Feedback from Human Instructors Is Superior to Guidance by a Virtual Reality Simulator When Learning Flexible...

Area of Science:

• Medical Simulation
• Respiratory Medicine
• Medical Education

Background:

• Virtual reality (VR) simulators offer potential for bronchoscopy training with live feedback.
• The efficacy of VR guidance compared to expert guidance in simulation-based bronchoscopy is under investigation.

Purpose of the Study:

• To determine if virtual reality (VR) simulator guidance is superior to expert instructor guidance for novice bronchoscopy trainees.
• To compare the effectiveness of VR guidance, tutor guidance, and no guidance on learning bronchoscopy skills.

Main Methods:

• A randomized controlled trial involving 36 residents using the EndoSim simulator.
• Trainees were assigned to VR guidance, tutor guidance, or control groups for 12 practice sessions.
• Evaluations included Structured Progress (SP), Diagnostic Completeness (DC), procedure time (PT), and NASA-TLX index.

Main Results:

• All groups improved SP, DC, PT, and NASA-TLX over 12 sessions, with sustained performance weeks later.
• Tutor guidance significantly improved novices' SP compared to both VR guidance (P=.026) and the control group (P=.017).
• VR guidance did not show a significant advantage over the control group (P=1.00).

Conclusions:

• Human expert (tutor) guidance is superior to VR guidance and no guidance for improving bronchoscopy skills in novices.
• Structured Progress (SP) is a more sensitive metric for assessing bronchoscopic navigational skills than Diagnostic Completeness (DC).
• Tutor feedback enhances bronchoscopy quality and trainee performance more effectively than current VR guidance methods.