Vannaprathip N.Haddawy P.Schultheis H.Suebnukarn S.Mahidol University2025-03-052025-03-052025-04-01Artificial Intelligence in Medicine Vol.162 (2025)09333657https://repository.li.mahidol.ac.th/handle/20.500.14594/105505Background: While VR simulation has already had a significant impact on training of psychomotor surgical skills, there is still a lack of work on the use of VR simulation to teach surgical decision making. Since surgical decision making is a cognitive process, a simulation for teaching it must be able to not only accurately simulate the surgical environment but to also represent and reason about the cognitive aspects involved. Materials and methods: This paper presents and evaluates SDMentor, a virtual training environment that integrates high-fidelity VR simulation with an intelligent tutoring system for teaching surgical decision making in dentistry. SDMentor provides a virtual dental operating room with 3D stereoscopic graphics and with haptic feedback to realistically render the interaction of dental tools with the patient teeth. The intelligent tutor evaluates the student's actions and generates a variety of tutorial feedback. To evaluate the teaching effectiveness of the system, we carried out a randomized controlled trial in the domain of root canal treatment. Results: In all three aspects of scores: situation awareness ability, procedural knowledge, and overall performance; the post-test scores showed significant improvement over the pre-test scores of students in the same group (P < .05). The students from the experimental group had significantly higher learning gains than the students in the control group (P < .05). Conclusions: The integration of high-fidelity VR simulation with intelligent tutoring is a promising approach to teaching surgical decision making and could be useful for teaching decision making in other high-precision psychomotor tasks.Computer ScienceMedicineArticleSCOPUS10.1016/j.artmed.2025.1030922-s2.0-8521847260918732860