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The goal of this study is to find out if virtual reality (VR) training helps orthopedic residents improve their skills in placing screws in the pelvic bone. The study will also compare VR training with standard training to see which method is more effective and easier to use.
The main questions it aims to answer are:
Does VR training improve performance compared to standard training? Does VR training help reduce procedure time and X-ray use? Do participants prefer VR training? Researchers will compare VR training with standard training using a crossover design, where all participants receive both types of training.
Participants will:
Take part in both VR and standard training sessions Practice the procedure on a bone model Be evaluated by experts on their performance Complete a satisfaction questionnaire
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| VR Simulation Training → Standard Training (Sequence AB) | Experimental | Participants first undergo VR simulation training, followed by standard training after a washout period |
|
| Standard Training → VR Simulation Training (Sequence BA) | Active Comparator | Participants first undergo standard training, followed by VR simulation training after a washout period. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Virtual reality based simulation training | Device | Participants train using a VR platform simulating antegrade anterior column screw placement. Three-dimensional pelvic models reconstructed from CT data are integrated into a virtual operating environment. Participants interact using a VR headset with simulated instruments and fluoroscopic imaging, allowing repeated practice with real-time feedback. Duration: up to 30 minutes. |
| Measure | Description | Time Frame |
|---|---|---|
| Global Rating Scale (GRS) Score for Technical Performance | Overall technical performance score (range 6-36) assessed by two independent blinded orthopedic trauma experts using a validated Global Rating Scale. A higher score means better outcomes. | Immediately after each training session |
| Measure | Description | Time Frame |
|---|---|---|
| Procedure Time | Total time required to complete the screw placement procedure (minutes). | Immediately after each training session |
| Fluoroscopy Time | Total duration of fluoroscopic use during the procedure (seconds). |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Pornsak Nirunsuk | Faculty of medicine Vajira Hospital | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Faculty of medicine Vajira hospital | Bangkok | Bangkok | 10300 | Thailand |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20046623 | Background | Kamper SJ, Maher CG, Mackay G. Global rating of change scales: a review of strengths and weaknesses and considerations for design. J Man Manip Ther. 2009;17(3):163-70. doi: 10.1179/jmt.2009.17.3.163. | |
| 38511201 | Background | Kuhn AW, Yu JK, Gerull KM, Silverman RM, Aleem AW. Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives. JB JS Open Access. 2024 Mar 20;9(1):e23.00142. doi: 10.2106/JBJS.OA.23.00142. eCollection 2024 Jan-Mar. |
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Individual participant data (IPD) will not be shared. The dataset contains sensitive information collected from a limited number of participants within a single institution, and there is a potential risk of participant re-identification despite de-identification procedures. Therefore, data sharing is restricted to protect participant confidentiality in accordance with institutional review board (IRB) requirements.
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|
| Standard Training | Other | Participants perform screw placement on a pelvic sawbone model under fluoroscopic guidance using standard instruments, including a 2.0 mm K-wire. The setup simulates real operative conditions. Duration: up to 30 minutes. |
|
| Immediately after each training session |
| Guidewire Reposition Attempts | Number of times the guidewire trajectory is adjusted during the procedure. | Immediately after each training session |
| User Satisfaction (QUIS Score) | Participant satisfaction assessed using the Questionnaire for User Interaction Satisfaction (Likert scale). This score contains of 9-point bipolar Likert scale, the analysis focuses on Central Tendency (Mean) and Variability (Standard Deviation). A Higher mean of the score indicates better outcome. Minimum score =1, Maximum score = 9. | Immediately after each training session |
| 11668138 | Background | McCloy R, Stone R. Science, medicine, and the future. Virtual reality in surgery. BMJ. 2001 Oct 20;323(7318):912-5. doi: 10.1136/bmj.323.7318.912. No abstract available. |
| 39755924 | Background | Gansslen A, Lindahl J, Lindtner RA, Krappinger D, Staresinic M. Special screw corridors and imaging in pelvic ring trauma. Arch Orthop Trauma Surg. 2025 Jan 4;145(1):110. doi: 10.1007/s00402-024-05610-0. |
| 38829845 | Background | Berk T, Zderic I, Schwarzenberg P, Pastor T, Drenchev L, Skulev HK, Richards G, Hierholzer C, Halvachizadeh S, Pape HC, Gueorguiev B. Antegrade anterior column acetabulum fracture fixation with cannulated compression headless screws-A biomechanical study on standardized osteoporotic artificial bone. PLoS One. 2024 Jun 3;19(6):e0300256. doi: 10.1371/journal.pone.0300256. eCollection 2024. |
| 31664465 | Background | Osterhoff G, Wulsten D, Babu S, Heyland M, Pari C. Antegrade versus retrograde screw fixation of anterior column acetabular fractures: a biomechanical in vitro study. Eur J Trauma Emerg Surg. 2021 Oct;47(5):1307-1312. doi: 10.1007/s00068-019-01255-6. Epub 2019 Oct 29. |
| 39809210 | Background | Unal YC, Adanas C, Kaya S, Ozkan S, Ismailov U. Virtual reality headset versus traditional training in orthopedic surgery: A comparative study on real surgical performance in total knee arthroplasty. Medicine (Baltimore). 2024 Nov 22;103(47):e40615. doi: 10.1097/MD.0000000000040615. |
| 27528830 | Background | Martin KD, Akoh CC, Amendola A, Phisitkul P. Comparison of Three Virtual Reality Arthroscopic Simulators as Part of an Orthopedic Residency Educational Curriculum. Iowa Orthop J. 2016;36:20-5. |
| 40622017 | Background | Kayaalp ME, Konstantinou E, Karaismailoglu B, Lucidi GA, Kaymakoglu M, Vieider R, Giusto JD, Inoue J, Hirschmann MT. The metaverse in orthopaedics: Virtual, augmented and mixed reality for advancing surgical training, arthroscopy, arthroplasty and rehabilitation. Knee Surg Sports Traumatol Arthrosc. 2025 Aug;33(8):3039-3050. doi: 10.1002/ksa.12723. Epub 2025 Jul 7. |
| 31056442 | Background | Hooper J, Tsiridis E, Feng JE, Schwarzkopf R, Waren D, Long WJ, Poultsides L, Macaulay W; NYU Virtual Reality Consortium. Virtual Reality Simulation Facilitates Resident Training in Total Hip Arthroplasty: A Randomized Controlled Trial. J Arthroplasty. 2019 Oct;34(10):2278-2283. doi: 10.1016/j.arth.2019.04.002. Epub 2019 Apr 8. |
| 40837459 | Background | de Andrade ALL, Yuamoto FY, Malcher CMSR, Appenzeller S, Garcia TA, Belangero WD. ARTHROSCOPY LEARNING IN VIRTUAL REALITY: SYSTEMATIC REVIEW AND METANALYSIS. Acta Ortop Bras. 2025 Aug 18;33(3):e287823. doi: 10.1590/1413-785220253303e287823. eCollection 2025. |
| 25378507 | Background | Cannon WD, Garrett WE Jr, Hunter RE, Sweeney HJ, Eckhoff DG, Nicandri GT, Hutchinson MR, Johnson DD, Bisson LJ, Bedi A, Hill JA, Koh JL, Reinig KD. Improving residency training in arthroscopic knee surgery with use of a virtual-reality simulator. A randomized blinded study. J Bone Joint Surg Am. 2014 Nov 5;96(21):1798-806. doi: 10.2106/JBJS.N.00058. |
| 32035854 | Background | Blumstein G, Zukotynski B, Cevallos N, Ishmael C, Zoller S, Burke Z, Clarkson S, Park H, Bernthal N, SooHoo NF. Randomized Trial of a Virtual Reality Tool to Teach Surgical Technique for Tibial Shaft Fracture Intramedullary Nailing. J Surg Educ. 2020 Jul-Aug;77(4):969-977. doi: 10.1016/j.jsurg.2020.01.002. Epub 2020 Feb 5. |
| 26751581 | Background | Vaughan N, Dubey VN, Wainwright TW, Middleton RG. A review of virtual reality based training simulators for orthopaedic surgery. Med Eng Phys. 2016 Feb;38(2):59-71. doi: 10.1016/j.medengphy.2015.11.021. Epub 2015 Dec 29. |
| 34785971 | Background | Hasan LK, Haratian A, Kim M, Bolia IK, Weber AE, Petrigliano FA. Virtual Reality in Orthopedic Surgery Training. Adv Med Educ Pract. 2021 Nov 10;12:1295-1301. doi: 10.2147/AMEP.S321885. eCollection 2021. |
| 35821110 | Background | Cevallos N, Zukotynski B, Greig D, Silva M, Thompson RM. The Utility of Virtual Reality in Orthopedic Surgical Training. J Surg Educ. 2022 Nov-Dec;79(6):1516-1525. doi: 10.1016/j.jsurg.2022.06.007. Epub 2022 Jul 9. |
| 38013875 | Background | Cate G, Barnes J, Cherney S, Stambough J, Bumpass D, Barnes CL, Dickinson KJ. Current status of virtual reality simulation education for orthopedic residents: the need for a change in focus. Global Surg Educ. 2023;2(1):46. doi: 10.1007/s44186-023-00120-w. Epub 2023 Mar 22. |