Simulation-based education for endoscopic third ventriculostomy: A comparison between virtual and physical training models

BACKGROUND: The relative educational benefits of virtual reality (VR) and physical simulation models for endoscopic third ventriculostomy (ETV) have not been evaluated "head to head." OBJECTIVE: To compare and identify the relative utility of a physical and VR ETV simulation model for use in neurosurgical training. METHODS: Twenty-three neurosurgical residents and 3 fellows performed an ETV on both a physical and VR simulation model. Trainees rated the models using 5-point Likert scales evaluating the domains of anatomy, instrument handling, procedural content, and the overall fidelity of the simulation. Paired t tests were performed for each domain's mean overall score and individual items. RESULTS: The VR model has relative benefits compared with the physical model with respect to realistic representation of intraventricular anatomy at the foramen of Monro (4.5, standard deviation [SD] = 0.7 vs 4.1, SD = 0.6; P =.04) and the third ventricle floor (4.4, SD=0.6 vs 4.0, SD=0.9; P=.03), although the overall anatomy score was similar (4.2, SD = 0.6 vs 4.0, SD = 0.6; P =.11). For overall instrument handling and procedural content, the physical simulator outperformed the VR model (3.7, SD = 0.8 vs 4.5; SD = 0.5, P <.001 and 3.9; SD = 0.8 vs 4.2, SD = 0.6; P =.02, respectively). Overall task fidelity across the 2 simulators was not perceived as significantly different. CONCLUSION: Simulation model selection should be based on educational objectives. Training focused on learning anatomy or decision-making for anatomic cuesmay be aided with the VR simulationmodel. A focus on developing manual dexterity and technical skills using endoscopic equipment in the operating room may be better learned on the physical simulation model.