• Joakim Grant Frederiksen, Stine Maya Dreier Sørensen, Lars Konge, Morten Bo Søndergaard Svendsen, Morten Nobel-Jørgensen, Flemming Bjerrum, and Andersen Steven Arild Wuyts SAW Copenhagen Academy for Medical Education and Simulation (CAMES), the Capital Region of Denmark, Rigshospitalet, Blegdamsvej 9, 2100, Copen.
• Copenhagen Academy for Medical Education and Simulation (CAMES), the Capital Region of Denmark, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark. Joakim.grant.f@gmail.com.
• Surg Endosc. 2020 Mar 1; 34 (3): 1244-1252.

BackgroundVirtual reality simulators combined with head-mounted displays enable highly immersive virtual reality (VR) for surgical skills training, potentially bridging the gap between the simulation environment and real-life operating room conditions. However, the increased complexity of the learning situation in immersive VR could potentially induce high cognitive load thereby inhibiting performance and learning. This study aims to compare cognitive load and performance in immersive VR and conventional VR simulation training.MethodsA randomized controlled trial of residents (n = 31) performing laparoscopic salpingectomies with an ectopic pregnancy in either immersive VR or conventional VR simulation. Cognitive load was estimated by secondary-task reaction time at baseline, and during nonstressor and stressor phases of the procedure. Simulator metrics were used to evaluate performance.ResultsCognitive load was increased by 66% and 58% during immersive VR and conventional VR simulation, respectively (p < 0.001), compared to baseline. A light stressor induced a further increase in cognitive load by 15.2% and a severe stressor by 43.1% in the immersive VR group compared to 23% (severe stressor) in the conventional VR group. Immersive VR also caused a significantly worse performance on most simulator metrics.ConclusionImmersive VR simulation training induces a higher cognitive load and results in a poorer performance than conventional VR simulation training in laparoscopy. High extraneous load and element interactivity in the immersive VR are suggested as mechanisms explaining this finding. However, immersive VR offers some potential advantages over conventional VR such as more real-life conditions but we only recommend introducing immersive VR in surgical skills training after initial training in conventional VR.

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