# Perception of Simulation and Virtual Reality (VR) in Surgery in the Public Sector Tertiary Care Teaching Hospitals of Southern Punjab, Pakistan: A Cross-Sectional Survey

## TL;DR

This study explores how surgical professionals in southern Punjab, Pakistan, perceive the use of virtual reality and simulation in medical training and identifies challenges like cost and lack of availability.

## Contribution

The study provides new insights into the perception and adoption barriers of VR and simulation in surgical training within a specific regional healthcare context.

## Key findings

- 76.61% of participants were familiar with simulation and VR, while 54.50% cited limited realism and high cost as challenges.
- 81.80% of participants confirmed that simulation and VR improve surgical skills and reduce errors.
- A statistically significant positive correlation (rs=0.159, p=0.019) was found between perception and effectiveness of simulation and VR.

## Abstract

Background: The use of virtual simulation (VS)-based institutional practices is increasing with a gradual shift in the incorporation of the latest technology such as virtual reality (VR) and artificial intelligence (AI) in medical education. Our cross-sectional study aimed to evaluate the perception and practice of simulation and VR among professionals in surgery. It was also aimed to identify how their integration would affect the surgical practice, including their significance and acceptance among relevant stakeholders.

Materials and methods: A pre-designed questionnaire was filled in by 218 participants, from all four public sector tertiary care teaching hospitals of the southern Punjab region of Pakistan. A sample size of 218 was calculated with a 5% margin of error and an 80% confidence interval. The questionnaire included sections on perception, familiarity, and effectiveness of integrating simulation and VR into the surgical practice. The survey was performed from January 1, 2025, to January 31, 2025. Data was collected through online platforms (Google Forms, Google LLC, Mountain View, CA), and hard copies. Data was analyzed by IBM SPSS Statistics, version 20 (IBM Corp., Armonk, NY) and submitted responses were represented in terms of percentage and frequency.

Results: Among the participants, 76.61% (n=167) showed their familiarity with simulation and VR, and 54.50% (n=119) reported limited realism and high cost as the challenges for implementing simulation and VR. All participants (100%) reported the lack of availability of simulation and VR in their institutions. Among the participants, 81.80% (n=201) confirmed the improvement of surgical skills, decreased errors, and increased performance by using simulation and VR. Spearman’s rank-order correlation showed a positive relationship (rs=0.159) and a statistically significant result (p=0.019).

Conclusion: Despite the challenges and limitations, the integration of simulation and VR into the training curriculum should be prioritized with the allocation of funds and training of supervisors. Competencies of the surgical trainees should be signed off including specified time on rehearsal before practical implications.