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Hyper-realistic and immersive surgical simulation training environment will improve team performance
  1. Tuan N Hoang1,
  2. Anthony J LaPorta2,
  3. John D Malone3,
  4. Roland Champagne4,
  5. Kit Lavell5,
  6. Gabriel M De La Rosa6,
  7. Lawrence Gaul7,
  8. Mitchell Dukovich4
  1. 1Naval Surface Forces, US Pacific Fleet, San Diego, California, USA
  2. 2Rocky Vista University College of Osteopathic Medicine, Parker, Colorado, USA
  3. 3Medicine, Uniformed Services University, Bethesda, Maryland, USA
  4. 4Naval Medical Center San Diego, San Diego, California, USA
  5. 5Strategic Operations, Inc, San Diego, California, USA
  6. 6Naval Center for Combat and Operational Stress Control, San Diego, California, USA
  7. 7Chinle Comprehensive Health Care Facility, Chinle, Arizona, USA
  1. Correspondence to Dr John D Malone; jdmalone123{at}


Background Surgical trauma care requires excellent multidisciplinary team skills and communication to ensure the highest patient survival rate. This study investigated the effects of Hyper-realistic immersive surgical team training to improve individual and team performance. A Hyper-realistic surgical training environment is defined as having a high degree of fidelity in the replication of battlefield conditions in a training environment, so participants willingly suspend disbelief that they become totally immersed and eventually stress inoculated in a way that can be measured physiologically.

Methods Six multispecialty member US Navy Fleet Surgical/US Army Forward Surgical Teams (total n=99 evaluations) underwent a 6-day surgical training simulation using movie industry special effects and role players wearing the Human Worn Surgical Simulator (Cut Suit). The teams were immersed in trauma care scenarios requiring multiple complex interventions and decision making in a realistic, fast-paced, intensive combat trauma environment.

Results Hyper-realistic immersive simulation training enhanced performance between multidisciplinary healthcare team members. Key efficacy quantitative measurements for the same simulation presented on day 1 compared with day 6 showed a reduction in resuscitation time from 24 minutes to 14 minutes and critical error decrease from 5 to 1. Written test scores improved an average of 21% (Medical Doctors 11%, Registered Nurses 25%, and Corpsman/Medics 26%). Longitudinal psychometric survey results showed statistically significant increases in unit readiness (17%), combat readiness (12%), leadership quality (7%), vertical cohesion (7%), unit cohesion (5%), and team communication (3%). An analysis of salivary cortisol and amylase physiologic biomarkers indicated an adaptive response to the realistic environment and a reduction in overall team stress during performance evaluations.

Conclusions Hyper-realistic immersive simulation training scenarios can be a basis for improved military and civilian trauma training.

Level of evidence Level III.

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  • Contributors LG: data collection and critical revision. RC: data collection/data interpretation. GMDLR: study design/data analysis and interpretation. KL: study design/data analysis and interpretation, writing, and critical revision. TNH, AJL, JDM, MD: literature search, study design, data analysis and interpretation, writing, and critical revision.

  • Funding Data presented are the results of a Congressionally Directed Medical Research Program (CDMRP) Grant Award Research Protocol of the Medical Simulation and Information Sciences Research Program/Joint Program Committee-1 (Team Performance Training Research Initiative). This work is supported by Funded Award Number DM140571, under funding opportunity W81XWH-14-DMRDP-JPC1-TPT. The study protocol NMCSD.2015.0094 was approved by the Naval Medical Center San Diego Institutional Review board in compliance with all applicable Federal regulations governing the protection of human subjects. The data are presented in conjunction with NCRADA-NMCSD 18-490 engaging Strategic Operations, Inc.

  • Disclaimer The views expressed in this article reflect the results of research conducted by the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.

  • Competing interests KL is Executive Vice President, Strategic Operations, San Diego, California.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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