INTRODUCTION: The treatment for acute appendicitis is laparoscopic appendicectomy (LA), usually performed
by trainees who face significant challenges to training. Simulation curricula are being
increasingly utilised and optimised to accelerate learning and improve skill retention in a safe
environment. The aim of this study is to produce and implement a virtual reality (VR)
curriculum for laparoscopic appendicectomy (LA) on the high-fidelity LAP Mentor VR
simulator. METHODOLOGY: Performance data of randomised experts and novices were compared to assess the construct
validity of the LAP Mentor basic skills (BS) and LA modules. Face validity of the simulator and
module was assessed by questionnaire. These results informed the construction of a VR LA
curriculum on an evidence-based theoretical framework. The curriculum was implemented
and evaluated by analysis of participant diaries. RESULTS: Thirty-five novices and 25 experienced surgeons performed either BS, five LA procedural tasks
or the LA full procedure. Both modules demonstrated construct validity. The LA module was
deemed moderately realistic and useful for developing laparoscopic psychomotor skills.
Seven novice trainees completed the new LA curriculum (three others dropped out). Analysis
of participants diaries revealed the presence of frustration, the benefits of feedback sessions
and the advantages and pitfalls of open access. DISCUSSION: Evaluations of the implementation of similar curricula are rare and participant diaries led to
critical insights. The curriculum was difficult and sometimes frustrating, mitigated by
rewarding experiences and coaching. The latter facilitated deliberate practice. Scheduling issues were mitigated by open access. Limitations of the curricula include the invariability in
the presentation of appendicitis, and the reason for dropouts are not known. CONCLUSION: Several BS and all LA tasks are construct-valid. A new VR LA curriculum was implemented and
analysis of participant diaries yielded critical insights into real-world implementation. Future
study should investigate its effect on real-world performance and patient outcomes.