Virtual Reality Versus Box Laparoscopic Simulators in Trainee Selection and Aptitude Testing

Background: The purpose of this study was to compare the validity of high-fidelity and low-fidelity simulators in a selection center environment, using measures of construct and concurrent validity. Methods: A total of 46 novice and expert participants were tested on both the low-fidelity Fundamentals of Laparoscopic Surgery (FLS) box trainer and the high fidelity, Lapsim, virtual reality laparoscopic simulator. Outcome scores and performance metrics where recorded. Results: Experts performed better than novices on the FLS (median 71% vs. 51%; P < 0.0001) but not the Lapsim (59.1% vs. 57.1%; P = 0.41). No correlation was found between overall Lapsim metrics and FLS outcome scores (correlation = -0.024; P = 0.874). Although most novice participants performed within a narrow window on the FLS simulator, a few high-performing and low-performing outliers where identified. Conclusions: In a selection center scenario, testing with low-fidelity platforms appears to demonstrate greater validity. Outliers can be identified using low-fidelity simulators.