Blended learning in surgery using the Inmedea Simulator

Simulation in a blended learning curriculum for neonatology

Blended learning is a learner-centered educational method that combines online and traditional face-to-face educational strategies. Simulation is a commonly utilized platform for experiential learning and an ideal component of a blended learning curriculum. This section describes blended learning, including its strengths and limitations, educational frameworks, uses within health professions education, best practices, and challenges. Also included is a brief introduction to simulation-based education, along with theoretical and real-world examples of how simulation may be integrated into a blended learning curriculum. Examples of blended learning in Neonatal-Perinatal Medicine, specifically within the Neonatal Resuscitation Program, procedural skills training, and the National Neonatology Curriculum, are reviewed.

Virtual Trauma Meeting as a Component of Undergraduate Orthopaedic Education

Introduction: Virtual teaching has proven effective for medical students during the COVID-19 pandemic. This study is the first to describe an undergraduate orthopaedic teaching strategy in the format of virtual trauma meetings (VTM).

Methods: Clinical medical students from the Universities of Bristol and Cardiff were invited to attend five VTM between October and November 2020. These were delivered by consultants and speciality doctors via Zoom software. An 11-item feedback form was distributed after each session to assess the relevance of teaching material, student confidence in asking and answering questions, and if students would benefit from further sessions. Several open-ended questions were designed to evaluate aspects of the session that were most useful, which orthopaedic topics were of high priority and if they had any suggestions for improvement. Our initial aim was to assess student acceptance of the virtual format. Several months later pre-recorded material was uploaded onto YouTube and post hoc questionnaires were analysed.

Results: A total of 50 students attended, with a median of 11±6 attending per session, producing a total of 26 feedback responses. Among the responders, there were 10 males and nine females and 63% of the students were in their third year. 100% of students felt comfortable asking questions and 96% felt comfortable answering questions. X-ray interpretation and management of fractures were the highest priority subjects. The majority of students considered the interaction between senior and junior doctors most valuable, and the most common improvement suggested was the inclusion of polls or OSCE-styled questions.

Conclusions: VTM could be a useful resource to enhance undergraduate trauma and orthopaedic (T&O) education by providing student-focused material in an open learning environment.

A Pandemic of Webinars in the COVID Era—Can It be the Way Forward?

Introduction Conferences are important and sometimes mandatory to update the clinician with latest knowledge. Attending conferences requires planning, expenditure, and leave from work. Webinars have become the new normal in the coronavirus disease (COVID) era. We surveyed the esteemed medical fraternity on their opinion on webinars.

Methods This was conducted as an online survey (Survey Monkey) through personal electronic mails and social media with 24 questions. Details on demographic profile, specialization and affiliation, experience, choice of frequency of webinar sessions, suitable platform, mode of intimation of webinars, number of days for prior intimation, appropriate timing of the day and week, and ideas on payment options were enquired. Need for technical assistance, choice of topic for discussions, methods to make webinars more interactive, availability of recorded content, and impact on clinical practice were also assessed.

Results A total of 235 medical professionals voiced their opinion; 67% were < 35 years of age and 49% were residents. An average of 2 to 3 webinars per month (33.8%), conducted on weekdays (63%), after 6 p.m. (54%) in the form of case discussion (67.3%) or lectures from experts (55%) with at least 7 days' notice (41.7%) was the most common choice; free webinars were the wish of 56.1% participants and 28% felt webinars would definitely impact practice.

Conclusion Webinars are welcoming even after the COVID era and should go hand-in-hand with conventional conferences. Virtual learning experience should be optimized by proper scheduling of multiple simultaneous events and converting them into interlinked or serial events.

Challenges to the orthopedic resident workforce during the first wave of COVID-19 pandemic: Lessons learnt from a global cross-sectional survey

BACKGROUND

The COVID-19 pandemic has caused unprecedented concerns on the safety, well-being, quality of life(QOL), and training of the orthopedic resident physician workforce worldwide. Although orthopedic residency programs across the globe have attempted to redefine resident roles, educational priorities, and teaching methods, the global orthopedic residents' perspective with regards to their safety, well-being, QOL, and training, taking into account regional variances remains unknown.

METHODS

A 56-item-questionnaire-based cross-sectional survey was conducted online during the COVID-19 pandemic involving 1193 orthopedic residents from 29 countries across six geographical regions to investigate the impact of the COVID-19 pandemic on the well-being, safety, and training of orthopedic residents at a global level, as well as to analyze the challenges confronted by orthopedic residency programs around the world to safeguard and train their resident workforce during this period.

RESULTS

The total response rate was 90.3%(1077/1193). Time spent on residency-training activities decreased by 24.7 h/week (95% CI, -26.5 to -22.9,p < 0.001), with 50.2% (n = 541) residents performing duties outside their residency curriculum. 80.5% (n = 869) residents had no prior experience working in infectious outbreaks. A greater percentage of residents from Middle East, Asia and Europe were redeployed to the COVID-19 frontlines, p < 0.001. Only 46.5% (n = 491) and 58.4% (n = 600) of residents underwent training in critical care or PPE (Personal Protective equipment) usage, respectively; 28.5% (n = 302) residents (majority from Africa, Middle East, South America) reported lack of institutional guidelines to handle infectious outbreaks; 15.4% (n = 160) residents (majority from Africa, Asia, Europe) had concerns regarding availability of PPE and risk of infection. An increase in technology-based virtual teaching modalities was observed. The most significant stressor for residents was the concern for their family's health. Residents' QOL significantly decreased from 80/100 (IQR 70-90) to 65/100 (IQR 50-80) before and during the pandemic, p < 0.001.

CONCLUSIONS

The COVID-19 pandemic has significantly impacted the safety, well-being, QOL, and training of the global orthopedic resident physician workforce to different extents across geographical regions. The findings of this study will aid educators, program leaderships, and policy makers globally in formulating flexible, generalizable, and sustainable strategies to ensure resident safety, well-being, and training, while maintaining patient care.

Interactive live-stream surgery contributes to surgical education in the context of contact restrictions

BACKGROUND

Attendance teaching is the predominant teaching method at universities but needs to be questioned in the context of digital transformation. This study establishes and evaluates a method to accomplish electronic learning to supplement traditional attendance courses.

MATERIALS AND METHODS

Surgery was transmitted in real-time conditions via an online live stream from the surgical theater. Visualization was transferred from a fully digital surgical microscope, an endoscope or an environmental camera in high definition quality. Students were able to participate at home from their personal computer. After following the surgery, they participated in an online-evaluation.

RESULTS

A total of 65 students participated in the live stream. The majority of students (61.54%) indicated a significant subjective increase in knowledge after participation. The majority of students (53.85%) indicated that live surgeries should be offered as a permanent component in addition to classroom teaching. Likewise, a broader offer was desired by many students (63.08%).

CONCLUSIONS

Live streaming of surgery is a promising approach as an alternative or supplement to traditional attendance teaching. An expansion of digital teaching can be explicitly supported on the basis of this study.

[Electronic learning for otorhinolaryngology students using the content management system ILIAS]

BACKGROUND

With increasing access to online teaching materials, traditional teaching methods at universities need to be questioned in the context of digital transformation. The aim of this study was to evaluate whether electronic learning may serve as or replace conventional internship in otorhinolaryngology.

MATERIALS AND METHODS

A completely digital electronic learning concept was created and made available at the online learning platform ILIAS. Students were introduced to the program. Four learning units (neck [I], pharynx/larynx [II], nose [III], ear [IV]) were set up, with a topic-related multiple-choice test at the end of each unit. The students took part in the evaluation before and after completion of the course.

RESULTS

A total of 105 students participated in the evaluation before and 85 students after the electronic learning program. After completing the courses, the majority of students (52.94%) stated to be more satisfied with the content and the presentation of the learning sequences as well as with their own self-control concerning learning pace and time management compared to the situation before completing the program (34.29%; p < 0.0001). The majority of students (54.12%) stated that they would appreciate the electronic learning program in addition to practical internship.

CONCLUSION

The electronic learning program is a promising approach to supplement traditional learning and internships. An expansion of digital teaching proposals should be supported based on this study.

Orthopedic surgery residents' perception of online education in their programs during the COVID-19 pandemic: should it be maintained after the crisis?

Background and purpose - During the COVID-19 pandemic, most of the teaching centers in Chile have shifted to online resources. We decided to do a survey on orthopedic residents regarding this type of education to assess for strengths and weaknesses of digital education in orthopedic programs.Methods - A survey was performed targeting 110 orthopedic residents belonging to different training programs around the country. 100 residents completed the survey.Results - 86% stated that their programs are using online education. When asked in detail, 86% had been involved in webinars, 28% had received online presentations, 12% had participated in online tests, and 7% had evaluated patients. Webinars were rated (1 = very unsatisfactory, 10 = very satisfactory) with a mean grade of 8.1 (1-10), online presentations 7.3 (1-10), online tests 3.8 (1-8), and online patient evaluations 2.9 (1-9). When asked if, after the end of the pandemic, they would continue using the online modalities, 82% would continue attending webinars, 72% would continue watching online presentations, 27% would continue performing online tests, and 33% of the residents would continue performing online evaluations of patients.Interpretation - Even though resident evaluation of online activities is positive, face-to-face theoretical activities are still valued as a necessary complement for orthopedic residency education.

The potential of blended learning in education and training for advanced civilian and military trauma care

INTRODUCTION

In the field of advanced care of the complex trauma patient, there is an emerging need for focused education and training. However, several hospitals do not support further education and training in this field, and the challenge of releasing time for physicians and nurses is well-known. Educational strategies using blended learning, which combines traditional classroom methods with modern computer-assisted methods and media, have not yet been widely used. This study analysed the educational challenges and areas for improvement, according to senior physicians and nurses, and investigated the potential use of blended learning.

METHOD

The setting was an international course, Definitive Surgical Trauma Care (DSTC) - Military Version, part of a programme which prepares health professionals for work during extreme conditions. The sample consisted of senior physicians and nurses, participating in the course in September 2015. A survey was completed, interviews were performed and a post-course survey was conducted 18 months later in March 2017.

RESULTS

The most difficult aspect of learning how to manage the complex trauma patient, was the lack of real practice. Even though the respondents were knowledgeable in advanced trauma, they lacked personal experience in managing complex trauma cases. Cases presented during the course represented significantly greater complexity of injury compared to those usually seen in hospitals and during military deployment. The following educational challenges were identified from the study: (1) Lack of experience and knowledge of advanced trauma care. (2) Lack of the use of blended learning as support for education and training. (3) Limited time available for preparation and reflection in the education and training process. (4) Lack of support for such education and training from home hospitals. (5) The unfulfilled requirement for multidisciplinary team-training in the military medical environment.

CONCLUSION

Educational strategies and methods, such as blended learning can support education and training, and the learning process by unlimited practice in reasoning and decision making in virtual patients. It can also provide flexibility and mobility for senior health professionals and their home hospitals, and contribute to an improved military pre-deployment training with less time strain on the civilian home hospitals.

Institutional and technological barriers to the use of open educational resources (OERs) in physiology and medical education

Open educational resources (OERs) are becoming increasingly common as a tool in education, particularly in medical and biomedical education. However, three key barriers have been identified to their use: 1) lack of awareness of OERs, 2) lack of motivation to use OERs, and 3) lack of training in the use of OERs. Here, we explore these three barriers with teachers of medical and biomedical science to establish how best to enhance the use of OERs to improve pedagogical outcomes. An online survey was completed by 209 educators, many of whom (68.4%) reported using OERs in their teaching and almost all (99.5%) showing awareness of at least one OER. The results suggest that key problems that prevent educators from adopting OERs in their teaching include suitability for particular classes, time, and copyright. Most (81.8%) educators were somewhat, very, or extremely comfortable with OERs so there is no innate motivational barrier to adoption. A lack of training was reported by 13.9% of respondents, and 40% of respondents stated that there was little or no support from their institutions. OER users were no more comfortable with technology or better supported by departments but tended to be aware of a greater number of sources of OERs. Our study illustrates key opportunities for the expansion of OER use in physiology and medical teaching: increased breadth of awareness, increased institutional support (including time, training, and copyright support), and greater sharing of diverse OERs to suit the range of teaching challenges faced by staff in different subdisciplines.

Using Foreign Virtual Patients With Medical Students in Germany: Are Cultural Differences Evident and Do They Impede Learning?

Background

Learning with virtual patients (VPs) is considered useful in medical education for fostering clinical reasoning. As the authoring of VPs is highly demanding, an international exchange of cases might be desirable. However, cultural differences in foreign VPs might hamper learning success.

Objective

We investigated the need for support for using VPs from the United States at a German university, with respect to language and cultural differences. Our goal was to better understand potential implementation barriers of a intercultural VP exchange.

Methods

Two VPs were presented to 30 German medical students featuring a cultural background different from German standards with respect to diagnostic and therapeutic procedures, ethical aspects, role models, and language (as identified by a cultural adaptation framework). Participants were assigned to two groups: 14 students were advised to complete the cases without further instructions (basic group), and 16 students received written explanatory supplemental information specifically with regard to cultural differences (supplement group). Using a 6-point scale (6=strongly agree), we analyzed the results of an integrated assessment of learning success as well as an evaluation of cases by the students on usefulness for learning and potential issues regarding the language and cultural background.

Results

The German students found it motivating to work with cases written in English (6-point scale, 4.5 points). The clinical relevance of the VPs was clearly recognized (6 points), and the foreign language was considered a minor problem in this context (3 points). The results of the integrated learning assessment were similar in both groups (basic 53% [SD 4] vs supplement 52% [SD 4] correct answers, P=.32). However, students using the supplemental material more readily realized culturally different diagnostic and therapeutic strategies (basic 4 vs supplement 5 points, P=.39) and were less affirmative when asked about the transferability of cases to a German context (basic 5 vs supplement 3 points, P=.048).

Conclusions

German students found English VPs to be highly clinically relevant, and they rated language problems much lower than they rated motivation to work on cases in English. This should encourage the intercultural exchange of VPs. The provision of supplemental explanatory material facilitates the recognition of cultural differences and might help prevent unexpected learning effects.

E-learning in orthopedic surgery training: A systematic review

E-learning is the use of internet-based resources in education. In the field of surgical education, this definition includes the use of virtual patient cases, digital modeling, online tutorials, as well as video recordings of surgical procedures and lectures. In recent years, e-learning has increasingly been considered a viable alternative to traditional teaching within a number of surgical fields. Here we present (1) a systematic review of literature assessing the efficacy of e-learning modules for orthopedic education and (2) a discussion of their relevance. A systematic search of PubMed, Embase, Web of Science, and the Cochrane Library was conducted according to the guidelines defined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). The search yielded a total of 255 non-duplicate citations that were screened using predetermined inclusion/exclusion criteria. A total of 9 full text articles met inclusion criteria, which included the use of an objective outcome measure to evaluate an orthopedic e-learning module. Six studies assessed knowledge using a multiple-choice test and 4 assessed skills using a clinical exam. All studies showed positive score improvement pre- to post-intervention, and a majority showed greater score improvement than standard teaching methods in both knowledge (4/6 studies) and clinical skills (3/4 studies). E-learning represents an effective supplement or even alternative to standard teaching techniques within orthopedic education for both medical students and residents. Future work should focus on validating specific e-learning programs using standardized outcome measures and assessing long-term knowledge retention using e-learning platforms.

[Blended-learning in psychosomatics and psychotherapy - Increasing the satisfaction and knowledge of students with a web-based e-learning tool]

OBJECTIVES

To improve the synergy of established methods of teaching, the Department of Psychosomatics and Psychotherapy, University Hospital Münster, developed a web-based elearning tool using video clips of standardized patients. The effect of this blended-learning approach was evaluated.

METHODS

A multiple-choice test was performed by a naive (without the e-learning tool) and an experimental (with the tool) cohort of medical students to test the groups' expertise in psychosomatics. In addition, participants' satisfaction with the new tool was evaluated (numeric rating scale of 0-10).

RESULTS

The experimental cohort was more satisfied with the curriculum and more interested in psychosomatics. Furthermore, the experimental cohort scored significantly better in the multiple-choice test.

CONCLUSION

The new tool proved to be an important addition to the classical curriculum as a blended-learning approach which improves students' satisfaction and knowledge in psychosomatics.

What Are We Looking for in Computer-Based Learning Interventions in Medical Education? A Systematic Review

Background

Computer-based learning (CBL) has been widely used in medical education, and reports regarding its usage and effectiveness have ranged broadly. Most work has been done on the effectiveness of CBL approaches versus traditional methods, and little has been done on the comparative effects of CBL versus CBL methodologies. These findings urged other authors to recommend such studies in hopes of improving knowledge about which CBL methods work best in which settings.

Objective

In this systematic review, we aimed to characterize recent studies of the development of software platforms and interventions in medical education, search for common points among studies, and assess whether recommendations for CBL research are being taken into consideration.

Methods

We conducted a systematic review of the literature published from 2003 through 2013. We included studies written in English, specifically in medical education, regarding either the development of instructional software or interventions using instructional software, during training or practice, that reported learner attitudes, satisfaction, knowledge, skills, or software usage. We conducted 2 latent class analyses to group articles according to platform features and intervention characteristics. In addition, we analyzed references and citations for abstracted articles.

Results

We analyzed 251 articles. The number of publications rose over time, and they encompassed most medical disciplines, learning settings, and training levels, totaling 25 different platforms specifically for medical education. We uncovered 4 latent classes for educational software, characteristically making use of multimedia (115/251, 45.8%), text (64/251, 25.5%), Web conferencing (54/251, 21.5%), and instructional design principles (18/251, 7.2%). We found 3 classes for intervention outcomes: knowledge and attitudes (175/212, 82.6%), knowledge, attitudes, and skills (11.8%), and online activity (12/212, 5.7%). About a quarter of the articles (58/227, 25.6%) did not hold references or citations in common with other articles. The number of common references and citations increased in articles reporting instructional design principles (P=.03), articles measuring online activities (P=.01), and articles citing a review by Cook and colleagues on CBL (P=.04). There was an association between number of citations and studies comparing CBL versus CBL, independent of publication date (P=.02).

Conclusions

Studies in this field vary highly, and a high number of software systems are being developed. It seems that past recommendations regarding CBL interventions are being taken into consideration. A move into a more student-centered model, a focus on implementing reusable software platforms for specific learning contexts, and the analysis of online activity to track and predict outcomes are relevant areas for future research in this field.

Airway Management: A Structured Curriculum for Critical Care Transport Providers

OBJECTIVE

Airway assessment and management are vital skills for the critical care transport provider. Nurses and paramedics often enter a transport program with limited or no exposure to airway management. Many programs lack a structured curriculum to show skill competence. Optimal methods in the development of airway management competence and the frequency of training needed to maintain skills have not been clearly defined. Because of this lack of standardization, the actual level of competence in both new and experienced critical care transport providers is unknown.

METHODS

A pretest, post-test repeated measures approach using an online curriculum combined with a deliberate practice model was used. Competence in airway management was measured using 3 evaluation points: static mannequin head, simulation scenario, and the live patient.

RESULTS

A convenience sample of critical care transport providers participated (N = 9). Knowledge improvement was significant, with a higher percentage of participants scoring above 85% on the post-test compared with the pretest (P = .028). Mean scores in completion of the airway checklist pre- versus postintervention were significantly increased on all 3 evaluation points (P < .001 for all comparisons). Significant changes were noted in the response profile evaluating participants' confidence in their ability to verbalize indications for endotracheal intubation (P < .05).

CONCLUSION

The development of a standardized, blended learning curriculum combined with deliberate simulation practice and rigorous assessment showed improvements in multiple areas of airway assessment and management.

Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education

Background

Clinical reasoning is based on the declarative and procedural knowledge of workflows in clinical medicine. Educational approaches such as problem-based learning or mannequin simulators support learning of procedural knowledge. Immersive patient simulators (IPSs) go one step further as they allow an illusionary immersion into a synthetic world. Students can freely navigate an avatar through a three-dimensional environment, interact with the virtual surroundings, and treat virtual patients. By playful learning with IPS, medical workflows can be repetitively trained and internalized. As there are only a few university-driven IPS with a profound amount of medical knowledge available, we developed a university-based IPS framework. Our simulator is free to use and combines a high degree of immersion with in-depth medical content. By adding disease-specific content modules, the simulator framework can be expanded depending on the curricular demands. However, these new educational tools compete with the traditional teaching

Objective

It was our aim to develop an educational content module that teaches clinical and therapeutic workflows in surgical oncology. Furthermore, we wanted to examine how the use of this module affects student performance.

Methods

The new module was based on the declarative and procedural learning targets of the official German medical examination regulations. The module was added to our custom-made IPS named ALICE (Artificial Learning Interface for Clinical Education). ALICE was evaluated on 62 third-year students.

Results

Students showed a high degree of motivation when using the simulator as most of them had fun using it. ALICE showed positive impact on clinical reasoning as there was a significant improvement in determining the correct therapy after using the simulator. ALICE positively impacted the rise in declarative knowledge as there was improvement in answering multiple-choice questions before and after simulator use.

Conclusions

ALICE has a positive effect on knowledge gain and raises students’ motivation. It is a suitable tool for supporting clinical education in the blended learning context.

e-Learning in Surgical Education: A Systematic Review

OBJECTIVE

e-Learning involves the delivery of educational content through web-based methods. Owing to work-hour restrictions and changing practice patterns in surgery, e-learning can offer an effective alternative to traditional teaching. Our aims were to (1) identify current modalities of e-learning, (2) assess the efficacy of e-learning as an intervention in surgical education through a systematic review of the literature, and (3) discuss the relevance of e-learning as an educational tool in surgical education. This is the first such systematic review in this field.

DESIGN

A systematic search of MEDLINE and EMBASE was conducted for relevant articles published until July 2014, using a predefined search strategy. The database search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

A total of 38 articles were found which met the inclusion criteria. In these studies, e-learning was used as an intervention in 3 different ways: (1) to teach cases through virtual patients (18/38); (2) to teach theoretical knowledge through online tutorials, or other means (18/38); and (3) to teach surgical skills (2/38). Nearly all of the studies reviewed report significant knowledge gain from e-learning; however, 2 in 3 studies did not use a control group.

CONCLUSIONS

e-Learning has emerged as an effective mode of teaching with particular relevance for surgical education today. Published studies have demonstrated the efficacy of this method; however, future work must involve well-designed randomized controlled trials comparing e-learning against standard teaching.

Design, Realization, and First Validation of an Immersive Web-Based Virtual Patient Simulator for Training Clinical Decisions in Surgery

BACKGROUND

Immersive patient simulators (IPS) allow an illusionary immersion into a synthetic world where the user can freely navigate through a 3-dimensional environment similar to computer games. Playful learning with IPS allows internalization of medical workflows without harming real patients. Ideally, IPS show high student acceptance and can have positive effect on knowledge gain. Development of IPS with high technical quality is resource intensive. Therefore most of the "high-fidelity" IPS are commercially driven. Usage of IPS in the daily curriculum is still rare. There is no academic-driven simulator that is freely accessible to every student and combines high immersion grade with a profound amount of medical content.

AIM

Therefore it was our aim to develop an academic-driven IPS prototype that is free to use and combines a high immersion grade with profound medical content. In addition, a first validation of the prototype was conducted.

METHODS

The conceptual design included definition of the following parameters: amount of curricular content, grade of technical quality, availability, and level of validation. A preliminary validation was done with 25 students. Students' opinion about acceptance was evaluated by a Likert-scale questionnaire. Effect on knowledge gain was determined by testing concordance and predictive validity.

RESULTS

A custom-made simulator prototype (Artificial learning interface for clinical education [ALICE]) displays a virtual clinic environment that can be explored from a first-person view similar to a video game. By controlling an avatar, the user navigates through the environment, is able to treat virtual patients, and faces the consequence of different decisions. ALICE showed high students' acceptance. There was positive correlation for concordance validity and predictive validity. Simulator usage had positive effect on reproduction of trained content and declarative knowledge.

CONCLUSIONS

We successfully developed a university-based, IPS prototype (ALICE) with profound medical content. ALICE is a nonprofit simulator, easy to use, and showed high students' acceptance; thus it potentially provides an additional tool for supporting student teaching in the daily clinical curriculum.

Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices

This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches.

3D immersive patient simulators and their impact on learning success: a thematic review

Background

Immersive patient simulators (IPSs) combine the simulation of virtual patients with a three-dimensional (3D) environment and, thus, allow an illusionary immersion into a synthetic world, similar to computer games. Playful learning in a 3D environment is motivating and allows repetitive training and internalization of medical workflows (ie, procedural knowledge) without compromising real patients. The impact of this innovative educational concept on learning success requires review of feasibility and validity.

Objective

It was the aim of this paper to conduct a survey of all immersive patient simulators currently available. In addition, we address the question of whether the use of these simulators has an impact on knowledge gain by summarizing the existing validation studies.

Methods

A systematic literature search via PubMed was performed using predefined inclusion criteria (ie, virtual worlds, focus on education of medical students, validation testing) to identify all available simulators. Validation testing was defined as the primary end point.

Results

There are currently 13 immersive patient simulators available. Of these, 9 are Web-based simulators and represent feasibility studies. None of these simulators are used routinely for student education. The workstation-based simulators are commercially driven and show a higher quality in terms of graphical quality and/or data content. Out of the studies, 1 showed a positive correlation between simulated content and real content (ie, content validity). There was a positive correlation between the outcome of simulator training and alternative training methods (ie, concordance validity), and a positive coherence between measured outcome and future professional attitude and performance (ie, predictive validity).

Conclusions

IPSs can promote learning and consolidation of procedural knowledge. The use of immersive patient simulators is still marginal, and technical and educational approaches are heterogeneous. Academic-driven IPSs could possibly enhance the content quality, improve the validity level, and make this educational concept accessible to all medical students.