The influence of virtual reality simulation on surgical residents' heart rate during an assessment of arthroscopic technical skills: A prospective, paired observational study

Hypothesis: To demonstrate that a virtual reality (VR) simulation training program reduces heart rate variability during an assessment of surgical trainees' technical skills in arthroscopy. Study design: Prospective observational matched study. Materials & methods: Thirty-six orthopaedic surgery residents, new to arthroscopy, received standard training in arthroscopic knee surgery, supplemented by additional monthly training for 6 months on a VR simulator for 16 of them. At inclusion, the 2 groups (VR and NON-VR) answered a questionnaire and performed a meniscectomy on a VR simulator. After 6 months of training, two independent trainers blinded to the inclusion arms evaluated the technical skills of the two groups during meniscectomies on a model and on an anatomical subject. Heart rate variability (HRV) was measured using a wireless heart rate monitor during baseline, VR training, and assessment. Results: After removing incomplete data, the analysis focused on 10 VR residents matched at inclusion with 10 NON-VR residents. The VR group had a significantly lower heart rate at the final assessment (p = 0.02) and lower overall HRV (p = 0.05). The low/high frequency ratio (LF/HF) was not significantly different between the groups (1.84 vs 2.05, p = 0.66) but the before-after training comparison showed a greater decrease in this ratio in the VR group compared to the NON-VR group -0.76 (-41%) vs -0.08 (-4%). Conclusion: This study demonstrates a significant difference in heart rate variability between trained residents versus untrained residents during the final assessment of their technical skills at 6 months. It appears that improving stress management should be an integral part of training programs in arthroscopic surgery. Clinical Interest: VR simulators in arthroscopy could improve non-technical skills such as heart rate variability, from the perspective of accountability. Level of evidence: III. (c) 2024 Elsevier Masson SAS. All rights are reserved, including those for text and data mining, AI training, and similar technologies.