Virtual reality versus box laparoscopic simulators in trainee selection and aptitude testing.

Hennessey, Iain A M; Hewett, Peter

BACKGROUND The purpose of this study was to compare the validity of high-fidelity and low-fidelity simulators in a selection center environment, using measures of construct and concurrent validity. METHODS A total of 46 novice and expert participants were tested on both the low-fidelity Fundamentals of Laparoscopic Surgery (FLS) box trainer and the high fidelity, Lapsim, virtual reality laparoscopic simulator. Outcome scores and performance metrics where recorded. RESULTS Experts performed better than novices on the FLS (median 71% vs. 51%; P<0.0001) but not the Lapsim (59.1% vs. 57.1%; P = 0.41). No correlation was found between overall Lapsim metrics and FLS outcome scores (correlation = -0.024; P = 0.874). Although most novice participants performed within a narrow window on the FLS simulator, a few high-performing and low-performing outliers where identified. CONCLUSIONS In a selection center scenario, testing with low-fidelity platforms appears to demonstrate greater validity. Outliers can be identified using low-fidelity simulators.