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The Effect of Simulator-Integrated Tutoring for Guidance in Virtual Reality Simulation Training
Steven Arild Wuyts Andersen1, Peter Trier Mikkelsen, Mads Sølvsten Sørensen
1From the Department of Otorhinolaryngology-Head & Neck Surgery (S.A.W., M.S.S.), Rigshospitalet, Copenhagen; The Simulation Centre at Rigshospitalet (S.A.W.), Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark; and The Alexandra Institute (P.T.M.), Aarhus, Denmark.
Introduction:
Simulation-integrated tutoring in virtual reality (VR) simulation training by green lighting is a common learning support in simulation-based temporal bone surgical training. However, tutoring overreliance can negatively affect learning. We therefore wanted to investigate the effects of simulator-integrated tutoring on performance and learning.
Methods:
A prospective, educational cohort study of a learning intervention (simulator-integrated tutoring) during repeated and distributed VR simulation training for directed, self-regulated learning of the mastoidectomy procedure. Two cohorts of novices (medical students) were recruited: 16 participants were trained using the intervention program (intermittent simulator-integrated tutoring) and 14 participants constituted a nontutored reference cohort. Outcomes were final-product performance assessed by 2 blinded raters and simulator-recorded metrics.
Results:
Simulator-integrated tutoring had a large and positive effect on the final-product performance while turned on (mean difference = 3.8 points, P < 0.0001). However, this did not translate to a better final-product performance in subsequent nontutored procedures. The tutored cohort had a better metrics-based score, reflecting higher efficiency of drilling (mean difference = 3.6%, P = 0.001). For the individual metrics, simulator-integrated tutoring had mixed effects both during procedures and on the tutored cohort in general (learning effect).
Conclusions:
Simulator-integrated tutoring by green lighting did not induce a better final-product performance but increased efficiency. The mixed effects on learning could be caused by tutoring overreliance, resulting from a lack of cognitive engagement when the tutor function is on. Further learning strategies such as feedback should be explored to support novice learning and cognitive engagement.
