(I-750) Virtual Reality Simulation Module for Spinal Instrumentation Demonstrates Improved Confidence & Performance Dose-response in Neurosurgical Trainees: Pilot Study

Introduction: Virtual reality (VR) represents an opportunity for low cost, accessible technology to deliver higher quality education through simulated operative techniques as a supplement to traditional training curricula. No prior at home, independent learning, VR simulation based training curriculum has been implemented in a surgical training program.

Methods: A VR simulation module was developed with a high-fidelity replication of the operating room with procedural capabilities involving placement of pedicle screw instrumentation into an anatomically realistic model of the lumbar spine. Commercially available VR headsets (Oculus 2, Facebook) were distributed to neurosurgical residents at a single institution over a 6-week period using a randomized, intervention-control design with crossover as part of a pilot study feasibility trial. Trainees were asked to participate in a pre-post exposure survey design evaluating procedural confidence. Intraprocedural performance metrics were tracked including instrumentation accuracy and surgical time.

Results: A total of 6 neurosurgical trainees (100%) in a single institution successfully completed a 6-week, at home, independent learning VR simulation curriculum. Post-exposure survey results demonstrated an improvement in confidence with anatomical landmarks and with placement of pedicle screws in the lumbar spine for 100% (6/6) of the residents. On average, overall breach rate and surgical time improved over each session for 67% (4/6) of the residents. 100% (6/6) of the residents felt that VR simulation could be a useful adjunct to the current neurosurgical training paradigm.

Conclusion : Single institution pilot study demonstrate the feasibility of implementing a 6-week at home, independent learning, VR-simulation based training curriculum for neurosurgical trainees. Participants demonstrated both subjective improvement in procedural confidence as well as an objective dose response to training simulations, with improved performance metrics over successive simulation sessions.

How to Improve Patient Care: This may improve patient care by allowing neurosurgical residents to supplement their current training curriculum. By harnessing virtual reality to conduct at home, unobserved, independently directed simulations of placing lumbar pedicle screws in an anatomically realistic model of the lumbar spine, neurosurgical trainees can better understand how to place these screws at the time of surgery. This may allow residents to augment their technical skills, knowledge, and confidence when performing this procedure in the operating room.