A Randomized Controlled Study On The Effect Of Virtual Reality And Box Trainer Simulation Training On The Improvement Of Basic Laparoscopic Skills Of Medical Undergraduates

Objective By establishing a structured training curriculum,the effects of virtual reality(VR)simulation training and training box(BT)simulation training on the improvement of basic skills of medical undergraduates in laparoscopy were compared.Methods Select the fifth-year undergraduates who have not entered the production practice in the clinical medicine major of Inner Mongolia Medical University,fill in the questionnaire(surgical operation,laparoscopic operation experience,dominant hand,etc.)There were 20 male and 20 female trainees in each hand,and they were equally divided into the VR group and the BT group according to the random number table method.Before the training,the two groups of trainees were tested for their skill level(passing training,knotting training).Both groups completed a 7-day similar laparoscopic basic skills training course(including 8 tasks including position training,collar training,gripping and moving training,ligation ring training,scissors training,and knotting training).Record the completion time of each task and compare the improvement of each basic skill in the group.Three identical tasks were selected between the two groups,and the percentages of improvement before and after training were compared.A learning curve was plotted against the total time to complete the 8 tasks.After the training,an isolated sheep liver reperfusion model was prepared,simulated laparoscopic cholecystectomy was performed,and videos were recorded.Three experts used the Global Operative Assessment of Laparoscopic Skills(GOALS)to evaluate the operation effect blindly.Results There were no differences between the two groups in gender(P=0.527),age(P=0.602),pre-training skill level(transfer training,p=0.960;knotting training,p=0.819)and related surgical experience.There were significant improvements in both groups after each task training(P<0.001).The two groups selected 3 identical tasks for comparison.Compared with the VR group,the BT group was trained in ring training(59.72±6.45VS51.43±11.91,P=0.009)and knot training(77.92±4.01VS74.61±5.32,P= 0.031),and no difference in scissors training(55.46±6.51 vs 55.70±6.54,P=0.905).The learning curves of the 8 tasks in the two groups showed that the plateau period of basic skill learning was approximately reached after 6 days of training(24 class hours).The GOALS score results of laparoscopic simulated cholecystectomy in the two groups showed that the BT group was better than the VR group in terms of total score(15.90±2.57vs13.27±1.80,P<0.001),depth perception(3.62±0.66vs2.88±0.42,P<0.001).0.001),Bimanual dexterity(3.36±0.60vs2.72±0.37,P<0.001),efficiency(3.11±0.75vs2.36±0.39,p<0.001),autonomy(3.13±0.60vs2.79±0.38,P=0.039)scores were statistically different,and there was no difference in tissue processing scores(2.69 ± 0.75 vs 2.36 ± 0.41,P=0.078).Conclusion(1).Although both VR and BT training can improve the basic skills of laparoscopy,BT training can better improve the basic skills of medical undergraduates;(2).The effect of BT simulation training for medical undergraduates is better in transferring basic skills to laparoscopic simulation surgery;(3).The learning curve shows that it is more reasonable to set the basic skills training time of laparoscopy for medical undergraduates to 24 class hours.