Anterior cervical discectomy and fusion training with virtual reality: enhance cognition, attitudes, self-efficacy and performance in residents.

Abstract

Purpose: Anterior cervical discectomy and fusion (ACDF) is the most commonly performed surgical procedure for degenerative cervical spine surgery, which has a long learning curve. Surgical technique training is fundamental for spine surgeons, however, there is a lack of techniques for training on ACDF. Virtual reality (VR) has been introduced into spine surgery training within safe environments. So far, no existing studies have comprehensively evaluated the potential benefits of VR in training residents in ACDF field. This study aims to develop the VR based ACDF training system and evaluate the effect of VR on surgical training for residents.

Methods: A VR simulation module for ACDF training was developed, involving 19 interactive operation steps. Residents of postgraduate years (PGY) 1-3 in our spine center were randomly assigned to VR training (VR group) and standard programmatic training (ST group). The test on ACDF surgery knowledge was conducted as cognitive evaluation, attitudes toward training were evaluated with the neurosurgical evaluation of attitudes towards simulation training (NEAT) tool, self-efficacy evaluation by using the general self-efficacy scale (GSES), and a performance questionnaire was used to evaluate the performance of all participants.

Results: A total of 60 residents were included in this study, with 30 in VR group and 30 in ST group. No significant differences were observed in terms of the demographic data such as age, gender, PGY between the two groups. After the training, the knowledge test scores of residents in the VR group (76.91 ± 9.07) were significantly higher than those in ST group (82.23 ± 8.49), MD= -5.32 with 95%CI (-9.87, -0.79), P < 0.05. VR group showed a better NEAT score (38.23 ± 0.59) than ST group (27.83 + 0.62), MD= -10.43 with 95%CI (-12.67, -8.19), P < 0.05; VR group showed a higher GSES (31.11 ± 3.25) than ST group (29.36 + 3.05), MD= -1.73 with 95%CI (-3.20, -0.23), P < 0.05, and better performance questionnaire score (21.15 ± 2.41) compared with ST group (19.38 ± 2.55), MD= -1.77 with 95%CI (-3.12, -0.55), P < 0.05.

Conclusions: This study developed a VR training system of ACDF, which offers an immersive and interactive 3D environment, enabling trainees to actively engage in the entire ACDF surgical process. The VR training can enhance the cognition of knowledge, positively affect attitudes, improve self-efficacy and intraoperative performance in residents compared with traditional training, thereby supporting its potential application as an educational tool for ACDF training in the future.