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Kang C, Shin CJ, Han JY, Jarmale SN, Scott IU, Sanders KM, Greenberg PB. Virtual Supervision in Graduate Medical Education: A Systematic Review. J Grad Med Educ 2024; 16:415-426. [PMID: 39148867 PMCID: PMC11324182 DOI: 10.4300/jgme-d-23-00505.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/02/2023] [Accepted: 05/01/2024] [Indexed: 08/17/2024] Open
Abstract
Background Despite the increased use of telemedicine, the evidence base on virtual supervision in graduate medical education (GME) is not well described. Objective To systematically review the impact of virtual supervision on trainee education, patient care, and patient satisfaction in Accreditation Council for Graduate Medical Education (ACGME)-accredited specialties. Methods Two databases (PubMed, EMBASE) were searched from database inception to December 2022. Inclusion criteria were peer-reviewed, full-text, English-language articles reporting the use of virtual supervision in GME in ACGME-accredited specialties. Exclusion criteria were studies involving direct supervision, supervisors who were not credentialed physicians, or non-GME trainees. Two investigators independently extracted data and appraised the methodological quality of each study using the Mixed Methods Appraisal Tool (MMAT). The reporting of this systematic review was guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Results Of 5278 records identified, 26 studies met the eligibility criteria. Virtual supervision was predominantly utilized in operating rooms and inpatient settings, facilitating clinical examinations or surgical procedures through videoconferencing software in specialties such as dermatology, neurosurgery, and orthopedics. However, some studies reported technical challenges that hindered effective teaching and communication. Based on self-reported surveys, supervisor and trainee satisfaction with virtual supervision was mixed, while patient satisfaction with the care was generally high. The MMAT ratings suggested limitations in sampling strategy, outcome measurement, and confounding factors. Conclusions Virtual supervision was applicable to various specialties and settings, facilitating communication between supervisors and trainees, although there were some technological challenges.
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Affiliation(s)
- Chaerim Kang
- Chaerim Kang, is a Student, Program in Liberal Medical Education, Brown University, Providence, Rhode Island, USA
| | - Christopher J. Shin
- Christopher J. Shin, is a Student, Brown University, Providence, Rhode Island, USA
| | - Ji Yun Han
- Ji Yun Han, BS, is a Medical Student, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Spandana N. Jarmale
- Spandana N. Jarmale, BS, is a Medical Student, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ingrid U. Scott
- Ingrid U. Scott, MD, MPH, is Professor of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Karen M. Sanders
- Karen M. Sanders, MD, is Senior Advisor (retired), Office of Academic Affiliations, US Department of Veterans Affairs, Washington, DC, USA; and
| | - Paul B. Greenberg
- Paul B. Greenberg, MD, MPH, is Professor of Surgery, Division of Ophthalmology, Warren Alpert Medical School, Brown University, and Associate Chief of Staff for Surgery, VA Providence Healthcare System, Providence, Rhode Island, USA
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Heo K, Cheng S, Joos E, Joharifard S. Use of Innovative Technology in Surgical Training in Resource-Limited Settings: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2024; 81:243-256. [PMID: 38161100 DOI: 10.1016/j.jsurg.2023.11.004] [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: 05/16/2023] [Revised: 08/23/2023] [Accepted: 11/03/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND There has been a rapid growth in interest in global surgery. This increased commitment to improving global surgical care, however, has not translated into an equal exchange of surgical information between high-income countries (HICs) and low-income countries (LMICs). In recent years, a greater emphasis has been placed on training local medical personnel in order to increase surgical capacity while simultaneously decreasing reliance on expatriate visitors. Virtual curricular models, simulators, and immersive technologies have been developed and implemented in order to maximize training opportunities in low-resource settings. This study aims to assess and summarize innovative technologies used for surgical training in low-resource settings. METHODS We conducted a scoping review of the literature from 2000 to 2021. We included both academic and grey literature on surgical education technologies. Searches were performed on Medline and Embase as well as on Google, iOS, and Android app stores. RESULTS Four main categories of surgical training platforms were identified: web-based platforms, app-based platforms, virtual and augmented reality, and simulation. The platforms were analyzed based on their content, effectiveness, cost, accessibility, and barriers to use. CONCLUSIONS Virtual learning platforms show potential in surgical training as they are easily accessible, not limited by geography, continuously updated, and evaluated for effectiveness. In order to provide access to educational resources for surgical trainees all around the world, particularly in low-resource settings, increased effort and resources should be dedicated to developing free, open-access surgical training programs . Doing so will promote sustainable and equitable development in global surgical care.
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Affiliation(s)
- Kayoung Heo
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samuel Cheng
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emilie Joos
- Division of General Surgery, Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shahrzad Joharifard
- Division of Pediatric Surgery, Department of Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Muroi K, Kyogoku S, Sakano Y, Sakamoto H, Nakazeko K, Koyama K, Fukunaga I, Hori K, Kotake K, Nojiri S, Sekine M, Nishizaki Y, Daida H. An analysis of the effectiveness of reflective learning through watching videos recorded with smart glasses-With multiple views (student, patient, and overall) in radiography education. PLoS One 2024; 19:e0296417. [PMID: 38165849 PMCID: PMC10760730 DOI: 10.1371/journal.pone.0296417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024] Open
Abstract
The Objective Structured Clinical Examination (OSCE) is designed to assess medical students' skills and attitude competencies before clinical practice. However, no method of reflective learning using video-based content has been used in OSCE education. This study aimed to confirm whether using smart glasses-based educational content is effective for OSCE reflective learning using multiple views (patient, student, and overall). This educational intervention study included a control group exposed to the traditional learning method and an intervention group exposed to a learning method incorporating smart glasses. Participants were 117 (72 in the control group and 45 in the intervention group) third-year radiological technology students scheduled to take the OSCE and 70 (37 in the control group and 33 in the intervention group) who met the eligibility criteria. Mock OSCEs were administered before and after the educational intervention (traditional and smart glasses-based education) to investigate changes in scores. After the educational intervention, a self-reported comprehension survey and a questionnaire were administered on the effectiveness of the video-based content from different views for student reflective learning. Unexpectedly, the OSCE evaluation score after the preliminary investigation significantly increased for the smart glasses control group (0.36±0.1) compared to the intervention group (0.06±0.1) setting up the radiographic conditions (x-ray center and detector center; p = 0.042). The intervention group's lower score in the mock OSCEs may have been due to the discomfort of wearing the smart glasses to perform the radiography procedure and their unfamiliarity with the smart glasses, which may have affected their concentration. The findings suggest that smart glasses-based education for OSCEs can be improved (e.g., being easy to handle and use and trouble-free).
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Affiliation(s)
- Kenzo Muroi
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Shinsuke Kyogoku
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yasuaki Sakano
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hajime Sakamoto
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuma Nakazeko
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kazuya Koyama
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Issei Fukunaga
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kensuke Hori
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kumiko Kotake
- Home Care Nursing, Faculty of Nursing, Nara Medical University, Kashihara, Nara, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Miwa Sekine
- Division of Medical Education, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Yuji Nishizaki
- Division of Medical Education, Faculty of Medicine, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Radiological Technology, Faculty of Health Science, Juntendo University, Bunkyo-ku, Tokyo, Japan
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Sommer F, Waterkeyn F, Hussain I, Navarro-Ramirez R, Goldberg J, Ahmad AA, Balsano M, Kirnaz S, Shabani H, Haber S, Sullivan V, Ng A, Gadjradj P, Härtl R. Telemedical Support Using Smartphones for Spine Surgery in Low- and Middle-Income Countries. Telemed J E Health 2023; 29:1834-1842. [PMID: 37126940 DOI: 10.1089/tmj.2022.0250] [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] [Indexed: 05/03/2023] Open
Abstract
Objective: Low- and middle-income countries (LMICs) face many challenges compared to industrialized nations, most notably in regard to the health care system. Patients often have to travel long distances to receive medical care with few reliable transportation mechanisms. In time-critical emergencies, this is a significant disadvantage. One specialty that is particularly affected by this is spine surgery. Within this field, traumatic injuries and acutely compressive pathologies are often time-critical. Increasing global networking capabilities through internet access offers the possibility for telemedical support in remote regions. Recently, high-performance cameras and processors became available in commercially available smartphones. Due to their wide availability and ease of use, this could provide a unique opportunity to offer telemedical support in LMICs. Methods: We conducted a feasibility study with a neurosurgical institution in east Africa. To ensure telemedical support, a commercially available smartphone was selected as the experimental hardware. Preoperatively, resolution, contrast, brightness, and color reproduction were assessed under theoretical conditions using a test chart. Intraoperatively, the image quality was assessed under different conditions. In the first step, the instrumentation table was displayed, and the mentor surgeon marked an instrument that the mentee surgeon should recognize correctly. In the next evaluation step, the surgical field was shown on film and the mentor surgeon marked an anatomical structure, and in the last evaluation step, the screen of the X-ray machine was captured, and the mentor surgeon again marked an anatomical structure. Subjective image quality was rated by two independent reviewers using the similar modified Likert scale as before on a scale of 1-5, with 1 indicating inadequate quality and 5 indicating excellent quality. Results: The image quality during the video calls was rated as sufficient overall. When evaluating the test charts, a quality of 97% ± 5 on average was found for the chart with the white background and a quality of 84% ± 5 on average for the chart with the black background. The color reproduction, the contrast, and the reproduction of brightness were rated excellent. Intraoperatively, the visualization of the instrument table was also rated excellent. Visualization of the operative site was rated 1.5 ± 0.5 on average and it was not possible to recognize relevant anatomical structures with the required confidence for surgical procedures. Image quality of the X-ray screen was rated 1.5 ± 0.9 on average. Conclusion: Current generation smartphones have high imaging performance, high computing power, and excellent connectivity. However, relevant anatomical structures during spine surgery procedures and on the X-ray screen in the operating room could not be identified with reliability to provide adequate surgical support. Nevertheless, our study showed the potential in smartphones supporting surgical procedures in LMICs, which could be helpful in other surgical fields.
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Affiliation(s)
- Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Francois Waterkeyn
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
- Department of Neurosciences, Grand Hôpital de Charleroi, Charleroi, Belgium
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Dar Es Salaam, Tanzania
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Jacob Goldberg
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Alaaeldin Azmi Ahmad
- Pediatric Orthopedic Surgery, Palestine Polytechnic University, Ramallah, Palestine
| | - Massimo Balsano
- Regional Spinal Department, UOC Ortopedia A, AOUI, Verona, Italy
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Hamisi Shabani
- Department of Neurosurgery, Muhimbili Orthopedic Institute, Dar Es Salaam, Tanzania
| | - Sam Haber
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Vincent Sullivan
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Amanda Ng
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Pravesh Gadjradj
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York Presbyterian Hospital, New York, New York, USA
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Fang C, Mo P, Chan H, Cheung J, Wong JSH, Wong TM, Mak YK, Ching K, Ho G, Leung F. Can a Wireless Full-HD Head Mounted Display System Improve Knee Arthroscopy Performance? - A Randomized Study Using a Knee Simulator. Surg Innov 2023; 30:477-485. [PMID: 36448618 PMCID: PMC10403956 DOI: 10.1177/15533506221142960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2023]
Abstract
INTRODUCTION Our prototype wireless full-HD Augmented Reality Head-Mounted Display (AR-HMD) aims to eliminate surgeon head turning and reduce theater clutter. Learning and performance versus TV Monitors (TVM) is evaluated in simulated knee arthroscopy. METHODS 19 surgeons and 19 novices were randomized into either the control group (A) or intervention group (B) and tasked to perform 5 simulated loose-body retrieval procedures on a bench-top knee arthroscopy simulator. A cross-over study design was adopted whereby subjects alternated between devices during trials 1-3, deemed the "Unfamiliar" phase, and then used the same device consecutively in trials 4-5, to assess performance in a more "Familiarized" state. Measured outcomes were time-to-completion and incidence of bead drops. RESULTS In the unfamiliar phase, HMD had 67% longer mean time-to-completion than TVM (194.7 ± 152.6s vs 116.7 ± 78.7s, P < .001). Once familiarized, HMD remained inferior to TVM, with 48% longer completion times (133.8 ± 123.3s vs 90.6 ± 55s, P = .052). Cox regression revealed device type (OR = 0.526, CI 0.391-0.709, P < .001) and number of procedure repetitions (OR = 1.186, CI 1.072-1.311, P = .001) are significantly and independently related to faster time-to-completion. However, experience is not a significant factor (OR = 1.301, CI 0.971-1.741, P = .078). Bead drops were similar between the groups in both unfamiliar (HMD: 27 vs TVM: 22, P = .65) and familiarized phases (HMD: 11 vs TVM: 17, P = .97). CONCLUSION Arthroscopic procedures continue to be better performed under conventional TVM. However, similar quality levels can be reached by HMD when given more time. Given the theoretical advantages, further research into improving HMD designs is advocated.
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Affiliation(s)
- Christian Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Pinky Mo
- The University of Hong Kong, Hong Kong
| | - Holy Chan
- The University of Hong Kong, Hong Kong
| | - Jake Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Janus Siu Him Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Tak-Man Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Yan-Kit Mak
- Department of Orthopaedics and Traumatology, Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | - Kathine Ching
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Grace Ho
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - Frankie Leung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
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Baashar Y, Alkawsi G, Wan Ahmad WN, Alomari MA, Alhussian H, Tiong SK. Towards Wearable Augmented Reality in Healthcare: A Comparative Survey and Analysis of Head-Mounted Displays. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3940. [PMID: 36900951 PMCID: PMC10002206 DOI: 10.3390/ijerph20053940] [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: 01/30/2023] [Revised: 02/16/2023] [Accepted: 02/19/2023] [Indexed: 06/18/2023]
Abstract
Head-mounted displays (HMDs) have the potential to greatly impact the surgical field by maintaining sterile conditions in healthcare environments. Google Glass (GG) and Microsoft HoloLens (MH) are examples of optical HMDs. In this comparative survey related to wearable augmented reality (AR) technology in the medical field, we examine the current developments in wearable AR technology, as well as the medical aspects, with a specific emphasis on smart glasses and HoloLens. The authors searched recent articles (between 2017 and 2022) in the PubMed, Web of Science, Scopus, and ScienceDirect databases and a total of 37 relevant studies were considered for this analysis. The selected studies were divided into two main groups; 15 of the studies (around 41%) focused on smart glasses (e.g., Google Glass) and 22 (59%) focused on Microsoft HoloLens. Google Glass was used in various surgical specialities and preoperative settings, namely dermatology visits and nursing skill training. Moreover, Microsoft HoloLens was used in telepresence applications and holographic navigation of shoulder and gait impairment rehabilitation, among others. However, some limitations were associated with their use, such as low battery life, limited memory size, and possible ocular pain. Promising results were obtained by different studies regarding the feasibility, usability, and acceptability of using both Google Glass and Microsoft HoloLens in patient-centric settings as well as medical education and training. Further work and development of rigorous research designs are required to evaluate the efficacy and cost-effectiveness of wearable AR devices in the future.
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Affiliation(s)
- Yahia Baashar
- Faculty of Computing and Informatics, Universiti Malaysia Sabah (UMS), Labuan 87000, Malaysia
| | - Gamal Alkawsi
- Institute of Sustainable Energy (ISE), Universiti Tenaga Nasional, Kajang 43000, Malaysia
- Faculty of Computer Science and Information Systems, Thamar University, Thamar 87246, Yemen
| | | | - Mohammad Ahmed Alomari
- Institute of Informatics and Computing in Energy, Universiti Tenaga Nasional (UNITEN), Kajang 43000, Malaysia
| | - Hitham Alhussian
- Department of Computer and Information Sciences, Universiti Teknologi PETRONAS, Seri Iskandar 32610, Malaysia
| | - Sieh Kiong Tiong
- Institute of Sustainable Energy (ISE), Universiti Tenaga Nasional, Kajang 43000, Malaysia
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Lyon DR, Colletta MD, Biggs P, Pierce DC, Tarima SS, Visotcky A, Ishman SL, Brown DJ, Chun RH. Can we learn faster? A pilot study using surgical videos to improve pediatric tonsillectomy competency in OSATS. Int J Pediatr Otorhinolaryngol 2022; 163:111366. [PMID: 36368192 DOI: 10.1016/j.ijporl.2022.111366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/06/2022] [Accepted: 10/16/2022] [Indexed: 11/08/2022]
Affiliation(s)
| | - Miranda D Colletta
- Medical College of Wisconsin, Department of Otolaryngology & Communication Sciences, Milwaukee, WI, USA
| | - Philip Biggs
- University California San Diego, Department of Otolaryngology, San Diego Ca, USA
| | - Douglas C Pierce
- Medical College of Wisconsin, Department of Radiology, Milwaukee, WI, USA
| | - Sergey S Tarima
- Medical College of Wisconsin, Division of Biostatistics, Milwaukee, WI, USA
| | - Alexis Visotcky
- Medical College of Wisconsin, Division of Biostatistics, Milwaukee, WI, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, Division of Pulmonary Medicine, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Department of Otolaryngology-Head and Neck Surgery, Cincinnati, OH, USA
| | - David J Brown
- Department of Otolaryngology, University of Michigan, Ann Arbor, MI, USA
| | - Robert H Chun
- Medical College of Wisconsin, Department of Otolaryngology & Communication Sciences, Milwaukee, WI, USA.
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Sommer F, Waterkeyn F, Hussain I, Goldberg JL, Kirnaz S, Navarro-Ramirez R, Ahmad AA, Balsano M, Medary B, Shabani H, Ng A, Gadjradj PS, Härtl R. Feasibility of smart glasses in supporting spinal surgical procedures in low- and middle-income countries: experiences from East Africa. Neurosurg Focus 2022; 52:E4. [PMID: 35921190 DOI: 10.3171/2022.3.focus2237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Telemedicine technology has been developed to allow surgeons in countries with limited resources to access expert technical guidance during surgical procedures. The authors report their initial experience using state-of-the-art wearable smart glasses with wireless capability to transmit intraoperative video content during spine surgery from sub-Saharan Africa to experts in the US. METHODS A novel smart glasses system with integrated camera and microphone was worn by a spine surgeon in Dar es Salaam, Tanzania, during 3 scoliosis correction surgeries. The images were transmitted wirelessly through a compatible software system to a computer viewed by a group of fellowship-trained spine surgeons in New York City. Visual clarity was determined using a modified Snellen chart, and a percentage score was determined on the smallest line that could be read from the 8-line chart on white and black backgrounds. A 1- to 5-point scale (from 1 = unrecognizable to 5 = optimal clarity) was used to score other visual metrics assessed using a color test card including hue, contrast, and brightness. The same scoring system was used by the group to reach a consensus on visual quality of 3 intraoperative points including instruments, radiographs (ability to see pedicle screws relative to bony anatomy), and intraoperative surgical field (ability to identify bony landmarks such as transverse processes, pedicle screw starting point, laminar edge). RESULTS All surgeries accomplished the defined goals safely with no intraoperative complications. The average download and upload connection speeds achieved in Dar es Salaam were 45.21 and 58.89 Mbps, respectively. Visual clarity with the modified white and black Snellen chart was 70.8% and 62.5%, respectively. The average scores for hue, contrast, and brightness were 2.67, 3.33, and 2.67, respectively. Visualization quality of instruments, radiographs, and intraoperative surgical field were 3.67, 1, and 1, respectively. CONCLUSIONS Application of smart glasses for telemedicine offers a promising tool for surgical education and remote training, especially in low- and middle-income countries. However, this study highlights some limitations of this technology, including optical resolution, intraoperative lighting, and internet connection challenges. With continued collaboration between clinicians and industry, future iterations of smart glasses technology will need to address these issues to stimulate robust clinical utilization.
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Affiliation(s)
- Fabian Sommer
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Francois Waterkeyn
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York.,2Department of Neurosurgery, Clinique Universitaire Saint-Luc, Brussels, Belgium.,3Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Ibrahim Hussain
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Jacob L Goldberg
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Sertac Kirnaz
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Rodrigo Navarro-Ramirez
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Alaaeldin Azmi Ahmad
- 4Pediatric Orthopedic Surgery, Palestine Polytechnic University, Ramallah, Palestine; and
| | - Massimo Balsano
- 5Regional Spinal Department, UOC Ortopedia A, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Branden Medary
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Hamisi Shabani
- 3Muhimbili Orthopedic Institute, Dar es Salaam, Tanzania
| | - Amanda Ng
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Pravesh Shankar Gadjradj
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Roger Härtl
- 1Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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Esposito AC, Coppersmith NA, White EM, Yoo PS. Video Coaching in Surgical Education: Utility, Opportunities, and Barriers to Implementation. JOURNAL OF SURGICAL EDUCATION 2022; 79:717-724. [PMID: 34972670 DOI: 10.1016/j.jsurg.2021.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/30/2021] [Accepted: 12/04/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This review discusses the literature on Video-Based Coaching (VBC) and explores the barriers to widespread implementation. DESIGN A search was performed on Scopus and PubMed for the terms "operation," "operating room," "surgery," "resident," "house staff," "graduate medical education," "teaching," "coaching," "assessment," "reflection," "camera," and "video" on July 27, 2021, in English. This yielded 828 results. A single author reviewed the titles and abstracts and eliminated any results that did not pertain to operative VBC or assessment. All bibliographies were reviewed, and appropriate manuscripts were included in this study. This resulted in a total of 52 manuscripts included in this review. SETTING/PARTICIPANTS Original, peer-reviewed studies focused on VBC or assessment. RESULTS VBC has been both subjectively and objectively found to be a valuable educational tool. Nearly every study of video recording in the operating room found that subjects, including surgical residents and seasoned surgeons alike, overwhelmingly considered it a useful, non-redundant adjunct to their training. Most studies that evaluated skill acquisition via standardized assessment tools found that surgical residents who underwent a VBC program had significant improvements compared to their counterparts who did not undergo video review. Despite this evidence of effectiveness, fewer than 5% of residency programs employ video recording in the operating room. Barriers to implementation include significant time commitments for proposed coaching curricula and difficulty with integration of video cameras into the operating room. CONCLUSIONS VBC has significant educational benefits, but a scalable curriculum has not been developed. An optimal solution would ensure technical ease and expediency, simple, high-quality cameras, immediate review, and overcoming entrenched surgical norms and culture.
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Affiliation(s)
- Andrew C Esposito
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut
| | | | - Erin M White
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut
| | - Peter S Yoo
- Yale School of Medicine, Department of Surgery, New Haven, Connecticut.
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Abu-Rmaileh M, Osborn T, Gonzalez SR, Yuen JC. The Use of Live Streaming Technologies in Surgery: A Review of the Literature. Ann Plast Surg 2022; 88:122-127. [PMID: 34270473 DOI: 10.1097/sap.0000000000002909] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Live streaming surgery is a developing communication platform in medicine. To maximize the technological advances that allow for the live streaming of surgery, it is crucial to have an understanding of the various video-capturing devices that are available and their pros and cons of implementation. Possible barriers to the widespread use of live streaming surgery include cost, concerns about patient safety and privacy, and limited understanding of the current available resources. In this article, we present the results of our literature review of techniques for live streaming of surgery as a means to inform readers and promote their implementation. METHODS We conducted a literature review of the literature to identify previous articles indexed in PubMed and Ovid. We used the following search terms: [Surgery AND Streaming], which generated 32 articles for initial review. References were reviewed within each document to find similar articles that were not captured by the initial search. The article selection criteria were peer-reviewed publications, case reports, and case series describing the use of live surgical streaming technologies. RESULTS Literature review showed enhanced surgeon interaction with viewers and improved anatomy scores with the widespread use of live streaming. Surgeons reported positive feedback and wished to engage in more sessions in the future. The largest barriers to implementation of streaming technology are video quality through the Internet and patient information protection. CONCLUSIONS Live streaming of surgery for educational purposes has not been widely accepted in surgical training programs to date. Streaming accessibility has advanced over the past 2 decades with the availability of handheld mobile devices. However, little has been done to allow for live streaming of surgery to trainees in a manner compliant with the Health Portability Insurance and Accountability Act.
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Affiliation(s)
| | - Tamara Osborn
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Santiago R Gonzalez
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - James C Yuen
- Division of Plastic Surgery, Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR
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11
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Galvao Neto M, Jerez J, Brunaldi VO, Cabrera D, Benavides C, Moreno M, Romero G, Guiatara D, Abu Dayyeh BK. Learning Process Effectiveness During the COVID-19 Pandemic: Teleproctoring Advanced Endoscopic Skills by Training Endoscopists in Endoscopic Sleeve Gastroplasty Procedure. Obes Surg 2021; 31:5486-5493. [PMID: 34664148 PMCID: PMC8523006 DOI: 10.1007/s11695-021-05757-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 01/29/2023]
Abstract
Background and Aims The COVID‐19 pandemic has led health institutions to cancel many of the activities including training in different fields. Most practices and training programs have been encouraged to use teleproctoring as an alternative method to enhance physician’s ability and assure training. We aimed to evaluate remote training program for endoscopy sleeve gastroplasty (ESG). Methods Ten consecutive patients underwent an endoscopic sleeve gastroplasty procedure guided by a proctor expert using an online platform. A stepwise approach was created to assure skill acquisition. Results All cases were safely performed with no serious adverse events under teleproctoring. The average surgical and suturing times significantly decreased during the training model. From the first 5 cases to the last 5 ones, the endoscopic procedure time decreased from 120 to 93.4 min while suturing time from 92.8 to 68.4 min. The effect size was large in both cases, and the changes were meaningful according to the fitted learning curves. Conclusions The proposed teleproctoring program was effective to deliver advanced endoscopic skills such as endosuturing for ESG, despite the restrictions imposed by the COVID-19 pandemic. Graphical abstract ![]()
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Affiliation(s)
- Manoel Galvao Neto
- Division of Gastrointestinal Endoscopy, ABC Medical School, São Paulo, Brazil
| | - Jonathan Jerez
- Diagnostic and Therapeutic Gastroenterology Amazon Region, Puyo, Ecuador
| | - Vitor Ottoboni Brunaldi
- Center for Digestive Endoscopy, Surgery and Anatomy Department, Hospital das Clínicas de Ribeirão Preto, Ribeirão Preto, Brazil.
| | - David Cabrera
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Christian Benavides
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Monica Moreno
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Ginesio Romero
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Daniela Guiatara
- Endoscopic Bariatric, Overweight Obesity and Metabolism Clinic, Quito, Ecuador
| | - Barham K Abu Dayyeh
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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12
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Is the use of augmented reality-assisted surgery beneficial in urological education? A systematic review. Curr Urol 2021; 15:148-152. [PMID: 34552454 PMCID: PMC8451320 DOI: 10.1097/cu9.0000000000000036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Google Glass is an optical head-mounted display that has been used in multiple medical and surgical settings to enhance delivery of education and training. This systematic review focuses solely on the use of this technology in urology operating theaters for the purpose of surgical education. Materials and methods: A systematic search strategy was employed using EMBASE (1996–2019), Medline (1946–2019) and PubMed. Search terms included optical head-mounted displays, Google Glass and urological surgical training. Use of this technology in a nonurological setting, nonteaching sessions, case reports, reviews, editorials, abstracts, and articles not in English were rejected. Three studies were identified following the exclusion criteria. Results: All 3 studies received positive feedback from trainees regarding this technology in relation to enhanced surgical education. In addition, in all studies the trainees felt the technology had a place for educational training in the future. All studies described disadvantages to the technology as well including battery life, comfort, and cost. Conclusions: Studies describe a big potential for Google Glass and similar head-mounted devices for the role of surgical training in urology, however, larger studies looking at more varied operations can help reinforce this viewpoint.
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Baashar Y, Alkawsi G, Ahmad WNW, Alhussian H, Alwadain A, Capretz LF, Babiker A, Alghail A. The Effectiveness of Using Augmented Reality for Training in the Medical Professions: A Meta Analysis (Preprint). JMIR Serious Games 2021; 10:e32715. [PMID: 35787488 PMCID: PMC9297143 DOI: 10.2196/32715] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/12/2022] [Accepted: 04/22/2022] [Indexed: 11/19/2022] Open
Abstract
Background Augmented reality (AR) is an interactive technology that uses persuasive digital data and real-world surroundings to expand the user's reality, wherein objects are produced by various computer applications. It constitutes a novel advancement in medical care, education, and training. Objective The aim of this work was to assess how effective AR is in training medical students when compared to other educational methods in terms of skills, knowledge, confidence, performance time, and satisfaction. Methods We performed a meta-analysis on the effectiveness of AR in medical training that was constructed by using the Cochrane methodology. A web-based literature search was performed by using the Cochrane Library, Web of Science, PubMed, and Embase databases to find studies that recorded the effect of AR in medical training up to April 2021. The quality of the selected studies was assessed by following the Cochrane criteria for risk of bias evaluations. Results In total, 13 studies with a total of 654 participants were included in the meta-analysis. The findings showed that using AR in training can improve participants' performance time (I2=99.9%; P<.001), confidence (I2=97.7%; P=.02), and satisfaction (I2=99.8%; P=.006) more than what occurs under control conditions. Further, AR did not have any effect on the participants’ knowledge (I2=99.4%; P=.90) and skills (I2=97.5%; P=.10). The meta-regression plot shows that there has been an increase in the number of articles discussing AR over the years and that there is no publication bias in the studies used for the meta-analysis. Conclusions The findings of this work suggest that AR can effectively improve performance time, satisfaction, and confidence in medical training but is not very effective in areas such as knowledge and skill. Therefore, more AR technologies should be implemented in the field of medical training and education. However, to confirm these findings, more meticulous research with more participants is needed.
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Affiliation(s)
- Yahia Baashar
- Faculty of Computing and Informatics, Universiti Malaysia Sabah, Labuan, Malaysia
| | - Gamal Alkawsi
- Institute of Sustainable Energy, Universiti Tenaga Nasional, Kajang, Malaysia
| | | | - Hitham Alhussian
- Department of Computer and Information Sciences, Universiti Teknologi Petronas, Seri Iskandar, Malaysia
| | - Ayed Alwadain
- Department of Computer Science, King Saud University, Riyadh, Saudi Arabia
| | - Luiz Fernando Capretz
- Department of Electrical & Computer Engineering, Western University, Ontario, ON, Canada
| | - Areej Babiker
- Department of Computer Engineering, Future University, Khartoum, Sudan
| | - Adnan Alghail
- Department of World Languages, Greece Central School District, New York, NY, United States
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Davids J, Manivannan S, Darzi A, Giannarou S, Ashrafian H, Marcus HJ. Simulation for skills training in neurosurgery: a systematic review, meta-analysis, and analysis of progressive scholarly acceptance. Neurosurg Rev 2021; 44:1853-1867. [PMID: 32944808 PMCID: PMC8338820 DOI: 10.1007/s10143-020-01378-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/17/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
Abstract
At a time of significant global unrest and uncertainty surrounding how the delivery of clinical training will unfold over the coming years, we offer a systematic review, meta-analysis, and bibliometric analysis of global studies showing the crucial role simulation will play in training. Our aim was to determine the types of simulators in use, their effectiveness in improving clinical skills, and whether we have reached a point of global acceptance. A PRISMA-guided global systematic review of the neurosurgical simulators available, a meta-analysis of their effectiveness, and an extended analysis of their progressive scholarly acceptance on studies meeting our inclusion criteria of simulation in neurosurgical education were performed. Improvement in procedural knowledge and technical skills was evaluated. Of the identified 7405 studies, 56 studies met the inclusion criteria, collectively reporting 50 simulator types ranging from cadaveric, low-fidelity, and part-task to virtual reality (VR) simulators. In all, 32 studies were included in the meta-analysis, including 7 randomised controlled trials. A random effects, ratio of means effects measure quantified statistically significant improvement in procedural knowledge by 50.2% (ES 0.502; CI 0.355; 0.649, p < 0.001), technical skill including accuracy by 32.5% (ES 0.325; CI - 0.482; - 0.167, p < 0.001), and speed by 25% (ES - 0.25, CI - 0.399; - 0.107, p < 0.001). The initial number of VR studies (n = 91) was approximately double the number of refining studies (n = 45) indicating it is yet to reach progressive scholarly acceptance. There is strong evidence for a beneficial impact of adopting simulation in the improvement of procedural knowledge and technical skill. We show a growing trend towards the adoption of neurosurgical simulators, although we have not fully gained progressive scholarly acceptance for VR-based simulation technologies in neurosurgical education.
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Affiliation(s)
- Joseph Davids
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, WC1N 3BG, UK.
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK.
| | - Susruta Manivannan
- Department of Neurosurgery, Southampton University NHS Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Ara Darzi
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Stamatia Giannarou
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Hutan Ashrafian
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
| | - Hani J Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, Holborn, London, WC1N 3BG, UK
- Imperial College Healthcare NHS Trust, St Mary's Praed St, Paddington, London, W2 1NY, UK
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Manfuso A, Pansini A, Cassano L, Pederneschi N, Tewfik K, Califano L, Copelli C. Osmo Pocket© vs VITOM®: comparison of surgical educational video recording means in head and neck reconstructive surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2021; 123:209-214. [PMID: 34273574 DOI: 10.1016/j.jormas.2021.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/01/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To highlight the needs for better intraoperative educational video recording in head and neck reconstructive surgery and to provide some information to standardize camera positioning in operative room. METHODS The Authors compared the Osmo Pocket© and the VITOM® 0° Telescope, evaluating the faculty and trainees point of view through specific questionnaires. The study was performed during two Masterclasses on Head and Neck Reconstructive Surgery that took place in the Hospital Casa Sollievo della Sofferenza in 2018 e 2019. Camera positioning in the Operative Room was also assessed. RESULTS In the faculty group, Osmo Pocket© was reported as frequently interfering with surgical intervention; the need for repositioning was reported more frequently in recording with VITOM®, that was evaluated as better in keeping a good "recording flow". In trainees' group, the perceived image quality with VITOM® was more appreciated, while Osmo Pocket© was considered superior in surgical field vision. Regarding the systems' positioning in the OR, in all the surgical procedures it was observed the need for the first operator and the trainees to have the HD monitor placed in front of them. Only during forearm flap harvesting the HD monitor was placed laterally to the first operator and the trainees. CONCLUSIONS The Osmo Pocket© is a cheap solution and allows a stable and continuous vision of the operative field, without the needing for stop and repositioning. The Vitom®, despite its major costs and the needing for periodic repositioning, allows a better view of anatomical details with less discomfort for the surgeon. Moreover it's important a standardization of the video means positioning in the operative room to reduce the pre-operative times and to aid in the choice of the most useful method for educational video recording.
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Affiliation(s)
- A Manfuso
- Fondazione IRCCS Casa Sollievo della Sofferenza, Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, San Giovanni Rotondo (Fg), Italy
| | - A Pansini
- Maxillo-Facial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences; Federico II University, Naples, Italy
| | - L Cassano
- Fondazione IRCCS Casa Sollievo della Sofferenza, Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, San Giovanni Rotondo (Fg), Italy
| | - N Pederneschi
- Fondazione IRCCS Casa Sollievo della Sofferenza, Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, San Giovanni Rotondo (Fg), Italy
| | - K Tewfik
- Fondazione IRCCS Casa Sollievo della Sofferenza, Operative Unit of Maxillo-Facial Surgery, Otolaryngology and Dentistry, San Giovanni Rotondo (Fg), Italy
| | - L Califano
- Maxillo-Facial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences; Federico II University, Naples, Italy
| | - C Copelli
- Maxillo-Facial Surgery, Department of Surgical Sciences, University of Turin, Corso A.M Dogliotti 14, 10126 Turin, Italy.
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16
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Molina CA, Sciubba DM, Greenberg JK, Khan M, Witham T. Clinical Accuracy, Technical Precision, and Workflow of the First in Human Use of an Augmented-Reality Head-Mounted Display Stereotactic Navigation System for Spine Surgery. Oper Neurosurg (Hagerstown) 2021; 20:300-309. [PMID: 33377137 DOI: 10.1093/ons/opaa398] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Augmented reality mediated spine surgery is a novel technology for spine navigation. Benchmark cadaveric data have demonstrated high accuracy and precision leading to recent regulatory approval. Absence of respiratory motion in cadaveric studies may positively bias precision and accuracy results and analogous investigations are prudent in live clinical scenarios. OBJECTIVE To report a technical note, accuracy, precision analysis of the first in-human deployment of this technology. METHODS A 78-yr-old female underwent an L4-S1 decompression, pedicle screw, and rod fixation for degenerative spine disease. Six pedicle screws were inserted via AR-HMD (xvision; Augmedics, Chicago, Illinois) navigation. Intraoperative computed tomography was used for navigation registration as well as implant accuracy and precision assessment. Clinical accuracy was graded per the Gertzbein-Robbins (GS) scale by an independent neuroradiologist. Technical precision was analyzed by comparing 3-dimensional (3D) (x, y, z) virtual implant vs real implant position coordinates and reported as linear (mm) and angular (°) deviation. Present data were compared to benchmark cadaveric data. RESULTS Clinical accuracy (per the GS grading scale) was 100%. Technical precision analysis yielded a mean linear deviation of 2.07 mm (95% CI: 1.62-2.52 mm) and angular deviation of 2.41° (95% CI: 1.57-3.25°). In comparison to prior cadaveric data (99.1%, 2.03 ± 0.99 mm, 1.41 ± 0.61°; GS accuracy 3D linear and angular deviation, respectively), the present results were not significantly different (P > .05). CONCLUSION The first in human deployment of the single Food and Drug Administration approved AR-HMD stereotactic spine navigation platform demonstrated clinical accuracy and technical precision of inserted hardware comparable to previously acquired cadaveric studies.
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Affiliation(s)
- Camilo A Molina
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jacob K Greenberg
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, Missouri
| | - Majid Khan
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy Witham
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ramlogan RR, Chuan A, Mariano ER. Contemporary training methods in regional anaesthesia: fundamentals and innovations. Anaesthesia 2021; 76 Suppl 1:53-64. [PMID: 33426656 DOI: 10.1111/anae.15244] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 12/26/2022]
Abstract
Over the past two decades, regional anaesthesia and medical education as a whole have undergone a renaissance. Significant changes in our teaching methods and clinical practice have been influenced by improvements in our theoretical understanding as well as by technological innovations. More recently, there has been a focus on using foundational education principles to teach regional anaesthesia, and the evidence on how to best teach and assess trainees is growing. This narrative review will discuss fundamentals and innovations in regional anaesthesia training. We present the fundamentals in regional anaesthesia training, specifically the current state of simulation-based education, deliberate practice and curriculum design based on competency-based progression. Moving into the future, we present the latest innovations in web-based learning, emerging technologies for teaching and assessment and new developments in alternate reality learning systems.
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Affiliation(s)
- R R Ramlogan
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - A Chuan
- Department of Anaesthesia, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - E R Mariano
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA.,Anesthesiology and Peri-operative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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18
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Jack MM, Gattozzi DA, Camarata PJ, Shah KJ. Live-Streaming Surgery for Medical Student Education - Educational Solutions in Neurosurgery During the COVID-19 Pandemic. JOURNAL OF SURGICAL EDUCATION 2021; 78:99-103. [PMID: 32747320 DOI: 10.1016/j.jsurg.2020.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/04/2020] [Accepted: 07/08/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The COVID-19 pandemic significantly altered medical student education. The ability for students to be a part of the operating room team was highly restricted. Technology can be used to ensure ongoing surgical education during this time of limited in-person educational opportunities. DESIGN We have developed an innovative solution of securely live-streaming surgery with real-time communication between the surgeon and students to allow for ongoing education during the pandemic. RESULTS We successfully live-streamed multiple different types of neurosurgical operations utilizing multiple video sources. This method uses inexpensive, universal equipment that can be implemented at any institution to enable virtual education of medical students and other learners. CONCLUSIONS This technology has facilitated education during this challenging time. This technological set-up for live-streaming surgery has the potential of improving medical and graduate medical education in the future.
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Affiliation(s)
- Megan M Jack
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Domenico A Gattozzi
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Paul J Camarata
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Kushal J Shah
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, Kansas.
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Yaqinuddin A, Kashir J, AlKattan W, AlKattan K. Applying integrated video assisted learning approaches for medical clerkship - potential adaptations in the post-COVID-19 era. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520963043. [PMID: 33195800 PMCID: PMC7594250 DOI: 10.1177/2382120520963043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/04/2020] [Indexed: 06/01/2023]
Abstract
Lockdowns and social distancing measures due to the ongoing COVID-19 pandemic have forced the delivery and assessment of educational material to be performed via online and virtual educational tools. Such disruption has greatly affected hands-on training programs essential to acquire clinical competencies, particularly modes requiring physical patient encounters. While most educational content has successfully been shifted to predominantly web-conferencing platforms, the essential clinical teaching at affiliated hospitals for undergraduate medicine clerkship years has been severely disrupted due to barring of students from hospital premises to minimise spread of COVID-19, presenting a problem requiring unique solutions to ensure that quality of education and subsequent healthcare is kept sufficiently high. To this degree, technological advances increasingly present several elegant solutions which may provide the required levels of educational delivery. In this article, we briefly discuss the number of options that could be deployed to aid in acquisition of requisite skills during the clerkship years, with a focus on wearable technologies and video recording/broadcasting. Given the ongoing pandemic, application of technological advances could provide, with some global coordination, the medical education community with numerous proactive solutions rather than just educational luxuries or novelties.
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Affiliation(s)
- Ahmed Yaqinuddin
- College of Medicine, Alfaisal
University, Riyadh, Kingdom of Saudi Arabia
| | - Junaid Kashir
- College of Medicine, Alfaisal
University, Riyadh, Kingdom of Saudi Arabia
- Department of Comparative Medicine, King
Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi
Arabia
| | - Wael AlKattan
- College of Medicine, Alfaisal
University, Riyadh, Kingdom of Saudi Arabia
| | - Khaled AlKattan
- College of Medicine, Alfaisal
University, Riyadh, Kingdom of Saudi Arabia
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Carrera JF. A Systematic Review of the Use of Google Glass in Graduate Medical Education. J Grad Med Educ 2019; 11:637-648. [PMID: 31871562 PMCID: PMC6919184 DOI: 10.4300/jgme-d-19-00148.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/13/2019] [Accepted: 08/21/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Graduate medical education (GME) has emphasized the assessment of trainee competencies and milestones; however, sufficient in-person assessment is often constrained. Using mobile hands-free devices, such as Google Glass (GG) for telemedicine, allows for remote supervision, education, and assessment of residents. OBJECTIVE We reviewed available literature on the use of GG in GME in the clinical learning environment, its use for resident supervision and education, and its clinical utility and technical limitations. METHODS We conducted a systematic review in accordance with 2009 PRISMA guidelines. Applicable studies were identified through a review of PubMed, MEDLINE, and Web of Science databases for articles published from January 2013 to August 2018. Two reviewers independently screened titles, abstracts, and full-text articles that reported using GG in GME and assessed the quality of the studies. A systematic review of these studies appraised the literature for descriptions of its utility in GME. RESULTS Following our search and review process, 37 studies were included. The majority evaluated GG in surgical specialties (n = 23) for the purpose of surgical/procedural skills training or supervision. GG was predominantly used for video teleconferencing, and photo and video capture. Highlighted positive aspects of GG use included point-of-view broadcasting and capacity for 2-way communication. Most studies cited drawbacks that included suboptimal battery life and HIPAA concerns. CONCLUSIONS GG shows some promise as a device capable of enhancing GME. Studies evaluating GG in GME are limited by small sample sizes and few quantitative data. Overall experience with use of GG in GME is generally positive.
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21
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Dorey S, Gray L, Tootell A, Higgins R, Al-Islam S, Baxter H, Dixon P, Hogg P. Radiation protection value to the operator from augmented reality smart glasses in interventional fluoroscopy procedures using phantoms. Radiography (Lond) 2019; 25:301-307. [DOI: 10.1016/j.radi.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 02/09/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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22
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Rahman R, Wood ME, Qian L, Price CL, Johnson AA, Osgood GM. Head-Mounted Display Use in Surgery: A Systematic Review. Surg Innov 2019; 27:88-100. [DOI: 10.1177/1553350619871787] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. We analyzed the literature to determine (1) the surgically relevant applications for which head-mounted display (HMD) use is reported; (2) the types of HMD most commonly reported; and (3) the surgical specialties in which HMD use is reported. Methods. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched through August 27, 2017, for publications describing HMD use during surgically relevant applications. We identified 120 relevant English-language, non-opinion publications for inclusion. HMD types were categorized as “heads-up” (nontransparent HMD display and direct visualization of the real environment), “see-through” (visualization of the HMD display overlaid on the real environment), or “non–see-through” (visualization of only the nontransparent HMD display). Results. HMDs were used for image guidance and augmented reality (70 publications), data display (63 publications), communication (34 publications), and education/training (18 publications). See-through HMDs were described in 55 publications, heads-up HMDs in 41 publications, and non–see-through HMDs in 27 publications. Google Glass, a see-through HMD, was the most frequently used model, reported in 32 publications. The specialties with the highest frequency of published HMD use were urology (20 publications), neurosurgery (17 publications), and unspecified surgical specialty (20 publications). Conclusion. Image guidance and augmented reality were the most commonly reported applications for which HMDs were used. See-through HMDs were the most commonly reported type used in surgically relevant applications. Urology and neurosurgery were the specialties with greatest published HMD use.
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Affiliation(s)
- Rafa Rahman
- The Johns Hopkins University, Baltimore, MD, USA
| | | | - Long Qian
- The Johns Hopkins University, Baltimore, MD, USA
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Saun TJ, Zuo KJ, Grantcharov TP. Video Technologies for Recording Open Surgery: A Systematic Review. Surg Innov 2019; 26:599-612. [PMID: 31165687 DOI: 10.1177/1553350619853099] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Video recording of surgical procedures is an important tool for surgical education, performance enhancement, and error analysis. Technology for video recording open surgery, however, is limited. The objective of this article is to provide an overview of the available literature regarding the various technologies used for intraoperative video recording of open surgery. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines using the MEDLINE, Cochrane Central, and EMBASE databases. Two authors independently screened the titles and abstracts of the retrieved articles, and those that satisfied the defined inclusion criteria were selected for a full-text review. A total of 2275 publications were initially identified, and 110 were included in the final review. The included articles were categorized based on type of article, surgical subspecialty, type and positioning of camera, and limitations identified with their use. The most common article type was primary-technical (29%), and the dominant specialties were general surgery (22%) and plastic surgery (18%). The most commonly cited camera used was the GoPro (30%) positioned in a head-mount configuration (60%). Commonly cited limitations included poor video quality, inadequate battery life, light overexposure, obstruction by surgical team members, and excessive motion. Open surgery remains the mainstay of many surgical specialties today, and technological innovation is absolutely critical to fulfill the unmet need for better video capture of open surgery. The findings of this article will be valuable for guiding future development of novel technology for this purpose.
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Affiliation(s)
- Tomas J Saun
- 1 St Michael's Hospital, Toronto, ON, Canada.,2 University of Toronto, ON, Canada
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24
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Ebner F, De Gregorio A, Schochter F, Bekes I, Janni W, Lato K. Effect of an Augmented Reality Ultrasound Trainer App on the Motor Skills Needed for a Kidney Ultrasound: Prospective Trial. JMIR Serious Games 2019; 7:e12713. [PMID: 31042155 PMCID: PMC6658324 DOI: 10.2196/12713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/05/2019] [Accepted: 03/24/2019] [Indexed: 11/13/2022] Open
Abstract
Background Medical education is evolving from "learning by doing" to simulation-based hands-on tutorials. Objective The aim of this prospective 2-armed study was to evaluate a newly developed augmented reality ultrasound app and its effect on educational training and diagnostic accuracy. Methods We recruited 66 medical students and, using imaging and measuring a kidney as quality indicators, tested them on the time they needed for these tasks. Both groups used textbooks as preparation; in addition, the study group had access to a virtual ultrasound simulation app for mobile devices. Results There was no significant difference between the study arms regarding age (P=.97), sex (P=.14), and previous ultrasound experience (P=.66). The time needed to complete the kidney measurements also did not differ significantly (P=.26). However, the results of the longitudinal kidney measurements differed significantly between the study and control groups, with larger, more realistic values in the study group (right kidney: study group median 105.3 mm, range 86.1-127.1 mm, control group median 92 mm, range 50.4-112.2 mm; P<.001; left kidney: study group median 100.3 mm, range 81.7-118.6 mm, control group median 85.3 mm, range 48.3-113.4 mm; P<.001). Furthermore, whereas all students of the study group obtained valid measurements, students of the control group did not obtain valid measurements of 1 or both kidneys in 7 cases. Conclusions The newly developed augmented reality ultrasound simulator mobile app provides a useful add-on for ultrasound education and training. Our results indicate that medical students’ use of the mobile app for training purposes improved the quality of kidney measurements.
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Affiliation(s)
- Florian Ebner
- Helios Amper Klinikum, Dachau, Germany.,University of Ulm, Ulm, Germany
| | | | | | - Inga Bekes
- Obstetrics and Gynecology Department, University of Ulm, Ulm, Germany
| | - Wolfgang Janni
- Obstetrics and Gynecology Department, University of Ulm, Ulm, Germany
| | - Krisztian Lato
- Obstetrics and Gynecology Department, University of Ulm, Ulm, Germany
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25
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Ganry L, Sigaux N, Ettinger KS, Salman SO, Fernandes RP. Modified GoPro Hero 6 and 7 for Intraoperative Surgical Recording-Transformation Into a Surgeon-Perspective Professional Quality Recording System. J Oral Maxillofac Surg 2019; 77:1703.e1-1703.e6. [PMID: 31009633 DOI: 10.1016/j.joms.2019.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/18/2019] [Indexed: 11/27/2022]
Abstract
Recent innovations in wearable action cameras with high-definition video recording enable surgeons to use cameras for their surgical procedures. In this study, the GoPro HERO 6 (and 7) Black edition camera was modified step by step to allow for a completely wireless surgeon-perspective recording with a battery life and memory capacity never previously obtained with such a high level of digital video quality. With this system, a surgeon can record for more than 14 hours 26 minutes in 1,080 pixels at 60 frames per second without breaking scrub and capture the operating surgeon's direct view of the field. By modifying the newest generation of devices, the authors successfully eliminated all shortcomings of the prior generation of GoPro cameras for surgical recording. The modified GoPro HERO6 camera produced professional recording quality for a total cost lower than US$850. This is critically important, because video-based surgical training will continue to be a primary area of development in the future and represents a novel and effective way for young generations of surgeons to attain technical excellence and knowledge in surgery.
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Affiliation(s)
- Laurent Ganry
- Head and Neck Oncologic Surgery and Microvascular Reconstruction Fellow, Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL.
| | - Nicolas Sigaux
- Assisting Professor, Maxillofacial Surgery, Hospices Civils de Lyon, Centre Hospitalo-Universitaire Lyon-Sud, Université Claude Bernard Lyon I, Lyon; Plastic, Reconstructive and Esthetic Surgery, Hospices Civils de Lyon, Groupement Hospitalier Nord, Université Claude Bernard Lyon I, Lyon; Maxillofacial Surgery, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | - Kyle S Ettinger
- Head and Neck Oncologic Surgery and Microvascular Reconstruction Fellow, Division of Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL; Senior Associate Consultant, Mayo Clinic and Department of Surgery, Division of Oral and Maxillofacial Surgery, Mayo College of Medicine, Rochester, MN
| | - Salam O Salman
- Residency Program Director and Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Florida Health-Jacksonville, Jacksonville, FL
| | - Rui P Fernandes
- Chief, Division of Head and Neck Surgery; Program Director, Head and Neck Oncologic Surgery and Microvascular Fellowship; Associate Department Chair and Professor, Department of Oral and Maxillofacial Surgery, University of Florida College of Medicine-Jacksonville, Jacksonville, FL
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26
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Landry EC, Yong M, Pauwels J, Chadha NK. The use of video glasses improved learning of tonsillectomy and adenoidectomy surgery: A randomized controlled trial. Int J Pediatr Otorhinolaryngol 2019; 117:12-16. [PMID: 30579065 DOI: 10.1016/j.ijporl.2018.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE One of the most common challenges in surgical education for trainees is gaining practical experience through observing procedures in the operating room. Due to the nature of some procedures, a narrow surgical view severely limits the learning experience. Video glasses are new devices that offer the potential to project the primary surgeon's exact view to learners in real-time, allowing for an enhanced operative learning experience. STUDY DESIGN Single center randomized prospective trial. SETTING Tertiary care pediatric hospital. PARTICIPANTS Using block randomization, medical students and surgical residents observed either a tonsillectomy or adenoidectomy, either directly at table-side or by real-time video feed from the surgeon's video glasses projected to a screen in the operating room, in random order. Participants then completed a survey comparing aspects of their learning experience viewing the procedure through the video feed in comparison to direct observation. MAIN OUTCOME MEASURES Evaluating the hypothesis that video glasses provided an improved overall learning experience and a realistic simulation of the open surgical procedures tested. RESULTS 23 trainees participated in the study. Survey results demonstrated that the overall learning experience with the use of video glasses was significantly improved when compared to direct visualization (average Visual Analog Scale (VAS) score 82/100 vs. 64/100, p = 0.021). Video glasses were shown to be superior when comparing the view of the surgical field (83/100 vs. 54/100 on VAS, p < 0.001) and the ability to identify anatomical structures (79/100 vs. 56/100 on VAS, p = 0.001). The ease of following surgical steps with video glasses was also shown to be better than by direct visualization (81/100 vs. 69/100 on VAS, p = 0.039). All participants stated that video glasses closely simulated the learning environment of the real-life open procedure. CONCLUSION This study showed that the use of video glasses was beneficial for surgical education and a realistic tool for learners at varying levels of training. Video glasses may significantly improve the learning experience for procedures with a narrow field of view.
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Affiliation(s)
- Evie C Landry
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | - Michael Yong
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Julie Pauwels
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Neil K Chadha
- Division of Pediatric Otolaryngology-Head and Neck Surgery, BC Children's Hospital, University of British Columbia, Vancouver, Canada
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27
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McCullough MC, Kulber L, Sammons P, Santos P, Kulber DA. Google Glass for Remote Surgical Tele-proctoring in Low- and Middle-income Countries: A Feasibility Study from Mozambique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1999. [PMID: 30656104 PMCID: PMC6326622 DOI: 10.1097/gox.0000000000001999] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Untreated surgical conditions account for one-third of the total global burden of disease, and a lack of trained providers is a significant contributor to the paucity of surgical care in low- and middle-income countries (LMICs). Wearable technology with real-time tele-proctoring has been demonstrated in high-resource settings to be an innovative method of advancing surgical education and connecting providers, but application to LMICs has not been well-described. METHODS Google Glass with live-stream capability was utilized to facilitate tele-proctoring between a surgeon in Mozambique and a reconstructive surgeon in the United States over a 6-month period. At the completion of the pilot period, a survey was administered regarding the acceptability of the image quality as well as the overall educational benefit of the technology in different surgical contexts. RESULTS Twelve surgical procedures were remotely proctored using the technology. No complications were experienced in any patients. Both participants reported moderate visual impairment due to image distortion and light over-exposure. Video-stream latency and connection disruption were also cited as limitations. Overall, both participants reported that the technology was highly useful as training tool in both the intraoperative and perioperative setting. CONCLUSIONS Our experience in Mozambique demonstrates the feasibility of wearable technology to enhance the reach and availability of specialty surgical training in LMICs. Despite shortcomings in the technology and logistical challenges inherent to international collaborations, this educational model holds promise for connecting surgeons across the globe and introducing expanded access to education and mentorship in areas with limited opportunities for surgical trainees.
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Affiliation(s)
- Meghan C McCullough
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
| | | | - Patrick Sammons
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
| | - Pedro Santos
- Department of Surgery, Matola Hospital, Matola, Mozambique
| | - David A Kulber
- Division of Plastic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, Calif
- Department of Plastic and Reconstructive Surgery, Cedars Sinai Hospital, Los Angeles, Calif
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28
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Piegari G, Iovane V, Carletti V, Fico R, Costagliola A, De Biase D, Prisco F, Paciello O. Assessment of Google Glass for Photographic Documentation in Veterinary Forensic Pathology: Usability Study. JMIR Mhealth Uhealth 2018; 6:e180. [PMID: 30249586 PMCID: PMC6231880 DOI: 10.2196/mhealth.9975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/03/2018] [Accepted: 05/08/2018] [Indexed: 02/06/2023] Open
Abstract
Background Google Glass is a head-mounted device designed in the shape of a pair of eyeglasses equipped with a 5.0-megapixel integrated camera and capable of taking pictures with simple voice commands. Objective The objective of our study was to determine whether Google Glass is fit for veterinary forensic pathology purposes. Methods A total of 44 forensic necropsies of 2 different species (22 dogs and 22 cats) were performed by 2 pathologists; each pathologist conducted 11 necropsies of each species and, for each photographic acquisition, the images were taken with a Google Glass device and a Nikon D3200 digital single-lens reflex (DSLR) camera. The pictures were collected, divided into 3 groups (based on the external appearance of the animal, organs, and anatomical details), and evaluated by 5 forensic pathologists using a 5-point score system. The parameters assessed were overall color settings, region of interest, sharpness, and brightness. To evaluate the difference in mean duration between necropsies conduced with Google Glass and DSLR camera and to assess the battery consumption of the devices, an additional number of 16 necropsies were performed by the 2 pathologists. In these cases, Google Glass was used for photographic reports in 8 cases (4 dogs and 4 cats) and a Nikon D3200 reflex camera in the other 8 cases. Statistical evaluations were performed to assess the differences in ratings between the quality of the images taken with both devices. Results The images taken with Google Glass received significantly lower ratings than those acquired with reflex camera for all 4 assessed parameters (P<.001). In particular, for the pictures of Groups A and B taken with Google Glass, the sum of frequency of ratings 5 (very good) and 4 (good) was between 50% and 77% for all 4 assessed parameters. The lowest ratings were observed for the pictures of Group C, with a sum of frequency of ratings 5 and 4 of 21.1% (342/1602) for region of interest, 26% (421/1602) for sharpness, 35.5% (575/1602) for overall color settings, and 61.4% (995/1602) for brightness. Furthermore, we found a significant reduction in the mean execution time for necropsy conduced with the Google Glass with respect to the reflex group (P<.001). However, Google Glass drained the battery very quickly. Conclusions These findings suggest that Google Glass is usable in veterinary forensic pathology. In particular, the image quality of Groups A and B seemed adequate for forensic photographic documentation purposes, although the quality was lower than that with the reflex camera. However, in this step of development, the high frequency of poor ratings observed for the pictures of Group C suggest that the device is not suitable for taking pictures of small anatomical details or close-ups of the injuries.
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Affiliation(s)
- Giuseppe Piegari
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | | | - Vincenzo Carletti
- Department of Information and Electrical Engineering and Applied Mathematics, University of Salerno, Fisciano, Italy
| | - Rosario Fico
- Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana, National Center for the Forensic Veterinary Medicine, Grosseto, Italy
| | - Alessandro Costagliola
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Davide De Biase
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Francesco Prisco
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
| | - Orlando Paciello
- Department of Veterinary Medicine and Animal Production, University of Naples Federico II, Naples, Italy
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Clark J, Crandall P, Shabatura J. Wearable Technology Effects on Training Outcomes of Restaurant Food Handlers. J Food Prot 2018; 81:1220-1226. [PMID: 29963922 DOI: 10.4315/0362-028x.jfp-18-033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Food safety training does not always result in behavior change, perhaps because of flaws inherent in traditional training designs. New technologies such as augmented reality headsets or head-mounted action cameras could transform the way food safety training is conducted in the food industry. Training conducted with wearable technology presents visual content in the first-person or actor's perspective, as opposed to the traditional third-person or observer perspective. This visual hands-on first-person perspective may provide an effective way of conveying information and encouraging behavior execution because it uses the mirror neuron system. There is little published literature about the impact of perspective on food safety training outcomes, such as motivation. The present study included a repeated-measures design to determine how first- and third-person camera angles affected hand washing training reactions among 108 currently employed restaurant food handlers. Participants were assessed on their posttraining compliance intentions, compliance self-efficacy, perceived utility of the training, overall satisfaction with the training, and video perspective preference. A significant proportion of food handlers (64%) preferred the first-person video perspective ( z = 5.00, P < 0.001), and a significant correlation was found between compliance intentions and compliance self-efficacy ( r(108) = 0.361, P < 0.001) for the first-person video. No significant differences in video preference were found for demographic variables, including age (χ2 (2, n = 104) = 1.69, P = 0.430), which suggests that the first-person training format appeals to a diverse workforce. These findings support the application of wearable technology to enhance hand washing training outcomes across a wide range of demographic groups. This research lays the framework for future studies to assess the impact of instructional design on compliance concerning hand washing and other food handling behaviors.
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Affiliation(s)
- Jeffrey Clark
- 1 University of Arkansas, 2650 North Young Avenue, Fayetteville, Arkansas 72704; and
| | - Phil Crandall
- 1 University of Arkansas, 2650 North Young Avenue, Fayetteville, Arkansas 72704; and
| | - Jessica Shabatura
- 2 University of Arkansas Global Campus, 2 East Center Street, Fayetteville, Arkansas 72701, USA
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Wei NJ, Dougherty B, Myers A, Badawy SM. Using Google Glass in Surgical Settings: Systematic Review. JMIR Mhealth Uhealth 2018; 6:e54. [PMID: 29510969 PMCID: PMC5861300 DOI: 10.2196/mhealth.9409] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/13/2018] [Accepted: 01/17/2018] [Indexed: 12/13/2022] Open
Abstract
Background In recent years, wearable devices have become increasingly attractive and the health care industry has been especially drawn to Google Glass because of its ability to serve as a head-mounted wearable device. The use of Google Glass in surgical settings is of particular interest due to the hands-free device potential to streamline workflow and maintain sterile conditions in an operating room environment. Objective The aim is to conduct a systematic evaluation of the literature on the feasibility and acceptability of using Google Glass in surgical settings and to assess the potential benefits and limitations of its application. Methods The literature was searched for articles published between January 2013 and May 2017. The search included the following databases: PubMed MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, PsycINFO (EBSCO), and IEEE Xplore. Two reviewers independently screened titles and abstracts and assessed full-text articles. Original research articles that evaluated the feasibility, usability, or acceptability of using Google Glass in surgical settings were included. This review was completed following the Preferred Reporting Results of Systematic Reviews and Meta-Analyses guidelines. Results Of the 520 records obtained, 31 met all predefined criteria and were included in this review. Google Glass was used in various surgical specialties. Most studies were in the United States (23/31, 74%) and all were conducted in hospital settings: 29 in adult hospitals (29/31, 94%) and two in children’s hospitals (2/31, 7%). Sample sizes of participants who wore Google Glass ranged from 1 to 40. Of the 31 studies, 25 (81%) were conducted under real-time conditions or actual clinical care settings, whereas the other six (19%) were conducted under simulated environment. Twenty-six studies were pilot or feasibility studies (84%), three were case studies (10%), and two were randomized controlled trials (6%). The majority of studies examined the potential use of Google Glass as an intraoperative intervention (27/31, 87%), whereas others observed its potential use in preoperative (4/31, 13%) and postoperative settings (5/31, 16%). Google Glass was utilized as a videography and photography device (21/31, 68%), a vital sign monitor (6/31, 19%), a surgical navigation display (5/31, 16%), and as a videoconferencing tool to communicate with remote surgeons intraoperatively (5/31, 16%). Most studies reported moderate or high acceptability of using Google Glass in surgical settings. The main reported limitations of using Google Glass utilization were short battery life (8/31, 26%) and difficulty with hands-free features (5/31, 16%). Conclusions There are promising feasibility and usability data of using Google Glass in surgical settings with particular benefits for surgical education and training. Despite existing technical limitations, Google Glass was generally well received and several studies in surgical settings acknowledged its potential for training, consultation, patient monitoring, and audiovisual recording.
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Affiliation(s)
- Nancy J Wei
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Bryn Dougherty
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Aundria Myers
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States
| | - Sherif M Badawy
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Pediatrics, Division of Hematology and Oncology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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