Use of virtual reality simulation in surgical training: a systematic review on predictive validity and current use in surgical curricula

Background: Simulated surgical learning is an evolving training modality for surgical trainees. Its use in transferring simulation-based skills to the operating room is an integral aspect of its use as a pedagogical tool for surgical trainees in an era of reduced working hours and fewer intra-operative opportunities. These systems may allow trainees to upskill in simulated scenarios leading to improved skillsets and patient safety. The aim of this review was to evaluate if acquisition of surgical skills developed in simulated procedures results in improved intra-operative performance and whether this can be integrated into current surgical curricula. Methods: A systematic search was conducted using PubMed, OVID Medline and CINAHL. Articles included were based on specific inclusion and exclusion criteria. Critical appraisal tools were used to assess each article’s authenticity, applicability and quality of results. Results: Twenty-six studies were reviewed in full and included in this review according to PRISMA guidelines. Thematic analysis yielded four main themes: predictive validity, surgical curriculum, timing of training, clinical outcomes. All studies demonstrated validity. Conclusion: A heterogeneous group of studies demonstrated mixed findings in the predictive validity of virtual reality learning. However, adaptation into surgical curricula in conjunction with other forms of surgical education yielded positive results, with predictive validity demonstrated in surgical trainees. Further research is required to elicit optimal training stages and use of simulation in development of non-technical skills.