Integrating Virtual Reality and Large Language Models for Team-Based Non-Technical Skills Training and Evaluation in the Operating Room
This addresses the need for scalable, objective training and evaluation tools for surgical team non-technical skills, though it is incremental as it combines existing VR and LLM technologies in a new application.
The authors tackled the problem of limited structured training for non-technical skills in surgery by developing VORTeX, a multi-user VR platform integrated with LLM analytics, which was rated as intuitive and valuable by 12 surgical professionals in pilot sessions. The LLM produced interpretable communication networks reflecting expected operative hierarchies, such as surgeons as central integrators.
Although effective teamwork and communication are critical to surgical safety, structured training for non-technical skills (NTS) remains limited compared with technical simulation. The ACS/APDS Phase III Team-Based Skills Curriculum calls for scalable tools that both teach and objectively assess these competencies during laparoscopic emergencies. We introduce the Virtual Operating Room Team Experience (VORTeX), a multi-user virtual reality (VR) platform that integrates immersive team simulation with large language model (LLM) analytics to train and evaluate communication, decision-making, teamwork, and leadership. Team dialogue is analyzed using structured prompts derived from the Non-Technical Skills for Surgeons (NOTSS) framework, enabling automated classification of behaviors and generation of directed interaction graphs that quantify communication structure and hierarchy. Two laparoscopic emergency scenarios, pneumothorax and intra-abdominal bleeding, were implemented to elicit realistic stress and collaboration. Twelve surgical professionals completed pilot sessions at the 2024 SAGES conference, rating VORTeX as intuitive, immersive, and valuable for developing teamwork and communication. The LLM consistently produced interpretable communication networks reflecting expected operative hierarchies, with surgeons as central integrators, nurses as initiators, and anesthesiologists as balanced intermediaries. By integrating immersive VR with LLM-driven behavioral analytics, VORTeX provides a scalable, privacy-compliant framework for objective assessment and automated, data-informed debriefing across distributed training environments.