrument appearance- 61.1%) and ArthroSim (external appearance- 50%; user friendliness-68.8%).

These results demonstrate that ArthroS has the highest overall face validity of the three current arthroscopic VR simulators. However, only external appearance for ArthroS reached statistical significance when compared to the other simulators. Additionally, each simulator had satisfactory intraarticular quality. This study helps further the understanding of VR simulation and necessary features for accurate arthroscopic representation. This data also provides objective data for educators when selecting equipment that will best facilitate residency training.