1
|
Ferrari FA, Youssef Y, Naem A, Ferrari F, Odicino F, Krentel H, Moawad G. Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward? Front Med (Lausanne) 2024; 11:1387036. [PMID: 38504917 PMCID: PMC10948538 DOI: 10.3389/fmed.2024.1387036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024] Open
Abstract
Endometriosis is a chronic debilitating disease that affects nearly 10% of women of the reproductive age. Although the treatment modalities of endometriosis are numerous, surgical excision of the endometriotic implants and nodules remains the sole cytoreductive approach. Laparoscopic excision of endometriosis was proven to be beneficial in improving the postoperative pain and fertility. Moreover, it was also proved to be safe and efficient in treating the visceral localization of deep endometriosis, such as urinary and colorectal endometriosis. More recently, robotic-assisted surgery gained attention in the field of endometriosis surgery. Although the robotic technology provides a 3D vision of the surgical field and 7-degree of freedom motion, the safety, efficacy, and cost-effectiveness of this approach are yet to be determined. With this paper, we aim to review the available evidence regarding the role of robotic surgery in the management of endometriosis along with the current practices in the field.
Collapse
Affiliation(s)
| | - Youssef Youssef
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynaecology-Maimonides Medical Center, Brooklyn, NY, United States
| | - Antoine Naem
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Federico Ferrari
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Franco Odicino
- Department of Clinical and Experimental Sciences, Division of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology, and Senology, Bethesda Hospital Duisburg, Duisburg, Germany
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, United States
- The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, United States
| |
Collapse
|
2
|
Su JM, Wu CY, Hong WT, Chen PS, Hung KS, Wang CJ. Application of mobile-based web app to enhance simple suturing skills of nurse practitioners. NURSE EDUCATION TODAY 2023; 131:105959. [PMID: 37713781 DOI: 10.1016/j.nedt.2023.105959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/11/2023] [Accepted: 09/03/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Suturing is a crucial clinical skill for nurse practitioners (NPs), but the effectiveness of traditional training methods (e.g., physical suture kits combined with video content) is low. OBJECTIVE This study compared the effectiveness and usability of a mobile-based web app (MoWa) developed for NPs to learn simple suturing skills with those of traditional instructional video-based training. METHODS The MoWa system utilizes mobile devices to simulate hands-on suturing and provides learning guidance and feedback to support self-learning with a physical suturing kit. Fifty-four suturing novices (NPs) were recruited as participants, divided into an experimental group (EG: 28 participants) and a control group (CG: 26 participants), and instructed to self-learn for 3 weeks. Learning effectiveness and system usability were evaluated through a pretest and posttest. RESULTS The EG exhibited significant improvements in learning outcomes, self-confidence, self-efficacy, and learning anxiety and expressed satisfaction with the MoWa system. Furthermore, the EG also considerably enhanced learning outcomes, self-efficacy, and learning anxiety compared to the CG, with no significant difference in self-confidence. CONCLUSION The MoWa system combined with deliberate practice is an effective strategy for supporting suturing skills training.
Collapse
Affiliation(s)
- Jun-Ming Su
- Department of Information and Learning Technology, National University of Tainan, Tainan 700301, Taiwan
| | - Chen-Yu Wu
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Wei-Ting Hong
- Department of Information and Learning Technology, National University of Tainan, Tainan 700301, Taiwan
| | - Pin-Shuo Chen
- National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Kuo-Shu Hung
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan
| | - Chih-Jung Wang
- Division of Trauma, Department of Surgery, National Cheng Kung University Hospital, Tainan 70428, Taiwan.
| |
Collapse
|
3
|
Huber T, Huettl F, Vradelis L, Lang H, Grimminger P, Sommer N, Hanke LI. [Evidence, Availability and Future Visions in Simulation in General and Visceral Surgery]. Zentralbl Chir 2023; 148:337-346. [PMID: 37562395 DOI: 10.1055/a-2111-0916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Practice makes perfect - a saying that everyone has certainly heard. Surgeons of all levels of training can demonstrably practice to some extent on simulators. This training outside the operating theatre and independent of patients makes sense, both ethically and financially. Although the effectiveness of simulation in surgery has been proven several times, simulation training is not a mandatory part of surgical specialist training in Germany. Simulation covers a very wide range in terms of application, effort and costs. This review is intended to give an overview of the systems and their areas of application and the target group. The focus lies on the commonly available systems and possible advantages and disadvantages. Practical skills are in the foreground and all three pillars of general and visceral surgery - conventional techniques, laparoscopy and robotics - are taken into account. However, simulators alone do not achieve cost-benefit effectiveness. The full potential of such an investment can only be exploited with a site-specific, structured training concept in which simulation training according to the post-graduate year and appropriate allocation to surgeries in the operating room are closely interlinked. It should always be possible to train basic skills on site. The significant additional costs for complex simulation systems are possible, depending on the financial resources, or should be purchased in a network or for national courses. The techniques of immersive virtual reality in combination with artificial intelligence and deformation algorithms will certainly play a decisive role for the future of simulation, whereby the use of the available systems must be a primary goal. The integration of simulation into specialist training should be striven for, not least in order to justify the costs.
Collapse
Affiliation(s)
- Tobias Huber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Florentine Huettl
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Lukas Vradelis
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Peter Grimminger
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - Nils Sommer
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax-und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Laura Isabel Hanke
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| |
Collapse
|
4
|
van der Kruk SR, Gunn KM, MacDougall H, Milne D, Smith K, Zielinski R. Feasibility and preliminary effectiveness of virtual reality as a patient education tool for people with cancer undergoing immunotherapy: a protocol for a randomised controlled pilot study in a regional setting. BMJ Open 2023; 13:e071080. [PMID: 37311632 DOI: 10.1136/bmjopen-2022-071080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Patient education is a critical component of healthcare delivery. However, medical information and knowledge are complex and can be difficult for patients and families to comprehend when delivered verbally. The use of virtual reality (VR) to convey medical information to patients may bridge this communication gap and lead to more effective patient education. It may be of increased value to those with low health literacy and levels of patient activation, in rural and regional settings. The objective of this randomised, single-centre pilot study is to examine the feasibility and preliminary effectiveness of VR as an education tool for people with cancer. The results will provide data to inform the feasibility of a future randomised controlled trial, including sample size calculations. METHODS AND ANALYSIS Patients with cancer undergoing immunotherapy will be recruited. A total of 36 patients will be recruited and randomised to one of three trial arms. Participants will be randomised 1:1:1 to receive VR, a two-dimensional video or standard care (ie, verbal communication and information leaflets). Feasibility will be assessed by recruitment rate, practicality, acceptability, usability and related adverse events. The potential impact of VR on patient-reported outcomes (ie, perceived information provision quality, knowledge about immunotherapy and patient activation) will be assessed and stratified by information coping style (ie, monitors vs blunters) whenever statistical analyses are significant. The patient-reported outcomes will be measured at baseline, post-intervention and 2 weeks post-intervention. In addition, semistructured interviews will be conducted with health professionals and participants randomised to the VR trial arm, to further explore acceptability and feasibility. ETHICS AND DISSEMINATION Ethics approval was obtained from the Greater Western Human Research Ethics Committee, New South Wales Local Health District (2022/ETH01760). Informed consent will be obtained from all participants. Findings will be disseminated via relevant conference presentations and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12622001473752.
Collapse
Affiliation(s)
- Shannen R van der Kruk
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Kate M Gunn
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Hamish MacDougall
- RPA Institute of Academic Surgery, Sydney Local Health District, Sydney, New South Wales, Australia
| | - Donna Milne
- Melanoma and Skin Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Katherine Smith
- School of Rural Health, The University of Sydney, Orange, New South Wales, Australia
| | - Rob Zielinski
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
- Central West Cancer Care Centre, Orange Base Hospital, Orange, New South Wales, Australia
| |
Collapse
|
5
|
Lang F, Willuth E, Haney CM, Felinska EA, Wennberg E, Kowalewski KF, Schmidt MW, Wagner M, Müller-Stich BP, Nickel F. Serious gaming and virtual reality in the multimodal training of laparoscopic inguinal hernia repair: a randomized crossover study. Surg Endosc 2023; 37:2050-2061. [PMID: 36289083 PMCID: PMC10017619 DOI: 10.1007/s00464-022-09733-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/11/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aim of this study was to assess the transferability of surgical skills for the laparoscopic hernia module between the serious game Touch Surgery™ (TS) and the virtual reality (VR) trainer Lap Mentor™. Furthermore, this study aimed to collect validity evidence and to discuss "sources of validity evidence" for the findings using the laparoscopic inguinal hernia module on TS. METHODS In a randomized crossover study, medical students (n = 40) in their clinical years performed laparoscopic inguinal hernia modules on TS and the VR trainer. TS group started with "Laparoscopic Inguinal Hernia Module" on TS (phase 1: Preparation, phase 2: Port Placement and Hernia Repair), performed the module first in training, then in test mode until proficiency was reached. VR group started with "Inguinal Hernia Module" on the VR trainer (task 1: Anatomy Identification, task 2: Incision and Dissection) and also performed the module until proficiency. Once proficiency reached in the first modality, the groups performed the other training modality until reaching proficiency. Primary endpoint was the number of attempts needed to achieve proficiency for each group for each task/phase. RESULTS Students starting with TS needed significantly less attempts to reach proficiency for task 1 on the VR trainer than students who started with the VR trainer (TS = 2.7 ± 0.6 vs. VR = 3.2 ± 0.7; p = 0.028). No significant differences for task 2 were observed between groups (TS = 2.3 ± 1.1 vs. VR = 2.1 ± 0.8; p = 0.524). For both phases on TS, no significant skill transfer from the VR trainer to TS was observed. Aspects of validity evidence for the module on TS were collected. CONCLUSION The results show that TS brought additional benefit to improve performances on the VR trainer for task 1 but not for task 2. Skill transfer from the VR trainer to TS could not be shown. VR and TS should thus be used in combination with TS first in multimodal training to ensure optimal training conditions.
Collapse
Affiliation(s)
- Franziska Lang
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - E Willuth
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - C M Haney
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - E A Felinska
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - E Wennberg
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - K F Kowalewski
- Department of Urology and Urological Surgery, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - M W Schmidt
- Department of Gynecology and Obstetrics, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - M Wagner
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany.
| |
Collapse
|
6
|
Luong T, Holz C. Characterizing Physiological Responses to Fear, Frustration, and Insight in Virtual Reality. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2022; 28:3917-3927. [PMID: 36048988 DOI: 10.1109/tvcg.2022.3203113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Physiological sensing often complements studies of human behavior in virtual reality (VR) to detect users' affective and cognitive states. Some psychological states, such as fear and frustration, can be particularly hard to differentiate from a physiological perspective as they are close in the arousal and valence emotional space. Moreover, it is largely unclear how users' physiological reactions are expressed in response to transient psychological states such as fear, frustration, and insight-especially since these are rich indicators for characterizing users' responses to dynamic systems but are hard to capture in highly interactive settings. We conducted a study ($N=24$) to analyze participants' pulmonary, electrodermal, cardiac, and pupillary responses to moments of fear, frustration, and insight in immersive settings. Participants interacted in five VR environments, throughout which we measured their physiological reactions and analyzed the patterns we observed. We also measured subjective fear and frustration using questionnaires. We found differences between fear and frustration pupillary, respiratory, and electrodermal responses, as well as between the pupillary changes that followed fear in a horror game and those that followed fear in a vertigo experiment. We present the relationships between fear levels, frustration levels, and their physiological responses. To detect these affective events and states, we introduce user-independent binary classification models that achieved an average micro $F_{1}$ score of 71% for detecting fear in a horror game, 75% for fear of vertigo, 76% for frustration, and 75% for insight, showing the promise for detecting these states from passive and objective signals.
Collapse
|
7
|
Eber J, Peterson AC. Specific steps in the operation determine resident speed: Experience with a live tissue simulation model of laparoscopic nephrectomy. Front Surg 2022; 9:997324. [PMID: 36338655 PMCID: PMC9632983 DOI: 10.3389/fsurg.2022.997324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION It is increasingly important to identify and eliminate inefficiencies in resident education. We hypothesize that slower performance of specific operative steps in laparoscopic nephrectomy accounts for much of the slower operative speed observed in junior residents vs. their senior colleagues. Therefore, we sought to evaluate the by-step time-differential between experienced senior residents and their junior colleagues in a live-tissue simulation. MATERIALS AND METHODS Residents participated in our swine model surgical simulation of laparoscopic radical and partial nephrectomy (LRNx and LPNx). PGY5 and 6 residents were considered senior; junior residents were PGY3 and 4. We defined discrete surgical steps. Residents' post-graduate training levels were tracked and time-to-completion of each operative step was recorded. RESULTS Seven live-tissue simulations sessions took place, with 12 residents conducting 22 operations (12 LRNx, 10 LPNx). On average, each resident operated in 2 simulation sessions (range 1-4). The average time required by senior residents for LPNx was 152 min; junior residents required 173 min (p = 0.35). When considering the operative steps, juniors required nearly twice as much time to achieve hilar control (42 min vs. 23 min, p = 0.03). Significant differences in performance time were not seen in the other steps. DISCUSSION The performance differential between senior and junior residents conducting nephrectomies was most evident during hilar dissection. Our study suggests that specific efforts should be focused on teaching junior residents the skills required for this step early in their training.
Collapse
Affiliation(s)
- Jackson Eber
- University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States
| | - Andrew C. Peterson
- Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC, United States,Correspondence: Andrew C. Peterson
| |
Collapse
|
8
|
van der Kruk SR, Zielinski R, MacDougall H, Hughes-Barton D, Gunn KM. Virtual reality as a patient education tool in healthcare: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:1928-1942. [PMID: 35168856 DOI: 10.1016/j.pec.2022.02.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 01/26/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To explore what is currently known about the use of virtual reality (VR) as a patient education tool in healthcare. METHODS Arksey and O'Malley's scoping review method and the PRISMA-ScR Checklist were employed. Four peer-reviewed databases were searched (Medline, Embase, PsychINFO, the Cochrane library). Pre-defined selection criteria identified 18 studies for inclusion. Results were synthesized using a narrative approach. RESULTS VR as an educational tool in healthcare is feasible and acceptable, and may improve patient's knowledge about their illness and satisfaction with treatment. Most studies used the Oculus VR glasses or headset, educated patients though the use of 3D 360° VR anatomical models, and were conducted with people affected with cancer. Opportunities exist for exploring unintended consequences, and the role of VR in educating populations with lower health literacy. CONCLUSION VR could assist in communicating medical information and knowledge to patients, but more research is needed, particularly to identify for whom and in what situations this method is most useful and to improve understanding about the potential unintended consequences. PRACTICE IMPLICATIONS Health professionals should consider using VR to educate their patients, and researchers can use this as a road map on how to address knowledge gaps in this field.
Collapse
Affiliation(s)
| | - Rob Zielinski
- Central West Cancer Care Centre, Orange Base Hospital, Orange, Australia; School of Medicine, Western Sydney University, Sydney, Australia.
| | | | - Donna Hughes-Barton
- Department of Rural Health, University of South Australia, Adelaide, Australia.
| | - Kate M Gunn
- Department of Rural Health, University of South Australia, Adelaide, Australia.
| |
Collapse
|
9
|
Nicholas R, Heinze Z, Papavasiliou T, Fiadeiro R, Atherton D, Timoney N, Echlin K. Educational Impact of a Novel Cleft Palate Surgical Simulator: Improvement in Surgical Trainees’ Knowledge and Confidence. J Plast Reconstr Aesthet Surg 2022; 75:3817-3825. [DOI: 10.1016/j.bjps.2022.06.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/01/2022] [Accepted: 06/07/2022] [Indexed: 10/17/2022]
|
10
|
Beverly E, Rigot B, Love C, Love M. Perspectives of 360-Degree Cinematic Virtual Reality: Interview Study Among Health Care Professionals. JMIR MEDICAL EDUCATION 2022; 8:e32657. [PMID: 35486427 PMCID: PMC9107048 DOI: 10.2196/32657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/20/2021] [Accepted: 03/22/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND The global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters. OBJECTIVE The aim of this study was to explore health care professionals' experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience. METHODS We conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. RESULTS We conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67%, women; n=22, 92%, White; and n=4, 17%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character's frustrations and disappointments; perceived ease of use of cine-VR: 96% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them. CONCLUSIONS Participants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals.
Collapse
Affiliation(s)
- Elizabeth Beverly
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, United States
| | - Brooke Rigot
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH, United States
| | - Carrie Love
- J Warren McClure School of Emerging Communication Technologies, Ohio University, Athens, OH, United States
| | - Matt Love
- J Warren McClure School of Emerging Communication Technologies, Ohio University, Athens, OH, United States
| |
Collapse
|
11
|
Jiang H, Vimalesvaran S, Wang JK, Lim KB, Mogali SR, Car LT. Virtual Reality in Medical Students' Education: Scoping Review. JMIR MEDICAL EDUCATION 2022; 8:e34860. [PMID: 35107421 PMCID: PMC8851326 DOI: 10.2196/34860] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/25/2021] [Accepted: 12/30/2021] [Indexed: 05/12/2023]
Abstract
BACKGROUND Virtual reality (VR) produces a virtual manifestation of the real world and has been shown to be useful as a digital education modality. As VR encompasses different modalities, tools, and applications, there is a need to explore how VR has been used in medical education. OBJECTIVE The objective of this scoping review is to map existing research on the use of VR in undergraduate medical education and to identify areas of future research. METHODS We performed a search of 4 bibliographic databases in December 2020. Data were extracted using a standardized data extraction form. The study was conducted according to the Joanna Briggs Institute methodology for scoping reviews and reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. RESULTS Of the 114 included studies, 69 (60.5%) reported the use of commercially available surgical VR simulators. Other VR modalities included 3D models (15/114, 13.2%) and virtual worlds (20/114, 17.5%), which were mainly used for anatomy education. Most of the VR modalities included were semi-immersive (68/114, 59.6%) and were of high interactivity (79/114, 69.3%). There is limited evidence on the use of more novel VR modalities, such as mobile VR and virtual dissection tables (8/114, 7%), as well as the use of VR for nonsurgical and nonpsychomotor skills training (20/114, 17.5%) or in a group setting (16/114, 14%). Only 2.6% (3/114) of the studies reported the use of conceptual frameworks or theories in the design of VR. CONCLUSIONS Despite the extensive research available on VR in medical education, there continue to be important gaps in the evidence. Future studies should explore the use of VR for the development of nonpsychomotor skills and in areas other than surgery and anatomy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2020-046986.
Collapse
Affiliation(s)
- Haowen Jiang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Sunitha Vimalesvaran
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Jeremy King Wang
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Kee Boon Lim
- School of Biological Sciences, Nanyang Technological University Singapore, Singapore, Singapore
| | | | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| |
Collapse
|
12
|
Papavasiliou T, Nicholas R, Cooper L, Chan JCY, Ibanez J, Bain CJ, Uppal L. Utilisation of a 3D printed ex vivo flexor tendon model to improve surgical training. J Plast Reconstr Aesthet Surg 2021; 75:1255-1260. [PMID: 34896043 DOI: 10.1016/j.bjps.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgery for hand trauma accounts for a significant proportion of the plastic surgery trainee activity. The aim of this article is to create a standardised simulation training module for flexor tendon repair techniques for residents prior to their first encounter in the clinical setting. METHODS A step-ladder approach flexor tendon repair training with four levels of difficulty was conducted using a three-dimensional (3D) printed anatomical simulation model and a silicone tendon rod on a cohort of 28 plastic surgery Senior House Officers (SHOs) of various stages in their training (n=28). Assessment of knowledge (online questionnaire) and practical skills using validated score systems (global rating scale and task specific score) was performed at the beginning and end of the module by hand experts of our unit. RESULTS The overall average knowledge-based scores of the cohort pre- and post-assessment were 1.48/5 (29.6%) and 3.56/5 (71.5%), respectively. The overall average skills-based scores of the cohort pre- and post-assessments were 3.05/5 (61%) and 4.12/5 (82.5%), respectively. Significant (p<0.01) difference of improvement of knowledge and skills was noted on all trainees. All trainees confirmed that the training module improved their confidence with flexor tendon repair. CONCLUSION We demonstrate a standardised simulation training framework that employs a 3D printed flexor tendon simulation model proven to improve the skills of residents especially during their early learning curve and which paves the way to a more universal, standardised and validated training across hand surgery.
Collapse
Affiliation(s)
- Theodora Papavasiliou
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth SE1 7EH, London.
| | - Rebecca Nicholas
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth SE1 7EH, London
| | - Lilli Cooper
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth SE1 7EH, London
| | - Jeffrey C Y Chan
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth SE1 7EH, London
| | - Javier Ibanez
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth SE1 7EH, London
| | - Charles J Bain
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth SE1 7EH, London
| | - Lauren Uppal
- Department of Plastic Surgery, Guys' and St' Thomas' Hospitals, Westminster Bridge Rd, Lambeth SE1 7EH, London
| |
Collapse
|
13
|
Zaidman M, Al-Shaqsi S, Yeung C, Novak CB, Dengler J. COVID-19 Restrictions Presented Opportunities and Challenges for Plastic Surgery Residents. Plast Surg (Oakv) 2021; 29:294-302. [PMID: 34760847 PMCID: PMC8573642 DOI: 10.1177/22925503211024842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Restrictions placed during the COVID-19 pandemic to prevent viral spread led to substantial changes in surgical resident education. The aim of this study was to assess the positive and negative impact of COVID-19 on plastic surgery education and training and provide recommendations for continued competency. METHODS A cross-sectional online survey of plastic surgery residents across Canada was used to evaluate the impact of COVID-19 on clinical exposure, experience with virtual education, and long-term impact of COVID-19 on surgical training. RESULTS This study included 61 plastic surgery residents (40% participation rate). Common educational modalities used during COVID-19 included online seminars (95%) and workshops (58%). Teaching sessions were effective if structured around patient cases (72%), recorded (66%), and limited to 1 hour (64%). There were mixed reactions towards online education sessions; residents reported feeling grateful (54%), motivated (38%), enthusiastic (28%), overwhelmed (41%), pressured to participate (23%), and anxious (13%). There were significantly less residents who felt that their clinical exposure was sufficient during (21%) versus before (72%) pandemic restrictions (P < .001). Overall, 87% of residents felt that the pandemic had a negative impact on their training, surgical skill development, fellowship plans, and job prospects. CONCLUSIONS During the initial wave of COVID-19, residents faced altered educational opportunities, which elicited positive and negative emotions with concern regarding surgical skill development and impact on future career plans. Characterizing early educational impact on residency training to identify opportunities for change is worthwhile as the overall effect of the pandemic is ongoing and remains uncertain.
Collapse
Affiliation(s)
- Maya Zaidman
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sultan Al-Shaqsi
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Celine Yeung
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Christine B. Novak
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
14
|
Gib MC, Zanirati T, Simas P, Wender OCB, Cavazzola LT. Comparison of the internal thoracic artery flow dissected by video endoscopy or conventional technique. Acta Cir Bras 2021; 36:e360803. [PMID: 34644771 PMCID: PMC8516423 DOI: 10.1590/acb360803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: To compare the blood flow in the internal thoracic artery when dissected
endoscopically in a conventional manner, in addition to develop a reliable
experimental training model for the surgical team. Methods: Paired experimental study. Ten pigs were operated and had both internal
thoracic arteries dissected, the right with a conventional technique and the
left by video endoscopy. The main outcomes to be studied were flow, length,
and time of dissection of each vessel. Results: Blood flow measurements were performed with mean heart rate of 100 ± 16 bpm
and mean arterial pressure of 89.7 ± 13 mm Hg. The mean blood flow of
endoscopic dissection of the internal thoracic artery was 170.2 ± 66.3
mL/min and by direct view was 180.8 ± 70.5 (p = 0.26). Thus, there was no
statistically significant difference between the flows, showing no
inferiority between the methods. Conclusions: The minimally invasive dissection of the internal thoracic artery was shown
to be not inferior to the dissection by open technique in relation to the
blood flow in the present experimental model. In addition, the model that we
replicated was shown to be adequate for the development of the learning
curve and improvement of the endoscopic abilities.
Collapse
|
15
|
Paludo ADO, Knijnik P, Brum P, Cachoeira E, Gorgen A, Burttet L, Cabral R, Puliatti S, Rosito T, Berger M, Neto BS. Urology Residents Simulation Training Improves Clinical Outcomes in Laparoscopic Partial Nephrectomy. JOURNAL OF SURGICAL EDUCATION 2021; 78:1725-1734. [PMID: 33849788 DOI: 10.1016/j.jsurg.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/08/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Partial nephrectomy (PN) is the preferred modality of treatment for small renal masses. Laparoscopic partial nephrectomy (LPN) has been adopted worldwide and a fundamental role is played by surgical skills. The need for skill instruction outside the operating room is well recognized in the modern models of surgery residency training. We aim to investigate the impact of residents' laparoscopic surgical skills training on the successful implementation of LPN in a reference public teaching hospital in southern Brazil. METHODS We accessed all patients undergoing LPN by senior's urology residents at Hospital de Clínicas de Porto Alegre. Patients were stratified in 2 periods of time named 'LPN eras' 1 and 2, to report the training impact on the outcome. LPN era 1 was from October 2012 to February 2017 and LPN era 2 from March 2017 to June 2019. All the senior residents of LPN era 2 followed a simulation training divided into 4 years with a total training time of 244 hours before performing the LPN. Residents from LPN era 1 did not have simulation training. RESULTS 124 patients underwent LPN during the study period, 53 (42.7%) of those were performed in LPN era 1 and 71 (57.3%) in LPN era 2. Baseline characteristics of the patients in the two groups were similar. The training performed by LPN era 2 residents was able to significantly reduce estimated blood loss, ischemia time and LOS with p value respectively 0.007, 0.001 and 0.001. LPN era 2 group also reached Trifecta in 77.5% of patients, being significantly more than in the LPN era 1 (p = 0.007). CONCLUSIONS Simulation in residents surgical training was able to improve clinical outcomes in LPN. These data reinforce the fundamental importance of adequate residents training before performing surgery on a patient.
Collapse
Affiliation(s)
- Artur de Oliveira Paludo
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil.
| | - Pedro Knijnik
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Pietro Brum
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Eduardo Cachoeira
- Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Antonio Gorgen
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Burttet
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil
| | - Renan Cabral
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil
| | - Stefano Puliatti
- ORSI Academy - Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia - Modena, Italy
| | - Tiago Rosito
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Milton Berger
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| | - Brasil Silva Neto
- Department of Urology, Hospital de Clínicas de Porto Alegre Porto Alegre, Rio, Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul - Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
16
|
Feasibility of extracting tissue material properties via cohesive elements: a finite element approach to probe insertion procedures in non-invasive spine surgeries. Med Biol Eng Comput 2021; 59:2051-2061. [PMID: 34431026 DOI: 10.1007/s11517-021-02432-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
Modeling the mechanical behavior of soft tissue probe insertion remains a challenging endeavor due to involved interdependent phenomena comprising tissue nonlinear deformation, contact between the probe and the tissue, crack propagation, and viscoelastic effects. To that matter, cohesive elements allow simulating crack formation and propagation, which provides a promising path to modeling the mechanical behavior of probe insertion in soft tissues. As such, the aim of the present study was to investigate the feasibility of devising and integrating an algorithm in a finite element (FE) case study in efforts of reverse engineering the material properties of non-homogeneous soft tissues. A layered nonlinear tissue model with a cohesive zone was created in the commercial software ABAQUS. Material properties were iteratively modified via a hybrid gradient descent optimization algorithm: minimizing the resultant error to first find optimum Ogden's hyperelastic parameters, followed by obtaining the damage parameters. Perceived material properties were then compared to those obtained via experimental human cadaver testing. Under the investigated four-layered muscle model, numerical results overlapped, to a great extent, with six different force-insertion experimental profiles with an average error of [Formula: see text] 15%. The best profile fit was realized when the highest sudden force drop was less than 60% of the peak force. Lastly, the FE analysis revealed an increase in stiffness as the probe advanced inside the tissue. The optimization algorithm demonstrated its capability to reverse engineer the material parameters required for the FE analysis of real, non-homogeneous, soft tissues. The significance of this procedure lies within its ability to extract tissue material parameters, in real time, with little to no intervention or invasive experimental tests. This could potentially further serve as a database for different muscle layers and force-insertion profiles, used for surgeon and physician clinical training purposes.
Collapse
|
17
|
|
18
|
Valente M, Campanelli M, Benavoli D, Arcudi C, Riccó M, Bianciardi E, Gentileschi P. Safety and Outcomes of Laparoscopic Sleeve Gastrectomy in a General Surgery Residency Program. JSLS 2021; 25:JSLS.2020.00063. [PMID: 33879991 PMCID: PMC8035819 DOI: 10.4293/jsls.2020.00063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: With the escalation of surgical treatment of morbid obesity, there is a growing interest in the training of bariatric surgeons. Laparoscopic sleeve gastrectomy (LSG) gained popularity both as a first-stage approach and as a stand-alone procedure. Objectives: The aim of this study was to assess detectable differences in LSG with intra-operative resident involvement. Methods: We reviewed obese patients, who had undergone LSG between January 1, 2017 and January 31, 2020. Collected data reported demographic factors, operative time, postoperative complications, and outcomes. Results: Among 313 patients who met the inclusion criteria, 94 were men and 219 were women. The procedures were performed either by an expert bariatric surgeon (group 1), or a general surgery resident (group 2), respectively in 228 and 85 cases. Mean operative time of the first group was 65.3 ± 18.8 minutes, while it was 74.3 ± 17.2 among trainees (p < 0.001). Perioperative complications were diagnosed in 13 patients (10 in group 1 and 3 in group 2). Mean excess body weight loss after 12 months was 87.7 ± 28.2% in the first group and 81.1 ± 31.6% in the residents group. Between the two groups, we found no differences in the incidence of perioperative complications and in surgical outcomes. Trainee involvement was associated with increased operative time, with no correlation with a worse postoperative course. Conclusions: Residents can safely perform LSG in referral centers under the supervision of an expert bariatric surgeon. Trainee involvement is not related to increased leak rate, nor to suboptimal short-term outcome.
Collapse
Affiliation(s)
- Marina Valente
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Michela Campanelli
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Domenico Benavoli
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | - Claudio Arcudi
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| | | | | | - Paolo Gentileschi
- Obesity Unit, Department of Surgery, University of Rome Tor Vergata, Roma, Italy
| |
Collapse
|
19
|
Lowe S, Mares K, Khadjesari Z. Immersive technology in ophthalmology education: a systematic review. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:600-604. [PMID: 35520978 PMCID: PMC8936631 DOI: 10.1136/bmjstel-2021-000906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/18/2021] [Indexed: 11/03/2022]
Abstract
Background Despite the increasing use of immersive technology (IT) in ophthalmology, the effectiveness of this approach compared to other teaching practices is unclear. This systematic review aimed to determine the value of IT to teach students ophthalmic skills and whether it can supplement or replace conventional teaching practices. Methods A systematic search was performed of CENTRAL, MEDLINE, EMBASE, ERIC and PsychINFO databases. Randomised controlled trials comparing IT interventions versus (1) no training, (2) standard training, (3) different types of IT interventions, (4) different doses of IT interventions were eligible for inclusion. Results Seven trials involving 177 participants were included. IT offered some benefit compared to standard training as most trials demonstrated evidence of learning represented by composite performance score and performance time. Repetitive training with IT displayed similar results. Conclusion IT appears to improve the ophthalmic skill of healthcare trainees and should be considered as a supplement to training.
Collapse
Affiliation(s)
- Shakeel Lowe
- Norwich Medical School, University of East Anglia, Norwich, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Kathryn Mares
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | |
Collapse
|
20
|
Weeks JK, Pakpoor J, Park BJ, Robinson NJ, Rubinstein NA, Prouty SM, Nachiappan AC. Harnessing Augmented Reality and CT to Teach First-Year Medical Students Head and Neck Anatomy. Acad Radiol 2021; 28:871-876. [PMID: 32828663 DOI: 10.1016/j.acra.2020.07.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 06/30/2020] [Accepted: 07/05/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Three-dimensional (3D) visualization has been shown to benefit new generations of medical students and physicians-in-training in a variety of contexts. However, there is limited research directly comparing student performance after using 3D tools to those using two-dimensional (2D) screens. MATERIALS AND METHODS A CT was performed on a donated cadaver and a 3D CT hologram was created. A total of 30 first-year medical students were randomly assigned into two groups to review head and neck anatomy in a teaching session that incorporated CT. The first group used an augmented reality headset, while the second group used a laptop screen. The students were administered a five-question anatomy test before and after the session. Two-tailed t-tests were used for statistical comparison of pretest and posttest performance within and between groups. A feedback survey was distributed for qualitative data. RESULTS Pretest vs. posttest comparison of average percentage of questions answered correctly demonstrated both groups showing significant in-group improvement (p < 0.05), from 59% to 95% in the augmented reality group, and from 57% to 80% in the screen group. Between-group analysis indicated that posttest performance was significantly better in the augmented reality group (p = 0.022, effect size = 0.73). CONCLUSION Immersive 3D visualization has the potential to improve short-term anatomic recall in the head and neck compared to traditional 2D screen-based review, as well as engage millennial learners to learn better in anatomy laboratory. Our findings may reflect additional benefit gained from the stereoscopic depth cues present in augmented reality-based visualization.
Collapse
Affiliation(s)
- Joanna K Weeks
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA
| | - Jina Pakpoor
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA
| | - Brian J Park
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA
| | - Nicole J Robinson
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Neal A Rubinstein
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stephen M Prouty
- Department of Cell and Developmental Biology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Arun C Nachiappan
- Department of Radiology, University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA.
| |
Collapse
|
21
|
Haowen J, Vimalesvaran S, Myint Kyaw B, Tudor Car L. Virtual reality in medical students' education: a scoping review protocol. BMJ Open 2021; 11:e046986. [PMID: 34039577 PMCID: PMC8160201 DOI: 10.1136/bmjopen-2020-046986] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/15/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Virtual reality (VR) is a technology that produces a virtual manifestation of the real world. In recent years, VR has been increasingly used as a tool in medical education. The use of VR in medical education has large potential, as it allows for distance learning and training which may be challenging to deliver in real life. VR encompasses different tools and applications. There is a need to explore how VR has been employed in medical education to date. OBJECTIVE The objective of this scoping review is to conceptualise the VR tools available and the applications of VR in undergraduate medical education as reported in the literature. This scoping review will identify any gaps in this field and provide suggestions for future research. METHODS AND ANALYSIS The relevant studies will be examined using the Joanna Briggs Institute methodological framework for scoping studies. A comprehensive search from a total of six electronic databases and grey literature sources will be performed. The reference list of included studies will be screened for additional studies. The screening and data extraction will be done in parallel and independently by two review authors. Any discrepancies will be resolved through consensus or discussion with a third review author. A data extraction form has been developed using key themes from the research questions. The extracted data will be qualitatively analysed and presented in a diagrammatic or tabular form, alongside a narrative summary, in line with Preferred Reporting Items for Systematic Reviews and Meta-Analysis: extension for Scoping Reviews reporting guidelines. ETHICS AND DISSEMINATION All data will be collected from published and grey literature. Ethics approval is therefore not a requirement. We will present our findings at relevant conferences and submit them for publications in peer-reviewed journals.
Collapse
Affiliation(s)
- Jiang Haowen
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Bhone Myint Kyaw
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
- Department of Primary Care and Public Health, Imperial College London, London, UK
| |
Collapse
|
22
|
A T P, Lakshmikantha N, Lakshman K. The impact of virtual reality training on laparoscopic surgical skills; A prospective blinded controlled trial. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2021. [DOI: 10.25083/2559.5555/6.1.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background. Laparoscopic surgery has gained popularity in the last few decades replacing open standard techniques in several procedures. While its use and scope expand, a standardized method of training and assessment in laparoscopic skills is lacking. Aim. To assess the effect of virtual reality (VR) training on laparoscopic surgical skills. Materials and Methods. It is a prospective, controlled study conducted at Sagar Hospital’s skill lab and Shanthi Hospital and Research Centre (SHRC). We included 27 post graduates in general surgery. They were divided into two groups. One group underwent training in VR Simulator for one week, 30 minutes each day. The second group received no training. Their proficiency while mobilizing the Gallbladder from its liver bed was assessed using a validated scale by a single blinded observer. Results. The statistical analysis was done using a non-parametric test (Mann-Whitney U test). Residents who underwent training in VR simulator got better scores in Overall rating and also in individual parameters when compared with the control group (P = <0.05). Conclusions. Laparoscopic surgical skills can be increased by using proficiency-based VR simulator training and it can be transferred to actual operations. VR simulators are a valid tool for laparoscopic surgical skills training.
Collapse
|
23
|
Li Y, Ye H, Ye F, Liu Y, Lv L, Zhang P, Zhang X, Zhou Y. The Current Situation and Future Prospects of Simulators in Dental Education. J Med Internet Res 2021; 23:e23635. [PMID: 33830059 PMCID: PMC8063092 DOI: 10.2196/23635] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/26/2020] [Accepted: 01/29/2021] [Indexed: 01/22/2023] Open
Abstract
The application of virtual reality has become increasingly extensive as this technology has developed. In dental education, virtual reality is mainly used to assist or replace traditional methods of teaching clinical skills in preclinical training for several subjects, such as endodontics, prosthodontics, periodontics, implantology, and dental surgery. The application of dental simulators in teaching can make up for the deficiency of traditional teaching methods and reduce the teaching burden, improving convenience for both teachers and students. However, because of the technology limitations of virtual reality and force feedback, dental simulators still have many hardware and software disadvantages that have prevented them from being an alternative to traditional dental simulators as a primary skill training method. In the future, when combined with big data, cloud computing, 5G, and deep learning technology, dental simulators will be able to give students individualized learning assistance, and their functions will be more diverse and suitable for preclinical training. The purpose of this review is to provide an overview of current dental simulators on related technologies, advantages and disadvantages, methods of evaluating effectiveness, and future directions for development.
Collapse
Affiliation(s)
- Yaning Li
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- NHC Key Laboratory of Digital Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hongqiang Ye
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- NHC Key Laboratory of Digital Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Fan Ye
- The State Key Laboratory of Virtual Reality Technology and Systems, School of Computer Science and Engineering, Beihang University, Beijing, China
| | - Yunsong Liu
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- NHC Key Laboratory of Digital Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Longwei Lv
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- NHC Key Laboratory of Digital Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Ping Zhang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- NHC Key Laboratory of Digital Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Xiao Zhang
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- NHC Key Laboratory of Digital Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, China
- National Clinical Research Center for Oral Diseases, Peking University School and Hospital of Stomatology, Beijing, China
- National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
- NHC Key Laboratory of Digital Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| |
Collapse
|
24
|
Mahajan UV, Sunshine KS, Herring EZ, Labak CM, Wright JM, Smith G. Virtual reality in presurgical patient education: A scoping review and recommended trial design guidelines. Am J Surg 2021; 222:704-705. [PMID: 33752872 DOI: 10.1016/j.amjsurg.2021.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/30/2020] [Accepted: 03/10/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Uma V Mahajan
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Kerrin S Sunshine
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Eric Z Herring
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Collin M Labak
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - James M Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Gabriel Smith
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
25
|
Consorti F, Panzera G. Low versus high level of physical resemblance in simulation for the acquisition of basic surgical skill: a meta-analysis. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2021; 7:422-427. [PMID: 35515747 PMCID: PMC8936611 DOI: 10.1136/bmjstel-2020-000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/14/2021] [Indexed: 11/22/2022]
Abstract
Background Many studies explored the use of simulation in basic surgical education, with a variety of devices, contexts and outcomes, with sometimes contradictory results. Objectives The objectives of this meta-analysis were to focus the effect that the level of physical resemblance in a simulation has on the development of basic surgical skill in undergraduate medical students and to provide a foundation for the design and implementation of a simulation, with respect to its effectiveness and alignment with the learning outcomes. Study selection We searched PubMed and Scopus database for comparative randomised studies between simulations with a different level of resemblance. The result was synthesised as the standardised mean difference, under a random effect model. Findings We selected 12 out of 2091 retrieved studies, reporting on 373 undergraduate students (mean of subjects 15.54±6.89). The outcomes were the performance of simple skills and the time to complete a task. Two studies reported a scoring system; seven studies reported time for a task; and three studies reported both. The total number of measures included in the meta-analysis was 456 for score and 504 for time. The pooled effect size did not show any significant advantage in a simulation of a high level of physical resemblance over a lower level, both for the scoring system (−0.19, 95% CI −0.44 to 0.06) and for time (−0.14, 95% CI −0.54 to 0.27). Conclusion Simulations with a low level of physical resemblance showed the same effect as the simulation using a higher level of resemblance on the development of basic surgical skills in undergraduate students.
Collapse
Affiliation(s)
- Fabrizio Consorti
- Surgical Sciences, University of Rome La Sapienza Sapienza Faculty of Medicine and Dentistry, Roma, Italy
| | - Gianmarco Panzera
- Surgical Sciences, University of Rome La Sapienza Sapienza Faculty of Medicine and Dentistry, Roma, Italy
| |
Collapse
|
26
|
Kuhn S, Huettl F, Deutsch K, Kirchgässner E, Huber T, Kneist W. [Surgical Education in the Digital Age - Virtual Reality, Augmented Reality and Robotics in the Medical School]. Zentralbl Chir 2021; 146:37-43. [PMID: 33588501 PMCID: PMC7884202 DOI: 10.1055/a-1265-7259] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The digital transformation of healthcare is changing the medical profession. Augmented/Virtual Reality (AR/VR) and robotics are being increasingly used in different clinical contexts and require supporting education and training, which must begin within the medical school. There is currently a large discrepancy between the high demand and the number of scientifically proven concepts. The aim of this thesis was the conceptual design and structured evaluation of a newly developed learning/teaching concept for the digital transformation of medicine, with a special focus on the influence of surgical teaching. METHODS Thirty-five students participated in three courses of the blended learning curriculum "Medicine in the digital age". The 4th module of this course deals with virtual reality, augmented reality and robotics in surgery. It is divided into the following course parts: (1) immersive surgery simulation of a laparoscopic cholecystectomy, (2) liver surgery planning using AR/VR, (3) basic skills on the VR simulator for robotic surgery, (4) collaborative surgery planning in virtual space and (5) expert discussion. After completing the overall curriculum, a qualitative and quantitative evaluation of the course concept was carried out by means of semi-structured interviews and standardised pre-/post-evaluation questionnaires. RESULTS In the qualitative evaluation procedure of the interviews, 79 text statements were assigned to four main categories. The largest share (35%) was taken up by statements on the "expert discussion", which the students consider to be an elementary part of the course concept. In addition, the students perceived the course as a horizon-widening "learning experience" (29% of the statements) with high "practical relevance" (27%). The quantitative student evaluation shows a positive development in the three sub-competences knowledge, skills and attitude. CONCLUSION Surgical teaching can be profitably used to develop digital skills. The speed of the change process of digital transformation in the surgical specialty must be considered. Curricular adaptation should be anchored in the course concept.
Collapse
Affiliation(s)
- Sebastian Kuhn
- AG 4 – Digitale Medizin, Medizinische Fakultät OWL, Universität Bielefeld
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Deutschland
| | - Florentine Huettl
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Deutschland
| | - Kim Deutsch
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Deutschland
| | - Elisa Kirchgässner
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsmedizin Mainz, Deutschland
| | - Tobias Huber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Deutschland
| | - Werner Kneist
- Klinik und Poliklinik für Allgemein- und Abdominalchirurgie, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
- Klinik für Allgemein- und Viszeralchirurgie, St. Georg Klinikum Eisenach gGmbH, Deutschland
| |
Collapse
|
27
|
Aspari AR, Ramesh V, Lakshman K. An Indigenous Virtual Reality-Based Simulator—a Tool in Surgical Training. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02347-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
28
|
Adesoye T, Davis CH, Del Calvo H, Shaikh AF, Chegireddy V, Chan EY, Martinez S, Pei KY, Zheng F, Tariq N. "Optimization of Surgical Resident Safety and Education During the COVID-19 Pandemic - Lessons Learned". JOURNAL OF SURGICAL EDUCATION 2021; 78:315-320. [PMID: 32739443 PMCID: PMC7328568 DOI: 10.1016/j.jsurg.2020.06.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 05/12/2023]
Abstract
The COVID-19 pandemic has engendered rapid and significant changes in patient care. Within the realm of surgical training, the resultant reduction in clinical exposure and case volume jeopardizes the quality of surgical training. Thus, our general surgery residency program proceeded to develop a tailored approach to training that mitigates impact on resident surgical education and optimizes clinical exposure without compromising safety. Residents were engaged directly in planning efforts to craft a response to the pandemic. Following the elimination of elective cases, the in-house resident complement was effectively decreased to reduce unnecessary exposure, with a back-up pool to address unanticipated absences and needs. Personal protective equipment availability and supply, the greatest concern to residents, has remained adequate, while being utilized according to current guidelines. Interested residents were given the opportunity to work in designated COVID ICUs on a volunteer basis. With the decrease in operative volume and clinical duties, we shifted our educational focus to an intensive didactic schedule using a teleconferencing platform and targeted areas of weakness on prior in-service exams. We also highlighted critical COVID-19 literature in a weekly journal club to better understand this novel disease and its effect on surgical practice. The long-term impact of the COVID-19 pandemic on resident education remains to be seen. Success may be achieved with commitment to constant needs assessment in the changing landscape of healthcare with the goal of producing a skilled surgical workforce for public service.
Collapse
Affiliation(s)
- T Adesoye
- Department of Surgery, Houston Methodist Hospital, Houston, Texas.
| | - C H Davis
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - H Del Calvo
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - A F Shaikh
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - V Chegireddy
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - E Y Chan
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - S Martinez
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - K Y Pei
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - F Zheng
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - N Tariq
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| |
Collapse
|
29
|
Management of Bleeding Complications in Virtual Reality Laparoscopy. Int Surg 2020. [DOI: 10.9738/intsurg-d-15-00190.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to compare the impact of induced bleeding complication training with regular training on a virtual reality laparoscopic (VRL) simulator. Although bleeding complications occur rarely during laparoscopic surgery, they usually arise without warning and may have severe consequences for the patient because complication management training is not currently widespread. Third-year medical students (n = 41) were randomly selected for 2 curricular courses on how to perform a bimanual task on a VRL simulator. Both the regular training group (RTG) and the induced bleeding complication training (ICT) group performed 2 regular training sessions and 9 training sessions. For the ICT group the training sessions were with a bleeding complication. The 2 groups were comparable regarding their initial performance levels and improved significantly in task time and handling economics throughout the course (P < 0.001). When a bleeding complication occurred during the initial phase, performance parameters were significantly worse (P < 0.05). During a bleeding complication, the ICT group showed a significant improvement in time, handling economics, and blood loss (P < 0.001) throughout the training course, whereas the RTG group showed no improvement. Induced complication training has a positive influence on the management of bleeding on the VRL simulator. Structured laparoscopic complication management training should be implemented during surgical education as an add-on to regular procedural training.
Collapse
|
30
|
Portelli M, Bianco SF, Bezzina T, Abela JE. Virtual reality training compared with apprenticeship training in laparoscopic surgery: a meta-analysis. Ann R Coll Surg Engl 2020; 102:672-684. [PMID: 32820649 DOI: 10.1308/rcsann.2020.0178] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Since its inception, laparoscopic surgery has evolved and new techniques have been developed due to technological advances. This requires a different and more complex skill set in comparison with open surgery. Reduced working hours, less training time and patient safety factors demand that such skills need to be achieved outside the operating theatre environment. Several studies have been published and have determined the effectiveness of virtual reality training. We aimed to compare virtual reality training with the traditional apprenticeship method of training and determine whether it can supplement or replace the traditional apprenticeship model. We also aimed to perform a meta-analysis of the literature and develop conclusions with respect to the benefits achieved by adding virtual reality training on a regular basis to surgical training programmes. METHODS A literature search was carried out on PubMed, MEDLINE, EMBASE and Google Scholar academic search engines using the MESH terms 'randomised controlled trials', 'virtual reality', 'laparoscopy', 'surgical education' and 'surgical training'. All randomised controlled trials published to January 2018 comparing virtual reality training to apprenticeship training were included. Data were collected on improved dexterity, operative performance and operating times. Each outcome was calculated with 95% confidence intervals and with intention-to-treat analysis; 24 randomised controlled trials were analysed. FINDINGS Meta-analytical data were extracted for time, path length, instrument handling, tissue handling, error scores and objective structure assessment of technical skills scoring. There was significant improvement in individual trainee skill in all meta-analyses (p < 0.0002). CONCLUSION This meta-analysis shows that virtual reality not only improves efficiency in the trainee's surgical practice but also improves quality with reduced error rates and improved tissue handling.
Collapse
Affiliation(s)
- M Portelli
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| | - S F Bianco
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| | - T Bezzina
- Department of Pathology, Mater Dei Hospital, Msida, Malta
| | - J E Abela
- Department of Surgery, Mater Dei Hospital, Msida, Malta
| |
Collapse
|
31
|
Moore N, Yoo S, Poronnik P, Brown M, Ahmadpour N. Exploring User Needs in the Development of a Virtual Reality-Based Advanced Life Support Training Platform: Exploratory Usability Study. JMIR Serious Games 2020; 8:e20797. [PMID: 32763877 PMCID: PMC7442950 DOI: 10.2196/20797] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/25/2020] [Accepted: 07/26/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Traditional methods of delivering Advanced Life Support (ALS) training and reaccreditation are resource-intensive and costly. Interactive simulations and gameplay using virtual reality (VR) technology can complement traditional training processes as a cost-effective, engaging, and flexible training tool. OBJECTIVE This exploratory study aimed to determine the specific user needs of clinicians engaging with a new interactive VR ALS simulation (ALS-SimVR) application to inform the ongoing development of such training platforms. METHODS Semistructured interviews were conducted with experienced clinicians (n=10, median age=40.9 years) following a single playthrough of the application. All clinicians have been directly involved in the delivery of ALS training in both clinical and educational settings (median years of ALS experience=12.4; all had minimal or no VR experience). Interviews were supplemented with an assessment of usability (using heuristic evaluation) and presence. RESULTS The ALS-SimVR training app was well received. Thematic analysis of the interviews revealed five main areas of user needs that can inform future design efforts for creating engaging VR training apps: affordances, agency, diverse input modalities, mental models, and advanced roles. CONCLUSIONS This study was conducted to identify the needs of clinicians engaging with ALS-SimVR. However, our findings revealed broader design considerations that will be crucial in guiding future work in this area. Although aligning the training scenarios with accepted teaching algorithms is important, our findings reveal that improving user experience and engagement requires careful attention to technology-specific issues such as input modalities.
Collapse
Affiliation(s)
- Nathan Moore
- Research and Education Network, Western Sydney Local Health District, Westmead, Australia
| | - Soojeong Yoo
- Design Lab, Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, Australia
| | - Philip Poronnik
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Martin Brown
- Innovative Technologies, Office of the Vice-Chancellor and Principal Westmead Operations, The University of Sydney, Sydney, Australia
| | - Naseem Ahmadpour
- Design Lab, Sydney School of Architecture, Design and Planning, The University of Sydney, Sydney, Australia
| |
Collapse
|
32
|
Tey HTV, Foo SMJ, Fong SS, Chong CS. Short Term Postoperative and Oncological Outcomes of Two-Dimensional Versus Three-Dimensional Laparoscopic Transanal Total Mesorectal Excision of Rectal Cancer. J Laparoendosc Adv Surg Tech A 2020; 30:1350-1353. [PMID: 32522084 DOI: 10.1089/lap.2020.0093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Transanal total mesorectal excision (TaTME) carried out synchronously with laparoscopy is a useful surgical technique in rectal cancer patients who are overweight or who have a narrow pelvis. This retrospective study aims to compare the safety and efficacy of two-dimensional (2D) and three-dimensional (3D) laparoscopic TaTME of rectal cancer based on the short-term postoperative and oncological outcomes of 40 patients in Singapore who underwent laparoscopic TaTME. Materials and Methods: Forty patients underwent laparoscopic TaTME for rectal cancer in one of three centers in Singapore from October 2015 to August 2018. Out of these patients, 23 underwent 3D laparoscopic TaTME with the Olympus Flexible Tip™ 10 mm scope. Data on patient demographics, operative details, and postoperative and oncological outcomes were collected retrospectively by going through soft copy patient records, analyzed and compared. Results: The operative time for 3D group was significantly shorter (340 versus 419 minutes, P = .04). Complete TME grade and R0 resection was achieved in a higher percentage of patients in the 3D group although this was not statistically significant. There were no other significant differences between the two groups in terms of oncological outcomes and other short-term postoperative outcomes. Discussion and Conclusion: TaTME is overall a safe technique. Three-dimensional TaTME for rectal cancers is as safe and feasible as 2D TaTME, with the advantage of a shorter operative time.
Collapse
Affiliation(s)
- Hwee Ting Vanessa Tey
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, National University Hospital, Singapore, Singapore
| | - Shuo Min Jonathan Foo
- Division of General Surgery, National University Health System, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Sau Shung Fong
- Division of Colorectal Surgery, National Healthcare Group, Tan Tock Seng Hospital, Singapore, Singapore
| | - Choon Seng Chong
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, National University Hospital, Singapore, Singapore
| |
Collapse
|
33
|
Keskinkılıç Yağız B, Yalaza M, Sapmaz A. Is Youtube a potential training source for total extraperitoneal laparoscopic inguinal hernia repair? Surg Endosc 2020; 35:2014-2020. [PMID: 32367448 DOI: 10.1007/s00464-020-07596-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the quality of the most commonly viewed total extraperitoneal laparoscopic inguinal hernia repair (TEP) videos on Youtube, which is the largest social and medical media broadcasting service, concerning educational purposes. METHOD A search with the keyword "total extraperitoneal laparoscopic inguinal hernia repair" was performed on Youtube. The first 120 videos among the search results were downloaded and 55 of them were included in the study. A scoring system developed by the authors according to the recent literature was utilized for evaluation of the videos. Video demographics were evaluated for the quality and upload source. RESULTS Among the enrolled videos, video quality was rated as good in 13 (23.6%), as moderate in 22 (40%), and as poor in 20 (36.4%). Video length, presence of narration, number of likes, and comments were significantly higher in the good group. Upload source was an academic center in 14 (25.5%), a community hospital in 22 (40.0%), and a physician in 19 (34.5%). The mean video score of the academic center group (8 ± 4.095) and community hospital group (8.64 ± 3.259) was significantly higher than the physician group (5.47 ± 2.632) (p = 0.010). Video quality was not correlated with total views or views per day. CONCLUSION Total extraperitoneal laparoscopic inguinal hernia repair procedure videos uploaded to Youtube demonstrate considerable heterogeneity in terms of educational quality and the number of good quality videos is significantly low. This heterogeneity is attributed to the lack of peer review process for the evaluation of educational quality of the videos. Therefore, a physician intending to learn and practice a surgical procedure properly (TEP repair in this situation) should not consider a broadcasting service without a peer review process as a reliable training source.
Collapse
Affiliation(s)
- Betül Keskinkılıç Yağız
- Department of General Surgery, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey.
| | - Metin Yalaza
- Department of General Surgery, Subdivision of Surgical Oncology, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey
| | - Ali Sapmaz
- Department of General Surgery, Ministry of Health Ankara City Hospital, Üniversiteliler caddesi Bilkent bulvarı no:1, Çankaya, Ankara, Turkey
| |
Collapse
|
34
|
Fundus first as the standard technique for laparoscopic cholecystectomy. Sci Rep 2019; 9:18736. [PMID: 31822771 PMCID: PMC6904718 DOI: 10.1038/s41598-019-55401-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/27/2019] [Indexed: 01/10/2023] Open
Abstract
In previous studies the fundus first technique (FF) has been a cost-effective way to simplify the laparoscopic cholecystectomy (LC) and facilitate patient rehabilitation. The feasibility and safety profile when introducing FF as the standard technique were aimed in this study. Between 2004–2014, 29 surgeons performed 1425 LC with FF and 320 with a conventional technique. During the first year 56% were with FF and 98% during the last four years. More females, ultrasonic shears, urgent operations, daycare operations and a shorter operation time were found with FF. 63 (3.6%) complications occurred: 10 (0.6%) bleedings, 33 (1.9%) infections and 12 (0.7%) bile leakages. Leakage from cystic duct occurred in 4/112 (3.6%) when closed with ultrasonic shears and in 4/1633 (0.2%) with clips (p 0.008). A common bile duct lesion occurred in 1/1425 (0.07%) with FF and in 3/320 (0.9%) with the conventional approach (p 0.003). In a multivariate regression model, the conventional technique was a risk factor for bile duct injury with an odds ratio of 20.8 (95% CI 1.6–259.2). In conclusion FF was effectively established as the standard procedure and associated with lower rates of bile duct injuries. Clipless closure of the cystic duct increased the rate of leakage.
Collapse
|
35
|
Use of laparoscopic videos amongst surgical trainees in the United Kingdom. Surgeon 2019; 17:334-339. [DOI: 10.1016/j.surge.2018.10.004] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/09/2018] [Accepted: 10/14/2018] [Indexed: 12/15/2022]
|
36
|
Simulation in surgical training: Prospective cohort study of access, attitudes and experiences of surgical trainees in the UK and Ireland. Int J Surg 2019; 67:94-100. [DOI: 10.1016/j.ijsu.2019.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/13/2019] [Accepted: 04/10/2019] [Indexed: 11/22/2022]
|
37
|
Hann A, Walter BM, Mehlhase N, Meining A. Virtual reality in GI endoscopy: intuitive zoom for improving diagnostics and training. Gut 2019; 68:957-959. [PMID: 30228217 PMCID: PMC6580767 DOI: 10.1136/gutjnl-2018-317058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 07/29/2018] [Accepted: 08/26/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Alexander Hann
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Benjamin M Walter
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Niklas Mehlhase
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Alexander Meining
- Interventional and Experimental Endoscopy (InExEn), Department of Internal Medicine I, Ulm University, Ulm, Germany
| |
Collapse
|
38
|
Kyaw BM, Saxena N, Posadzki P, Vseteckova J, Nikolaou CK, George PP, Divakar U, Masiello I, Kononowicz AA, Zary N, Tudor Car L. Virtual Reality for Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration. J Med Internet Res 2019; 21:e12959. [PMID: 30668519 PMCID: PMC6362387 DOI: 10.2196/12959] [Citation(s) in RCA: 218] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 12/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background Virtual reality (VR) is a technology that allows the user to explore and manipulate computer-generated real or artificial three-dimensional multimedia sensory environments in real time to gain practical knowledge that can be used in clinical practice. Objective The aim of this systematic review was to evaluate the effectiveness of VR for educating health professionals and improving their knowledge, cognitive skills, attitudes, and satisfaction. Methods We performed a systematic review of the effectiveness of VR in pre- and postregistration health professions education following the gold standard Cochrane methodology. We searched 7 databases from the year 1990 to August 2017. No language restrictions were applied. We included randomized controlled trials and cluster-randomized trials. We independently selected studies, extracted data, and assessed risk of bias, and then, we compared the information in pairs. We contacted authors of the studies for additional information if necessary. All pooled analyses were based on random-effects models. We used the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach to rate the quality of the body of evidence. Results A total of 31 studies (2407 participants) were included. Meta-analysis of 8 studies found that VR slightly improves postintervention knowledge scores when compared with traditional learning (standardized mean difference [SMD]=0.44; 95% CI 0.18-0.69; I2=49%; 603 participants; moderate certainty evidence) or other types of digital education such as online or offline digital education (SMD=0.43; 95% CI 0.07-0.79; I2=78%; 608 participants [8 studies]; low certainty evidence). Another meta-analysis of 4 studies found that VR improves health professionals’ cognitive skills when compared with traditional learning (SMD=1.12; 95% CI 0.81-1.43; I2=0%; 235 participants; large effect size; moderate certainty evidence). Two studies compared the effect of VR with other forms of digital education on skills, favoring the VR group (SMD=0.5; 95% CI 0.32-0.69; I2=0%; 467 participants; moderate effect size; low certainty evidence). The findings for attitudes and satisfaction were mixed and inconclusive. None of the studies reported any patient-related outcomes, behavior change, as well as unintended or adverse effects of VR. Overall, the certainty of evidence according to the GRADE criteria ranged from low to moderate. We downgraded our certainty of evidence primarily because of the risk of bias and/or inconsistency. Conclusions We found evidence suggesting that VR improves postintervention knowledge and skills outcomes of health professionals when compared with traditional education or other types of digital education such as online or offline digital education. The findings on other outcomes are limited. Future research should evaluate the effectiveness of immersive and interactive forms of VR and evaluate other outcomes such as attitude, satisfaction, cost-effectiveness, and clinical practice or behavior change.
Collapse
Affiliation(s)
- Bhone Myint Kyaw
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Nakul Saxena
- Health Services and Outcomes Research, National Healthcare Group Singapore, Singapore, Singapore
| | - Pawel Posadzki
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Jitka Vseteckova
- Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, United Kingdom
| | | | - Pradeep Paul George
- Health Services and Outcomes Research, National Healthcare Group Singapore, Singapore, Singapore
| | - Ushashree Divakar
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Italo Masiello
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Faculty of Social Sciences, Linnaeus University, Växjö, Sweden
| | - Andrzej A Kononowicz
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - Nabil Zary
- Games for Health Innovations Centre, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,International Medical Simulation Centre, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Lorainne Tudor Car
- Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
39
|
Abstract
With the ongoing changes in graduate medical education, emphasis has been placed on simulation models to increase clinical exposure and optimize learning. In specific, high-fidelity simulation presents as a potential option for procedural-skill development in interventional radiology. With improved haptic, visual, and tactile dynamics, high-fidelity endovascular simulators have gained increasing support from trainees and certified interventionalists alike. The 2 most common high-fidelity endovascular simulators utilized today are the Procedicus VIST and ANGIO Mentor, which contain notable differences in technical features, case availability, and cost. From the perspective of a trainee, high-fidelity simulation allows for the ability to perform a greater volume of cases. Additionally, without the risk of potential harm to the patient, trainees can focus on repetition and improved performance in a stress-free environment. When errors are made, high-fidelity simulator metrics will generate instantaneous feedback and error notification, erasing ambiguity and thus facilitating learning. Furthermore, in an environment devoid of time and cost stressors, the supervising physician is afforded the opportunity to properly mentor and instruct the trainee throughout the case. For the experienced interventionalists, high-fidelity simulation allows for a decreased learning curve for new procedures or techniques, as well as the opportunity for procedure rehearsal for unusual or high-risk cases. Despite the limitations created by cost, high-fidelity endovascular simulation should continue to be increasingly utilized in the development of the interventional radiology curriculum.
Collapse
Affiliation(s)
- Ayush Amin
- Department of Interventional Radiology, Miller School of Medicine, University of Miami, Miami, FL.
| | - Jason Salsamendi
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami, Miami, FL
| | - Thomas Sullivan
- Department of Interventional Radiology, Jackson Memorial Hospital, University of Miami, Miami, FL
| |
Collapse
|
40
|
Kowalewski KF, Minassian A, Hendrie JD, Benner L, Preukschas AA, Kenngott HG, Fischer L, Müller-Stich BP, Nickel F. One or two trainees per workplace for laparoscopic surgery training courses: results from a randomized controlled trial. Surg Endosc 2018; 33:1523-1531. [PMID: 30194644 DOI: 10.1007/s00464-018-6440-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 09/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are no standards for optimal utilization of workplaces in laparoscopic training. This study aimed to define whether laparoscopy training should be done alone or in pairs (known as dyad training). METHODS This was a three-arm randomized controlled trial with laparoscopically naïve medical students (n = 100). Intervention groups participated alone (n = 40) or as dyad (n = 40) in a multimodality training curriculum with e-learning, basic, and procedural skills training using box and VR trainers. The control group (n = 20) had no training. Post-performance of a cadaveric porcine laparoscopic cholecystectomy (LC) was measured as the primary outcome by blinded raters using the objective structured assessment of technical skills (OSATS). Global operative assessment of laparoscopic skills (GOALS), time for LC, and VR performances were secondary outcomes. RESULTS There were no differences between groups for performance scores [OSATS: alone (40.2 ± 9.8) vs. dyad (39.8 ± 8.6), p = 0.995; alone vs. control (37.1 ± 7.4), p = 0.548; or dyad vs. control, p = 0.590; and GOALS score: alone (10.6 ± 3.0) vs. dyad (10.0 ± 2.7), p = 0.599; alone vs. control (10.1 ± 3.0), p = 0.748; or dyad vs. control, p = 0.998]. Dyad finished LC faster than control [median = 62.5 min (CI 58.0-73.0) vs. 76.5 min (CI 72.0-80+); p = 0.042], while there were no inter-group differences between alone vs. control [median = 69.0 min (CI 62.0-76.0) vs. control; p = 0.099] or alone vs. dyad (p = 0.840). Dyad and alone showed superior performance on the VR trainer vs. control for time, number of movements, and path length, but not for complications and application of cautery. CONCLUSIONS The curriculum provided trainees with the laparoscopic skills needed to perform LC safely, irrespective of the number of trainees per workplace. Dyad training reduced the operation time needed for LC. Therefore, dyad training seems to be a promising alternative, especially if training time is limited and resources must be used as efficiently as possible. Trial registration German Clinical Trials Register: DRKS00004675.
Collapse
Affiliation(s)
- Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Andreas Minassian
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jonathan David Hendrie
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Laura Benner
- Institute for Medical Biometry and Informatics, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Anas Amin Preukschas
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hannes Götz Kenngott
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Lars Fischer
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| |
Collapse
|
41
|
Vergis A, Steigerwald S. Skill Acquisition, Assessment, and Simulation in Minimal Access Surgery: An Evolution of Technical Training in Surgery. Cureus 2018; 10:e2969. [PMID: 30221097 PMCID: PMC6136887 DOI: 10.7759/cureus.2969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Diminishing resources and expanding technologies, such as minimal access surgery, have complicated the acquisition and assessment of technical skills in surgical training programs. However, these challenges have been met with both innovation and an evolution in our understanding of how learners develop technical competence and how to better measure it. As these skills continue to grow in breadth and complexity, so too must the surgical education systems’ ability. This literature review examines and describes the pressures placed on surgical education programs and the development of methods to ameliorate them with a focus on surgical simulation.
Collapse
|
42
|
Xu L, Lu Y, Liu Q. Integrating viscoelastic mass spring dampers into position-based dynamics to simulate soft tissue deformation in real time. ROYAL SOCIETY OPEN SCIENCE 2018; 5:171587. [PMID: 29515870 PMCID: PMC5830759 DOI: 10.1098/rsos.171587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 01/02/2018] [Indexed: 05/13/2023]
Abstract
We propose a novel method to simulate soft tissue deformation for virtual surgery applications. The method considers the mechanical properties of soft tissue, such as its viscoelasticity, nonlinearity and incompressibility; its speed, stability and accuracy also meet the requirements for a surgery simulator. Modifying the traditional equation for mass spring dampers (MSD) introduces nonlinearity and viscoelasticity into the calculation of elastic force. Then, the elastic force is used in the constraint projection step for naturally reducing constraint potential. The node position is enforced by the combined spring force and constraint conservative force through Newton's second law. We conduct a comparison study of conventional MSD and position-based dynamics for our new integrating method. Our approach enables stable, fast and large step simulation by freely controlling visual effects based on nonlinearity, viscoelasticity and incompressibility. We implement a laparoscopic cholecystectomy simulator to demonstrate the practicality of our method, in which liver and gallbladder deformation can be simulated in real time. Our method is an appropriate choice for the development of real-time virtual surgery applications.
Collapse
Affiliation(s)
- Lang Xu
- Britton Chance Center for Biomedical Photonics, School of Engineering Sciences, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Hubei, Wuhan 430074, People's Republic of China
- Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Ministry of Education, 1037 Luoyu Road, Hubei, Wuhan 430074, People's Republic of China
| | - Yuhua Lu
- Britton Chance Center for Biomedical Photonics, School of Engineering Sciences, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Hubei, Wuhan 430074, People's Republic of China
- Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Ministry of Education, 1037 Luoyu Road, Hubei, Wuhan 430074, People's Republic of China
| | - Qian Liu
- Britton Chance Center for Biomedical Photonics, School of Engineering Sciences, Wuhan National Laboratory for Optoelectronics-Huazhong University of Science and Technology, Hubei, Wuhan 430074, People's Republic of China
- Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Ministry of Education, 1037 Luoyu Road, Hubei, Wuhan 430074, People's Republic of China
| |
Collapse
|
43
|
Neveu ME, Debras E, Niro J, Fernandez H, Panel P. Standardizing hysteroscopy teaching: development of a curriculum using the Delphi method. Surg Endosc 2017. [PMID: 28634628 DOI: 10.1007/s00464-017-5620-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hysteroscopy is performed often and in many indications but is challenging to learn. Hands-on training in live patients faces ethical, legal, and economic obstacles. Virtual reality simulation may hold promise as a hysteroscopy training tool. No validated curriculum specific in hysteroscopy exists. The aim of this study was to develop a hysteroscopy curriculum, using the Delphi method to identify skill requirements. METHODS Based on a literature review using the key words "curriculum," "simulation," and "hysteroscopy," we identified five technical and non-technical areas in which skills were required. Twenty hysteroscopy experts from different French hospital departments participated in Delphi rounds to select items in these five areas. The rounds were to be continued until 80-100% agreement was obtained for at least 60% of items. A curriculum was built based on the selected items and was evaluated in residents. RESULTS From November 2014 to April 2015, 18 of 20 invited experts participated in three Delphi rounds. Of the 51 items selected during the first round, only 25 (49%) had 80-100% agreement during the second round, and a third round was therefore conducted. During this last round, 80-100% agreement was achieved for 31 (61%) items, which were used to create the curriculum. All 14 residents tested felt that a simulator training session was acceptable and helped them to improve their skills. CONCLUSIONS We describe a simulation-based hysteroscopy curriculum focusing on skill requirements identified by a Delphi procedure. Its development allows standardization of training programs offered to residents.
Collapse
Affiliation(s)
| | - Elodie Debras
- Department of Gynecology and Obstetrics, Versailles Hospital, Le Chesnay, France
| | - Julien Niro
- Department of Gynecology and Obstetrics, Versailles Hospital, Le Chesnay, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Versailles Hospital, Le Chesnay, France
| |
Collapse
|
44
|
Cheng Luo C, Mao Wu S, Kuei Chien W, Sheng Huang C, Cheng Lin W, Chun Chang Y. Students' Interest in Surgery Affects Laparoscopic Practicing Performance. JSLS 2017; 20:JSLS.2016.00039. [PMID: 27493472 PMCID: PMC4968611 DOI: 10.4293/jsls.2016.00039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background and Objective: Earlier exposure to laparoscopic techniques is thought to be beneficial for medical students. Reports have demonstrated that practice improves performance in laparoscopies. In this study, we intended to evaluate whether medical students' interest in surgery is affected by the amount of practice and the performance on a laparoscopic simulator. Methods: A laparoscopic simulation curriculum was introduced at Taipei Medical University, Wan-Fang Medical Center. Study participants included 36 sixth-year and 14 seventh-year students who were divided according to whether they had indicated an interest (group A) or not (group B) in surgery. The students had twice-a-week practice sessions for 2 weeks. They underwent baseline measurement (BM) before training and posttraining measurement (PTM). Self-guided practice on the simulator was allowed. The learning outcomes were assessed comparing the BM and PTM scores by using the interquartile range (IQR) test. We also tested the correlation between total score and number of self-guided practice sessions. Results: All study participants showed improvement. No differences were observed between BM and PTM scores and between 6th- and 7th-year medical students. Significant differences were found in PTM scores between groups A and B (P < .001). Analysis of variance with a post hoc test for different groups revealed that the PTMs were significantly higher for both the 6th- and 7th-year medical students in group A than for those in group B (P < .001). Total performance scores were improved with a higher number of self-guided practice sessions. Linear regression analysis demonstrated a significant correlation between the number of self-guided practice sessions and total performance score (P < .001). Conclusion: Those clerks and interns interested in surgery who had more sessions for self-guided practice, displayed more improvement than those not interested in surgery did. Improvement in performance correlated highly with trainees' number of self-guided practice sessions.
Collapse
Affiliation(s)
| | - Sheng Mao Wu
- Department of Traumatology, Wan Fang Medical Center
| | - Wen Kuei Chien
- Biostatistics Center, Taipei Medical University, Taipai, Taiwan
| | | | | | | |
Collapse
|
45
|
Kurenov S, Cendan J, Dindar S, Attwood K, Hassett J, Nawotniak R, Cherr G, Cance WG, Peters J. Surgeon-Authored Virtual Laparoscopic Adrenalectomy Module Is Judged Effective and Preferred Over Traditional Teaching Tools. Surg Innov 2017; 24:72-81. [PMID: 27758896 PMCID: PMC5832352 DOI: 10.1177/1553350616672971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study assesses user acceptance and effectiveness of a surgeon-authored virtual reality (VR) training module authored by surgeons using the Toolkit for Illustration of Procedures in Surgery (TIPS). METHODS Laparoscopic adrenalectomy was selected to test the TIPS framework on an unusual and complex procedure. No commercial simulation module exists to teach this procedure. A specialist surgeon authored the module, including force-feedback interactive simulation, and designed a quiz to test knowledge of the key procedural steps. Five practicing surgeons, with 15 to 24 years of experience, peer reviewed and tested the module. In all, 14 residents and 9 fellows trained with the module and answered the quiz, preuse and postuse. Participants received an overview during Surgical Grand Rounds session and a 20-minute one-on-one tutorial followed by 30 minutes of instruction in addition to a force-feedback interactive simulation session. Additionally, in answering questionnaires, the trainees reflected on their learning experience and their experience with the TIPS framework. RESULTS Correct quiz response rates on procedural steps improved significantly postuse over preuse. In the questionnaire, 96% of the respondents stated that the TIPS module prepares them well or very well for the adrenalectomy, and 87% indicated that the module successfully teaches the steps of the procedure. All participants indicated that they preferred the module compared to training using purely physical props, one-on-one teaching, medical atlases, and video recordings. CONCLUSIONS Improved quiz scores and endorsement by the participants of the TIPS adrenalectomy module establish the viability of surgeons authoring VR training.
Collapse
Affiliation(s)
- Sergei Kurenov
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Juan Cendan
- Clinical Skills and Simulation Center, University of Central Florida, Orlando, FL, USA
| | - Sahel Dindar
- Department of Computer & Information Science & Engineering, University of Florida, Gainesville, FL, USA
| | - Kristopher Attwood
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - James Hassett
- Department of Surgery, University at Buffalo, Buffalo, NY, USA
| | - Ruth Nawotniak
- Department of Surgery, University at Buffalo, Buffalo, NY, USA
| | - Gregory Cherr
- Department of Surgery, University at Buffalo, Buffalo, NY, USA
| | - William G. Cance
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Jörg Peters
- Department of Computer & Information Science & Engineering, University of Florida, Gainesville, FL, USA
| |
Collapse
|
46
|
Badash I, Burtt K, Solorzano CA, Carey JN. Innovations in surgery simulation: a review of past, current and future techniques. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:453. [PMID: 28090509 DOI: 10.21037/atm.2016.12.24] [Citation(s) in RCA: 156] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
As a result of recent work-hours limitations and concerns for patient safety, innovations in extraclinical surgical simulation have become a desired part of residency education. Current simulation models, including cadaveric, animal, bench-top, virtual reality (VR) and robotic simulators are increasingly used in surgical training programs. Advances in telesurgery, three-dimensional (3D) printing, and the incorporation of patient-specific anatomy are paving the way for simulators to become integral components of medical training in the future. Evidence from the literature highlights the benefits of including simulations in surgical training; skills acquired through simulations translate into improvements in operating room performance. Moreover, simulations are rapidly incorporating new medical technologies and offer increasingly high-fidelity recreations of procedures. As a result, both novice and expert surgeons are able to benefit from their use. As dedicated, structured curricula are developed that incorporate simulations into daily resident training, simulated surgeries will strengthen the surgeon's skill set, decrease hospital costs, and improve patient outcomes.
Collapse
Affiliation(s)
- Ido Badash
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Karen Burtt
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carlos A Solorzano
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Joseph N Carey
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| |
Collapse
|
47
|
Pelargos PE, Nagasawa DT, Lagman C, Tenn S, Demos JV, Lee SJ, Bui TT, Barnette NE, Bhatt NS, Ung N, Bari A, Martin NA, Yang I. Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery. J Clin Neurosci 2016; 35:1-4. [PMID: 28137372 DOI: 10.1016/j.jocn.2016.09.002] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/12/2016] [Indexed: 01/16/2023]
Abstract
Neurosurgery has undergone a technological revolution over the past several decades, from trephination to image-guided navigation. Advancements in virtual reality (VR) and augmented reality (AR) represent some of the newest modalities being integrated into neurosurgical practice and resident education. In this review, we present a historical perspective of the development of VR and AR technologies, analyze its current uses, and discuss its emerging applications in the field of neurosurgery.
Collapse
Affiliation(s)
- Panayiotis E Pelargos
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Daniel T Nagasawa
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Carlito Lagman
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Stephen Tenn
- Department of Radiation Oncology, University of California, Los Angeles, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA 90095-6951, United States
| | - Joanna V Demos
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Seung J Lee
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Timothy T Bui
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Natalie E Barnette
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Nikhilesh S Bhatt
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Nolan Ung
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Ausaf Bari
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Neil A Martin
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States
| | - Isaac Yang
- Department of Neurosurgery, University of California, Los Angeles, 300 Stein Plaza, 5th Floor Wasserman Bldg., Los Angeles, CA 90095-6901, United States.
| |
Collapse
|
48
|
Nousiainen MT, McQueen SA, Ferguson P, Alman B, Kraemer W, Safir O, Reznick R, Sonnadara R. Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs? Clin Orthop Relat Res 2016; 474:935-44. [PMID: 26335344 PMCID: PMC4773347 DOI: 10.1007/s11999-015-4512-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time. QUESTIONS/PURPOSES This study presents a cost and faculty work-hours analysis of implementing simulation as a teaching and evaluation tool in the University of Toronto's novel competency-based curriculum program compared with the historic costs of using simulation in the residency training program. METHODS All invoices for simulation training were reviewed to determine the financial costs before and after implementation of the competency-based curriculum. Invoice items included costs for cadavers, artificial models, skills laboratory labor, associated materials, and standardized patients. Costs related to the surgical skills laboratory rental fees and orthopaedic implants were waived as a result of special arrangements with the skills laboratory and implant vendors. Although faculty time was not reimbursed, faculty hours dedicated to simulation were also evaluated. The academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum. During this year, 12 residents used simulation for teaching. The academic year of 2010 to 2011 was chosen to represent an academic year when the competency-based curriculum training program was functioning parallel but separate from the regular stream of training. In this year, six residents used simulation for teaching and assessment. The academic year of 2012 to 2013 was chosen to represent an academic year when simulation was used equally among the competency-based curriculum and regular stream residents for teaching (60 residents) and among 14 competency-based curriculum residents and 21 regular stream residents for assessment. RESULTS The total costs of using simulation to teach and assess all residents in the competency-based curriculum and regular stream programs (academic year 2012-2013) (CDN 155,750, USD 158,050) were approximately 15 times higher than the cost of using simulation to teach residents before the implementation of the competency-based curriculum (academic year 2008-2009) (CDN 10,090, USD 11,140). The number of hours spent teaching and assessing trainees increased from 96 to 317 hours during this period, representing a threefold increase. CONCLUSIONS Although the financial costs and time demands on faculty in running the simulation program in the new competency-based curriculum at the University of Toronto have been substantial, augmented learner and trainer satisfaction has been accompanied by direct evidence of improved and more efficient learning outcomes. CLINICAL RELEVANCE The higher costs and demands on faculty time associated with implementing simulation for teaching and assessment must be considered when it is used to enhance surgical training.
Collapse
Affiliation(s)
- Markku T. Nousiainen
- Department of Surgery, University of Toronto, Toronto, ON Canada ,Holland Orthopaedic and Arthritic Centre, Sunnybrook Health Sciences Centre, 621-43 Wellesley Street East, Toronto, ON M4Y 1H1 Canada
| | | | - Peter Ferguson
- Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Benjamin Alman
- Department of Surgery, Duke University Medical Center, Durham, NC USA
| | - William Kraemer
- Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Oleg Safir
- Department of Surgery, University of Toronto, Toronto, ON Canada
| | - Richard Reznick
- Department of Surgery, Queen’s University, Kingston, ON Canada
| | - Ranil Sonnadara
- Department of Surgery, University of Toronto, Toronto, ON Canada ,Department of Surgery, McMaster University, Hamilton, ON Canada
| |
Collapse
|
49
|
Willaert W, Van De Putte D, Van Renterghem K, Van Nieuwenhove Y, Ceelen W, Pattyn P. Training Models in Laparoscopy: a Systematic Review Comparing their Effectiveness in Learning Surgical Skills. Acta Chir Belg 2016. [DOI: 10.1080/00015458.2013.11680892] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- W. Willaert
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - D. Van De Putte
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - K. Van Renterghem
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - Y. Van Nieuwenhove
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - W. Ceelen
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| | - P. Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
50
|
Schlickum M, Hedman L, Felländer-Tsai L. Visual-spatial ability is more important than motivation for novices in surgical simulator training: a preliminary study. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2016; 7:56-61. [PMID: 26897701 PMCID: PMC4764245 DOI: 10.5116/ijme.56b1.1691] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/02/2016] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To investigate whether surgical simulation performance and previous video gaming experience would correlate with higher motivation to further train a specific simulator task and whether visual-spatial ability would rank higher in importance to surgical performance than the above. It was also examined whether or not motivation would correlate with a preference to choose a surgical specialty in the future and if simulator training would increase the interest in choosing that same work field. METHODS Motivation and general interest in surgery was measured pre- and post-training in 30 medical students at Karolinska Institutet who were tested in a laparoscopic surgical simulator in parallel with measurement of visual-spatial ability and self-estimated video gaming experience. Correlations between simulator performance metrics, visual-spatial ability and motivation were statistically analyzed using regression analysis. RESULTS A good result in the first simulator trial correlated with higher self-determination index (r =-0.46, p=0.05) in male students. Visual-spatial ability was the most important underlying factor followed by intrinsic motivation score and finally video gaming experience (p=0.02, p=0.05, p=0.11) regarding simulator performance in male students. Simulator training increased interest in surgery when studying all subjects (p=0.01), male subjects (p=0.02) as well as subjects with low video gaming experience (p=0.02). CONCLUSIONS This preliminary study highlights individual differences regarding the effect of simulator training on motivation that can be taken into account when designing simulator training curricula, although the sample size is quite small and findings should be interpreted carefully.
Collapse
Affiliation(s)
- Marcus Schlickum
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopedics and Biotechnology Karolinska Institutet, Stockholm, Sweden
| | - Leif Hedman
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Li Felländer-Tsai
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Orthopedics and Biotechnology Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|