Assessing surgical skill training under hazardous conditions in a virtual environment.

The present study examined the performance of a surgical procedure under simulated combat conditions. Eleven residents performed a cricothyroidotomy on a mannequin-based simulator in a fully immersive virtual environment running a combat simulation with a virtual sniper under both day and night time lighting conditions. The results showed that completion times improved between the first and second attempt and that differences between day and night time conditions were minimal. However, three participants were killed by the virtual sniper before completing the procedure. These results suggest that some participants' ability to allocate attention to the task and their surroundings was inappropriate even under simulated hazardous conditions. Further, this study shows that virtual environments offer the chance to study a wider variety of medical procedures performed under an unlimited number of conditions.