The effect of distributed virtual reality simulation training on cognitive load during subsequent dissection training

Abstract

Background: Complex tasks such as surgical procedures can induce excessive cognitive load (CL), which can have a negative effect on learning, especially for novices.

Aim: To investigate if repeated and distributed virtual reality (VR) simulation practice induces a lower CL and higher performance in subsequent cadaveric dissection training.

Methods: In a prospective, controlled cohort study, 37 residents in otorhinolaryngology received VR simulation training either as additional distributed practice prior to course participation (intervention) (9 participants) or as standard practice during the course (control) (28 participants). Cognitive load was estimated as the relative change in secondary-task reaction time during VR simulation and cadaveric procedures.

Results: Structured distributed VR simulation practice resulted in lower mean reaction times (32% vs. 47% for the intervention and control group, respectively, p < 0.01) as well as a superior final-product performance during subsequent cadaveric dissection training.

Conclusions: Repeated and distributed VR simulation causes a lower CL to be induced when the learning situation is increased in complexity. A suggested mechanism is the formation of mental schemas and reduction of the intrinsic CL. This has potential implications for surgical skills training and suggests that structured, distributed training be systematically implemented in surgical training curricula.

Acknowledgements

The authors would like to thank the following student assistants at the Simulation Centre for assistance with data collection for this study: D. Overgaard, C. Geneser, J. Grant, R. J. Jørgensen, O. Mahmood, E. Stevens, and S. D. Sørensen.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

Dr. Andersen has received an unrestricted research grant from the Oticon Foundation. The development of the Visible Ear Simulator software has been financially supported by the Oticon Foundation. The foundation did not play a role in the design or conduct of the study.

Notes on contributors

Steven Arild Wuyts Andersen

Steven Arild Wuyts Andersen, MD, PhD, is a resident at the Department of Otorhinolaryngology, Rigshospitalet, Copenhagen, Denmark, and postdoc at Copenhagen Academy for Medical Education and Simulation (CAMES).

Lars Konge

Lars Konge, MD, PhD, is a Professor of Medical Education and Simulation at Copenhagen Academy for Medical Education and Simulation (CAMES).

Mads Sølvsten Sørensen

Mads Sølvsten Sørensen, MD, DMSc, is a Professor at the Department of Otorhinolaryngology, Rigshospitalet, Copenhagen, Denmark, and has developed the academic freeware virtual reality temporal bone surgical simulator, the Visible Ear Simulator.