Feedback from human instructors is superior to guidance by a virtual reality simulator when learning flexible bronchoscopy: A randomized controlled trial

Introduction: Virtual reality (VR) simulators have been applied to bronchoscopy training, providing trainees with useful live feedback and guidance. Therefore, it prompts exploration to investigate whether VR guidance could be superior to expert guidance in simulation-based training. The aim of this randomized controlled trial was to investigate the effects of continuous VR guidance versus tutor feedback for novices navigating the bronchial tree in bronchoscopy simulator training. Methods: A randomized controlled trial was conducted with 36 residents using the EndoSim simulator. The trainees were divided into three groups: VR-guidance group, tutor-guidance group, and control group. They performed for 12 consecutive practice sessions, conducting a full, structured inspection of the bronchial tree, and were evaluated according to structured progress (SP), diagnostic completeness (DC), procedure time (PT), and National Aeronautics and Space Administration Task Load Index (NASA-TLX index). Results: All three groups showed an improvement in SP, DC, PT, and NASA-TLX during their 12 procedures (p < 0.05), without a decrease in performance 3 weeks later (p > 0.05). SP was the only distinguished metric among the three groups. Tutor guidance had a significantly better impact on the novices’ SP compared to both VR-guidance (18 ± 0 vs. 15.0 ± 5.3, p = 0.026) and the control group (18 ± 0 vs. 15.5 ± 4.5, p = 0.017). Participants in the VR-guidance group did not outperform the control group (p = 1.00). Conclusion: Tutor feedback is superior to VR guidance feedback and no feedback. Human supervisor guidance enhances bronchoscopy quality, and SP offers a more nuanced assessment of bronchoscopic navigational skills than DC.