Survey of Surgical Competency Assessment and a Possible Role for Virtual Reality
2008, Volume 1, Number 2 69 Introduction The Accreditation Council for Graduate Medical Edu-cation (ACGME) in 2001 responded to the growing public outcry for closer scrutiny of residency training by establishing six general competencies for resident education: medical knowledge, patient care, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice. The American Board of Ophthalmology (ABO) added surgical skills as a seventh competency. Currently, subjective evaluation forms, surgical logs, and incident reports are used in the evaluation of sur-gical competency; but these methods still fail in quan-tifying competency in objective terms [1]. Exact mechanisms for teaching and evaluation within the framework of a competency-based curriculum have led to an expanding body of literature in ophthalmol-ogy education [1-5]. In the 1990s a growing interest in the potential for simulation to improve the quality of medical educa-tion training and assessment surfaced. A medium of delivering repeatable and quantifiable scenarios was named virtual reality (VR) and can be broadly defined as the use of props and/or computational methods to propel users into an environment that simulates real-Survey of Surgical Competency Assessment and a Possible Role for Virtual Reality Simulation Yousuf M. Khalifa, MD 1* , Nadeem H. Fatteh 1 , David Bogorad, MD 1 , and Julian Nussbaum, MD 1 1 Department of Ophthalmology, Medical College of Georgia, Augusta, GA * Corresponding Author & e-mail: yousuf_khalifa@yahoo.com Abstract To define assessment methods of surgical competency in ophthalmology residency programs and to survey opin-ions of virtual reality (VR) surgical simulation incorporation in the residency surgical curriculum. Participants were Association of University Professors of Ophthalmology (AUPO) members. A 23-question sur-vey assessed the following areas: 1. Surgical Assessment Methods (6 questions); 2. Familiarity with VR surgical simulation (4 questions); 3. Opinions of VR (17 Likert items, where 1= strongly disagree and 5=strongly agree, were divided into six areas assessing opinions on skill transferability, financial cost, added safety to surgical training, curriculum structure, awareness/acceptance by residents and faculty, and technical level of current VR technology). Data was entered into an Excel spreadsheet format and analyzed with standard statistical methods. Main outcome measures wereSurgical Assess-ment Methods Employed, Familiarity with VR, and Opinions of VR. Surveys were received August 2005 to January 2006. The number of surgical assessment tools used in individual programs ranged from 0 to 5. Of all respondents, 91.1% felt that wetlab simulation was beneficial. 11% were completely unfamiliar with VR; 28% had a familiarity score of 1. Safety added to training, perceived acceptance by faculty and staff, and benefits to the curriculum were all scored above a 3 (neutral) among all familiarity levels. Transferability to the OR, technical quality of current simulation systems, and cost were all scored at or below a 3 by the majority of respondents indi-cating these aspects of VR are lacking. The ACGME has mandated a competency-based training curriculum in which residency programs must ver-ify a trainee's skills and not merely the experience. Number and combination of current surgical skill assessment tools in each program is variable. Virtual reality simulation is a relatively unfamiliar training and assessment tool. Current opinion on VR is more favorable amongst respondents more experienced with VR. Those most familiar with VR view it as a means of delivering a safe, structured surgical curriculum that not only allows for training but also for verification of surgical skill sets. Accepted for publication August 11, 2008 Revision received October 19, 2008 2008; 1:69-78 Available via open-access on the web at http://www.academic-ophthalmology.com The author(s) have no personal financial interest in any of the products or technologies cited herein. 2008