Validity of the construction of the ArthroSTM FAST and SHOULDER virtual reality simulator: validation in the NOVICE, CONFIRMED and EXPERTS cohorts

BACKGROUND: Recently, training in arthroscopy was improved with the integration of virtual reality (VR) simulators which enable semi-autonomous learning for novices. The NOVICE cohort confirmed that residents had better basic triangulation skills when they followed a regular 6-month VR simulator program, instead of occasional workshop-type training. We attempted to discover whether the skills of novices recorded for the NOVICE cohort were different from those of residents at the end of the degree course (CONFIRMED) or those of expert practitioners (EXPERTS), according to the type of training. METHODS: 2 new cohorts were formed: French residents at the end of training (CONFIRMED), and international shoulder experts (EXPERTS). They all performed “Periscoping” and “Catch the stars Glenohumeral” exercises in a single session with 3 trials, and completed the same questionnaire. Their results were compared to those of the NOVICE cohort with 6 trials after 6 months without specific training (NOVICE A), with occasional training (NOVICE B) or with regular training on a VR simulator for 6 months (NOVICE C). The variables of Time, Camera Alignment, Camera Movement and Clamp Movement were analyzed. RESULTS: For the Periscoping exercise, there was a significant difference in Time (EXPERTS: 138s, CONFIRMED: 110s, NOVICE A: 149s (p > 0.0001) and NOVICE C: 129s (p=0.00976)), Camera Alignment (EXPERTS: 81%, CONFIRMED: 87%, NOVICE A: 92% (p > 0.00141)), and Camera Movement (EXPERTS: 123cm, CONFIRMED: 101cm, NOVICE A: 126cm, NOVICE B: 114cm, NOVICE C: 115cm (p > 0.0001)). For the Catch the stars exercise, there was a significant difference in Time, (EXPERTS: 81s, CONFIRMED: 143s, NOVICE A: 121s, NOVICE B: 105s, NOVICE C: 112s (p > 0.0001)), Camera Movement (EXPERTS 41cm, CONFIRMED 63cm, NOVICE A 52cm, NOVICE B 45cm, NOVICE C 51cm (p > 0.0001)) and Clamp Movement (EXPERTS 116cm, CONFIRMED 204cm, NOVICE A 155cm, NOVICE B 146cm, NOVICE C 157cm (p > 0.0001)). CONCLUSION: The ‘Catch the stars’ exercise seemed to be an exercise that distinguishes the different levels of expertise, and was closer to the daily practice of arthroscopy. The Periscoping exercise was designed to teach the basics of triangulation, and novices who had many trials were likely to perform better than experts after three trials.