1
|
Wong SW, Crowe P. Cognitive ergonomics and robotic surgery. J Robot Surg 2024; 18:110. [PMID: 38441814 PMCID: PMC10914881 DOI: 10.1007/s11701-024-01852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 01/28/2024] [Indexed: 03/07/2024]
Abstract
Cognitive ergonomics refer to mental resources and is associated with memory, sensory motor response, and perception. Cognitive workload (CWL) involves use of working memory (mental strain and effort) to complete a task. The three types of cognitive loads have been divided into intrinsic (dependent on complexity and expertise), extraneous (the presentation of tasks) and germane (the learning process) components. The effect of robotic surgery on CWL is complex because the postural, visualisation, and manipulation ergonomic benefits for the surgeon may be offset by the disadvantages associated with team separation and reduced situation awareness. Physical fatigue and workflow disruptions have a negative impact on CWL. Intraoperative CWL can be measured subjectively post hoc with the use of self-reported instruments or objectively with real-time physiological response metrics. Cognitive training can play a crucial role in the process of skill acquisition during the three stages of motor learning: from cognitive to integrative and then to autonomous. Mentorship, technical practice and watching videos are the most common traditional cognitive training methods in surgery. Cognitive training can also occur with computer-based cognitive simulation, mental rehearsal, and cognitive task analysis. Assessment of cognitive skills may offer a more effective way to differentiate robotic expertise level than automated performance (tool-based) metrics.
Collapse
Affiliation(s)
- Shing Wai Wong
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
- School of Clinical Medicine, The University of New South Wales, Randwick Campus, Sydney, NSW, Australia.
| | - Philip Crowe
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
- School of Clinical Medicine, The University of New South Wales, Randwick Campus, Sydney, NSW, Australia
| |
Collapse
|
2
|
El-Sayed C, Yiu A, Burke J, Vaughan-Shaw P, Todd J, Lin P, Kasmani Z, Munsch C, Rooshenas L, Campbell M, Bach SP. Measures of performance and proficiency in robotic assisted surgery: a systematic review. J Robot Surg 2024; 18:16. [PMID: 38217749 DOI: 10.1007/s11701-023-01756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/07/2023] [Indexed: 01/15/2024]
Abstract
Robotic assisted surgery (RAS) has seen a global rise in adoption. Despite this, there is not a standardised training curricula nor a standardised measure of performance. We performed a systematic review across the surgical specialties in RAS and evaluated tools used to assess surgeons' technical performance. Using the PRISMA 2020 guidelines, Pubmed, Embase and the Cochrane Library were searched systematically for full texts published on or after January 2020-January 2022. Observational studies and RCTs were included; review articles and systematic reviews were excluded. The papers' quality and bias score were assessed using the Newcastle Ottawa Score for the observational studies and Cochrane Risk Tool for the RCTs. The initial search yielded 1189 papers of which 72 fit the eligibility criteria. 27 unique performance metrics were identified. Global assessments were the most common tool of assessment (n = 13); the most used was GEARS (Global Evaluative Assessment of Robotic Skills). 11 metrics (42%) were objective tools of performance. Automated performance metrics (APMs) were the most widely used objective metrics whilst the remaining (n = 15, 58%) were subjective. The results demonstrate variation in tools used to assess technical performance in RAS. A large proportion of the metrics are subjective measures which increases the risk of bias amongst users. A standardised objective metric which measures all domains of technical performance from global to cognitive is required. The metric should be applicable to all RAS procedures and easily implementable. Automated performance metrics (APMs) have demonstrated promise in their wide use of accurate measures.
Collapse
Affiliation(s)
- Charlotte El-Sayed
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom.
| | - A Yiu
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - J Burke
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - P Vaughan-Shaw
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - J Todd
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - P Lin
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - Z Kasmani
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - C Munsch
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - L Rooshenas
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - M Campbell
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| | - S P Bach
- RCS England/HEE Robotics Research Fellow, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
3
|
Pietrement C, Barbe C, Bouazzi L, Maisonneuve H. Impact of training in the supervision of clinical reasoning in the pediatric emergency department on residents' perception of the on-call experience. Arch Pediatr 2023; 30:550-557. [PMID: 37777347 DOI: 10.1016/j.arcped.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND In 2021, the prevalence of signs of burnout among medical residents was reported to be 67%. Being on call is particularly stressful for residents, notably due to their lack of medical experience. When they are on call, several factors contribute to a mismatch between the residents' theoretical knowledge and the operationalization of that knowledge in a clinical reasoning process. Using the script and cognitive load theories as a basis, we hypothesized that training clinician-teachers in the supervision of clinical reasoning could improve residents' perception of the experience of being on call. METHODS We performed a longitudinal, exploratory, controlled study with a cohort of medical residents who were on call in the pediatric emergency department during the semester from 1 November 2021 to 30 April 2022. During the night, the residents on call in the pediatric emergency department completed validated questionnaires investigating (1) mental effort, (2) cognitive weariness, (3) state anxiety, (4) feeling of self-efficacy, and (5) well-being. We compared the questionnaires of residents supervised by pediatricians trained in the supervision of clinical reasoning (supervision group) with those of residents in a control group, supervised by pediatricians with no specific pedagogical training. RESULTS A total of 284 questionnaires (174 supervision group, 110 controls) were collected from 38 residents in three pediatric emergency departments. The results confirm that being on call is difficult for residents. Compared to the control group, residents in the supervision group had lower cognitive weariness scores (mean 3.0 ± 1.1 vs. 3.5 ± 1.3). There was no significant difference between groups for any of the other dimensions of the on-call experience. In the supervision group, mental effort was significantly lower at the end of the study semester (5 [5-6] when on call in month 6 of the semester vs. 6 [5-7] when on call in months 1-5 of the semester; p = 0.01) and was greater for more senior residents (7 [6-8] for those in the 4th or higher semester of residency vs. 6 [5-7] for residents in their 1st, 2nd, or 3rd semester of residency; β = 0.92 ± 0.40; p = 0.02). CONCLUSION Beyond the positive effects for residents, this study illustrates the feasibility of implementing training for clinicians in the supervision of clinical reasoning.
Collapse
Affiliation(s)
- Christine Pietrement
- Université de Reims Champagne-Ardenne, MeDyC, F-51100 Reims, France; CHU Reims, Service de Pédiatrie Générale et Spécialisée, F-51100 Reims, France.
| | - Coralie Barbe
- Université de Reims Champagne-Ardenne, CURRS, F-51100 Reims, France
| | - Leila Bouazzi
- Université de Reims Champagne-Ardenne, CURRS, F-51100 Reims, France
| | - Hubert Maisonneuve
- Institut universitaire de Médecine de Famille et de l'Enfance, Faculté de médecine, Université de Genève, Rue Michel Servet 1, 1211, Genève 4, Switzerland
| |
Collapse
|
4
|
Vieira LMN, Ibiapina CDC, Camargos PAM, Brand PLP. Simulation-based bronchoscopy training: Randomized trial comparing worked example to video introduction. Pediatr Pulmonol 2023; 58:3227-3234. [PMID: 37642272 DOI: 10.1002/ppul.26648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Learning the complex skill of bronchoscopy involves the integration of cognitive domains and motor skills. The development of simulators has opened up new possibilities in bronchoscopy training. This study aimed at evaluating how effective the modeling example methodology is in training this skill and assessed its effect on cognitive load in learning. METHODS Forty-seven medical students participating in a simulator-based bronchoscopy training program were randomly allocated to a control group, receiving a video lesson, and the modeling example group. They were evaluated by the simulator's metrics at different time points: pre-, posttest, and 15 days and 12 months after training. Cognitive load was assessed with the modified Paas scale. RESULTS Simulation-based training was effective for both groups, based on simulator metrics (p < .05). The modeling example group outperformed the control group in all measures at posttest and after 15 days (p < .001). After 12 months, there was a decline in skill in both groups, but the modeling example group performed better (p < .001). Simulation-based training reduced cognitive load, more strongly so in the modeling example group (p < .001). CONCLUSION The modeling example group showed substantial benefits over the control group, both in reducing the cognitive load in learning and in retaining knowledge and skill after 15 days and 12 months.
Collapse
Affiliation(s)
- Lais M N Vieira
- Department of Pediatric Pulmonology, Federal University of Minas Gerais, Horizonte, Brazil
| | | | - Paulo A M Camargos
- Department of Pediatric Pulmonology, Federal University of Minas Gerais, Horizonte, Brazil
| | - Paul L P Brand
- Wenckebach Institute of Medical Education and Faculty Development, University Medical Center and University of Groningen, Groningen, The Netherlands
| |
Collapse
|
5
|
Rasheed F, Bukhari F, Iqbal W, Asif M, Chaudhry HAH. A low-cost unity-based virtual training simulator for laparoscopic partial nephrectomy using HTC Vive. PeerJ Comput Sci 2023; 9:e1627. [PMID: 37869468 PMCID: PMC10588702 DOI: 10.7717/peerj-cs.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023]
Abstract
Laparoscopic education and surgery assessments increase the success rates and lower the risks during actual surgeries. Hospital residents need a secure setting, and trainees require a safe and controlled environment with cost-effective resources where they may hone their laparoscopic abilities. Thus, we have modeled and developed a surgical simulator to provide the initial training in Laparoscopic Partial Nephrectomy (LPN-a procedure to treat kidney cancer or renal masses). To achieve this, we created a virtual simulator using an open-source game engine that can be used with a commercially available, reasonably priced virtual reality (VR) device providing visual and haptic feedback. In this study, the proposed simulator's design is presented, costs are contrasted, and the simulator's performance is assessed using face and content validity measures. CPU- and GPU-based computers can run the novel simulation with a soft body deformation based on simplex meshes. With a reasonable trade-off between price and performance, the HTC Vive's controlled soft body effect, physics-based deformation, and haptic rendering offer the advantages of an excellent surgical simulator. The trials show that the medical volunteers who performed the initial LPN procedures for newbie surgeons received positive feedback.
Collapse
Affiliation(s)
- Fareeha Rasheed
- Department of Data Science, University of the Punjab, Lahore, Pakistan
| | - Faisal Bukhari
- Department of Data Science, University of the Punjab, Lahore, Pakistan
| | - Waheed Iqbal
- Department of Data Science, University of the Punjab, Lahore, Pakistan
| | - Muhammad Asif
- Department of Computer Science, National Textile University, Faisalabad, Pakistan
| | | |
Collapse
|
6
|
Lee S, Shetty AS, Cavuoto L. Modeling of Learning Processes Using Continuous-Time Markov Chain for Virtual-Reality-Based Surgical Training in Laparoscopic Surgery. IEEE TRANSACTIONS ON LEARNING TECHNOLOGIES 2023; 17:462-473. [PMID: 38617582 PMCID: PMC11013959 DOI: 10.1109/tlt.2023.3236899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Recent usage of Virtual Reality (VR) technology in surgical training has emerged because of its cost-effectiveness, time savings, and cognition-based feedback generation. However, the quantitative evaluation of its effectiveness in training is still not studied thoroughly. This paper demonstrates the effectiveness of a VR-based surgical training simulator in laparoscopic surgery and investigates how stochastic modeling represented as Continuous-time Markov-chain (CTMC) can be used to explicit the training status of the surgeon. By comparing the training in real environments and in VR-based training simulators, the authors also explore the validity of the VR simulator in laparoscopic surgery. The study further aids in establishing learning models of surgeons, supporting continuous evaluation of training processes for the derivation of real-time feedback by CTMC-based modeling.
Collapse
Affiliation(s)
- Seunghan Lee
- Industrial and Systems Engineering Department at Mississippi State University
| | | | - Lora Cavuoto
- Industrial and Systems Engineering at the University at Buffalo, Buffalo, NY, USA
| |
Collapse
|
7
|
Rahimi AO, Ho K, Chang M, Gasper D, Ashouri Y, Dearmon-Moore D, Hsu CH, Ghaderi I. A systematic review of robotic surgery curricula using a contemporary educational framework. Surg Endosc 2022; 37:2833-2841. [PMID: 36481821 DOI: 10.1007/s00464-022-09788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND There has been a rising trend in robotic surgery. Thus, there is demand for a robotic surgery curriculum (RSC) for training surgical trainees and practicing surgeons. There are limited data available about current curricular designs and the extent to which they have incorporated educational frameworks. Our aim was to study the existing robotic surgery curricula using Kern's 6-step approach in curriculum development. METHODS A systematic review was conducted using PubMed, PubMed Central, Cochrane, Embase, and Scopus (we searched studies from 2001 to 2021). PRISMA Guidelines was used to guide the search. Curriculum designed for general surgery and its subspecialties were included. Urology and gynecology were excluded. The articles were reviewed by five reviewers. RESULTS Our review yielded 71 articles, including 39 curricula at 9 different settings. Using Kern's framework, we demonstrated that the majority of robotic surgery curricula contained all the elements of Kern's curricular design. However, there were significant deficiencies in important aspects of these curricula i.e., implementation, the quality of assessment tools for measurement of performance and evaluation of the educational value of these interventions. Most institutions used commercial virtual reality simulators (VRS) as the main component of their RSC and 23% of curricula only used VRS. CONCLUSIONS Although majority of these studies contained all the elements of Kern's framework, there are critical deficiencies in the components of existing curricula. Future curricula should be designed using established educational frameworks to improve the quality of robotic surgery training.
Collapse
|
8
|
Cevallos N, Zukotynski B, Greig D, Silva M, Thompson RM. The Utility of Virtual Reality in Orthopedic Surgical Training. JOURNAL OF SURGICAL EDUCATION 2022; 79:1516-1525. [PMID: 35821110 PMCID: PMC10364838 DOI: 10.1016/j.jsurg.2022.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/01/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To examine the efficacy of virtual reality (VR) to prepare surgical trainees for a pediatric orthopedic surgery procedure: pinning of a slipped capital femoral epiphysis (SCFE). DESIGN Participants were randomly assigned to a standard, study guide (SG) group or to a VR training group. All participants were provided a technique video and SG; the VR group additionally trained via an Osso VR surgical trainer (ossovr.com) with real-time feedback and coaching from an attending pediatric orthopedic surgeon. Following training, participants performed a SCFE guidewire placement on a SawBones model embedded in a soft-tissue envelope (SawBones model 1161). Participants were asked to achieve "ideal placement" based on the training provided. Participants were evaluated on time, number of pin "in-and outs," penetration of the articular surface, angle between the pin and the physis, distance from pin tip to subchondral bone and distance from the center-center point of the epiphysis. SETTING Orthopedic Institute for Children, Los Angeles, CA. PARTICIPANTS Twenty fourth-year medical students, first- and second-year orthopedic residents without experience with the SCFE procedure. RESULTS Twenty participants were randomized to SG (n = 10) or VR (n = 10). Average time to final pin placement was 19% shorter in VR group (706 vs 573 seconds, p = 0.26). When compared to SG, the VR group had, on average, 70% less pin in-and-outs (1.7 vs 0.5, p = 0.28), 50% less articular surface penetrations (0.4 vs 0.2, p = 0.36), and 18% smaller distance from pin tip to subchondral bone on lateral view (7.1 vs 5.8 mm, p = 0.42). Moreover, the VR group had a lower average angle deviation between pin and line perpendicular to the physis on coronal view (4.9° vs 2.5°, p < 0.05). CONCLUSIONS VR training is potentially more effective than traditional preparatory methods. This pilot study suggests that VR training may be a viable surgical training tool, which may alleviate constraints of time, money, and safety concerns with resultant broad applicability for surgical education.
Collapse
Affiliation(s)
| | - Brian Zukotynski
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Danielle Greig
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Mauricio Silva
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Orthopaedic Institute for Children, Los Angeles, California
| | - Rachel M Thompson
- Department of Orthopedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California; Orthopaedic Institute for Children, Los Angeles, California.
| |
Collapse
|
9
|
Yiasemidou M, Howitt A, Long J, Sedman P, Garcia-Olmo D, Guadalajara H, Van Cleynenbreugel B, Sharma D, Biyani SC, Patel B, Lam W, Harikrishnan A, Gómez Rivas J, Robinson J, Manuel Ribeiro de Oliveira T, Escalona Vivas G, Sanchez-Salas R, Tourinho-Barbosa R, Chetter I. An international consensus for mitigation of the detrimental effects of the COVID-19 pandemic on laparoscopic training. PLoS One 2022; 17:e0272446. [PMID: 36137091 PMCID: PMC9499280 DOI: 10.1371/journal.pone.0272446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/20/2022] [Indexed: 11/19/2022] Open
Abstract
Aim Achieve an international consensus on how to recover lost training opportunities. The results of this study will help inform future EAES guidelines about the recovery of surgical training before and after the pandemic. Background A global survey conducted by our team demonstrated significant disruption in surgical training during the COVID-19 pandemic. This was wide-spread and affected all healthcare systems (whether insurance based or funded by public funds) in all participating countries. Thematic analysis revealed the factors perceived by trainees as barriers to training and gave birth to four-point framework of recovery. These are recommendations that can be easily achieved in any country, with minimal resources. Their implementation, however, relies heavily on the active participation and leadership by trainers. Based on the results of the global trainee survey, the authors would like to conduct a Delphi-style survey, addressed to trainers on this occasion, to establish a pragmatic step-by-step approach to improve training during and after the pandemic. Methods This will be a mixed qualitative and quantitative study. Semi-structured interviews will be performed with laparoscopic trainers. These will be transcribed and thematic analysis will be applied. A questionnaire will then be proposed; this will be based on both the results of the semi structured interviews and of the global trainee survey. The questionnaire will then be validated by the steering committee of this group (achieve consensus of >80%). After validation, the questionnaire will be disseminated to trainers across the globe. Participants will be asked to consent to participate in further cycles of the Delphi process until more than 80% agreement is achieved. Results This study will result in a pragmatic framework for continuation of surgical training during and after the pandemic (with special focus on minimally invasive surgery training).
Collapse
Affiliation(s)
- Marina Yiasemidou
- NIHR Academic Clinical Lecturer, University of Hull, Hull, United Kingdom
- ST8 Colorectal Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
- * E-mail:
| | - Annabel Howitt
- General Surgery, Bradford Teaching Hospitals, Bradford, United Kingdom
| | - Judith Long
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - Peter Sedman
- Hull University Teaching Hospitals, Hull, United Kingdom
| | - Damian Garcia-Olmo
- Chief of Surgery Department at Fundacion Jimenez Díaz University Hospital (Universidad Autonoma de Madrid), Madrid, Spain
| | - Hector Guadalajara
- University Hospital Fundación Jimenez Díaz and Associate Professor at “Universidad Autonoma de Madrid”, Madrid, Spain
| | - Ben Van Cleynenbreugel
- University Hospitals of Leuven and a Guest Lecturer at the Catholic University of Leuven, Leuven, Belgium
| | | | - Shekhar Chandra Biyani
- Leeds Teaching Hospitals and Honorary Senior Clinical Lecturer, University of Leeds, Leeds, United Kingdom
| | - Bijendra Patel
- Barts Health NHS Trust and University College London Hospitals NHS Foundation Trust and Professor of Surgery, University of London, London, United Kingdom
| | - Wayne Lam
- Department of Surgery, Faculty of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, China
| | | | | | | | | | - Gabriel Escalona Vivas
- Hospital Sótero del Río and researcher at the Simulation and Experimental Surgery Center at the Pontificia Universidad Católica in Santiago, Santiago, Chile
| | - Rafael Sanchez-Salas
- Department of Urology L’Institut Mutualiste Montsouris Université, Paris Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology Hospital Cardio Pulmonar–Oncologia D’Or and Núcleo de Oncologia da Bahia, Faculdade de Medicina do ABC, Salvador, Bahia, Brazil
| | - Ian Chetter
- Hull University Teaching Hospitals, Hull, United Kingdom
| |
Collapse
|
10
|
Torkamani-Azar M, Lee A, Bednarik R. Methods and Measures for Mental Stress Assessment in Surgery: A Systematic Review of 20 Years of Literature. IEEE J Biomed Health Inform 2022; 26:4436-4449. [PMID: 35696473 DOI: 10.1109/jbhi.2022.3182869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Real-time mental stress monitoring from surgeons and surgical staff in operating rooms may reduce surgical injuries, improve performance and quality of medical care, and accelerate implementation of stress-management strategies. Motivated by the increase in usage of objective and subjective metrics for cognitive monitoring and by the gap in reviews of experimental design setups and data analytics, a systematic review of 71 studies on mental stress and workload measurement in surgical settings, published in 2001-2020, is presented. Almost 61% of selected papers used both objective and subjective measures, followed by 25% that only administered subjective tools - mostly consisting of validated instruments and customized surveys. An overall increase in the total number of publications on intraoperative stress assessment was observed from mid-2010 s along with a momentum in the use of both subjective and real-time objective measures. Cardiac activity, including heart-rate variability metrics, stress hormones, and eye-tracking metrics were the most frequently and electroencephalography (EEG) was the least frequently used objective measures. Around 40% of selected papers collected at least two objective measures, 41% used wearable devices, 23% performed synchronization and annotation, and 76% conducted baseline or multi-point data acquisition. Furthermore, 93% used a variety of statistical techniques, 14% applied regression models, and only one study released a public, anonymized dataset. This review of data modalities, experimental setups, and analysis techniques for intraoperative stress monitoring highlights the initiatives of surgical data science and motivates research on computational techniques for mental and surgical skills assessment and cognition-guided surgery.
Collapse
|
11
|
Meese MM, O'Hagan EC, Chang TP. Healthcare Provider Stress and Virtual Reality Simulation: A Scoping Review. Simul Healthc 2021; 16:268-274. [PMID: 32890319 DOI: 10.1097/sih.0000000000000484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY STATEMENT Despite the significant role that stress plays in clinical care and education and the potential benefit of virtual reality (VR) as a simulation modality, there is a dearth of literature on stress and VR. The results of this scoping review have shown the positive effect that VR simulation can have on mitigating the negative aspects of stress during simulation and clinical training as well as improving provider performance and affect. Virtual reality technology, and immersive VR specifically, has the potential to powerfully transform how simulation education is being conducted. Because of this, the authors encourage researchers to put more focus into this topic and in determining how VR can be used to provide simulations with excellent training and a strong sense of presence for the purpose of addressing how stress can impact learners' clinical training and performance.
Collapse
Affiliation(s)
- Merrick M Meese
- From Department of Anesthesiology & Perioperative Medicine (MMM, E.C.O.), The University of Alabama at Birmingham, Birmingham, AL; and Division of Emergency Medicine and Emergency and Transport Medicine (T.P.C.), Children's Hospital Los Angeles/University of Southern California, Los Angeles, CA
| | | | | |
Collapse
|
12
|
Yiasemidou M, Tomlinson J, Chetter I, Biyani CS. Impact of the SARS-CoV-2 (COVID-19) crisis on surgical training: global survey and a proposed framework for recovery. BJS Open 2021; 5:6226009. [PMID: 33855364 PMCID: PMC8047098 DOI: 10.1093/bjsopen/zraa051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background The SARS-CoV-2 pandemic had a profound impact on surgical services, potentially having a detrimental impact on training opportunities. The aim of this global survey was to assess the impact of the COVID-19 crisis on surgical training and to develop a framework for recovery. Methods A cross-sectional, web-based survey was conducted. This was designed by a steering committee of medical educationalists and validated by a group of trainees before dissemination. Results A total of 608 responses were obtained from 34 countries and 15 specialties. The results demonstrated major disruption in all aspects of training. The impact was greatest for conferences (525 of 608) and hands-on courses (517 of 608), but less for inpatient care-related training (268 of 608). European trainees were significantly more likely to experience direct training disruption than trainees in Asia (odds ratio 0.15) or Australia (OR 0.10) (χ2 = 87.162, P < 0.001). Alternative training resources (webinars, 359 of 608; educational videos, 234 of 608) have emerged, although trainees expressed some dissatisfaction with them. The collective responses generated a four-pillar framework for training recovery that involved: guidance from training stakeholders with the involvement of trainees; prioritization of training, especially the roles of senior surgeons/trainers; provision of access to alternative/new teaching methods; and measures to address trainee anxiety. Conclusion Training has been greatly affected by the COVID-19 pandemic. The introduction of new teaching methods and a focus on training after the pandemic are imperative.
Collapse
Affiliation(s)
| | - M Yiasemidou
- Leeds Teaching Hospitals, Leeds, UK; University of Hull, Hull, UK; Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | | - I Chetter
- University of Hull, Hull, UK; Hull University Teaching Hospitals NHS Trust, Hull, UK
| | | |
Collapse
|
13
|
Nagyné Elek R, Haidegger T. Non-Technical Skill Assessment and Mental Load Evaluation in Robot-Assisted Minimally Invasive Surgery. SENSORS (BASEL, SWITZERLAND) 2021; 21:2666. [PMID: 33920087 PMCID: PMC8068868 DOI: 10.3390/s21082666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND: Sensor technologies and data collection practices are changing and improving quality metrics across various domains. Surgical skill assessment in Robot-Assisted Minimally Invasive Surgery (RAMIS) is essential for training and quality assurance. The mental workload on the surgeon (such as time criticality, task complexity, distractions) and non-technical surgical skills (including situational awareness, decision making, stress resilience, communication, leadership) may directly influence the clinical outcome of the surgery. METHODS: A literature search in PubMed, Scopus and PsycNet databases was conducted for relevant scientific publications. The standard PRISMA method was followed to filter the search results, including non-technical skill assessment and mental/cognitive load and workload estimation in RAMIS. Publications related to traditional manual Minimally Invasive Surgery were excluded, and also the usability studies on the surgical tools were not assessed. RESULTS: 50 relevant publications were identified for non-technical skill assessment and mental load and workload estimation in the domain of RAMIS. The identified assessment techniques ranged from self-rating questionnaires and expert ratings to autonomous techniques, citing their most important benefits and disadvantages. CONCLUSIONS: Despite the systematic research, only a limited number of articles was found, indicating that non-technical skill and mental load assessment in RAMIS is not a well-studied area. Workload assessment and soft skill measurement do not constitute part of the regular clinical training and practice yet. Meanwhile, the importance of the research domain is clear based on the publicly available surgical error statistics. Questionnaires and expert-rating techniques are widely employed in traditional surgical skill assessment; nevertheless, recent technological development in sensors and Internet of Things-type devices show that skill assessment approaches in RAMIS can be much more profound employing automated solutions. Measurements and especially big data type analysis may introduce more objectivity and transparency to this critical domain as well. SIGNIFICANCE: Non-technical skill assessment and mental load evaluation in Robot-Assisted Minimally Invasive Surgery is not a well-studied area yet; while the importance of this domain from the clinical outcome's point of view is clearly indicated by the available surgical error statistics.
Collapse
Affiliation(s)
- Renáta Nagyné Elek
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- Doctoral School of Applied Informatics and Applied Mathematics, Óbuda University, 1034 Budapest, Hungary
| | - Tamás Haidegger
- Antal Bejczy Center for Intelligent Robotics, University Research and Innovation Center, Óbuda University, 1034 Budapest, Hungary;
- John von Neumann Faculty of Informatics, Óbuda University, 1034 Budapest, Hungary
- Austrian Center for Medical Innovation and Technology, 2700 Wiener Neustadt, Austria
| |
Collapse
|
14
|
Thornblade LW, Fong Y. Simulation-Based Training in Robotic Surgery: Contemporary and Future Methods. J Laparoendosc Adv Surg Tech A 2021; 31:556-560. [PMID: 33835885 DOI: 10.1089/lap.2021.0082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
While robotic surgery has grown in popularity and scope over the past decade, there is a persistent need for simulation-based training as surgeons adapt from the working at the bedside to the immersive and multisensory tasks at the console. From dry laboratory to virtual reality (VR) environments, simulation can be used to train surgeons in basic tasks, complex operative steps, and coordination of whole operations with members of the entire operating room (OR) staff. By integrating simulation into mentored training programs, surgeons can reduce the number of cases required to master a complex operation. Future VR based simulation will become essential to the adaptation of the surgical workforce to new technologies and adoption of emerging robotic platforms. Ultimately, robotic simulation will set standards for credentialing of new surgeons.
Collapse
Affiliation(s)
- Lucas W Thornblade
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| | - Yuman Fong
- Department of Surgery, City of Hope National Medical Center, Duarte, California, USA
| |
Collapse
|
15
|
Schertel A, Geiser T, Hautz WE. Man or machine? Impact of tutor-guided versus simulator-guided short-time bronchoscopy training on students learning outcomes. BMC MEDICAL EDUCATION 2021; 21:123. [PMID: 33618680 PMCID: PMC7898762 DOI: 10.1186/s12909-021-02526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/31/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulation based medical education is efficient for the acquisition of flexible bronchoscopy navigational skills and the knowledge of the tracheobronchial anatomy. However, bronchoscopy simulator training is not routinely integrated into pneumologic fellowship programs or undergraduate medical education for time and/or cost reasons. Our study compares the effect of self-guided bronchoscopy simulator training versus tutor guided training on the acquisition of navigational skills and knowledge of the bronchial anatomy. METHODS Third-year undergraduate medical students were randomized to either a tutor- or simulator guided bronchoscopy simulator training focusing on the acquisition of navigational skills and the knowledge of the tracheobronchial anatomy. Every student performed a baseline bronchoscopy followed by a structured bronchoscopy simulator training and finally an assessment bronchoscopy at the end of the training program. Groups were compared by means of a repeated measurement ANOVA and effect sizes calculated as Cohens' d. RESULTS Fifty-four eligible students participated in the study. Knowledge of the tracheobronchial anatomy significantly increased from pre- to post training (all p < 0.001; all d > 2), navigational skills significantly decreased (all p < 0.005; all d < 1). There were no significant differences between groups. Instruction by the simulator as well as by the tutor was rated as helpful by the students. Twenty-two (84.6%) of the participants of the simulator guided group would have appreciated an additional instruction by a tutor. CONCLUSION Short-time simulator guided bronchoscopy training improves knowledge of the tracheobronchial anatomy in novice bronchoscopists as much as tutor guided training, but navigational skills seem to worsen in both groups. Further studies assessing transfer to clinical practice are needed to find the optimal teaching method for basic flexible bronchoscopy.
Collapse
Affiliation(s)
- Anke Schertel
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Thomas Geiser
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Wolf E Hautz
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
16
|
Roehr M, Wu T, Maykowski P, Munter B, Hoebee S, Daas E, Kang P. The Feasibility of Virtual Reality and Student-Led Simulation Training as Methods of Lumbar Puncture Instruction. MEDICAL SCIENCE EDUCATOR 2021; 31:117-124. [PMID: 34457871 PMCID: PMC8368585 DOI: 10.1007/s40670-020-01141-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND There is limited data assessing simulation and virtual reality training as a standardized tool in medical education. This feasibility study aimed to evaluate the effectiveness of virtual reality training and a student-led simulation module in preparing medical students to perform a lumbar puncture. METHODS Twenty-five medical students completed a pre-intervention survey, and a baseline video recorded lumbar puncture procedure on a task trainer. Students were randomly distributed into the virtual reality group, or the curriculum's standard student-led procedural instruction group. Participants were then given 45 min to practice the lumbar puncture procedure. After the intervention, all participants were video recorded again as they performed a post-intervention lumbar puncture and completed a post-intervention survey. Pre- and post-intervention videos were scored using a critical action checklist in conjunction with time needed to complete the procedure to evaluate proficiency. RESULTS At baseline, there were no major statistically significant differences between groups. Assessing overall post-intervention performance, both groups showed improvement in aggregate score (p < 0.001) and time required to complete (p = 0.002) the lumbar puncture. Following interventions, the student-led group improved over the virtual reality group in a variety of metrics. The student-led group increased their aggregate score by 3.49 and decreased their time to completion by 34 s over the VR group when controlling for baseline measures. CONCLUSIONS Both virtual reality and student-led simulation training were useful training modalities, with hands-on simulation showing better results versus virtual reality training in this setting. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-020-01141-6.
Collapse
Affiliation(s)
- Mark Roehr
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Teresa Wu
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
- Department of Emergency Medicine, Banner University Medical Center – Phoenix, Phoenix, AZ USA
| | - Philip Maykowski
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Bryce Munter
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Shelby Hoebee
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Eshaan Daas
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| | - Paul Kang
- The University of Arizona College of Medicine – Phoenix, 435 N. 5th Street, 4th Floor, Office B420, Phoenix, AZ USA
| |
Collapse
|
17
|
Trafeli M, Foppa C, Montanelli P, Nelli T, Staderini F, Badii B, Skalamera I, Cianchi F, Coratti F. Robotic colorectal surgery checkpoint: a review of cited articles during the last year. Chirurgia (Bucur) 2021. [DOI: 10.23736/s0394-9508.19.04963-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
18
|
Reddavid R, Allum W, Polom K, Resendiz A, Hyung WJ, Kassab P, Molena D, Lanzarini E, Terashima M, Biondi A, Hilegersberg RV, D'Ugo D, Fumagalli U, Santi S, De Manzoni G, Roviello F, Degiuli M. Upper GI training of young surgeons: a reality full of hurdles. An international survey. Updates Surg 2021; 73:627-637. [PMID: 33417186 DOI: 10.1007/s13304-020-00955-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/18/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Anecdotal evidence suggests that the training of young surgeons in Upper GI is not homogeneous across the world. This survey aimed to investigate the different training programs and the level of satisfaction of young surgeons with their surgical and scientific education pathway. DESIGN A multiple-choice and single best answer format questionnaire was sent to 36 Upper GI chairs from international referral centres and then forwarded to young surgeons (attending physician less than 40 years old). The same questionnaire containing 5 main topics (demographics, residency, fellowship, academic research and activities, manual skill improvement) was posted online on a Surveymonkey website. SETTING San Luigi University Hospital, Orbassano (Turin), Italy; Tertiary University Hospital. RESULTS Fourteen replies were received from colleagues in 36 referral centres (39% response rate) and 65 voluntary answers from the survey monkey platform. During residency training, only 43% of residents had a specific training in upper GI tract surgery, which was characterized by a small number of interventions performed both with trainer scrubbed and unscrubbed. Fellowship programmes were undertaken by 49% of participants and 64% spent this training period abroad. Operative experience was reported by nearly all respondents with only 27% performing > 10 gastrectomies and only 11% performing > 10 oesophagectomies with the trainer scrubbed. The majority attended less than 10 meetings (58%), and 70% of them published less than 5 papers. CONCLUSIONS The present survey reveals that the young surgeons of the twenty-first century face many hurdles during their surgical training. Overall, the surgical education settings are limited for both practical and scientific training for upper GI trainees. As a result, it is not possible to train in upper GI surgery to a level of competent independent practice.
Collapse
Affiliation(s)
- Rossella Reddavid
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - William Allum
- Department of Academic Surgery, Royal Marsden NHS Foundation Trust London, London, UK
| | - Karol Polom
- Department of Surgical Oncology, Medical University of Gdansk, Gdańsk, Poland
| | - Aridai Resendiz
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, 10043, Turin, Italy
| | - Woo Jin Hyung
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Paolo Kassab
- Department of Surgery, School of Medicine, University of Santa Casa, São Paulo, Brasil
| | - Daniela Molena
- Division of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Enrique Lanzarini
- Department of Surgery, University Hospital, University of Chile, Santos Dumont #999, Santiago, Chile
| | - Masanori Terashima
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, Shizuoka, 411-8777, Japan
| | - Alberto Biondi
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | - Richard Van Hilegersberg
- Department of Surgical Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Domenico D'Ugo
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Rome, Italy
| | - Uberto Fumagalli
- Digestive Surgery, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Santi
- Unit of Esophageal Surgery, Department of Surgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56124, Pisa, Italy
| | | | - Franco Roviello
- Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Maurizio Degiuli
- University of Turin, Department of Oncology, San Luigi University Hospital, Surgical Oncology and Digestive Surgery Unit, Regione Gonzole 10, Orbassano, 10043, Turin, Italy.
| |
Collapse
|
19
|
Vasudevan MK, Isaac JHR, Sadanand V, Muniyandi M. Novel virtual reality based training system for fine motor skills: Towards developing a robotic surgery training system. Int J Med Robot 2020; 16:1-14. [PMID: 32976695 DOI: 10.1002/rcs.2173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/20/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Training surgeons to use surgical robots are becoming part of surgical training curricula. We propose a novel method of training fine-motor skills such as Microscopic Selection Task (MST) for robot-assisted surgery using virtual reality (VR) with objective quantification of performance. We also introduce vibrotactile feedback (VTFB) to study its impact on training performance. METHODS We use a VR-based environment to perform MST with varying degrees of difficulties. Using a well-known human-computer interaction paradigm and incorporating VTFB, we quantify the performance: speed, precision and accuracy. RESULTS MST with VTFB showed statistically significant improvement in performance metrics leading to faster completion of MST with higher precision and accuracy compared to that without VTFB. DISCUSSION The addition of VTFB to VR-based training for robot-assisted surgeries may improve performance outcomes in real robotic surgery. VTFB, along with proposed performance metrics, can be used in training curricula for robot-assisted surgeries.
Collapse
Affiliation(s)
- Madhan Kumar Vasudevan
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Joseph H R Isaac
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India.,Reconfigurable Intelligent Systems Engineering (RISE) Lab, Department of Computer Science and Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Venkatraman Sadanand
- Department of Neurosurgery, Loma Linda University Health System, Loma Linda, California, USA
| | - Manivannan Muniyandi
- Touch Lab, Department of Applied Mechanics, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| |
Collapse
|
20
|
Plastic Surgery Lockdown Learning during Coronavirus Disease 2019: Are Adaptations in Education Here to Stay? PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3064. [PMID: 32802695 PMCID: PMC7413776 DOI: 10.1097/gox.0000000000003064] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/30/2020] [Indexed: 11/25/2022]
Abstract
Summary: The novel coronavirus disease 2019 has had a major impact on human life and livelihood. The unprecedented challenges have expanded beyond just social and work life, and have grown to impact resident education. In this article, we review the structure of plastic surgery education before the pandemic, the different online learning opportunities for self-directed learning. A summary of the range of platforms and approaches of online remote access delivery of conferences and education that emerged or expanded as a result of the crisis has been reported. This article highlighted the rapid initiatives and efforts of programs and national and international societies to support continuing medical education in conjunction with the guidelines to “shelter at home” and maintain social distancing, and possible future for expanding the reach of online academic initiatives, in addition to the role of developing virtual technologies. The coronavirus disease 2019 crisis has created an opportunity to analyze and advance online learning options to overcome the associated challenges and continue as a reliable platform even following the resolution of the social distancing requirements.
Collapse
|
21
|
Richards JP, Done AJ, Barber SR, Jain S, Son YJ, Chang EH. Virtual coach: the next tool in functional endoscopic sinus surgery education. Int Forum Allergy Rhinol 2019; 10:97-102. [PMID: 31834672 DOI: 10.1002/alr.22452] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/19/2019] [Accepted: 09/10/2019] [Indexed: 01/22/2023]
Abstract
BACKGOUND Functional endoscopic sinus surgery (FESS) can be challenging as novices become accustomed to handling endoscopes and instruments while navigating complex sinonasal anatomy. Experts demonstrate fluid and efficient motions when addressing pathology. The training process from novice to expert relies on hands-on experience in cadaveric laboratories and preceptorship models that require significant time and expense. This study aims to validate the use of a virtual coach to guide users step-by-step through a basic FESS. METHODS Seventeen surgeons were grouped into novice (n = 10) and expert (n = 7) based on self-reported levels of surgical experience. Users were trained using the maxillary antrostomy module in the Neurorhinological Surgery (NRS) simulator combining the physical craniofacial model with virtual reality (VR)-tracked surgical instruments in the VR operating room. The virtual coach guided the user using surgical videos, auditory, and visual cues. The coach recorded data for each subject including the number of times borders of the nasal cavity were encountered and time to completion. Users graded the usefulness of the virtual coach on a Likert questionnaire. RESULTS Face validity of our NRS simulator was replicated by user questionnaires, and construct validity replicated by differentiation between novice and expert level surgeons (p < 0.01). Novices contacted a significantly higher number of anatomic borders (n = 17) and had a longer operative time (t = 370 seconds). All users reported high scores on the benefit and usefulness of the virtual coach. CONCLUSION The virtual coach provides a useful tool to enhance FESS education by providing objective real-time data in a novel mixed-reality surgical environment.
Collapse
Affiliation(s)
- John P Richards
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, AZ
| | - Aaron J Done
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, AZ
| | - Samuel R Barber
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, AZ
| | - Saurabh Jain
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, AZ
| | - Young-Jun Son
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, AZ
| | - Eugene H Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tucson, AZ
| |
Collapse
|
22
|
Sewell JL, Maggio LA, Ten Cate O, van Gog T, Young JQ, O'Sullivan PS. Cognitive load theory for training health professionals in the workplace: A BEME review of studies among diverse professions: BEME Guide No. 53. MEDICAL TEACHER 2019; 41:256-270. [PMID: 30328761 DOI: 10.1080/0142159x.2018.1505034] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
AIM Cognitive load theory (CLT) is of increasing interest to health professions education researchers. CLT has intuitive applicability to workplace settings, yet how CLT should inform teaching, learning, and research in health professions workplaces is unclear. METHOD To map the existing literature, we performed a scoping review of studies involving cognitive load, mental effort and/or mental workload in professional workplace settings within and outside of the health professions. We included actual and simulated workplaces and workplace tasks. RESULT Searching eight databases, we identified 4571 citations, of which 116 met inclusion criteria. Studies were most often quantitative. Methods to measure cognitive load included psychometric, physiologic, and secondary task approaches. Few covariates of cognitive load or performance were studied. Overall cognitive load and intrinsic load were consistently negatively associated with the level of experience and performance. Studies consistently found distractions and other aspects of workplace environments as contributing to extraneous load. Studies outside the health professions documented similar findings to those within the health professions, supporting relevance of CLT to workplace learning. CONCLUSION The authors discuss implications for workplace teaching, curricular design, learning environment, and metacognition. To advance workplace learning, the authors suggest future CLT research should address higher-level questions and integrate other learning frameworks.
Collapse
Affiliation(s)
- Justin L Sewell
- a Department of Medicine, Division of Gastroenterology , University of California San Francisco , San Francisco , CA , USA
| | - Lauren A Maggio
- b Department of Medicine , Uniformed Services University of the Health Sciences , Bethesda , MD , USA
| | - Olle Ten Cate
- c Center for Research and Development of Education , University Medical Center Utrecht , Utrecht , Netherlands
- d Department of Medicine, Research and Development in Medical Education , University of California San Francisco , San Francisco , CA , USA
| | - Tamara van Gog
- e Department of Education , Utrecht University , The Netherlands
| | - John Q Young
- f Department of Psychiatry , Zucker School of Medicine at Hofstra/Northwell , Hempstead , NY , USA
| | - Patricia S O'Sullivan
- d Department of Medicine, Research and Development in Medical Education , University of California San Francisco , San Francisco , CA , USA
| |
Collapse
|
23
|
Lee C, Wong GKC. Virtual reality and augmented reality in the management of intracranial tumors: A review. J Clin Neurosci 2019; 62:14-20. [PMID: 30642663 DOI: 10.1016/j.jocn.2018.12.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 12/22/2018] [Indexed: 01/19/2023]
Abstract
Neurosurgeons are faced with the challenge of planning, performing, and learning complex surgical procedures. With improvements in computational power and advances in visual and haptic display technologies, augmented and virtual surgical environments can offer potential benefits for tests in a safe and simulated setting, as well as improve management of real-life procedures. This systematic literature review is conducted in order to investigate the roles of such advanced computing technology in neurosurgery subspecialization of intracranial tumor removal. The study would focus on an in-depth discussion on the role of virtual reality and augmented reality in the management of intracranial tumors: the current status, foreseeable challenges, and future developments.
Collapse
Affiliation(s)
- Chester Lee
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - George Kwok Chu Wong
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong Special Administrative Region.
| |
Collapse
|
24
|
Kwong JC, Lee JY, Goldenberg MG. Understanding and Assessing Nontechnical Skills in Robotic Urological Surgery: A Systematic Review and Synthesis of the Validity Evidence. JOURNAL OF SURGICAL EDUCATION 2019; 76:193-200. [PMID: 29958854 DOI: 10.1016/j.jsurg.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/17/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Robotic urological surgery (RUS) has seen widespread adoption across institutions in the last decade. To match this rapid growth, it is imperative to develop a structured RUS curriculum that addresses both technical and nontechnical competencies. Emerging evidence has shown that nontechnical skills form a critical component of RUS training. The purpose of this review is to examine the validity evidence of available nontechnical skills assessment tools in RUS. METHODS A literature search of MEDLINE, EMBASE, and PsycINFO was conducted to identify primary articles using nontechnical skills assessment tools in RUS. Messick's validity framework and the Medical Education Research Study Quality Instrument were utilized to evaluate the quality of the validity evidence of the abstracted articles. RESULTS Of the 566 articles identified, 12 used nontechnical skills assessment tools in RUS. The metrics used ranged from self-assessment using global rating scales, to objective measures such as electroencephalography. The setting of these evaluations ranged from immersive and virtual reality-based simulators to live surgery. CONCLUSIONS Limited effort has been made to develop nontechnical skills assessment tools in RUS. Recently, there has been a shift from subjective to objective measures of nontechnical performance, as well as the development of assessments specific to RUS. However, the validity evidence supporting these nontechnical assessments is limited at this time, including their relationship to technical skills, and their impact on surgical outcomes.
Collapse
Affiliation(s)
- Jethro Cc Kwong
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jason Y Lee
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Mitchell G Goldenberg
- Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
25
|
Goldenberg MG, Lee JY, Kwong JCC, Grantcharov TP, Costello A. Implementing assessments of robot-assisted technical skill in urological education: a systematic review and synthesis of the validity evidence. BJU Int 2018; 122:501-519. [PMID: 29603869 DOI: 10.1111/bju.14219] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To systematically review and synthesise the validity evidence supporting intraoperative and simulation-based assessments of technical skill in urological robot-assisted surgery (RAS), and make evidence-based recommendations for the implementation of these assessments in urological training. MATERIALS AND METHODS A literature search of the Medline, PsycINFO and Embase databases was performed. Articles using technical skill and simulation-based assessments in RAS were abstracted. Only studies involving urology trainees or faculty were included in the final analysis. RESULTS Multiple tools for the assessment of technical robotic skill have been published, with mixed sources of validity evidence to support their use. These evaluations have been used in both the ex vivo and in vivo settings. Performance evaluations range from global rating scales to psychometrics, and assessments are carried out through automation, expert analysts, and crowdsourcing. CONCLUSION There have been rapid expansions in approaches to RAS technical skills assessment, both in simulated and clinical settings. Alternative approaches to assessment in RAS, such as crowdsourcing and psychometrics, remain under investigation. Evidence to support the use of these metrics in high-stakes decisions is likely insufficient at present.
Collapse
Affiliation(s)
| | - Jason Y Lee
- Division of Urology, University of Toronto, Toronto, ON, Canada
| | | | - Teodor P Grantcharov
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anthony Costello
- Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
| |
Collapse
|