Saving robots improves laparoscopic performance: transfer of skills from a serious game to a virtual reality simulator

Education in Laparoscopic Cholecystectomy: Design and Feasibility Study of the LapBot Safe Chole Mobile Game

BACKGROUND

 Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs.

OBJECTIVE

 To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making.

METHODS

 LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis.

RESULTS

 Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational.

CONCLUSIONS

 LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees.

Digital Training Resources in the Dutch Surgical Residency Curricula and the Perspectives of Residents: A Thematic Analysis of Resident Interviews

BACKGROUND

Digital training resources show great promise in augmenting traditional surgical education - especially in times of social distancing and limited surgical caseload. Embedding digital resources in surgical curricula is however not current, nor common practice in Dutch hospitals. While the digital world has become part of a resident's everyday life, surprisingly little is known about surgical residents' experiences and expectations towards use of digital resources for their own surgical education. This study aims to identify digital resources currently used in Dutch surgical curricula and to describe surgical residents' perspectives towards digital education.

METHODS

A series of semi-structured interviews with Dutch surgical residents were conducted until data sufficiency occurred. The interviews consisted of two parts: 1) current surgical training and implemented digital resources, and 2) future surgical training and the role of digital resources therein. All interviews were digitally recorded, transcribed verbatim, and thematically analyzed.

RESULTS

Sixteen surgical residents were interviewed - two out of each of the eight educational regions for surgery in the Netherlands. Five digital resource categories were identified and four general educational themes (requirements, advantages, disadvantages, and general education themes), overarching 13 sub-themes. In general, residents were enthusiastic with regard to using digital resources, especially when the perceived advantages supported their autonomy.

CONCLUSIONS

Dutch surgical residents indicate that digital resources may support their educational experiences, but state that ideally they must be combined with much appreciated on-the-job training, and be offered to them tailored to their individual needs. No resources are considered to be a "magic bullet" in itself. The specific needs of residents and educators need to be addressed clearly in order to successfully adopt and implement digital resources on a larger scale.

Video gaming improves robotic surgery simulator success: a multi-clinic study on robotic skills

We aimed to investigate the effects of video game habits, duration of experience, and training in different surgical clinics on the success of robotic surgery simulators. In this prospective, observational, comparative, and multi-clinical study, all participants played Temple Run and Piano Tiles 2^™ mobile games for 1 month, after answering a questionnaire including their sociodemographic characteristics, surgical experience, and past and current video game experience. At the end of the period, participants experienced four different robotic surgery simulator tasks (Camera Targeting 1, Energy Switching 1, Ring and Rail 2, Vertical Defect Suturing) in da Vinci^® Skills Simulator^™. Additionally, sociodemographic data were statistically analyzed with mobile game scores and 13 different performance scores obtained from the simulator. All robotic surgery simulator skill applications were carried out at Ege University Hospital in Izmir. All surgical residents in the general surgery, urology, and pediatric surgery clinics were included in the study. Sixty of the sixty-four participants in total completed all the processes. Four participants were excluded from the study. When clinical performances were compared, it was seen that the general surgery clinic performed better than other clinics in two parameters (overall score, time to complete) of the 'Camera Targeting' task (p = 0.01 and p = 0.006). Participants with mobile phone games experience were successful in the 'Energy Switching' task with less misapplied energy time (p = 0.039). Participants with high scores in Piano Tiles 2^™ were more successful in the 'Energy Switching' task and completed the 'Ring Rail' task with fewer movements (p < 0.05). Participants with more surgical and laparoscopic surgery experience scored higher in the 'Camera Targeting' and 'Energy Switching' tasks and completed the assignments with less movement. Again, these participants completed the 'Vertical Defect Suturing' task faster and the 'Ring Rail' task with less movement. In addition, participants with more laparoscopy experience scored higher in the 'Ring Rail' task (p < 0.05). In this study, we showed the effect of recent gaming experience on robotic surgery abilities along with previous video game experience. For surgeons and surgeon candidates in robotic surgery training, the importance of video game-based learning techniques will increase when combined with rapidly developing simulation technologies.ClinicalTrials.gov Identifier: NCT05510960.

Perceived effectiveness of an innovative mobile-based serious game on the improvement of soft skills in minimally invasive surgical training

INTRODUCTION

Soft skills have a pertinent role for the quality and efficient outcomes in minimally invasive surgical procedures that are difficult to practice due to time constraints, limited resources, and other logistical reasons. The literature says that serious games serve as better resources for learning soft skills but needs evaluation from stakeholders. This study explores the perceived effectiveness of serious gaming intervention as a learning tool to improve communication, collaborative skills among the residents in surgery, house officers and junior doctors.

METHOD

A total of nine participants volunteered to take part in the exploratory study. During the study, the participants responded to a pre-test quiz, followed by exploration of the game and a post-test quiz. The perceived perceptions on the effectiveness of the gaming intervention were collected on a five-point Likert scale questionnaire with open-ended questions.

RESULTS

There was no significant difference in pre-test and post-test scores on communication and collaborative skills. Among the three themes, there was significant effect of usefulness of the application of improvement of soft skills (90% response); however, technicalities should be addressed (50% of responses). The qualitative feedback renders that, better graphics, tutorial run, user-friendly interface and controls, and enhanced 3D environment would enhance the efficacy of the prototype.

CONCLUSION

An innovative mobile-based serious gaming intervention was developed and tested for its effectiveness as a resource to develop soft skills among surgeons in training. The results indicate that gamified interventions can serve as educational resources and supplement the self-directed learning in surgical education.

Simulation-based education in urology - an update

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.

Baseline characteristics in laparoscopic simulator performance: The impact of personal computer (PC)-gaming experience and visuospatial ability

BACKGROUND

Learning via simulators is under constant development, and it is important to further optimize simulator training curricula. This study investigates the impact of personal computer-gaming experience, visuospatial skills, and repetitive training on laparoscopic simulator performance and specifically on the constituent parameters of the simulator score.

METHODS

Forty-seven medical students completed 3 consecutive Minimally Invasive Surgical Trainer-Virtual Reality simulator trials. Previously, they performed a visuospatial test and completed a questionnaire regarding baseline characteristics and personal computer-gaming experience. Linear regression was used to analyze the relationship between simulator performance and type of personal computer-gaming experience and visuospatial ability.

RESULTS

During the first 2 Minimally Invasive Surgical Trainer-Virtual Reality simulation tasks, there was an association between personal computer-gaming experience and the coordination parameters of the score (eg, EconDiath task 1: P = .0047; EconDiath task 2: P = .0102; EconDiath task 3: P = .0836). The type of game category played seemed to have an impact on the coordination parameters (eg, EconDiath task 1-3 for sport games versus no-sport games: P = .01, P = .0013, and P = .01, respectively). In the first Minimally Invasive Surgical Trainer task, visuospatial ability correlated with Minimally Invasive Surgical Trainer simulator performance but was abolished with repetitive training (overall Minimally Invasive Surgical Trainer score task 1-3: P = .0122, P = .0991, and P = .3506, respectively). Sex-specific differences were noted initially but were abolished with training.

CONCLUSION

Sport games versus no-sport games demonstrated a significantly better Minimally Invasive Surgical Trainer performance. Furthermore, repetitive laparoscopic simulator training may compensate for a previous lack of personal computer-gaming experience, low visuospatial ability, and sex differences.

Serious Games for Improving Technical Skills in Medicine: Scoping Review

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.

The Evolution of Educational Technology in Veterinary Anatomy Education

"All learning is in the learner, not the teacher." Plato was right. The adage has passed the test of time and is still true in an era where technology accompanies us in not only professional but also recreational life every day, everywhere. On the other hand, the learner has evolved and so have the sources being used to satisfy curiosity and learning. It therefore appears intuitive to embrace these technological advances to bring knowledge to our pupils with the aim to facilitate learning and improve performance. It must be clear that these technologies are not intended to replace but rather consolidate knowledge partly acquired during more conventional teaching of anatomy. Veterinary medicine is no outlier. Educating students to the complexity of anatomy in multiple species requires that three-dimensional concepts be taught and understood accurately if appropriate treatment is to be set in place thereafter. Veterinary anatomy education has up to recently walked diligently in the footsteps of John Hunter's medical teaching using specimens, textbooks, and drawings. The discipline has yet to embrace fully the benefits of advancement being made in technology for the benefit of its learners. Three-dimensional representation of anatomy is undeniably a logical and correct way to teach whether it is through the demonstration of cadaveric specimen or alternate reality using smartphones, tablets, headsets or other digital media. Here we review some key aspects of the evolution of educational technology in veterinary anatomy.

Can video games enhance surgical skills acquisition for medical students? A systematic review

OBJECTIVE

To systematically assess literature examining the impact of being a gamer or participating in video-game-based training on surgical skills acquisition amongst medical students.

BACKGROUND

Video games and surgical procedures share similar skills such as visuospatial abilities and hand-eye coordination; therefore, video games can be a valuable tool for surgical training amongst medical students. However, comprehensive, up-to-date systematic reviews are necessary to confirm.

METHODS

A systematic literature search of PubMed, MEDLINE, and EMBASE was performed in April 2020 with no limits set on the date of publication. Observational and randomized controlled studies were included. Quality and bias were assessed using the Newcastle-Ottawa Scale for nonrandomized studies and the Grading of Recommendations Assessment, Development and Evaluation system for randomized studies.

RESULTS

A total of 575 participants from 16 studies were included. The most common surgical skills tested were laparoscopy (n = 283, from 8 studies) and robotic surgery (n = 199, from 5 studies). A history of gaming and video-game-based training were associated with improved metrics in robotic surgery and laparoscopy, respectively. Neither was beneficial in arthroscopy or bronchoscopy. Studies using the Wii U and Underground reported significant improvement in overall laparoscopic performance.

CONCLUSION

Video games demonstrate potential as adjunctive training in surgical skill education, with a history of gaming and video-game-based training being beneficial in robotic surgery and laparoscopy, respectively. Methodological heterogeneity amongst included studies limit the ability to make conclusive decisions; thus, future studies with long-term follow-up, larger sample sizes, outcomes stratified by video-game characteristics, and up-to-date technology are necessary.

The Fun Factor: Does Serious Gaming Affect the Volume of Voluntary Laparoscopic Skills Training?

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.

Construct Validity of a Serious Game for Laparoscopic Skills Training: Validation Study

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 (F_2,106=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 (F_1,106=14.42, P<.001 in favor of men) and prior video game experience (F_1,106=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.

Press Start to Play: Classifying Multi-Robot Operators and Predicting Their Strategies through a Videogame

One of the active challenges in multi-robot missions is related to managing operator workload and situational awareness. Currently, the operators are trained to use interfaces, but in the near future this can be turned inside out: the interfaces will adapt to operators so as to facilitate their tasks. To this end, the interfaces should manage models of operators and adapt the information to their states and preferences. This work proposes a videogame-based approach to classify operator behavior and predict their actions in order to improve teleoperated multi-robot missions. First, groups of operators are generated according to their strategies by means of clustering algorithms. Second, the operators’ strategies are predicted, taking into account their models. Multiple information sources and modeling methods are used to determine the approach that maximizes the mission goal. The results demonstrate that predictions based on previous data from single operators increase the probability of success in teleoperated multi-robot missions by 19%, whereas predictions based on operator clusters increase this probability of success by 28%.

Serious Games in Health Professions Education: Review of Trends and Learning Efficacy

OBJECTIVES

To provide an overview of research trends and a review regarding the learning efficacy of serious games for health professions education taking into account short-term learning outcomes.

METHODS

For the review of research trends, we performed the search on Web of Science from 1996 until the present. For the scoping review on learning efficacy, ERIC, Education Source, PsychINFO, Global Health, CINAHL, Web Of Science, and Medline were searched.

RESULTS

The publications trend is characterized by three phases: (i) an exploratory phase up to 2006, (ii) an early growth from 2007 to 2012, and (iii) a development phase from 2013 onwards. A total of 25 studies were identified in the scoping review. Sixteen had both pre-test and post-test, all of them showed significant improvement in learning scores after the use of serious games. Eighteen publications conducted controlled experiments, of which 14 indicated that post-test scores after serious games were significantly higher than with conventional teaching methods. The review revealed the lack of integration of affective learning with other competencies, as well as the need for serious games targeting postgraduate education.

CONCLUSION

Serious games research remains emergent. Using serious games for health professions education seems efficacious for short-term learning. Addressing more competencies and health professionals across the education continuum is needed before generalizable definitive statements can be made.