• Constantinos Loukas, Nikolaos Nikiteas, Meletios Kanakis, Argyris Moutsatsos, Emmanuel Leandros, and Evangelos Georgiou.
• Medical Physics Lab-Simulation Centre, University of Athens Medical School, Greece. cloukas@med.uoa.gr
• Acad Emerg Med. 2010 Oct 1; 17 (10): 1142-5.

ObjectivesAlthough virtual reality (VR) simulators play an important role in modern medical training, their efficacy is not often evaluated using learning curves. In this study, the learning curves of novice and intermediate users were elicited during a VR simulation-based curriculum for intravenous (IV) cannulation.MethodsThis was a prospective observational study of subjects undergoing training using a VR model of IV cannulation. Participants were divided into two groups: novices (third-year medical students with no prior practical experience in IV catheterization) and intermediates (recent graduates with limited experience). Performance was measured with two endpoints: time to completion and errors committed. Errors were categorized as critical or noncritical. Learning curves (error score and time completion vs. session number) were analyzed using the Friedman's test. Performance before and after training was compared using the Kruskal-Wallis test. The Spearman rank correlation coefficient (r(s)) was used to determine the correlation between time completion and error score estimates. The number of attempts required to complete the training phase was also measured and compared between the two groups.ResultsThirty subjects were enrolled: 17 in the novice group and 13 in the intermediate group. Learning curve plateaus of intermediates were reached in the sixth case scenario (session), whereas novices reached a plateau in the eighth session. Performance comparison of time to completion and errors showed significant improvement for both groups. Less time and fewer attempts were required by all trainees to complete a scenario while progressing through the curriculum. The overall number of IV cannulation attempts of novices was significantly higher than that of the intermediates throughout the course.ConclusionsSignificant learning curves for novice and intermediate students were demonstrated after following the VR simulation-based curriculum. Competencies acquired during this educational course may provide an important advantage for training prior to actual clinical practice.

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