Learning through surgeon's eyes : design, development, and evaluation of an immersive virtual reality training tool for oral and maxillofacial surgery

Background: Reduced training hours, over-crowded operating rooms, and lack of focus on non-technical skills are severely affecting surgical training. In specialities such as Oral and Maxillofacial Surgery, there is an increasing need for innovation in training. On the other hand, despite the application of technological advancements including virtual reality (VR) and augmented reality (AR), twenty-eight to forty percent of novice trainees are not confident in performing major surgery. The current research aims to address these challenges by finding a suitable way to develop an evidence-based immersive virtual reality (iVR) experience. Further, the research investigates the impact of this solution on the learning and confidence of trainees. This research introduces VR Surgery, an iVR experience, to address the gaps in the knowledge. VR Surgery is the first multi-sensory, holistic surgical training experience demonstrating Le Fort I osteotomy, a type of maxillofacial surgery, using Oculus Rift and Leap Motion devices. This research demonstrates the design, development and evaluation of VR Surgery and provides a way for future studies on the use of immersive technologies for surgical education. Methods: A design science research approach was followed to identify the problem, build the solution in collaboration with expert surgeons and evaluate it. Using a combination of multimedia, VR Surgery enables trainee surgeons to experience a realistic operating room environment, and interact with the patient’s anatomy while watching the surgery in a close-up stereoscopic 3D view. Consultant oral and maxillofacial surgeons in the UK evaluated VR Surgery for Face and Content validity. Surgeons commented on the content, usability and applicability of VR Surgery to surgical training. Further, to investigate the impact of VR Surgery on the perceived self-confidence of trainees, a single-blinded, parallel, randomised controlled trial (RCT) was performed. Surgical trainees (95) from seven dental schools took part in one of the first experiments to test the role of iVR on self-confidence. Experimental group participants learnt about the Le Fort I procedure using VR Surgery on an Oculus Rift. The control group used similar content in a standard PowerPoint presentation. The primary outcome measures were the self-assessment scores of trainees’ confidence as measured on a Likert scale and objective assessment based on the knowledge. Outcomes: The expert surgeons agreed with the validity of VR Surgery. The participants of the RCT were randomly divided into the experimental (51) and control (44) groups. Trainees had a mean age of 27∙14, and they were 45∙3% female students and 50∙5% male students. A repeated measures multivariate ANOVA was applied to the data to assess the overall impact of receiving the VR surgery intervention over conventional means on the confidence of trainees. Experimental group participants showed higher perceived self-confidence levels compared to those in the control group (p=0∙034, =0∙05). Novices in the first year of their training showed the highest improvement in their confidence, compared to those in the second and third year. Interpretation: Surgical trainees improve their knowledge and self-confidence levels after using an iVR training experience. The study proves that virtual reality applications such as VR Surgery have a substantial potential to bridge the differences in the quality of global surgical training. This research provides a framework for future researchers who use mixed reality for healthcare.