Virtual reality anatomy trainer turns teaching endobronchial ultrasound inside-out

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 demonstrate 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 to traditional methods?

Study design and methods: In this randomized, cross-over study design, subjects studied EBUS-related anatomy during two sequential sessions using a VR trainer and a traditional modality (two-dimensional pictures (2D) or a three-dimensional model (3D)). An EBUS simulator was used to test performance at baseline and following each training session. User experience and preferences were evaluated using a mixed-methods approach of surveys and interviews. Spatial reasoning ability was measured using the Mental Rotations Test (MRT).

Results: Sixty-eight fellows and residents at three institutions completed the study. All three learning methods improved EBUS performance significantly after 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 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.