INTRODUCTION: Use of virtual reality (VR) simulators in endovascular interventional education has become increasingly popular yet many questions surrounding this nascent technology remain unanswered. While progress has been made in other disciplines such as endoscopy and minimally invasive surgery, scientific evidence investigating endovascular simulations remains limited. The general aim of this dissertation was to conduct validation studies to elucidate the potential for skills acquisition and assessment outside of the catheterization laboratory using VR simulation. Endovascular skills transfer from VR-Lab to the porcine laboratory (P-Lab) was also investigated. An economic analysis was performed to assist in the establishment of a realistic VR implementation strategy. MATERIALS AND METHODS: Simulator validations were conducted by comparing performance metrics collected from novices and experienced physicians using Student’s t-test. Performance metrics were recorded by the simulator while participants treated simulated patients suffering from renal artery stenosis (RAS) and carotid artery stenosis (CAS). Endovascular skills transfer was tested using the P-Lab as an approximation of the human catheterization laboratory. A group of endovascular novices were evaluated in the P-Lab and the VR-Lab using an objective skills assessment of technical skills (OSATS), yielding a Total Score. Participants were then randomized into different training groups, put through their assigned training schema and subsequently re-evaluated in both laboratories. ANCOVA analysis was conducted to compare the cumulative effect each type of training had on Total Score. Consumable and rental fees from the skills transfer study were used to calculate the comparison data for the economical analysis. RESULTS: Face validity was demonstrated for both the renal and carotid artery stenosis modules. Neither construct validity study produced results which differentiated between the expert and novice performance metrics except for fluoroscopic and procedural times. VR-Lab training sessions generated skills which improved P-Lab performances. VR-Lab training cost less than the P-Lab using our economical analysis. CONCLUSIONS: Despite demonstrating face validity, VR-Lab simulations should not be used alone for skills assessment outside of the catheterization laboratory in its present form. Skills learned in virtual reality transfer favorably to the P-Lab and simulation training seems to offer a viable alternative of non-clinical training. The VR-Lab affords a more economical method to teach and practice endovascular skills compared to the P-lab. Further research is needed to elucidate the relative efficacies of both training method
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