A prospective randomized controlled study on virtual reality simulation training for cataract operating room workflow management_West China Medical Journal

Authors：

XIAO Xiao ¹ , LU Xiangheng ² , YIN Wen ^2,3 , WANG Song ² , WANG Zhoufeng ¹ ,  LIU Chunling ²

1. Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
3. Department of Ophthalmology, Affiliated Sichuan Ba-Yi Rehabilitation Center of Chengdu University of TCM (Sichuan Provincial Rehabilitation Hospital), Chengdu, Sichuan 611130, P. R. China;

Corresponding?author：

LIU Chunling, Email: liuchunling@wchscu.cn

Keywords：

Virtual reality; cataract surgery; operating room workflow management; simulation training; technology acceptance

DOI：

10.7507/1002-0179.202602146

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the self-developed virtual reality (VR) simulation training system for cataract operating room workflow management in terms of theoretical knowledge acquisition and user experience, and to explore its application value in cataract operating room workflow management training. Methods This prospective randomized controlled non-inferiority trial was conducted at the Clinical Skills Center of West China Hospital, Sichuan University, from September 2023 to September 2025. Trainees were randomly allocated to a trial group or a control group. Both groups received homogenized training content based on the standardized cataract operating room workflow management protocol established according to the surgical management regulations of this hospital. The trial group received one hour of immersive training in a three-dimensional operating room environment using the self-developed VR simulation training system for cataract operating room workflow management, while the control group watched a one-hour didactic teaching video recorded by ophthalmology experts from this hospital repeatedly. Both groups completed theoretical knowledge assessments on cataract phacoemulsification operating room workflow management before and after training, and completed the “User Acceptance and Perceived Advantages of Cataract Surgery Virtual Simulation Training System Questionnaire” after training. Differences in post-training theoretical knowledge assessment scores and user experience questionnaire scores were compared between the two groups. Results A total of 64 trainees were enrolled and randomly allocated to the trial group (n=34) or the control group (n=30). The trial group demonstrated non-inferiority to the control group in post-training theoretical knowledge assessment scores, with a between-group mean difference of ?0.57 [95% confidence interval (?4.65, 3.50)], meeting the pre-specified non-inferiority margin of ?5. User experience analysis revealed that the control group scored significantly higher than the trial group in “perceived usefulness” and “feedback quality and skill-mastery” (both P<0.05), while no significant difference was observed between the two groups in “technology acceptance and use willingness” or “overall satisfaction” (P>0.05). Both groups perceived VR training as having substantial advantages over traditional training across all 16 evaluation domains, with median scores ranging from 4 to 5. Conclusion The self-developed VR simulation training system for cataract operating room workflow management is non-inferior to traditional teaching in terms of theoretical knowledge acquisition, and demonstrates favorable user experience with significant perceived advantages, indicating promising application prospects in cataract operating room workflow management training.

Citation： XIAO Xiao, LU Xiangheng, YIN Wen, WANG Song, WANG Zhoufeng, LIU Chunling. A prospective randomized controlled study on virtual reality simulation training for cataract operating room workflow management. West China Medical Journal, 2026, 41(9): 1511-1516. doi: 10.7507/1002-0179.202602146 Copy

1.	Wang W, Yan W, Fotis K, et al. Cataract surgical rate and socioeconomics: a global study[J]. Invest Ophthalmol Vis Sci, 2016, 57(14): 5872-5881.
2.	Khanna R, Pujari S, Sangwan V. Cataract surgery in developing countries[J]. Curr Opin Ophthalmol, 2011, 22(1): 10-14.
3.	Day K, Soderman M. Preoperative time-out communication process[J]. J PeriAnesth Nurs, 2018, 33(4): e11.
4.	Alaker M, Wynn GR, Arulampalam T. Virtual reality training in laparoscopic surgery: a systematic review & meta-analysis[J]. Int J Surg, 2016, 29: 85-94.
5.	Reznick RK, MacRae H. Teaching surgical skills—changes in the wind[J]. N Engl J Med, 2006, 355(25): 2664-2669.
6.	Liu YQ. Virtual reality: the bridge between medical education and clinical practice[J]. World J Clin Cases, 2024, 12(32): 6575-6579.
7.	Pottle J. Virtual reality and the transformation of medical education[J]. Future Healthc J, 2019, 6(3): 181-185.
8.	Miller GE. The assessment of clinical skills/competence/performance[J]. Acad Med, 1990, 65(9 Suppl): S63-S67.
9.	Holden RJ, Karsh B. The technology acceptance model: its past and its future in health care[J]. J Biomed Inform, 2010, 43(1): 159-172.
10.	Davis FD. Perceived usefulness, perceived ease of use, and user accep[J]. MIS Quart, 1989, 13(3): 319-340.
11.	Toni E, Toni E, Fereidooni M, et al. Acceptance and use of extended reality in surgical training: an umbrella review[J]. Syst Rev, 2024, 13(1): 299.
12.	Kilteni K, Groten R, Slater M. The sense of embodiment in virtual reality[J]. Presence, 2012, 21(4): 373-387.
13.	Kolb DA. Experiential learning: experience as the source of learning and development[M]. Upper Saddle River: Prentice Hall, 1983: 16-17.
14.	Izard SG, Juanes JA, García Pe?alvo FJ, et al. Virtual reality as an educational and training tool for medicine[J]. J Med Syst, 2018, 42(3): 50.
15.	Hasan LK, Haratian A, Kim M, et al. Virtual reality in orthopedic surgery training[J]. Adv Med Educ Pract, 2021, 12: 1295-1301.
16.	Zaed I, Chibbaro S, Ganau M, et al. Simulation and virtual reality in intracranial aneurysms neurosurgical training: a systematic review[J]. J Neurosurg Sci, 2022, 66(6): 494-500.
17.	Mahmood T, Scaffidi MA, Khan R, et al. Virtual reality simulation in endoscopy training: current evidence and future directions[J]. World J Gastroenterol, 2018, 24(48): 5439-5445.
18.	Ya?ci R, Poirot J, Dormegny L, et al. Validity evidence of a new virtual reality simulator for phacoemulsification training in cataract surgery[J]. Sci Rep, 2024, 14(1): 25524.
19.	Nayer ZH, Murdock B, Dharia IP, et al. Predictive and construct validity of virtual reality cataract surgery simulators[J]. J Cataract Refract Surg, 2020, 46(6): 907-912.
20.	Lin JC, Yu Z, Scott IU, et al. Virtual reality training for cataract surgery operating performance in ophthalmology trainees[J]. Cochrane Database Syst Rev, 2021, 12(12): CD014953.
21.	Thomsen ASS, Bach-Holm D, Kj?rbo H, et al. Operating room performance improves after proficiency-based virtual reality cataract surgery training[J]. Ophthalmology, 2017, 124(4): 524-531.
22.	Dormegny L, Ya?ci R, Koestel E, et al. Global trends and practice patterns in virtual reality simulation training for ophthalmic surgery: an international survey use of virtual reality simulation training around the world[J]. Sci Rep, 2025, 15(1): 30886.
23.	Cook DA, Levinson AJ, Garside S, et al. Internet-based learning in the health professions: a meta-analysis[J]. JAMA, 2008, 300(10): 1181-1196.
24.	Lansingh VC, Ravindran RD, Garg P, et al. Embracing technology in cataract surgical training - The way forward[J]. Indian J Ophthalmol, 2022, 70(11): 4079-4081.
25.	Bakshi SK, Lin SR, Ting DSW, et al. The era of artificial intelligence and virtual reality: transforming surgical education in ophthalmology[J]. Br J Ophthalmol, 2021, 105(10): 1325-1328.
26.	Roizen MF. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis[J]. Yearb Anesthesiol Pain Manag, 2012, 2012: 414-415.
27.	Mussweiler T, Damisch L. Going back to Donald: how comparisons shape judgmental priming effects[J]. J Pers Soc Psychol, 2008, 95(6): 1295-1315.
28.	Means B, Toyama Y, Murphy R, et al. Evaluation of evidence-based practices in online learning: a meta-analysis and review of online learning studies[R]. Washington, D. C.: U. S. Department of Education, 2009.
29.	Seymour NE, Gallagher AG, Roman SA, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study[J]. Ann Surg, 2002, 236(4): 458-463.
30.	Locke EA. Self-efficacy: the exercise of control[J]. Pers Psychol, 1997, 50(3): 801-804.
31.	Al Btoush MR, Malak MZ, Hamaideh SH, et al. The relationship between emotional intelligence, self-efficacy, and clinical decision-making among critical care nurses in Jordan[J]. J Hum Behav Soc Environ, 2025, 35(3): 454-468.

1. Wang W, Yan W, Fotis K, et al. Cataract surgical rate and socioeconomics: a global study[J]. Invest Ophthalmol Vis Sci, 2016, 57(14): 5872-5881.
2. Khanna R, Pujari S, Sangwan V. Cataract surgery in developing countries[J]. Curr Opin Ophthalmol, 2011, 22(1): 10-14.
3. Day K, Soderman M. Preoperative time-out communication process[J]. J PeriAnesth Nurs, 2018, 33(4): e11.
4. Alaker M, Wynn GR, Arulampalam T. Virtual reality training in laparoscopic surgery: a systematic review & meta-analysis[J]. Int J Surg, 2016, 29: 85-94.
5. Reznick RK, MacRae H. Teaching surgical skills—changes in the wind[J]. N Engl J Med, 2006, 355(25): 2664-2669.
6. Liu YQ. Virtual reality: the bridge between medical education and clinical practice[J]. World J Clin Cases, 2024, 12(32): 6575-6579.
7. Pottle J. Virtual reality and the transformation of medical education[J]. Future Healthc J, 2019, 6(3): 181-185.
8. Miller GE. The assessment of clinical skills/competence/performance[J]. Acad Med, 1990, 65(9 Suppl): S63-S67.
9. Holden RJ, Karsh B. The technology acceptance model: its past and its future in health care[J]. J Biomed Inform, 2010, 43(1): 159-172.
10. Davis FD. Perceived usefulness, perceived ease of use, and user accep[J]. MIS Quart, 1989, 13(3): 319-340.
11. Toni E, Toni E, Fereidooni M, et al. Acceptance and use of extended reality in surgical training: an umbrella review[J]. Syst Rev, 2024, 13(1): 299.
12. Kilteni K, Groten R, Slater M. The sense of embodiment in virtual reality[J]. Presence, 2012, 21(4): 373-387.
13. Kolb DA. Experiential learning: experience as the source of learning and development[M]. Upper Saddle River: Prentice Hall, 1983: 16-17.
14. Izard SG, Juanes JA, García Pe?alvo FJ, et al. Virtual reality as an educational and training tool for medicine[J]. J Med Syst, 2018, 42(3): 50.
15. Hasan LK, Haratian A, Kim M, et al. Virtual reality in orthopedic surgery training[J]. Adv Med Educ Pract, 2021, 12: 1295-1301.
16. Zaed I, Chibbaro S, Ganau M, et al. Simulation and virtual reality in intracranial aneurysms neurosurgical training: a systematic review[J]. J Neurosurg Sci, 2022, 66(6): 494-500.
17. Mahmood T, Scaffidi MA, Khan R, et al. Virtual reality simulation in endoscopy training: current evidence and future directions[J]. World J Gastroenterol, 2018, 24(48): 5439-5445.
18. Ya?ci R, Poirot J, Dormegny L, et al. Validity evidence of a new virtual reality simulator for phacoemulsification training in cataract surgery[J]. Sci Rep, 2024, 14(1): 25524.
19. Nayer ZH, Murdock B, Dharia IP, et al. Predictive and construct validity of virtual reality cataract surgery simulators[J]. J Cataract Refract Surg, 2020, 46(6): 907-912.
20. Lin JC, Yu Z, Scott IU, et al. Virtual reality training for cataract surgery operating performance in ophthalmology trainees[J]. Cochrane Database Syst Rev, 2021, 12(12): CD014953.
21. Thomsen ASS, Bach-Holm D, Kj?rbo H, et al. Operating room performance improves after proficiency-based virtual reality cataract surgery training[J]. Ophthalmology, 2017, 124(4): 524-531.
22. Dormegny L, Ya?ci R, Koestel E, et al. Global trends and practice patterns in virtual reality simulation training for ophthalmic surgery: an international survey use of virtual reality simulation training around the world[J]. Sci Rep, 2025, 15(1): 30886.
23. Cook DA, Levinson AJ, Garside S, et al. Internet-based learning in the health professions: a meta-analysis[J]. JAMA, 2008, 300(10): 1181-1196.
24. Lansingh VC, Ravindran RD, Garg P, et al. Embracing technology in cataract surgical training - The way forward[J]. Indian J Ophthalmol, 2022, 70(11): 4079-4081.
25. Bakshi SK, Lin SR, Ting DSW, et al. The era of artificial intelligence and virtual reality: transforming surgical education in ophthalmology[J]. Br J Ophthalmol, 2021, 105(10): 1325-1328.
26. Roizen MF. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis[J]. Yearb Anesthesiol Pain Manag, 2012, 2012: 414-415.
27. Mussweiler T, Damisch L. Going back to Donald: how comparisons shape judgmental priming effects[J]. J Pers Soc Psychol, 2008, 95(6): 1295-1315.
28. Means B, Toyama Y, Murphy R, et al. Evaluation of evidence-based practices in online learning: a meta-analysis and review of online learning studies[R]. Washington, D. C.: U. S. Department of Education, 2009.
29. Seymour NE, Gallagher AG, Roman SA, et al. Virtual reality training improves operating room performance: results of a randomized, double-blinded study[J]. Ann Surg, 2002, 236(4): 458-463.
30. Locke EA. Self-efficacy: the exercise of control[J]. Pers Psychol, 1997, 50(3): 801-804.
31. Al Btoush MR, Malak MZ, Hamaideh SH, et al. The relationship between emotional intelligence, self-efficacy, and clinical decision-making among critical care nurses in Jordan[J]. J Hum Behav Soc Environ, 2025, 35(3): 454-468.

West China Medical Journal

A prospective randomized controlled study on virtual reality simulation training for cataract operating room workflow management

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content