Immersive Virtual Reality: A Paradigm Shift in Education and Training
Virtual reality (VR) is both a natural progression and a paradigm shift in orthopaedic training and education. Many orthopaedic surgeons can recall the popularization of arthroscopes, computer-assisted and -navigated procedures, and the use of novel implants based on patient-specific anatomy in regular practice. Incorporation of computing power into orthopaedic practice now provides opportunities for immersive, multisensory training experiences beyond low-fidelity physical constructs, such as bone models and bench-top simulators. Despite this natural technological progression of training modalities, the training environment of novices and established surgeons remains rooted in historic methods of mentorship and direct learning on patients.
Beyond the classic Halstedian “see one, do one, teach one” method of learning are extensively researched learning methods, including the Kolb experiential cycle, deliberate practice, and differential training with interleaving. VR training satisfies those learning methods through access to immersive operative environments for uninterrupted and varied repetition of training scenarios. This shift in education, leveraging new technology, has the potential for more rapid and efficient learning coupled with experiential gains and expertise earlier in training cycles.
How VR can improve education
VR was first described in 1986. In more recent years, with advancing computer power, there have been improvements in the realism and immersion of simulations. Currently, VR in surgical education draws from experiences in the gaming and entertainment industries. VR training is widely embraced in many industries for developing expertise through simulated experience-based learning. In such circumstances, VR has exposed trainees to challenging and atypical simulated cases and forces them to create more refined, specialized reasoning than what comes from a procedural manual or lecture.
Medical and surgical disciplines have adopted VR simulators following consensus statements on design and reporting standards. Currently, AAOS, the American College of Surgeons, and the Accreditation Council for Graduate Medical Education (ACGME) endorse the use of simulation products in orthopaedic education. To create the immersive experience of VR, a surgeon wears a head-mounted display that provides visual and auditory cues constructed to provide three-dimensional presence. To further the immersion, controllers with sense-of-touch feedback (haptics) allow for interaction with objects in the virtual world. Realistic visuals, including patient positioning, draping, and virtual replicas of surgical instruments and implants, allow for a lifelike simulated training environment (Figs. 1 and 2).
For early learners, VR offers repetition of common scenarios with specific and definable technical and nontechnical learning outcomes. Learning in a virtual environment negates both ethical considerations of patient care by trainees and direct patient harm. While learning fundamental orthopaedic skills, trainees can comfortably test the boundaries of their skills and make mistakes. After feedback and reflection, trainees can learn and repeat ad infinitum until they are proficient.