Authors' recommendations: The substantial body of literature for simulation training is highly variable in quality and largely focused on minimally invasive procedures. As indicated by the quasi-systematic reviews listed in Figure 1 above, not even systematic reviews in this area of research are perfectly conducted or reported, and the most consistent comment of available fully systematic reviews is poor quality and heterogeneity of primary research.The systematic review evidence suggests that virtual reality training for specific technical components of laparoscopic procedures is better than no training at all for novices prior to treating human patients. Less clear is the comparative role of simulation versus alternatives such as standard surgical apprenticeship training, other simulation approaches, or specific classroom methods like problem-based learning.The literature thus raises more questions than it answers: professional associations including the American College of Surgeons have or are contemplating standardized curricula including simulation, but opinion plays a larger role than research evidence to date in precisely defining the role of this compelling technology in medical training.Overriding concerns for the research agenda implicit in the list of ongoing trials below, should be more rigorous research, better reporting, and more careful editing by journals. The presence of randomized controlled trials and systematic reviews in this body of literature misleads the casual reader: the former often rely on convenience samples of uncertain relevance to target audience for training, are underpowered to detect important differences and generally lack other attributes of high quality research (specifically sample size calculations, reporting of randomization methods, and blinding of outcome assessors). The latter address unfocused questions, fail to tailor selection criteria to research questions, and can be too poorly reported to make optimal contributions to the knowledge base.To borrow from two of the systematic reviews included here, and for which conclusions have not been changed by more recently published research:“While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training (including computer simulation) has yet been shown to be better than other forms of surgical training. In addition, little is known about the real costs (including adverse outcomes in patients) of either simulated or standard surgical training.“Adequately powered, well-designed and unconfounded RCTs (preferably multicenter with similar protocols) are needed and outcome assessors need to be blinded. Outcomes need to be tested in actual operative circumstances (or on validated systems). In particular, model simulation needs to be further tested against computer simulation. Studies of cost comparisons also need to be done. The RCTs dealt exclusively with technical skills, although other skills such as cognitive skills and communication skills are clearly integral parts of surgical performance.” Sutherland (2006)“…The construct validity of the virtual reality (VR) simulators (ability to differentiate experienced versus inexperienced operators) has not to date been demonstrated for all simulated tasks. However, curriculum development on the basis of task validity and learning curve has been shown to improve performance during real procedures, and indeed, to shorten the time required to achieve proficiency in the real world…” Gurusamy (2009b).

Project Status: Completed

URL for project: http://www4.va.gov/VATAP/docs/SimulationTraining2009ttabm.pdf

Year Published: 2009

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: VA Technology Assessment Program

Contact Address: Liz Adams, VA Technology Assessment Program, Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D-142, 150 South Huntington Avenue, Boston, MA 02130 USA Tel: +1 617 278 4469; Fax: +1 617 264 6587;

Contact Name: elizabeth.adams@med.va.gov

Contact Email: elizabeth.adams@med.va.gov

Copyright: VA Technology Assessment Program (VATAP)