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Wczysla K, Sparn M, Schmied B, Hahnloser D, Bischofberger S. There is a need for a paradigm shift in laparoscopic surgical training: results of a nationwide survey among teaching hospitals in Switzerland. BMC MEDICAL EDUCATION 2024; 24:205. [PMID: 38413927 PMCID: PMC10900659 DOI: 10.1186/s12909-024-05209-4] [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: 07/14/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Surgical training curricula have changed little over the past decades. Current advances in surgical techniques, especially in minimally invasive surgery, as well as the rapidly changing socioeconomic environment pose a major challenge for the training of young surgeons. The aim of this survey was to provide a representative overview of the surgical training landscape in Switzerland focusing on laparoscopic surgical training: How do department chairs of teaching hospitals deal with the above challenges, and what should a future training curriculum look like? METHODS This is a prospective, questionnaire-based, cross-sectional study among the heads of departments of all certified surgical teaching hospitals in Switzerland. RESULTS The overall response rate was 56% (48/86) and 86% (19/22) for tertiary centers. Two-thirds of the centers (32) organize themselves in training networks. Laparoscopic training courses are offered in 25 (52%) hospitals, mainly in tertiary centers. Self-training opportunities exist in 40 (83%) hospitals. In addition to commercial (27) and self-built (7) box trainers, high-fidelity trainers are available in 16 (33%) hospitals. A mandatory training curriculum exists in 7 (15%) facilities, and a training assessment is performed in 15 (31%) institutions. Thirty-two (65%) heads of departments indicated that residents have sufficient practical exposure in the operating room, but the ability to work independently with obtaining the specialist title is seen critically (71%). They state that the surgical catalog does not adequately reflect the manual skills of the resident (64%). The desire is for training to be restructured from a numbers-based to a performance-based curriculum (53%) and for tools to assess residents' manual skills (56%) to be introduced. CONCLUSIONS Department chairs stated that the existing curriculum in Switzerland does not meet the requirements of a modern training curriculum. This study highlights the need to create an improved, competency-based curriculum that ensures the training of a new generation of surgeons, taking into account the growing evidence of the effectiveness of state-of-the-art training modalities such as simulation or proficiency-based training.
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Affiliation(s)
- Karolina Wczysla
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland
| | - Moritz Sparn
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland
| | - Bruno Schmied
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland
| | - Dieter Hahnloser
- Department of Surgery, Centre Hôpitalier Universitaire Vaudois, CH-1011, Lausanne, Switzerland
| | - Stephan Bischofberger
- Department of Surgery, Kantonsspital St. Gallen, Rorschacher Strasse 95, CH-9007, St. Gallen, Switzerland.
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Olgers T, Rozendaal J, van Weringh S, van de Vliert R, Laros R, Bouma H, Ter Maaten J. Teaching point-of-care ultrasound using a serious game: a randomized controlled trial. BMC MEDICAL EDUCATION 2023; 23:977. [PMID: 38115017 PMCID: PMC10731722 DOI: 10.1186/s12909-023-04964-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/11/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is an important diagnostic tool for internists. However, there are important barriers in learning POCUS, including lack of practice time and lack of experts for supervision. Alternative learning tools may assist in overcoming these barriers. A serious game is being developed specifically for teaching ultrasound. In this study, we assessed the use of a serious game in learning POCUS. METHODS Ultrasound-native medical students were randomly assigned to the intervention group (N = 27) or the control group (N = 26). Both groups performed a real ultrasound on a volunteer after a brief introduction, but the intervention group played a serious game in advance. The endpoints were the assessments of the videos by experts (scoring quality of the probe movements) and the research team (counting probe movements), and probe movements measured with an accelerometer. RESULTS The intervention group completed the exam faster (247 s vs. 347 s, p = 0.006 (95% CI: [30.20;168.80]) and lifted the probe less frequently from the model (0.54 vs. 3.79, p = 0.001 (95% CI: [1.39;5.11]). Also, we found an in-game learning effect between levels, showing a 48% decrease in total playing time (p < 0.001), 36% reduction in attempts per coin (p = 0.007), a 33% reduction in total probe distance (p = 0.002), and a 61% decrease in contact moments (p < 0.001). However, there was no significant difference in expert score between the two groups. CONCLUSION The serious game 'Underwater' is a fun and useful addition to traditional bedside ultrasound learning, which also may overcome one of the most important barriers in learning ultrasound: lack of supervised practice time. We show that the game improves real-practice probe handling with faster and more goal-oriented probe movements.
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Affiliation(s)
- Tycho Olgers
- Department Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands.
| | - Jelle Rozendaal
- Faculty of medical sciences, University of Groningen, Postbus 72, Groningen, 9700 AB, The Netherlands
| | - Sanne van Weringh
- Faculty of medical sciences, University of Groningen, Postbus 72, Groningen, 9700 AB, The Netherlands
| | - Rachel van de Vliert
- Faculty of medical sciences, University of Groningen, Postbus 72, Groningen, 9700 AB, The Netherlands
| | - Ranek Laros
- Faculty of medical sciences, University of Groningen, Postbus 72, Groningen, 9700 AB, The Netherlands
| | - Hjalmar Bouma
- Department Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
| | - Jan Ter Maaten
- Department Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, 9700 RB, The Netherlands
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Jitmun W, Palee P, Choosri N, Surapunt T. The Success of Serious Games and Gamified Systems in HIV Prevention and Care: Scoping Review. JMIR Serious Games 2023; 11:e39915. [PMID: 37669098 PMCID: PMC10509732 DOI: 10.2196/39915] [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: 05/27/2022] [Revised: 12/21/2022] [Accepted: 07/18/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND AIDS, which is caused by HIV, has long been one of the most significant global public health issues. Since the beginning of the HIV epidemic, various types of nonelectronic communication tools have been commonly used in HIV/AIDS prevention and care, but studies that apply the potential of electronic games are still limited. OBJECTIVE We aimed to identify, compare, and describe serious games and gamified systems currently used in HIV/AIDS prevention and care that were studied over a specific period of time. METHODS A scoping review was conducted into serious games and gamified systems used in HIV prevention and care in various well-known digital libraries from January 2010 to July 2021. RESULTS After identifying research papers and completing the article selection process, 49 of the 496 publications met the inclusion criteria and were examined. A total of 32 articles described 22 different serious games, while 17 articles described 13 gamified systems for HIV prevention and care. CONCLUSIONS Most of the studies described in the publications were conducted in the United States, while only a few studies were performed in sub-Saharan African countries, which have the highest global HIV/AIDS infection rates. Regarding the development platform, the vast majority of HIV/AIDS gaming systems were typically deployed on mobile devices. This study demonstrates the effectiveness of using serious games and gamified systems. Both can improve the efficacy of HIV/AIDS prevention strategies, particularly those that encourage behavior change.
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Affiliation(s)
- Waritsara Jitmun
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Patison Palee
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Noppon Choosri
- Data Analytics and Knowledge Synthesis for Healthcare (DAKSH) Research Group, College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
| | - Tisinee Surapunt
- College of Arts, Media, and Technology, Chiang Mai University, Chiang Mai, Thailand
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Ritchie A, Pacilli M, Nataraja RM. Simulation-based education in urology - an update. Ther Adv Urol 2023; 15:17562872231189924. [PMID: 37577030 PMCID: PMC10413896 DOI: 10.1177/17562872231189924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/08/2023] [Indexed: 08/15/2023] Open
Abstract
Over the past 30 years surgical training, including urology training, has changed from the Halstedian apprenticeship-based model to a competency-based one. Simulation-based education (SBE) is an effective, competency-based method for acquiring both technical and non-technical surgical skills and has rapidly become an essential component of urological education. This article introduces the key learning theory underpinning surgical education and SBE, discussing the educational concepts of mastery learning, deliberate practice, feedback, fidelity and assessment. These concepts are fundamental aspects of urological education, thus requiring clinical educators to have a detailed understanding of their impact on learning to assist trainees to acquire surgical skills. The article will then address in detail the current and emerging simulation modalities used in urological education, with specific urological examples provided. These modalities are part-task trainers and 3D-printed models for open surgery, laparoscopic bench and virtual reality trainers, robotic surgery simulation, simulated patients and roleplay, scenario-based simulation, hybrid simulation, distributed simulation and digital simulation. This article will particularly focus on recent advancements in several emerging simulation modalities that are being applied in urology training such as operable 3D-printed models, robotic surgery simulation and online simulation. The implementation of simulation into training programmes and our recommendations for the future direction of urological simulation will also be discussed.
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Affiliation(s)
- Angus Ritchie
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Maurizio Pacilli
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, Melbourne, Australia
| | - Ramesh M. Nataraja
- Department of Paediatric Surgery and Monash Children’s Simulation, Monash Children’s Hospital, 246 Clayton Road, Clayton, Melbourne 3168, Australia
- Departments of Paediatrics and Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne 3168, Australia
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Olgers TJ, van Os JM, Bouma HR, ter Maaten JC. The validation of a serious game for teaching ultrasound skills. Ultrasound J 2022; 14:29. [PMID: 35870092 PMCID: PMC9308840 DOI: 10.1186/s13089-022-00280-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/08/2022] [Indexed: 11/15/2022] Open
Abstract
Background Point-of-care ultrasound (POCUS) is an important bedside diagnostic tool and is being taught in several specialties. However, mastering the required psychomotor skills takes time and learning curves are different between students. Especially learning to make the right probe movements with the corresponding changes of the ultrasound image on screen, and integrating it into a 3D mental model takes time. This precious bedside-time of trainers and physicians may be reduced using other learning methods for mastering the psychomotor skills, for example the use of serious games. Such a game is under development but it needs to be validated before widespread use can be advised. In this article we describe the development and the first three steps in the validation of a serious game for ultrasound skills. Results We have included 18 ultrasound experts and 24 ultrasound novices who played the serious game ‘Underwater” and provided feedback. They concluded that “underwater” is fun to play and that movement of the 3D-printed probe resembled real ultrasound probe movements. Participants highly valued the potential of the game for training eye–hand coordination and stability of probe handling, two very important skills in performing ultrasound in real practice. Although we compared several in-game parameters such as distance and speed, no difference was observed between novices and experts. This means that content- and face validity of the serious game is demonstrated but optimal parameters to measure differences between novices and experts still have to be determined. Conclusions Our study shows solid content- and face validity of the serious game “UnderWater” for training ultrasound skills, although construct validity could not be demonstrated yet. The game is appreciated as a promising serious game for training eye–hand coordination and learning ultrasound, which may reduce expensive bed-side teaching. Supplementary Information The online version contains supplementary material available at 10.1186/s13089-022-00280-8.
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The impact of video games on training: can it change the game of endotracheal intubation? J Clin Monit Comput 2021; 36:901-906. [PMID: 34971437 DOI: 10.1007/s10877-021-00796-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
In recent years, several studies have demonstrated that the experience derived from video games improves interventions that require technical skills. Airway management is crucial to anesthesiologists, requiring technical and non-technical skills. We evaluated the benefits of video games for video stylet-guided tracheal intubation, which allows the use of video technology in airway management of residents with anesthesiology training. In the present study, the residents working in the Department of Anesthesiology and Reanimation at the Health Sciences University of Kartal Dr. Lütfi Kırdar City Hospital in Istanbul were assigned to two groups. Active users who played video games on a regular basis formed study group (n = 14), while those who did not have video gaming habits were assigned to the control group (n = 15). Female patients with the American Society of Anesthesiologists (ASA) I and II classification undergoing elective open or laparoscopic gynecological surgery through tracheal intubation under general anesthesia were included in the study. Female patients elective open and laparoscopic gynecological surgery under GA were included in the study. Time to intubate the trachea by using video stylet in (Group 1) was found to be 29 s on average, and it was 59.9 s for Group 2 ( p < 0.01) The average number of tracheal intubation attempts was 1.1 in Group 1, and 1.4 in Group 2 (p = 0.19). Video gaming experience improves the visual attention.Those accustomed to playing with video games, video stylet- guided tracheal intubation, performed intubation in less time.
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Johnson G, Vergis A, Unger B, Park J, Gillman L. Design and Validity Evidence for a Unique Endoscopy Simulator Using a Commercial Video Game. Cureus 2021; 13:e18379. [PMID: 34725623 PMCID: PMC8553393 DOI: 10.7759/cureus.18379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/05/2022] Open
Abstract
Background Procedural simulation enhances early endoscopy training. Multiple commercial simulators are available; however, their application is limited by cost and poor user compliance. First-person "shooter" (FPS) video games are popular. In this study, we aimed to show that a novel in-house designed colonoscope controller used to play an FPS video game shares similar constructs with real-life endoscopy. Methodology Participants completed the first three levels on an FPS video game, Portal (Valve Corporation, Bellevue, WA), first using a conventional controller and then the modified endoscope controller. A total of 12 expert endoscopists and 12 surgical residents with minimal endoscopy experience were evaluated based on completion time, button presses, and hand motion analyses. Results Experts outperformed novices for completion time (expert: 944 seconds; novice: 1,515 seconds; p = 0.006) and hand movements (expert: 1,263.1; novice: 2,052.6; p = 0.004) in using the novel colonoscope controller. There was no difference in button presses or total path length traveled. Furthermore, performance did not differ using conventional game controls. Conclusions Experts outperformed novices using the endoscope but not the conventional controller with respect to the economy of movement and completion time. This result confirms that our endoscope-controlled video game shares similar paradigms with real-life endoscopy and serves as a first step toward creating a more enjoyable and cheaper alternative to commercially available endoscopy simulators.
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Affiliation(s)
| | | | - Bertram Unger
- Internal Medicine, University of Manitoba, Winnipeg, CAN
| | - Jason Park
- Surgery, University of Manitoba, Winnipeg, CAN
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Nasiri M, Eslami J, Rashidi N, Paim CPP, Akbari F, Torabizadeh C, Havaeji FS, Goldmeier S, Abbasi M. "Playing with Surgical Instruments (PlaSurIn)" game to train operating room novices how to set up basic surgical instruments: A validation study. NURSE EDUCATION TODAY 2021; 105:105047. [PMID: 34242904 DOI: 10.1016/j.nedt.2021.105047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/01/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Game-based training has been considered as an alternative modality to traditional training in different perioperative nursing fields. OBJECTIVES To describe the adaptation and validation process of "Playing with Tweezers", a Portuguese game developed for novices to set up basic surgical instruments on the Mayo stand or a back table. DESIGN A validation study with three phases of translation, reconciliation, and evaluation (face, content, and construct validity). SETTINGS Several medical universities in Iran. PARTICIPANTS Twelve students in a pilot translation test, 18 experts in the reconciliation phase, 20 experts in the face and content validity stages, and 120 students (72 novices, 26 intermediates, and 22 experts) in the construct validity stage. METHODS Following "forward-backward" translation from Portuguese to English, the English version of the game was appraised in the reconciliation phase using a 57-item questionnaire. To test face and content validity of the final version of the game, a 30-item questionnaire addressing different aspects of the game was completed. The students' game performance (remained time for game completion, obtained score, and error) was compared to assess the construct validity. RESULTS Minor differences were detected and resolved during the translation process. The English version of the game was reconciled in two sequential steps, and the final game called "Playing with Surgical Instruments (PlaSurIn)" was developed. All the items regarding the face validity received 80-100% of positive responses. Moreover, regarding the content validity, all of the evaluated items obtained a content validity index of 0.90-1.0. Compared to the novices, the experts and intermediates received higher scores (p < 0.001 in two cases) and fewer errors (p < 0.001, p = 0.007). The remained time for game completion was significantly longer for experts than the novices (p = 0.011). CONCLUSIONS The "PlaSurIn", as a virtual training strategy, can prepare novices to set up basic surgical instruments.
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Affiliation(s)
- Morteza Nasiri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Department of Operating Room Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Jamshid Eslami
- Department of Operating Room Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Neda Rashidi
- Department of Operating Room, School of Paramedical Sciences, Dezful University of Medical Science, Dezful, Iran.
| | - Crislaine Pires Padilha Paim
- Department of Graduate Nursing Program, Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, Porto Alegre, Brazil.
| | - Fakhridokht Akbari
- Department of Nursing, Behbahan Faculty of Medical Sciences, Behbahan, Iran.
| | - Camellia Torabizadeh
- Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fahimeh Sadat Havaeji
- Department of Operating Room, School of Paramedical Sciences, Qom University of Medical Sciences, Qom, Iran.
| | - Silvia Goldmeier
- Department of Post-Graduate Program Research and Innovation Processes in Health, Institute of Cardiology of Rio Grande do Sul, University Foundation of Cardiology, Porto Alegre, Brazil.
| | - Mohammad Abbasi
- Department of Nursing, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran.
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French ED, Griffon DJ, Kass PH, Fahie MA, Gordon-Ross P, Levi O. Evaluation of a laparoscopic abdominal simulator assessment to test readiness for laparoscopic ovariectomy in live dogs. Vet Surg 2021; 50 Suppl 1:O49-O66. [PMID: 33615505 DOI: 10.1111/vsu.13604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/09/2020] [Accepted: 01/05/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To predict readiness for laparoscopic ovariectomy of live dogs on the basis of performance on a high-fidelity laparoscopic abdominal simulator and to determine interrater reliability of the assessment. STUDY DESIGN Experimental study. SAMPLE POPULATION Seventeen fourth-year veterinary students. METHODS After a standardized laparoscopic training course, each participant performed a laparoscopic ovariectomy with a simulator. This performance was scored in real time by two evaluators using a rubric. Participants achieving a score of 112 of 160 performed a laparoscopic ovariectomy in a live dog, supervised by an instructor in the room. Two evaluators scored video recordings of each procedure using the rubric. Participants' opinions about the simulator were collected with a survey. RESULTS All participants scored above the threshold (range, 126-151) and successfully completed laparoscopic ovariectomy in a live dog, with an average of 10 of 17 participants requiring verbal guidance and 5 of 17 participants requiring intervention from the instructor. Interrater concordance was excellent for the rubrics used to score performance on the simulator (R = 0.91) and in vivo (R = 0.81). All participants agreed that the simulator should be used to assess trainee readiness prior to surgery in a live dog. CONCLUSION Participants achieving a score of at least 126 of 160 on the simulator were able to perform a laparoscopic ovariectomy in a live dog under supervision. The scoring system for the simulator had excellent interrater concordance. CLINICAL SIGNIFICANCE This simulator and scoring system can be used in laparoscopic training programs to assess readiness for progression to the operative setting.
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Affiliation(s)
| | - Dominique J Griffon
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
| | - Philip H Kass
- School of Veterinary Medicine, University of California, Davis, California
| | - Maria A Fahie
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
| | - Paul Gordon-Ross
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
| | - Ohad Levi
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
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Olgers TJ, Bij de Weg AA, Ter Maaten JC. Serious Games for Improving Technical Skills in Medicine: Scoping Review. JMIR Serious Games 2021; 9:e24093. [PMID: 33492234 PMCID: PMC7870348 DOI: 10.2196/24093] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/30/2020] [Accepted: 12/14/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Serious games are being used to train specific technical skills in medicine, and most research has been done for surgical skills. It is not known if these games improve technical skills in real life as most games have not been completely validated. OBJECTIVE This scoping review aimed to evaluate the current use of serious games for improving technical skills in medicine and to determine their current validation state using a validation framework specifically designed for serious games. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A multidatabase search strategy was adopted, after which a total of 17 publications were included in this review. RESULTS These 17 publications described five different serious games for improving technical skills. We discuss these games in detail and report about their current validation status. Only one game was almost fully validated. We also discuss the different frameworks that can be used for validation of serious games. CONCLUSIONS Serious games are not extensively used for improving technical skills in medicine, although they may represent an attractive alternative way of learning. The validation of these games is mostly incomplete. Additionally, several frameworks for validation exist, but it is unknown which one is the best. This review may assist game developers or educators in validating serious games.
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Affiliation(s)
- Tycho Joan Olgers
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Anne Akke Bij de Weg
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Jan Cornelis Ter Maaten
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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IJgosse WM, van Goor H, Rosman C, Luursema JM. The Fun Factor: Does Serious Gaming Affect the Volume of Voluntary Laparoscopic Skills Training? World J Surg 2020; 45:66-71. [PMID: 32989581 PMCID: PMC7752875 DOI: 10.1007/s00268-020-05800-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 01/22/2023]
Abstract
Background The availability of validated laparoscopic simulators has not resulted in sustainable high-volume training. We investigated whether the validated laparoscopic serious game Underground would increase voluntary training by residents. We hypothesized that by removing intrinsic barriers and extrinsic barriers, residents would spend more time on voluntary training with Underground compared to voluntary training with traditional simulators. Methods After 1 year, we compared amount of voluntary time spent on playing Underground to time spent on all other laparoscopic training modalities and to time spent on performing laparoscopic procedures in the OR for all surgical residents. These data were compared to resident’ time spent on laparoscopic activities over the prior year before the introduction of Underground. Results From March 2016 until March 2017, 63 residents spent on average 20 min on voluntary serious gaming, 17 min on voluntary simulator training, 2 h and 44 min on mandatory laparoscopic training courses, and 14 h and 49 min on laparoscopic procedures in the OR. Voluntary activities represented 3% of laparoscopic training activities which was similar in the prior year wherein fifty residents spent on average 33 min on voluntary simulator training, 3 h and 28 min on mandatory laparoscopic training courses, and 11 h and 19 min on laparoscopic procedures. Conclusion Serious gaming has not increased total voluntary training volume. Underground did not mitigate intrinsic and extrinsic barriers to voluntary training. Mandatory, scheduled training courses remain needed. Serious gaming is flexible and affordable and could be an important part of such training courses.
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Affiliation(s)
- Wouter Martijn IJgosse
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands. .,Radboud University Medical Center, PO Box 9101 (960), 6500 HB, Nijmegen, The Netherlands.
| | - Harry van Goor
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Jan-Maarten Luursema
- Department of Surgery, Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Palee P, Wongta N, Khwanngern K, Jitmun W, Choosri N. Serious Game for Teaching Undergraduate Medical Students in Cleft lip and Palate Treatment Protocol. Int J Med Inform 2020; 141:104166. [PMID: 32570197 DOI: 10.1016/j.ijmedinf.2020.104166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 03/30/2020] [Accepted: 04/30/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To develop and evaluate a serious game to deliver knowledge about the cleft lip with or without cleft palate (CL/P) protocol used in Craniofacial Center, Chiang Mai University. METHODS The game "Cleft Island" was developed then extensively evaluated using different criteria, including the measured knowledge gained by participants, and gameplay experience. A group of 53 fourth and fifth-year medical students (male: 24, female: 29) were recruited to take part in an experiment. They were from the Faculty of Medicine, Chiang Mai University, and had just rotated to the Department of Surgery. Three evaluations were conducted: 1) to test whether the players had competently gained CL/P knowledge; 2) to evaluate the usability of the game according to the System Usability Scale (SUS); and 3) to evaluate the game experience in terms of a Game Experience Questionnaire (GEQ) test. RESULTS The results indicate a statistically significant improvement of medical students' knowledge after performing the Wilcoxon Signed-Ranks test (p < 0.5) between pre-test and post-test scores of the same medical student group; the acceptable average SUS score (M = 55.28) of the serious game; a moderate degree of experience of the GEQ components including positive affect (M = 2.64), competence (M = 2.49), and immersion (M = 2.21). CONCLUSIONS Cleft Island can be used as an effective supplementary instructional material, which has the potential to provide significant knowledge of CL/P treatment protocol for the players. As far as the authors are aware, this is the first study to implement and assess a serious game for training in CL/P protocol.
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Affiliation(s)
- Patison Palee
- College of Arts, Media, and Technology, Chiang Mai University, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand
| | - Noppon Wongta
- College of Arts, Media, and Technology, Chiang Mai University, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand
| | - Krit Khwanngern
- Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Suthep, Muang, Chiang Mai, 50200, Thailand; Center of Data Analytics and Knowledge Synthesis for Healthcare, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand
| | - Waritsara Jitmun
- College of Arts, Media, and Technology, Chiang Mai University, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand
| | - Noppon Choosri
- College of Arts, Media, and Technology, Chiang Mai University, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand; Center of Data Analytics and Knowledge Synthesis for Healthcare, 239 Huaykaew Rd., Suthep, Muang, Chiang Mai, 50200, Thailand.
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IJgosse W, van Goor H, Rosman C, Luursema JM. Construct Validity of a Serious Game for Laparoscopic Skills Training: Validation Study. JMIR Serious Games 2020; 8:e17222. [PMID: 32379051 PMCID: PMC7243133 DOI: 10.2196/17222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/27/2020] [Accepted: 03/23/2020] [Indexed: 01/19/2023] Open
Abstract
Background Surgical residents underutilize opportunities for traditional laparoscopic simulation training. Serious gaming may increase residents’ motivation to practice laparoscopic skills. However, little is known about the effectiveness of serious gaming for laparoscopic skills training. Objective The aim of this study was to establish construct validity for the laparoscopic serious game Underground. Methods All study participants completed 2 levels of Underground. Performance for 2 novel variables (time and error) was compared between novices (n=65, prior experience <10 laparoscopic procedures), intermediates (n=26, prior experience 10-100 laparoscopic procedures), and experts (n=20, prior experience >100 laparoscopic procedures) using analysis of covariance. We corrected for gender and video game experience. Results Controlling for gender and video game experience, the effects of prior laparoscopic experience on the time variable differed significantly (F2,106=4.77, P=.01). Both experts and intermediates outperformed novices in terms of task completion speed; experts did not outperform intermediates. A similar trend was seen for the rate of gameplay errors. Both gender (F1,106=14.42, P<.001 in favor of men) and prior video game experience (F1,106=5.20, P=.03 in favor of experienced gamers) modulated the time variable. Conclusions We established construct validity for the laparoscopic serious game Underground. Serious gaming may aid laparoscopic skills development. Previous gaming experience and gender also influenced Underground performance. The in-game performance metrics were not suitable for statistical evaluation. To unlock the full potential of serious gaming for training, a more formal approach to performance metric development is needed.
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Affiliation(s)
- Wouter IJgosse
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Levi O, Shettko DL, Battles M, Schmidt PL, Fahie MA, Griffon DJ, Gordon-Ross P, Hendrickson DA. Effect of Short- Versus Long-Term Video Game Playing on Basic Laparoscopic Skills Acquisition of Veterinary Medicine Students. JOURNAL OF VETERINARY MEDICAL EDUCATION 2018; 46:184-194. [PMID: 30565981 DOI: 10.3138/jvme.0617-077r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of this study was to investigate the effect of playing video games on the performance of basic laparoscopic skills. The study was an experimental pre-test-post-test comparison group design. Fifty-two students (31 from the Western University of Health Sciences College of Veterinary Medicine and 21 from the Colorado State University College of Veterinary Medicine) completing their first or second year of the veterinary curriculum were randomized into two intervention groups. The intervention consisted of playing the video game Marble Mania on a Nintendo Wii. group L (long) played 18 hours over 6 weeks and group S (short) played 3 hours during the last week of the 6-week intervention period. Before and after the intervention, basic laparoscopic skills for both groups were assessed using a modified McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) instrument. Participants performed two laparoscopic tasks. Results showed that the performance of students improved in both group S and L (p < .05) on both laparoscopic tasks. Both groups showed statistically significant improvement in their post-intervention scores (group L, N = 25, z = -3.711, p < .001, r = 0.742; group S, N = 27, z = -3.016, p < .003, r = 0.580). There was no significant difference in the degree of improvement between group S and group L. The results suggest that playing Marble Mania on a Wii for any time duration could be an effective method for veterinary medicine students to improve basic laparoscopic skills, and indicate the needs for additional studies.
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Harrington CM, Chaitanya V, Dicker P, Traynor O, Kavanagh DO. Playing to your skills: a randomised controlled trial evaluating a dedicated video game for minimally invasive surgery. Surg Endosc 2018; 32:3813-3821. [PMID: 29445864 DOI: 10.1007/s00464-018-6107-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/07/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Video gaming demands elements of visual attention, hand-eye coordination and depth perception which may be contiguous with laparoscopic skill development. General video gaming has demonstrated altered cortical plasticity and improved baseline/acquisition of minimally invasive skills. The present study aimed to evaluate for skill acquisition associated with a commercially available dedicated laparoscopic video game (Underground) and its unique (laparoscopic-like) controller for the Nintendo®Wii U™ console. METHODS This single-blinded randomised controlled study was conducted with laparoscopically naive student volunteers of limited (< 3 h/week) video gaming backgrounds. Baseline laparoscopic skills were assessed using four basic tasks on the Virtual Reality (VR) simulator (LAP MentorTM, 3D systems, Colorado, USA). Twenty participants were randomised to two groups; Group A was requested to complete 5 h of video gaming (Underground) per week and Group B to avoid gaming beyond their normal frequency. After 4 weeks participants were reassessed using the same VR tasks. Changes in simulator performances were assessed for each group and for intergroup variances using mixed model regression. RESULTS Significant inter- and intragroup performances were present for the video gaming and controls across four basic tasks. The video gaming group demonstrated significant improvements in thirty-one of the metrics examined including dominant (p ≤ 0.004) and non-dominant (p < 0.050) instrument movements, pathlengths (p ≤ 0.040), time taken (p ≤ 0.021) and end score [p ≤ 0.046, (task-dependent)]. The control group demonstrated improvements in fourteen measures. The video gaming group demonstrated significant (p < 0.05) improvements compared to the control in five metrics. Despite encouraged gameplay and the console in participants' domiciles, voluntary engagement was lower than directed due to factors including: game enjoyment (33.3%), lack of available time (22.2%) and entertainment distractions (11.1%). CONCLUSION Our work revealed significant value in training using a dedicated laparoscopic video game for acquisition of virtual laparoscopic skills. This novel serious game may provide foundations for future surgical developments on game consoles in the home environment.
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Affiliation(s)
- Cuan M Harrington
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Vishwa Chaitanya
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Patrick Dicker
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oscar Traynor
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, Dublin, Ireland
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Saving robots improves laparoscopic performance: transfer of skills from a serious game to a virtual reality simulator. Surg Endosc 2018; 32:3192-3199. [PMID: 29349543 DOI: 10.1007/s00464-018-6036-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Residents find it hard to commit to structural laparoscopic skills training. Serious gaming has been proposed as a solution on the premise that it is effective and more motivating than traditional simulation. We establish construct validity for the laparoscopic serious game Underground by comparing laparoscopic simulator performance for a control group and an Underground training group. METHODS A four-session laparoscopic basic skills course is part of the medical master students surgical internship at the Radboud University Medical Centre. Four cohorts, representing 107 participants, were assigned to either the Underground group or the control group. The control group trained on the FLS video trainer and the LapSim virtual reality simulator for four sessions. The Underground group played Underground for three sessions followed by a transfer session on the FLS video trainer and the LapSim. To assess the effect of engaging in serious gameplay on performance on two validated laparoscopic simulators, initial performance on the FLS video trainer and the LapSim was compared between the control group (first session) and the Underground group (fourth session). RESULTS We chose task duration as a proxy for laparoscopic performance. The Underground group outperformed the control group on all three LapSim tasks: Camera navigation F(1) = 12.71, p < .01; Instrument navigation F(1) = 8.04, p < .01; and Coordination F(1) = 6.36, p = .01. There was no significant effect of playing Underground for performance on the FLS video trainer Peg Transfer task, F(1) = 0.28, p = .60. CONCLUSIONS We demonstrated skills transfer between a serious game and validated laparoscopic simulator technology. Serious gaming may become a valuable, cost-effective addition to the skillslab, if transfer to the operating room can be established. Additionally, we discuss sources of transferable skills to help explain our and previous findings.
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Hori T, Machimoto T, Kadokawa Y, Hata T, Ito T, Kato S, Yasukawa D, Aisu Y, Kimura Y, Sasaki M, Takamatsu Y, Kitano T, Hisamori S, Yoshimura T. Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy. World J Gastroenterol 2017; 23:5849-5859. [PMID: 28932077 PMCID: PMC5583570 DOI: 10.3748/wjg.v23.i32.5849] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/25/2017] [Accepted: 08/02/2017] [Indexed: 02/06/2023] Open
Abstract
Acute appendicitis (AA) develops in a progressive and irreversible manner, even if the clinical course of AA can be temporarily modified by intentional medications. Reliable and real-time diagnosis of AA can be made based on findings of the white blood cell count and enhanced computed tomography. Emergent laparoscopic appendectomy (LA) is considered as the first therapeutic choice for AA. Interval/delayed appendectomy at 6-12 wk after disease onset is considered as unsafe with a high recurrent rate during the waiting time. However, this technique may have some advantages for avoiding unnecessary extended resection in patients with an appendiceal mass. Non-operative management of AA may be tolerated only in children. Postoperative complications increase according to the patient’s factors, and temporal avoidance of emergent general anesthesia may be beneficial for high-risk patients. The surgeon’s skill and cooperation of the hospital are important for successful LA. Delaying appendectomy for less than 24 h from diagnosis is safe. Additionally, a semi-elective manner (i.e., LA within 24 h after onset of symptoms) may be paradoxically acceptable, according to the factors of the patient, physician, and institution. Prompt LA is mandatory for AA. Fortunately, the Japanese government uses a universal health insurance system, which covers LA.
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Affiliation(s)
- Tomohide Hori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Takafumi Machimoto
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yoshio Kadokawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Toshiyuki Hata
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Tatsuo Ito
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Shigeru Kato
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Daiki Yasukawa
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yuki Aisu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yusuke Kimura
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Maho Sasaki
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Yuichi Takamatsu
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Taku Kitano
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Shigeo Hisamori
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
| | - Tsunehiro Yoshimura
- Department of Gastrointestinal Surgery, Tenriyorodusoudanjyo Hospital, Tenri, Nara 632-8552, Japan
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Abstract
Supplemental digital content is available in the text. Introduction Training emergency care skills is critical for patient safety but cost intensive. Serious games have been proposed as an engaging self-directed learning tool for complex skills. The objective of this study was to compare the cognitive skills and motivation of medical residents who only used a course manual as preparation for classroom training on emergency care with residents who used an additional serious game. Methods This was a quasi-experimental study with residents preparing for a rotation in the emergency department. The “reading” group received a course manual before classroom training; the “reading and game” group received this manual plus the game as preparation for the same training. Emergency skills were assessed before training (with residents who agreed to participate in an extra pretraining assessment), using validated competency scales and a global performance scale. We also measured motivation. Results All groups had comparable important characteristics (eg, experience with acute care). Before training, the reading and game group felt motivated to play the game and spent more self-study time (+2.5 hours) than the reading group. Game-playing residents showed higher scores on objectively measured and self-assessed clinical competencies but equal scores on the global performance scale and were equally motivated for training, compared with the reading group. After the 2-week training, no differences between groups existed. Conclusions After preparing training with an additional serious game, residents showed improved clinical competencies, compared with residents who only studied course material. After a 2-week training, this advantage disappeared. Future research should study the retention of game effects in blended designs.
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20
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Graafland M, Bemelman WA, Schijven MP. Game-based training improves the surgeon's situational awareness in the operation room: a randomized controlled trial. Surg Endosc 2017; 31:4093-4101. [PMID: 28281117 PMCID: PMC5636911 DOI: 10.1007/s00464-017-5456-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/03/2017] [Indexed: 01/26/2023]
Abstract
Background Equipment-related malfunctions directly relate to one-fourth of the adverse events in the surgical theater. A serious game trains residents to recognize and respond to equipment problems in minimally invasive surgery (MIS). These include disturbed vision, gas transport, electrocautery, and pathophysiological disturbances. This randomized controlled trial explores whether game-based training improves surgical residents’ response to equipment-related problems during surgery. Methods Thirty-one surgical residents with no previous experience in MIS took part in a standardized basic laparoscopy training course. Fifteen residents were randomly assigned to the game-enhanced curriculum (intervention) and sixteen were assigned to the regular curriculum (control). Participants performed a MIS task in a live anesthetized pig model, during which three standardized equipment malfunction scenarios occurred. Observers recorded the problems recognized and solved, time, and participants’ technical performance. Results Twenty-four participants completed the post-test (n = 12 per group). The intervention group solved more problems than the control group (59 vs. 33%, p = 0.029). The intervention group also recognized a larger proportion of problems, although this parameter was non-significant (67 vs. 42%, p = 0.14). Random effects modeling showed a significant improved game performance per participant over time. Conclusions Surgical residents, who play for only 1 h on a custom-made serious game, respond significantly better to equipment-related problems during surgery than residents trained by a standard training curriculum. These results imply that entertaining serious games can indeed be considered for use in official training for surgeons and other medical specialists.
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Affiliation(s)
- Maurits Graafland
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Kowalewski KF, Hendrie JD, Schmidt MW, Proctor T, Paul S, Garrow CR, Kenngott HG, Müller-Stich BP, Nickel F. Validation of the mobile serious game application Touch Surgery™ for cognitive training and assessment of laparoscopic cholecystectomy. Surg Endosc 2017; 31:4058-4066. [PMID: 28281111 DOI: 10.1007/s00464-017-5452-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Touch Surgery™ (TS) is a serious gaming application for cognitive task simulation and rehearsal of key steps in surgical procedures. The aim was to establish face, content, and construct validity of TS for laparoscopic cholecystectomy (LC). Furthermore, learning curves with TS and a virtual reality (VR) trainer were compared in a randomized trial. METHODS The performance of medical students and general surgeons was compared for all three modules of LC in TS to establish construct validity. Questionnaires assessed face and content validity. For analysis of learning curves, students were randomized to train on VR or TS first, and then switched to the other training modality. Performance data were recorded. RESULTS 54 Surgeons and 51 medical students completed the validation study. Surgeons outperformed students with TS: patient preparation (students = 45.0 ± 19.1%; surgeons = 57.3 ± 15.2%; p < 0.001), access and laparoscopy (students = 70.2 ± 10.9%; surgeons = 75.9 ± 9.7%; p = 0.008) and LC (students = 69.8 ± 12.4%; surgeons = 77.7 ± 9.6%; p < 0.001). Both groups agreed that TS was a highly useful and realistic application. 46 students were randomized for learning curve analysis. It took them 2-4 attempts to reach a 100% score with TS. Training with TS first did not improve students' performance on the VR trainer; however, students who trained with VR first scored significantly higher in module 3 of TS. CONCLUSION TS is an accepted serious gaming application for learning cognitive aspects of LC with established construct, face, and content validity. There appeared to be a synergy between TS and the VR trainer. Therefore, the two training modalities should accompany one another in a multimodal training approach to laparoscopy.
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Affiliation(s)
- Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jonathan D Hendrie
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Mona W Schmidt
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Tanja Proctor
- Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sai Paul
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Carly R Garrow
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hannes G Kenngott
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Overtoom EM, Jansen FW, van Santbrink EJP, Schraffordt Koops SE, Veersema S, Schreuder HWR. Training in Basic Laparoscopic Surgical Skills: Residents Opinion of the New Nintendo Wii-U Laparoscopic Simulator. JOURNAL OF SURGICAL EDUCATION 2017; 74:352-359. [PMID: 27789193 DOI: 10.1016/j.jsurg.2016.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/27/2016] [Accepted: 10/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Serious games are new in the field of laparoscopic surgical training. We evaluate the residents׳ opinion of a new laparoscopic simulator for the Nintendo Wii-U platform. DESIGN Prospective questionnaire study. Participants received a standardized introduction and completed level 3 and 4 of the game "Underground." They filled out a questionnaire concerning demographics and their opinion on realism, usefulness, suitability, haptic feedback, and home training-use of the game. SETTING Two tertiary teaching hospitals. PARTICIPANTS Obstetrics and gynaecology residents postgraduate year 1 to 6 (n = 59) from several European countries. RESULTS Subjects (n = 59) were divided into 2 groups based on laparoscopic experience: Group A (n = 38) and Group B (n = 21). The realism of different aspects of the game received mean scores around 3 on a 5-point Likert scale. The hand-eye coordination was regarded most useful for training with a mean of 3.92 (standard deviation 0.93) and the game was considered most suitable for residents in the first part of their postgraduate training with a mean of 3.73 (standard deviation 0.97). Both groups differed especially concerning their opinion of the usefulness of the game as a training tool. CONCLUSIONS Most residents liked the new serious game for the Nintendo Wii-U. The usefulness and suitability as a laparoscopic training tool were rated at an acceptable to high level. However, the game does require improvements such as inclusion of a good scoring system before it can be integrated in resident training curricula.
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Affiliation(s)
- Evelien M Overtoom
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank-Willem Jansen
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands; Faculty of Mechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | | | | | - Sebastiaan Veersema
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henk W R Schreuder
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, the Netherlands; UMC Utrecht Cancer Centre, Department of Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Abstract
STATEMENT Serious games are computer-based games designed for training purposes. They are poised to expand their role in medical education. This systematic review, conducted in accordance with PRISMA guidelines, aimed to synthesize current serious gaming trends in health care training, especially those pertaining to developmental methodologies and game evaluation. PubMed, EMBASE, and Cochrane databases were queried for relevant documents published through December 2014. Of the 3737 publications identified, 48 of them, covering 42 serious games, were included. From 2007 to 2014, they demonstrate a growth from 2 games and 2 genres to 42 games and 8 genres. Overall, study design was heterogeneous and methodological quality by MERQSI score averaged 10.5/18, which is modest. Seventy-nine percent of serious games were evaluated for training outcomes. As the number of serious games for health care training continues to grow, having schemas that organize how educators approach their development and evaluation is essential for their success.
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Fovet T, Micoulaud-Franchi JA, Vaiva G, Thomas P, Jardri R, Amad A. [Serious game as a therapeutic tool in psychiatry: A systematic review]. Encephale 2016; 42:463-469. [PMID: 27017317 DOI: 10.1016/j.encep.2016.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/02/2015] [Indexed: 10/22/2022]
Abstract
CONTEXT The growing field of new technologies offers new ways to tackle psychiatric disorders (e.g. virtual reality therapy, neurofeedback, etc.). Serious games (SG) are computer applications combining serious aspects with the fun side of video games. This kind of new media could find applications to treat psychiatric disorders. OBJECTIVE This paper summarizes available data in the literature about therapeutic interventions using SG in psychiatry. METHOD A Medline search was conducted in May 2014 using the following Medical Subject Headings (MESH) terms: "video games", "mental disorders", and "psychotherapy". RESULTS Only 10 relevant references were identified according to our inclusion criteria. These studies show that SG are very interesting tools to improve the management of psychiatric disorders. However, only low-level evidence is available to support treatment with SG in patients suffering from psychiatric disorders. Indeed, randomized controlled trials are rare in this field of research. CONCLUSION SG provide promising therapeutic innovations for the management of psychiatric disorders. Moreover, they could easily be developed in accordance with current dimensional approaches. Finally, major issues to facilitate the implementation of future work on SG in psychiatry are discussed.
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Affiliation(s)
- T Fovet
- UMR9193-PsychiC-SCALab, pôle de psychiatrie, CNRS, université de Lille, CHU de Lille, 59000 Lille, France.
| | - J-A Micoulaud-Franchi
- Unité de neurophysiologie et psychophysiologie, pôle de psychiatrie universitaire, CHU Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France; Laboratoire de neurosciences cognitives (LNC), UMR CNRS 7291, 31 Aix-Marseille université, site Saint-Charles, 3, place Victor-Hugo, 13331 Marseille cedex 3, France
| | - G Vaiva
- UMR9193-PsychiC-SCALab, pôle de psychiatrie, CNRS, université de Lille, CHU de Lille, 59000 Lille, France
| | - P Thomas
- UMR9193-PsychiC-SCALab, pôle de psychiatrie, CNRS, université de Lille, CHU de Lille, 59000 Lille, France
| | - R Jardri
- UMR9193-PsychiC-SCALab, pôle de psychiatrie, CNRS, université de Lille, CHU de Lille, 59000 Lille, France
| | - A Amad
- UMR9193-PsychiC-SCALab, pôle de psychiatrie, CNRS, université de Lille, CHU de Lille, 59000 Lille, France
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Wang TL, Ames TD, Le KM, Wee C, Phieffer LS, Quatman CE. Training Advanced Practice Providers to Collect Functional Outcomes After Fragility Fractures. Geriatr Orthop Surg Rehabil 2015; 6:130-9. [PMID: 26328225 PMCID: PMC4536498 DOI: 10.1177/2151458515577196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: The objective of this study was to determine whether advanced practice providers could learn to collect objective functional assessment data accurately and efficiently with commercially available devices that measure kinematics and kinetics (Nintendo Wii Balance Board [WBB] and Level Belt [LB]) to aid in the assessment of fall risk and outcomes after fragility fractures. Methods: Nine advanced practice providers participated in a 1-hour clinical assessment tools (CATs) training session on equipment use, providing standardized instructions, and practice of the testing procedures. Afterward, they participated in a skills demonstration evaluation and completed a postsession survey. Results: Participants successfully achieved a mean of 18.22 (standard deviation 1.56) of 20 performance measures. Of the incomplete or omitted tasks, the majority (10 of 16) occurred within the first of 3 CATs activities. Postsession survey results revealed that 9 of 9 participants reported that the 1 hour provided for training on the CATs was sufficient. All participants reported that after the training, they felt confident they could reliably carry out the tasks to test patients on both the WBB and the LB. The majority of participants reported that they believed that the WBB (7 of 9) and LB (8 out of 9) would be good assets to clinics in assessing patient functionality after fragility fractures. Conclusion: These results indicate that advanced practice providers can confidently learn and effectively test patients with the WBB and LB within 1 hour of training. In the future, adoption of CATs in the clinical setting may allow for objective, easy-to-use, portable, noninvasive, and relatively inexpensive measures to assess functional outcomes in patients with fragility fracture.
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Affiliation(s)
- Tiffany L Wang
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Tyler D Ames
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Khoi M Le
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Corinne Wee
- Department of Orthopaedics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Laura S Phieffer
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carmen E Quatman
- Department of Orthopaedic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Jalink MB, Goris J, Heineman E, Pierie JPE, ten Cate Hoedemaker HO. Face validity of a Wii U video game for training basic laparoscopic skills. Am J Surg 2015; 209:1102-6. [DOI: 10.1016/j.amjsurg.2014.09.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 08/31/2014] [Accepted: 09/05/2014] [Indexed: 11/24/2022]
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Esposito C, Escolino M, Saxena A, Montupet P, Chiarenza F, De Agustin J, Draghici IM, Cerulo M, Sagaon MM, Di Benedetto V, Gamba P, Settimi A, Najmaldin A. European Society of Pediatric Endoscopic Surgeons (ESPES) guidelines for training program in pediatric minimally invasive surgery. Pediatr Surg Int 2015; 31:367-73. [PMID: 25667047 DOI: 10.1007/s00383-015-3672-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE The aim of this paper was to propose structured guidelines for a European pediatric MIS training program created by ESPES. METHODS A questionnaire, focused on how the pediatric training program in MIS has to be structured, was proposed to all participants at the ESPES Congress in Marseille in 2013. RESULTS We received 178 questionnaires but only 139 questionnaires were fully completed and analyzed. All respondents agree that the training program has to be divided into 4 steps: (1) theoretical part: 2 theoretical courses in laparoscopy (101/139 respondents, 72.7 %), 1 theoretical course in retroperitoneoscopy (99/139 respondents, 71.2 %) and 1 in thoracoscopy (91/139 respondents, 65.5 %); (2) experimental part: 10-20 h of training on pelvic trainer (103/139 respondents, 74.1 %) and 10 h of training on animal models (91/139 respondents, 65.5 %); (3) stages in European centers of reference for MIS: a 1-3 months stage (96/139 respondents, 69.1 %); (4) personal experience: 30 procedures as cameraman (98/139 respondents, 70.5 %) and >50 basic MIS procedures as main surgeon under supervision (114/139 respondents, 82 %). CONCLUSIONS On the basis of our survey ESPES MIS training curriculum for pediatric surgeons must contain the following educational components: (1) theoretical knowledge; (2) practice-based learning and improvement in experimental setting; (3) stages in European centers of reference for MIS; (4) personal operative experience. At the end of the training program, ESPES will analyze the candidate training booklet and release for each applicant an ESPES certification after an exam.
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Affiliation(s)
- Ciro Esposito
- Department of Traslational Medical Sciences, Pediatric Surgery Unit, Federico II University, Via Pansini 5, 80131, Naples, Italy,
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Abstract
OBJECTIVE To identify all reported cases of injury and other problems caused by using a Nintendo video gaming system. DESIGN Review. DATA SOURCES AND REVIEW METHODS Search of PubMed and Embase in June 2014 for reports on injuries and other problems caused by using a Nintendo gaming system. RESULTS Most of the 38 articles identified were case reports or case series. Injuries and problems ranged from neurological and psychological to surgical. Traditional controllers with buttons were associated with tendinitis of the extensor of the thumb. The joystick on the Nintendo 64 controller was linked to palmar ulceration. The motion sensitive Wii remote was associated with musculoskeletal problems and various traumas. CONCLUSIONS Most problems are mild and prevalence is low. The described injuries were related to the way the games are controlled, which varies according to the video game console.
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Affiliation(s)
- Maarten B Jalink
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, 9700 RB Groningen, Netherlands
| | - Erik Heineman
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, 9700 RB Groningen, Netherlands
| | - Jean-Pierre E N Pierie
- Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, Netherlands
| | - Henk O ten Cate Hoedemaker
- Department of Surgery, University of Groningen, University Medical Centre Groningen, Groningen, 9700 RB Groningen, Netherlands Postgraduate School of Medicine, University Medical Center Groningen, Groningen, Netherlands
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Graafland M, Dankbaar M, Mert A, Lagro J, De Wit-Zuurendonk L, Schuit S, Schaafstal A, Schijven M. How to systematically assess serious games applied to health care. JMIR Serious Games 2014; 2:e11. [PMID: 25654163 PMCID: PMC4307812 DOI: 10.2196/games.3825] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 10/15/2014] [Accepted: 10/17/2014] [Indexed: 11/13/2022] Open
Abstract
The usefulness and effectiveness of specific serious games in the medical domain is often unclear. This is caused by a lack of supporting evidence on validity of individual games, as well as a lack of publicly available information. Moreover, insufficient understanding of design principles among the individuals and institutions that develop or apply a medical serious game compromises their use. This article provides the first consensus-based framework for the assessment of specific medical serious games. The framework provides 62 items in 5 main themes, aimed at assessing a serious game's rationale, functionality, validity, and data safety. This will allow caregivers and educators to make balanced choices when applying a serious game for healthcare purposes. Furthermore, the framework provides game manufacturers with standards for the development of new, valid serious games.
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Affiliation(s)
- Maurits Graafland
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
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Jalink MB, Heineman E, Pierie JPEN, ten Cate Hoedemaker HO. The effect of a preoperative warm-up with a custom-made Nintendo video game on the performance of laparoscopic surgeons. Surg Endosc 2014; 29:2284-90. [DOI: 10.1007/s00464-014-3943-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/07/2014] [Indexed: 01/08/2023]
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Goris J, Jalink MB, ten Cate Hoedemaker HO. Training basic laparoscopic skills using a custom-made video game. PERSPECTIVES ON MEDICAL EDUCATION 2014; 3:314-318. [PMID: 24408736 PMCID: PMC4152466 DOI: 10.1007/s40037-013-0106-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Video games are accepted and used for a wide variety of applications. In the medical world, research on the positive effects of playing games on basic laparoscopic skills is rapidly increasing. Although these benefits have been proven several times, no institution actually uses video games for surgical training. This Short Communication describes some of the theoretical backgrounds, development and underlying educational foundations of a specifically designed video game and custom-made hardware that takes advantage of the positive effects of games on basic laparoscopic skills.
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Affiliation(s)
- Jetse Goris
- Department of Surgery and Post Graduate School of Medicine (Wenckebach Institute), University Medical Center of Groningen, Huispostcode FC20, Postbus 30.001, 9700 RB Groningen, the Netherlands
| | - Maarten B. Jalink
- Department of Surgery and Post Graduate School of Medicine (Wenckebach Institute), University Medical Center of Groningen, Huispostcode FC20, Postbus 30.001, 9700 RB Groningen, the Netherlands
| | - Henk O. ten Cate Hoedemaker
- Department of Surgery and Post Graduate School of Medicine (Wenckebach Institute), University Medical Center of Groningen, Huispostcode FC20, Postbus 30.001, 9700 RB Groningen, the Netherlands
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Graafland M, Vollebergh MF, Lagarde SM, van Haperen M, Bemelman WA, Schijven MP. A Serious Game Can Be a Valid Method to Train Clinical Decision-Making in Surgery. World J Surg 2014; 38:3056-62. [DOI: 10.1007/s00268-014-2743-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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