A Comparative Study of Traditional Technique Guide versus Virtual Reality in Orthopedic Trauma Training

Ashley Lamb,1 Brandon McKinney,1 Petros Frousiakis,1 Graal Diaz,2 Stephan Sweet1 1Orthopedic Surgery, Community Memorial Hospital, Ventura, CA, USA; 2Research Department-Graduate Medical Education, Community Memorial Healthcare System, Ventura, CA, USACorrespondence: Graal Diaz, Research Department-Graduate Medical Education, Community Memorial Hospital, 147 N. Brent Street, Ventura, CA, 93003, USA, Email [email protected]: Medical and surgical education is an expansive field fraught with many challenges. Technology such as virtual reality could be a new venue that can offer a solution to improve surgical training.Objective: The objective of this prospective, blinded study was to evaluate virtual reality as a training model for orthopedic surgery and surgical training at large.Methods: Fourth-year medical students with novice skills volunteered to participate in this observer-blinded 1:1 randomized controlled trial. They had no prior experience in tibia intramedullary nail (IMN) surgery. They were randomized into traditional technique guide education and virtual reality. The participants were timed on their mock surgery, and a blinded observer was utilized to subjectively grade their performance throughout the procedure using the Global Assessment 5-point Rating Scale and Procedure-Specific Checklist.Results: Thirty-eight participants were recruited and randomized into virtual reality (19) and traditional (19) groups. There were trends in all categories favoring the virtual reality group. The VR group had improved time to completion (9.6 minutes vs 12.2 minutes, P = 0.034) and reduced need for corrections within the mock procedure (2.2 vs 2.5; P = 0.05).Conclusion: Virtual reality training was more effective than traditional training in learning and completing the steps of the tibia IMN surgery for novice medical students. Virtual reality training may be a useful method to augment orthopedic education and surgical training.Keywords: surgical training, virtual reality, traditional surgical training, operating room, mock procedures, comparative stud

Optical Coherence Tomography of the Retinal Ganglion Cell Complex in Leber�s Hereditary Optic Neuropathy and Dominant Optic Atrophy

Background: Mitochondrial optic neuropathies such as Leber�s Hereditary Optic Neuropathy (LHON) and Dominant Optic Atrophy (DOA) have been shown to produce an optic neuropathy secondary to retinal ganglion cell loss with thinning of the retinal ganglion cell complex (RGCC). Methods: We performed a retrospective analysis assessing the thicknesses of the peripapillary retinal nerve fiber layer (pRNFL) along with the macular retinal ganglion cell-inner plexiform layer (RGC-IPL) using optical coherence tomography (OCT). We compared these changes among acute and chronic LHON, DOA, and normal healthy control patients. Results: Patients with chronic LHON exhibited statistically significant thinning of the RNFL in the superior, nasal, and inferior quadrants of the retina. In acute LHON, the RNFL was relatively thicker in all but the temporal quadrant when compared with respective quadrants in normal eyes; however, statistical significance was not achieved. In DOA, the RNFL was thinnest in the superior and inferior quadrants of the retina, measuring between acute and chronic LHON thickness values. In chronic LHON and DOA, both the pRNFL and RGC-IPL were significantly thinner in all four retinal quadrants relative to controls. Conclusions: This article represents the first comparative study of the RGCC between LHON and DOA. Our findings demonstrated significant thickness reductions in pRNFL and macular RGC-IPL in patients with LHON and DOA, with different specific patterns consistent with the general patterns of thinning classically observed. This study suggests the usefulness of the RGCC as a potential in vivo biomarker for assessing disease in patients with LHON and DOA. © 2019, © 2019 Taylor & Francis Group, LLC