Application of Digital Virtual Reality Simulator for Dental Surgical Skill Training

doi:10.21203/rs.3.rs-4678023/v1

Download PDF

Research Article

Application of Digital Virtual Reality Simulator for Dental Surgical Skill Training

https://doi.org/10.21203/rs.3.rs-4678023/v1

This work is licensed under a CC BY 4.0 License

You are reading this latest preprint version

Aim

Dental surgical skills training assumes critical importance for aspiring dentists. Our present study aimed to investigate the effectiveness of innovative DVRS approach in preclinical dental surgical skill training.

Methods

A total of 142 students participated in this study. Within this cohort, 70 students from the 2017 intake were trained using traditional manikins (Group TM), while 72 students from the 2018 were trained using a Digital Virtual Reality Simulator for Dental Surgical Skills (Group DVRS). The scores of the training course between two groups were compared. Additionally, the experiences of students from Group DVRS were collected through a questionnaire survey regarding the use of DVRS in their preclinical training.

Results

The comparative analysis revealed that the average scores for Group DVRS were slightly higher than Group TM (P < 0.05). The feedback collected via questionnaires from Group DVRS participants reflected their satisfaction with the DVRS, praising its user-friendliness, clarity, training efficacy, and the resultant enhancement in their operational skills.

Conclusions

These findings suggest that DVRS is an effective and beneficial tool for preclinical dental surgical skill training.

dental education

dental surgery

preclinical training

virtual reality

Dentistry, as a remarkably hands-on discipline, necessitates dentists to conduct an array of procedures within the confines of a patient’s mouth^1,2. Most of these are marked by their irreproducibility and irreversibility, particularly in surgical dentistry. Key structures like the mandibular canal, lingual nerve, and maxillary sinus are involved in dental surgeries, obliging surgeons to hone both theoretical proficiency and practical dexterity. Consequently, dental surgical skills training assumes critical importance for aspiring dentists^3,4.

However, traditional training methodologies are apparently lacking in effectiveness. As students practice, they often remain unsure about the correctness of their procedures, and immediate feedback on their operative outcomes is mostly absent^5,6. Over time, this can diminish their enthusiasm for learning. The traditional manikins do not adequately simulate real-life oral clinical conditions, leading to students experiencing a transition hurdle from lab practice to actual clinical work⁷. This precipitates a lack of confidence and under preparedness, often resulting in overlooked preoperative doctor-patient communication and insufficient patient empathy.

Granted, advancements in digital technology, particularly Virtual Reality (VR), have brought about substantial improvements. Offering a virtually interactive milieu for operations, VR serves phenomenally in realizing practical teaching^8,9. Privy to this study is a training system, China’s maiden multifunctional VR platform, known as the Digital Virtual Reality Simulator for Dental Surgical Skill Training (DVRS). This unique system creates a complete 3D patient oral model, enabling full-fledged surgical training for students. The complete 3D models of the real patients and the clinical environment are built in to allow students to practice the whole process of clinical treatment from inquiry to operations. It can truly restore the patient's oral lesions and general health status and enable students to practice the whole process and key links of diagnosis and treatment in a virtual environment. The system can provide real-time feedback on students' learning results, through repeated practice can enhance students' self-confidence in clinical practice. The underlying purpose of this study was to juxtapose the traditional manikin-based pedagogy against the innovative DVRS approach and to scrutinize the upsides and drawbacks of the latter. We further endeavored to compile a comprehensive evaluation of the students’ experience with preclinical training supported by DVRS-based multimedia.

This study was approved by the Ethics Committee of Hospital of Stomatology, Wuhan University, the Clinical Trial Number is WDKQ2023-B61. The selection criteria for participation targeted fourth-year undergraduates majoring in stomatology who had completed theoretical coursework in dental and alveolar surgery. We enlisted all qualifying students admitted in the years 2017 and 2018 for our study, with cohorts categorized based on their year of admission. Specifically, 70 students who were admitted in 2017 participated in the study in 2021, and 72 students admitted in 2018 engaged in the study in 2022. Within this cohort, the students from 2017 underwent preclinical training using the traditional manikin (TM) teaching approach (designated as Group TM), whereas the students from 2018 employed a DVRS teaching methodology (labeled as Group DVRS). In this study, the students of 2017 participated in a traditional study. A comparative analysis was conducted on the performance scores between the two groups (Fig. 1).

Preclinical training using TM

The traditional manikin (TM) used head model. The TM-based preclinical training sequence began with the instructor detailing and demonstrating crucial steps, ensuring that students gain familiarity with pertinent anatomical sites and the procedures required for the experiment. Given that visibility can be a challenge for many students, instructors may need to perform multiple demonstrations and explanations. Following this, students practiced on traditional manikins under the guidance of the instructor. To conclude, three separate instructors individually evaluated and scored each student’s practical skills.

Preclinical training using DVRS

All the instructors received dedicated training in the use of this technology before commencing with their preclinical sessions to ensure the effectiveness of the teaching process. In the initial phase of the preclinical training courses, instructors diligently introduced the utilization of DVRS to students and performed an in-depth theoretical explanation on operational procedures through PowerPoint slides or illustrative videos. Subsequently, students were afforded the opportunity to independently carry out operations, following the guided demonstration by the instructor. The evaluation system inherent in DVRS provided an accurate and immediate feedback of each student’s operation. Each student’s practical skill was automatically scored by DVRS evaluation system (Fig. 2).

Assessment of Pedagogical Outcomes: TM vs. DVRS

All the students in both TM and DVRS groups experienced 48-hour theoretical and preclinical training courses such as local anesthesia, tooth extraction, abscess incision drainage, suture and so on. Subsequently, the students received a final examination to evaluate pedagogical outcome.

Questionnaire survey

The questionnaire, designed to capture the evaluations of 72 students in DVRS group on their preclinical practice experiences, contained eight focused items. These items were grouped into three main aspects: the authenticity of the simulation experience, the subjective feelings of the students, and the level of student confidence. Specifically, items 1 through 3 pertained to the authenticity of the simulation, items 4 to 7 addressed subjective feelings, and item 8 evaluated student confidence.

Anonymity was maintained as all students completed the questionnaire, which employed a five-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree, with ratings also translating from 1 = Poor to 5 = Excellent) for the quantifiable items, supplemented by an open-ended question soliciting candid feedback on the pros and cons of DVRS. Upon collection, the survey responses underwent rigorous analysis to ascertain the reliability and validity of the instrument.

Statistical analysis

Version 24.0 of the SPSS statistical software was employed for the analysis of anonymized data sets. Prior to conducting inferential statistics, data distribution was examined to ensure appropriateness for subsequent analyses. Comparative evaluation between the scores was facilitated by the student t-test. The questionnaire’s reliability was analyzed via a Cronbach’s Alpha value. The validity of the instrument was analyzed by the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy. Data were presented as Mean ± SD, and statistical significance was established at P < 0.05.

Students’ scores in DVRS group were significantly higher than those in TM group

In the dental surgery courses, students’ scores encompassed both theoretical knowledge and preclinical training based on the benchmarks for attending physicians. For the TM group, which consisted of 70 students, scores varied between 69 and 95. In contrast, the DVRS group, comprising 72 students, saw scores ranging from 80 to 100. A comparative analysis revealed that the average scores of the DVRS group (88.41±4.75) were significantly higher than those of the TM group (86.10±6.21) (P < 0.05) (Table 1).

Students regarded DVRS as an effective pedagogical mode according to questionnaire data

To guarantee the extraction of credible data from the questionnaire, we conducted a thorough analysis of its reliability, validity and communality. The questionnaire’s reliability was confirmed via a Cronbach’s Alpha value of 0.952, indicating a high level of internal consistency. The validity was verified via the Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy with a score of 0.710, pointing to the satisfactory construct validity of the questionnaire. All the communality value of eight items exceeded the 0.5 benchmark, affirming the absence of any incongruent items within the questionnaire (Table 2). The response rate of the questionnaire was 84.72% (61/72). The students’ responses, as presented in Table 3, underlined the constructive impact of DVRS on dental surgery courses. Unanimity was observed as all students concurred that the virtual reality technology was user-friendly and straightforward to operate (61/61, 100%). An overwhelming majority opined that the virtual simulation system’s automatic scoring was clear, with feedback that was both timely and beneficial (60/61, 98.36%). Nearly all participants agreed on the technology’s proficiency in replicating patient oral conditions realistically (59/61, 96.72%). A significant number also noted that virtual reality technology helped alleviate anxiety during procedures (59/61, 96.72%) and honed their clinical operational skills (57/61, 93.44%). Most students believed that the technology enhanced their comprehensive analytical and judgement abilities pertaining to patient conditions (57/61, 93.44%). There was a consensus that it heightened their attention to patient details (59/61, 96.72%). Additionally, the technology was credited for boosting their enthusiasm for learning and confidence in clinical practice (58/61, 95.08%). Taken questionnaire data revealed that students regarded DVRS as an effective pedagogical mode.

Medical students primarily gain essential clinical skills through experiential learning or preclinical training, a domain where traditional pedagogies increasingly fall short. The traditional manikin approach is fraught with limitations, most notably, its divergence from authentic clinical contexts and its inefficiency in providing realtime corrective feedback¹⁰. Further, it neglects the fundamental aspect of early doctor-patient interaction, thereby undermining the development of empathetic patient care. Our present study showed that the superiority of the VRM was apparent, evidenced by significantly enhancing not only theoretical knowledge but also practical skills^11,12.

Empirical research endorses the integration of theory and practice as a means to refine clinical acumen and augment practical skills within medical education^13–14. VR in preclinical training has gained considerable attention and holds great promise in various fields, including healthcare^15,16. VR technology provides a simulated environment that allows trainees to experience realistic scenarios without any physical risks or constraints^17,18. DVRS encompasses an inclusive array of interfaces: a receiving interface, an operating interface, an explanatory interface, and a scoring interface-each integral to the span of diagnosis and treatment procedures. The clinical receiving interface emulates the scenario of a dental department, simulating both the oral treatment environment and patient information. Within this virtual context, students independently conduct examinations and receptions, honing their clinical competencies in patient communication, medical history documentation, and treatment planning, as well as interaction with virtual patients in realistically simulated scenarios. The operating interface provides immediate feedback on any procedural deviations or errors, presenting operation details and key steps with clarity. Lastly, the scoring interface rigorously evaluates the students’ performance against established operational standards, offering prompt assessments. Taken together, the format of DVRS provides greater alignment with actual clinical practice, and the detailed explanations in DVRS complement hands-on activities, reinforcing theoretical knowledge concurrently with practical application. This integration underscores the importance of merging cognitive understanding with tangible experience, resulting in marked improvements in both conceptual understanding and technical proficiency among DVRS trainees.

DVRS provides realistic operational experiences and sensations, deepening students’ grasp of pertinent knowledge, in line with educational objectives. While introducing an innovative edge to medical education, DVRS do come with their share of limitations, notably the requirement of specialized equipment, smooth computer operation, and a higher investment cost.

In conclusion, we had a positive experience with the DVRS pedagogical mode in dental surgery course. DVRS led to improvements in students’ theoretical knowledge and preclinical dental surgical skills. Also, students expressed satisfaction with DVRS, highlighting its high operability, true-to-life scenarios and timely feedback.

Ethics approval and consent to participate

All experimental protocols were approved by the Ethics Committee of the School and Hospital of Stomatology, Wuhan University. Informed consent was obtained from all participants involved in this study. All methods were conducted in accordance with relevant guidelines, regulations, or the Declaration of Helsinki.

Consent for publication

Not applicable.

Availability of data and material

Not applicable.

Competing interests

The authors declare no conflict of interest.

Funding

This research is supported by the Teaching and Research Reform Project of Wuhan University (2024ZG144).

Authors' contributions

RFL and JGR contributed to the study design, data analysis, interpretation of results, and manuscript preparation. WZ and ZLY participated in research design, literature review, and manuscript revision. GC contributed to study design and provided critical review and editing of the manuscript. All authors have read and approved the final manuscript.

Acknowledgements

We would like to express our gratitude to the students who volunteered to participate in this survey.

Authors' information

¹State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan China. ²Department of Oral and Maxillofacial Surgery, School & Hospital of Stomatology, Wuhan University, Wuhan, China.

Amante L, Afonso JTM, Skrupskelyte G. Dentistry and the COVID-19 Outbreak. Int Dent J. 2021;71(5):358-368.
Jasinevicius TR, Landers M, Nelson S, Urbankova A. An evaluation of two dental simulation systems: virtual reality versus contemporary non-computer-assisted. J Dent Educ. 2004;68(11):1151-1162.
O'Brien B, Cooke M, Irby DM. Perceptions and attributions of third-year student struggles in clerkships: do students and clerkship directors agree? Acad Med. 2007;82(10):970-978.
Maran NJ, Glavin RJ. Low- to high-fidelity simulation - a continuum of medical education? Med Educ. 2003;37 Suppl 1:22-28.
LeBlanc VR, Urbankova A, Hadavi F, Lichtenthal RM. A preliminary study in using virtual reality to train dental students. J Dent Educ. 2004;68(3):378-383.
Urbankova A. Impact of computerized dental simulation training on preclinical operative dentistry examination scores. J Dent Educ. 2010;74(4):402-409.
Swamy M, Bloomfield TC, Thomas RH, Singh H, Searle RF. Role of SimMan in teaching clinical skills to preclinical medical students. BMC Med Educ. 2013;13:20.
Dzyuba N, Jandu J, Yates J, Kushnerev E. Virtual and augmented reality in dental education: The good, the bad and the better. Eur J Dent Educ. 2022 Nov 6. doi: 10.1111/eje.12871.
Zafar S, Lai Y, Sexton C, Siddiqi A. Virtual Reality as a novel educational tool in pre-clinical paediatric dentistry training: Students' perceptions. Int J Paediatr Dent. 2020;30(6):791-797.
Clancy JM, Lindquist TJ, Palik JF, Johnson LA. A comparison of student performance in a simulation clinic and a traditional laboratory environment: three-year results. J Dent Educ. 2002;66(12):1331-1337.
Mansoory MS, Azizi SM, Mirhosseini F, Yousefi D, Moradpoor H. A study to investigate the effectiveness of the application of virtual reality technology in dental education. BMC Med Educ. 2022;22(1):457.
Buchanan JA. Experience with virtual reality-based technology in teaching restorative dental procedures. J Dent Educ. 2004;68(12):1258-1265.
Torkshavand G, Khatiban M, Soltanian AR. Simulation-based learning to enhance students' knowledge and skills in educating older patients. Nurse Educ Pract. 2020;42:102678.
Priya SR, Padminee K, Deboral R, Sujatha G, Ramasamy M, Kumar PY. Knowledge and attitude toward use of internet in smartphones for dental education. Indian J Dent Res. 2019;30(5):798-802.
Plotzky C, Lindwedel U, Sorber M, Loessl B, Konig P, Kunze C, et al. Virtual reality simulations in nurse education: A systematic mapping review. Nurse Educ Today. 2021;101:104868.
Hoffmann C, Kobetic M, Alford N, Blencowe N, Ramirez J, Macefield R, et al. Shared Learning Utilizing Digital Methods in Surgery to Enhance Transparency in Surgical Innovation: Protocol for a Scoping Review. JMIR Res Protoc. 2022;11(9):e37544.
Yiannakopoulou E, Nikiteas N, Perrea D, Tsigris C. Virtual reality simulators and training in laparoscopic surgery. Int J Surg. 2015;13:60-64.
Boejen A, Grau C. Virtual reality in radiation therapy training. Surg Oncol. 2011;20(3):185-188.

Table 1 The scores for the dental surgery course

Scoring results

Group TM

(n=70)

Group DVRS

(n=72)

P value

dental surgery

86.10±6.21

88.41±4.75

0.014*

Table 2 Results of communality

Question	Communality
1. DVRS is easy to operate and user-friendly.	0.717
2. The automatic scoring process of DVRS is transparent, and feedback is timely and effective.	0.839
3. DVRS can simulate the oral condition of patients well.	0.729
4. DVRS can relieve my tension during operation.	0.896
5. DVRS can improve my clinical operation skills.	0.808
6. DVRS can improve my ability of comprehensive analysis and judgment of patient's condition.	0.738
7. DVRS can improve my attention to patient detail.	0.740
8. DVRS can improve my interest in learning and my confidence in entering the clinic.	0.681

Table 3 Questionnaire results

Questions	Strongly agree	Agree	Uncertain	Disagree	Strongly disagree
1. DVRS is easy to operate and user-friendly.	57 (93.44%)	4 (6.56%)	0 (0.00)	0 (0.00)	0 (0.00)
2. The automatic scoring process of DVRS is transparent, and feedback is timely and effective.	56 (91.80%)	4 (6.56%)	1 (1.64%)	0 (0.00)	0 (0.00)
3. DVRS can simulate the oral condition of patients well.	54 (88.52%)	5 (8.20%)	1 (1.64%)	1 (1.64%)	0 (0.00)
4. DVRS can relieve my tension during operation.	55 (90.16%)	4 (6.56%)	1 (1.64%)	1 (1.64%)	0 (0.00)
5. DVRS can improve my clinical operation skills.	54 (88.52%)	3 (4.92%)	3 (4.92%)	1 (1.64%)	0 (0.00)
6. DVRS can improve my ability of comprehensive analysis and judgment of patient's condition.	52 (85.24%)	5 (8.20%)	3 (4.92%)	1 (1.64%)	0 (0.00)
7. DVRS can improve my attention to patient detail.	50 (81.97%)	9 (14.75%)	1 (1.64%)	1 (1.64%)	0 (0.00)
8. DVRS can improve my interest in learning and my confidence in entering the clinic.	50 (81.97%)	8 (13.11%)	2 (3.28%)	1 (1.64%)	0 (0.00)

No competing interests reported.

Download PDF

Editorial decision: Revision requested
15 Jul, 2024
Editor assigned by journal
12 Jul, 2024
Submission checks completed at journal
12 Jul, 2024
First submitted to journal
03 Jul, 2024

You are reading this latest preprint version

Application of Digital Virtual Reality Simulator for Dental Surgical Skill Training

Status:

Version 1

Abstract

Aim

Methods

Results

Conclusions

Figures

Introduction

Methods

Preclinical training using TM

Preclinical training using DVRS

Assessment of Pedagogical Outcomes: TM vs. DVRS

Questionnaire survey

Statistical analysis

Results

Discussion

Declarations

References

Tables

Additional Declarations

Status:

Version 1