Introduction: Manual skill is an important attribute for any surgeon. Current methods to evaluate sensory-motor skills in neurosurgical residency applicants are limited. We aim to develop a valid and objective multifaceted measure of sensory-motor skill using a virtual reality surgical simulator.
Methods: A set of three tests of sensory-motor function was performed using ImmersiveTouchHD – a 3D surgical simulator with head and arm tracking, collocalization and haptic feedback: 1) Three-D trajectory planning: Virtual reality drilling of a pedicle. Entry point, target point and trajectory were scored – evaluating 3D memory and orientation; 2) Motor planning – sequence, timing and precision: Hemostasis in a post-resection cavity in the brain. 3) Haptic perception : touching virtual spheres to determine which is softest of the group, with progressive difficulty. Results were analyzed individually and for a combined score of all tasks. 95 consecutive applicants interviewed at a neurosurgery residency program over two years were offered anonymous participation in the study; 63 performed all tasks (36 year 1, 27 year 2). Ten first year medical students and 6 first year neurosurgery residents were also tested.
Results: A cumulative score was generated from all three games, producing a bell-shaped distribution of scores. Lower score -better performance (see Figure). Mean score 14.47 (SD= 4.37); Median = 13.42; best 8.41, worst 30.26. Separate analysis of applicants from each of two years yielded nearly identical results. Residents clustered on the higher performance side, and first year students not different from applicants.
Conclusions: 1) Our cumulative score measures sensory-motor skill in an objective, reproducible and internally valid way. 2) Better performance by residents hints at validity for neurosurgery. 3) Our data can be the basis for a prospective study correlating future performance with applicant scores.
Patient Care: We hope to improve the selection and training of neurosurgery residents through the use of virtual reality-type simulation. This may improve patient safety.
Learning Objectives: The learner will be able to discuss the use of surgical simulation as a tool to assess sensory-motor skill.