Process and outcome measures of expert/novice performance on a haptic virtual reality system

Objectives: The goal of dental education is to guide students' development through different stages from novice to competent, eventually resulting in an expert clinician. In this study we sought to identify process and outcome measures of clinical skill performance by comparing novices and experts using a virtual reality (VR) simulation system developed by our group. Methods: Ten novices (fourth-year dental students), and ten experts in prosthodontics performed a crown preparation task with a haptic VR that provided force feedback to the operating tool while interacting with the virtual tissue/organ. For each step of the crown preparation, the system automatically recorded data associated with performance process including time to task completion (T), force used (F), and angulations (A) of the bur. The preparation outcome (O) scores were graded by an expert in the field. An independent t-test was conducted on all dependent variables (F in x-, y-, z-axes; A in zy, zx, xy planes; T and O) between experts and novices. Results: Experts performed significantly better than novices (p < 0.05) as shown by greater O. Expert T was significantly less than that of novices (p < 0.05). Instrument A as well as F used were significantly different in almost all preparation steps in both groups (p < 0.05). Conclusion: This study clearly demonstrated the ability of outcome and process measures to distinguish between novice and expert performance in crown preparation using a haptic VR system.