The role of artificial intelligence, performance metrics, and virtual reality in neurosurgical education: an umbrella review

Virtual reality (VR) and artificial intelligence (AI) play a pivotal role in surgical education. VR is a transformative tool, providing a low-risk environment for trainees to hone their skills. AI, in conjunction with VR, holds promise in addressing contemporary challenges in surgical education by mitigating human bias in evaluations, identifying at-risk residents, and enhancing surgical training through AI-produced performance metrics. Due to the rapid growth of literatures in VR and AI, it is essential to systematically evaluate and reflect on the current evidence regarding AI’s role in assessing trainees’ performance.

As such, an umbrella review was conducted focused on neurosurgery due to its high-stakes nature and active literature. We synthesize evidence from four systematic reviews and meta-analyses.

Key findings reveal that AI metrics effectively measure neurosurgical performance in VR environments, with a focus on time, kinematics, and force as dominant metrics. Moreover, the integration of AI-enhanced VR demonstrates potential in addressing critical challenges faced by surgical educators, including a shortage of surgeons and financial constraints. The review underscores the need for a more unified understanding of metrics and recommends further research to explore non-technical skills and the delivery of personalized feedback in AI-enhanced VR settings. As the field matures, the exploration of virtual assets, such as digital twins or other atypical patient case scenarios, presents a promising avenue for a more comprehensive and diverse range of training experiences in neurosurgery.

Ultimately, this review outlines a bright future for the synergistic application of VR and AI metrics in neurosurgical education, with untapped potential in underexplored areas and a trajectory towards real-world implementation through both VR and Augmented Reality.