Advantage of three dimensional animated teaching over traditional surgical videos for teaching ophthalmic surgery: a randomised study

BACKGROUND/AIM

Owing to the complex topographical aspects of ophthalmic surgery, teaching with conventional surgical videos has led to a poor understanding among medical students. A novel multimedia three dimensional (3D) computer animated program, called "Ophthalmic Operation Vienna" has been developed, where surgical videos are accompanied by 3D animated sequences of all surgical steps for five operations. The aim of the study was to assess the effect of 3D animations on the understanding of cataract and glaucoma surgery among medical students.

METHOD

Set in the Medical University of Vienna, Department of Ophthalmology, 172 students were randomised into two groups: a 3D group (n=90), that saw the 3D animations and video sequences, and a control group (n=82), that saw only the surgical videos. The narrated text was identical for both groups. After the presentation, students were questioned and tested using multiple choice questions.

RESULTS

Students in the 3D group found the interactive multimedia teaching methods to be a valuable supplement to the conventional surgical videos. The 3D group outperformed the control group not only in topographical understanding by 16% (p<0.0001), but also in theoretical understanding by 7% (p<0.003). Women in the 3D group gained most by 19% over the control group (p<0.0001).

CONCLUSIONS

The use of 3D animations lead to a better understanding of difficult surgical topics among medical students, especially for female users. Gender related benefits of using multimedia should be further explored.

Video-endoscope assisted teaching during sub-periosteal orbital surgery

PURPOSE

The authors report the novel use of the video-endoscope as an adjunct in teaching orbital surgery, in particular within the sub-periosteal orbital space. This is of most use during situations where visualisation is of critical importance and direct supervision is not possible.

MATERIALS AND METHODS

This technique was used for 16 cases of orbital surgery during a 12-month period. There were 5 orbital fracture repairs, 8 orbital decompressions (4 via a swinging eyelid and 4 via a transcaruncular approach), an infraorbital nerve biopsy, an eosinophilic granuloma and an orbitofrontal cholesterol granuloma. All procedures were performed by the trainee under consultant supervision with the endoscope being used when direct visualisation was not possible for the consultant. A rigid Storz 3-chip video-endoscope with 0, 30 and 70-degree tips was used to enable visual supervision.

RESULTS

The endoscope was of particular use in procedures involving the posterior orbital floor, orbital roof and medial orbital wall. It also enabled safe supervision of curettage of an orbital roof lesion which abutted the dura. The technique was easy to use; it provided good local illumination and a magnified view for supervision.

CONCLUSION

This technique is a valuable adjunct in allowing the trainee to safely perform selected complex orbital surgery under video-endoscopic supervision.

Global Rating Assessment of Skills in Intraocular Surgery (GRASIS)

OBJECTIVE

The American Board of Ophthalmology in conjunction with the Accreditation Council for Graduate Medical Education has mandated the systematic assessment of surgical competence of ophthalmology residents at all residency programs. We present a tool complementary to the Objective Assessment of Skills in Intraocular Surgery (OASIS) to assess residents' surgical competence.

PARTICIPANTS

Twenty experts in resident education, including the chiefs of all ophthalmology services and the chief resident at the Harvard Medical School Department of Ophthalmology.

METHODS

A 1-page subjective evaluation form was developed in conjunction with the Objective Assessment of Skills in Intraocular Surgery evaluation form to assess the surgical skills of residents. A panel of surgeons at the Harvard Medical School Department of Ophthalmology at the Massachusetts Eye and Ear Infirmary reviewed the form and provided constructive feedback.

RESULTS

Experts' comments were incorporated, establishing face and content validity.

CONCLUSIONS

The Global Rating Assessment of Skills in Intraocular Surgery (GRASIS) has face and content validity. It can be used to assess a resident's surgical care of patients as well as a resident's surgical knowledge, preparedness, and interpersonal skills. Reliability and predictive validity will be determined at our institution. We believe the GRASIS evaluation form will be a valuable tool in conjunction with the OASIS evaluation form for assessing ophthalmology residents' surgical skills at other residency programs as well.

Selection, teaching and training in ophthalmology

This article examines the training requirements for ophthalmic surgical training, and the selection, assessment and training methodologies used for trainees, and also comments on the role of the surgical trainers. As an introduction to the article, a brief description of the current scheme in the UK is given.

Device for simulating anterior segment surgery

To provide a more realistic method for practicing anterior segment surgery, a device was designed that incorporates aspects of currently available cadaver globe fixation methods. A Styrofoam head was fitted with a funnel and tubing system that allows for direct application of variable external suction to a globe placed in an artificial socket. Prototypes were tested in a wet lab environment, which demonstrated that this method provides reliable globe fixation and allows for variable control of intraocular pressure during a variety of anterior and posterior segment surgical techniques.

A simple model for practicing surgery on the nasolacrimal drainage system

Practicing surgical techniques on models prior to operating on patients can be helpful in developing skills needed to perform surgery proficiently. A simple, inexpensive, and readily available model for instruction and practice of surgical maneuvers on the nasolacrimal drainage system is described.

Pig Eyelid as a Teaching Model for Eyelid Margin Repair

A surgical model was created to teach eyelid margin repair to ophthalmology residents. On gross and histopathologic examination, the pig eyelid was found to be similar to the human eyelid. Using the pig eyelid mounted on an easy-to-construct model, eyelid margin repair was effectively taught at a surgical workshop.

Illuminated artificial orbit for the training of vitreoretinal surgery in vitro

PURPOSE

Demonstrations and practical experiments are important constituents of the teaching of surgical principles and techniques to residents in ophthalmology. The objective was to develop an eye-support device for experimental and didactic use during vitreoretinal microsurgery in vitro.

METHODS

Various eye-support devices with different light sources and illumination intensities were designed and tested. The main components of the final prototype are a high-intensity halogen lamp, a flexible light guide, a cylinder with a mirror inside, and a replaceable, transparent eye support with a ring-adapter. Light from the point source is reflected via the light guide into the cylinder and through the eye support transsclerally into the eye.

RESULTS

The device illuminates the retina and the vitreous body sufficiently. It accentuates the transparent appearance of the retina and makes the three-dimensional structure more visible, for example, in case of retinal detachment. Subretinal tissue can be visualized and differentiated more precisely.

CONCLUSIONS

The device is useful, in the teaching of residents and in experimental vitreoretinal surgery.

Virtual reality simulator for vitreoretinal surgery

AIM

To develop computer simulation of steps in vitreoretinal surgery using virtual reality technology.

MATERIAL AND METHODS

A workstation with three-dimensional position tracking stylus was attached to a Pentium II desktop PC with a graphic accelerator. Computer algorithms were developed using Open GL and Microsoft Visual C++ languages to control the interaction and update the visual feedback tracking the instruments. Soft tissue computer modelling was carried out to mimic the removal of a vitreous opacity. Lens touch with the instruments was also detected. Mathematical modelling to allow for lens distortion was taken into account.

RESULTS

A virtual reality computer model has been developed that can simulate initial steps of vitreoretinal surgery. Soft tissue modelling of the vitreous opacity and its removal by the vitrector was successfully simulated. The movements of the active and passive instruments in the dummy eye corresponded to the movements on the computer screen. On evaluation of the system, there was a minimal but discernable time lag between the stylus movement and the visual feedback. There was no tactile feedback when the lens touch was simulated. No further complex vitreoretinal surgery simulation was possible at this stage.

Measuring surgical skill and proclivity in ophthalmology residency training program applicants using the American Dental Association Dental Admission (Sample) Test (DAT)

PURPOSE

To determine if typical DAT perceptual ability questions which are used to determine potential surgical skills in dental school applicants also do so for surgical ability for eye surgery.

METHOD

The subjects were all applicants for admission into the Ophthalmology Residency Training Program at the University of Florida. All applicants answered 11 questions from the "Perceptual Ability" section of the DAT. Their answers were neither reviewed nor scored at the time they took the test but were sealed and set aside. After completing the 3 year training program, each of fifteen consecutive trainees was scored by five masked faculty members for their surgical skill. Their tests were unsealed and scored. Data were obtained on 15 applicants.

RESULTS

There was a [Good] positive correlation between masked faculty surgical skill scores and DAT scores: r= +0.58, p < or -0.02.

CONCLUSION

DAT perceptual ability questions do indicate candidates with best innate and potential eye surgical skills.