Use of a Low-Cost Portable 3D Virtual Reality Simulator for Psychomotor Skill Training in Minimally Invasive Surgery: Task Metrics and Score Validity

Abstract

Background: The high cost and low availability of virtual reality simulators in surgical specialty training programs in developing countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery (MIS). Objective: To obtain validity evidence for relations to other variables, internal structure and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in MIS. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality). Methods: In this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability and consequences of testing) for the proposed SIMISGEST-VR tasks. One hundred undergraduate students (referents group), 20 surgical residents and 28 MIS experts took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate and terminal feedback and obtained the task metrics (time and score). From the referents group, 29 undergraduate students were randomly selected to do the tasks six months after the first one in order to determine test-retest reliability. Results: Evidence from multiple sources, including strong intra-rater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train people and teach them basic psychomotor skills in MIS via a new low-cost portable simulator that utilizes interaction technology mediated by gestures. Conclusions: The results obtained provided multiple sources of evidence to validate the SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills in MIS.