Medical Students / JMOsNews / Opinion

eMJA – Progress in virtual reality simulators for surgical training and certification


  • There is increasing evidence that educating trainee surgeons by simulation is preferable to traditional operating-room training methods with actual patients. Apart from reducing costs and risks to patients, training by simulation can provide some unique benefits, such as greater control over the training procedure and more easily defined metrics for assessing proficiency.
  • Virtual reality (VR) simulators are now playing an increasing role in surgical training. However, currently available VR simulators lack the fidelity to teach trainees past the novice-to-intermediate skills level. Recent technological developments in other industries using simulation, such as the games and entertainment and aviation industries, suggest that the next generation of VR simulators should be suitable for training, maintenance and certification of advanced surgical skills.
  • To be effective as an advanced surgical training and assessment tool, VR simulation needs to provide adequate and relevant levels of physical realism, case complexity and performance assessment. Proper validation of VR simulators and an increased appreciation of their value by the medical profession are crucial for them to be accepted into surgical training curricula.

The popular board game ‘Operation’ has been a family favourite for years but it seems advances in gaming technology may mean its full potential will be realised in the surgical training sector. Advances here have come off the back of a rapidly developing gaming industry continually striving to provide innovative and realistic gaming designs. The US Military have been the first to use this technology in a practical career-driven sense and now articles such as this one are citing randomised controlled trials demonstrating effectiveness.

The question that should now be asked is what is the potential for such a system of training to detract from the current standard of surgical training. Already new surgical consultants are inexperienced in older more classical surgical operations such as, for example, abdominal laporoscopic (‘key-hole’) surgery that needs to be converted to an ‘open’ operation. Predictions are that carotid endarterectomy surgery will soon only be performed endovascularly (through the blood vessels) as new surgical trainees proficeint in this method lack the skills to perform an open operation. What potential loss of ability could a system such as this introduce to the domain of surgical training.

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I personally feel - note that I have however no actual experience in such things - that a simulator would never be able to offer the level of variability, or diversity, of patients and conditions that traditional surgical training would. It wouldn't offer the same level of responsibility and it wouldn't react in the same unpredictable manner as real patients. Yes, I can see that it would reduce initial risk but in the long term I feel it wouldn't be beneficial. <br />
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I think if it were maintained as a supplement or initial foundation to traditional learning methods then the possibility of it acting as a detractor of knowledge or realistic experience would be lessened.
    I think you're right but simulators would only ever be a supplement to real surgical training. For example, in medical school you learn to take blood or put in a urinary catheter etc on a mannequin so you have some experience for whenever you do it for the first time on a patient. That doesn't mean you're particularly competent the first time but it does give you a little more confidence that you might have had otherwise (I think). These simulators in surgery would be used before a trainee surgeon attempts the operation on a real person but, as has always been done, it wouldn't substitute having assisted with the operation in real life and performing the operation carefully and undersupervision when they finally get the chance. <br />
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    One benefit is that it might be able to make trainees for competent/confident in dealing with things that might go wrong in real life if they've encountered them before during simulation. It might also make it either for different surgical techniques to be taught without people needing to travel the world for specific training.