Virtual-reality (VR) simulation offers the opportunity to practice surgical techniques and gain experience outside the operating room. Using VR simulators and tools recently developed by human performance researchers, different aspects of human performance (innate ability) can be measured objectively. These novel tools, General Systems Performance Theory, and application of nonlinear causal resource analysis (NCRA) may allow us to utilize VR simulators, not only to train physicians, but possibly to predict their performance prior to training. By analyzing objective measures of basic performance resources (BPRs) with performance models developed with NCRA, we showed that BPRs can predict a subject's ability to perform high-level tasks. Two pilot studies suggested that this approach may objectively identify limitations of the surgeons with the most worrisome performance scores. Thus, VR simulation and performance testing may help with identification and remediation of residents with poor endoscopic skills and with optimization of surgical training protocols. Although the initial observations provide encouraging results for objective prediction of surgical performance and identification of performance-limiting resources, further investigation in larger cohorts of surgical trainees appears warranted.
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