Virtual Reality Anatomy Trainer Turns Teaching Endobronchial Ultrasound Inside-Out

Abstract

Background: Traditional approaches for learning anatomy for curvilinear endobronchial ultrasound (EBUS) require learners to mentally visualize structures relative to the position of the bronchoscope. Virtual reality (VR) can show anatomy from the perspective of bronchoscopic tools. Research Question: Does the use of a VR anatomy trainer for teaching EBUS-associated anatomy improve procedural performance compared with traditional methods? Study Design and Methods: In this randomized, crossover study design, participants studied EBUS-related anatomy during 2 sequential sessions using a VR trainer and a traditional modality (2-dimensional pictures or a 3-dimensional model). An EBUS simulator was used to test performance at baseline and following each training session. User experience and preferences were evaluated by using a mixed-methods approach of surveys and interviews. Spatial reasoning ability was measured by using the Mental Rotation Test. Results: Sixty-eight fellows and residents at 3 institutions completed the study. All 3 learning methods improved EBUS performance significantly following the first, but not second, learning session. Learners spent more time (1.37 minutes) with VR, but no training method produced a greater improvement. Spatial reasoning ability was associated with improved EBUS performance. This impact was modified by training method: the VR approach leveled the impact of baseline spatial reasoning. The VR approach was preferred by 96% of learners. Qualitative data revealed a positive VR user experience with focused anatomy learning, ease of use, acceptable realism, and tolerance. This novel “inside-looking-out” perspective helped learners understand anatomy from the vantage of procedural tools and to create a mental map, but interpreting ultrasound remained challenging. Interpretation: A VR anatomy trainer was preferred by learners because it provided visualization that aligned best with the procedural perspective. This approach helped learners of all spatial reasoning ability improve their procedural performance.