Virtual reality assessment of technical skill using the Bonedoc DHS simulator P. Blyth a, * , N.S. Stott c , I.A. Anderson b a Department of Anatomy with Radiology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Park Road, Auckland, New Zealand b Bioengineering Institute, Faculty of Engineering, University of Auckland, Private Bag 92019, Auckland, New Zealand c Department of Surgery, University of Auckland, New Zealand Accepted 1 February 2008 Introduction The objective structured assessment of surgical skill provides a means whereby the technical skills of a trainee can be evaluated. 10 Although seen as essen- tial, this assessment is rarely performed, due to problems of cost, personnel requirement, objectiv- ity in marking and perhaps questions about surgical relevance. 9 Virtual reality has the potential to deli- ver on a number of these aspects. 11 We have recently developed Bonedoc, a virtual reality (VR) simulator of screw and plate fixation of hip fracture, to address some of these issues. The Injury, Int. J. Care Injured (2008) 39, 1127—1133 www.elsevier.com/locate/injury KEYWORDS Virtual reality; Simulation; Construct validity; Hip fracture; Surgery simulator; Non-haptic; VRML Summary The Bonedoc DHS simulator is a virtual reality simulator of screw and plate fixation of hip fractures which runs on a standard PC. We hypothesised that the simulator would be able to discriminate between subjects with different levels of operative experience. Three groups (medical students (MSs), basic trainees (BTs), and advanced trainees (ATs)) performed six virtual operations. Measurements included: reduction position, incision length, misplaced drill-holes, final screw placement, X-rays taken, surgical time as well as computer and operative experience. The accuracy, number of X-rays and speed were significantly different between novices and trainee surgeons ( p < 0.01, p < 0.05, p < 0.05). Intra-articular screw penetration by the medical students occurred 12 times, basic trainees 6 times and advanced trainees twice ( p < 0.01, MS vs. trainees). Amongst trainees, the advanced trainees placed the lag screw more accurately and took less X-rays (ns). The basic trainees performed the complete procedure fastest at 6 min compared to ATs at 9 min ( p < 0.05) but were not as accurate. The Bonedoc DHS simulator provides a means to discriminate between novices and trainee surgeons. # 2008 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +649 3737599; fax: +649 3737484. E-mail address: p.blyth@auckland.ac.nz (P. Blyth). 0020–1383/$ — see front matter # 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2008.02.006