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Vrzáková H, Tapiala J, Iso-Mustajärvi M, Timonen T, Dietz A. Estimating Cognitive Workload Using Task-Related Pupillary Responses in Simulated Drilling in Cochlear Implantation. Laryngoscope 2024. [PMID: 38989899 DOI: 10.1002/lary.31612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVES Training of temporal bone drilling requires more than mastering technical skills with the drill. Skills such as visual imagery, bimanual dexterity, and stress management need to be mastered along with precise knowledge of anatomy. In otorhinolaryngology, these psychomotor skills underlie performance in the drilling of the temporal bone for access to the inner ear in cochlear implant surgery. However, little is known about how psychomotor skills and workload management impact the practitioners' continuous and overall performance. METHODS To understand how the practitioner's workload and performance unfolds over time, we examine task-evoked pupillary responses (TEPR) of 22 medical students who performed transmastoid-posterior tympanotomy (TMPT) and removal of the bony overhang of the round window niche in a 3D-printed model of the temporal bone. We investigate how students' TEPR metrics (Average Pupil Size [APS], Index of Pupil Activity [IPA], and Low/High Index of Pupillary Activity [LHIPA]) and time spent in drilling phases correspond to the performance in key drilling phases. RESULTS All TEPR measures revealed significant differences between key drilling phases that corresponded to the anticipated workload. Enlarging the facial recess lasted significantly longer than other phases. IPA captured significant increase of workload in thinning of the posterior canal wall, while APS revealed increased workload during the drilling of the bony overhang. CONCLUSION Our findings contribute to the contemporary competency-based medical residency programs where objective and continuous monitoring of participants' progress allows to track progress in expertise acquisition. Laryngoscope, 2024.
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Affiliation(s)
- Hana Vrzáková
- School of Computing, University of Eastern Finland, Joensuu, Finland
| | - Jesse Tapiala
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | - Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland
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London DA, Royse LA. The Evidence Basis for Learning Theory and Technology in Surgical Skills Training. J Am Acad Orthop Surg 2023:00124635-990000000-00684. [PMID: 37130374 DOI: 10.5435/jaaos-d-23-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Orthopaedic trainees face a complex and challenging training environment that is currently becoming more competency driven. Associated with these changes are an increasing introduction and use of a variety of technologically driven surgical training augments. Although these new learning resources can positively transform the educational environment, they must be used appropriately by both learners and educators. To aid in this, we review learning theories because they apply to surgical skills training and highlight recent surgical training evidence that demonstrates how technology use can be optimized to promote surgical learning, with an emphasis on procedural learning theory and cognitive load theory. Specifically, we review the evidence demonstrating the importance of targeting technology to a learner's experience level and methods to optimize cognitive load by managing intrinsic load, minimizing extraneous load, and maximizing germane load.
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Affiliation(s)
- Daniel A London
- From the Department of Orthopaedic Surgery, University of Missouri School of Medicine, Columbia, MO
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Goldsmith DM, Flash S, Holdnack J, Brennan PF. Designing Immersive Virtual Reality Environments for Supporting Patients at Home: Translating Input From Home Care Nurse Experts to Design Requirements. Comput Inform Nurs 2023; 41:142-152. [PMID: 35470311 PMCID: PMC9588849 DOI: 10.1097/cin.0000000000000895] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immersive virtual reality computer programs provide new experimental and treatment interventions that hold great promise for nursing. Immersive virtual reality uses sensory cues to represent real-world environments in a way that makes participants feel as if they are in a physical space different from the one in which they currently exist. As the acceptance of immersive virtual reality as a clinical and experimental tool has grown, so has the need to ensure that the context depicted in the environment mirrors both the sensory and the task requirements of the real-world situation. Here, we describe the use of nurse expert key informant group interviews to generate requirements that must be fulfilled in immersive virtual reality environments designed to evoke and engage participants in self-management tasks. An expert panel of four home care nurses participated in three sessions designed to elicit details of common home care challenges, frequency of variation, and typical participants. More than 20 potential scenarios were identified. The design team later used this information to create design requirements for two key scenarios and subsequently develop immersive virtual reality environments for use in research studies, mapping sensory and functional expectations to immersive virtual reality implementations. Challenges in mapping from key informant group findings to requirements are addressed.
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Affiliation(s)
- Denise M Goldsmith
- Author Affiliations: National Institute of Nursing Research, Advanced Visualization Branch (Ms Goldsmith, Ms Flash, Dr Holdnack, and Dr Brennan); and National Library of Medicine (Dr Brennan), Bethesda, MD
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Tokuno J, Carver TE, Fried GM. Measurement and Management of Cognitive Load in Surgical Education: A Narrative Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:208-215. [PMID: 36335034 DOI: 10.1016/j.jsurg.2022.10.001] [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: 04/19/2022] [Revised: 08/18/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Cognitive load should be considered in designing optimal educational programs in health care. Despite the highly demanding nature of surgery and surgical education, a consensus on how to manage cognitive load has not been established. The objective of this review is to map out how recent surgical education research incorporates cognitive load. METHODS A literature search was performed using keywords related to cognitive load and digital education up to December 2021. Studies published in English relevant to assessment and management of cognitive load in surgical education were included. Terminology, assessment tools, association with different surgical procedures and training modalities, and programs considering cognitive load were reported. RESULTS We identified several terms to describe cognitive load. Cognitive load was measured by subjective, self-reported questionnaires and by objective measurements, such as physiological parameters or estimated by reaction time to secondary tasks. Subjective measurements reported cognitive load in one or multiple dimensions. Correlations between subjective and objective measurements were shown in multiple studies. Overall, higher cognitive load was observed in training for more complex tasks and high-fidelity modalities, and among less experienced trainees. Cognitive load theory has been lately incorporated into designing teaching programs. CONCLUSIONS A broad range of terms and assessment tools were identified for cognitive load. To maximize the learning outcome, management of cognitive load is necessary in surgical education. This review summarizes the current knowledge in assessment and management of cognitive load in surgical education and provides suggestions for future studies.
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Affiliation(s)
- Junko Tokuno
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada
| | - Tamara E Carver
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine and Health Science, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada; Institute for Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Gerald M Fried
- Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Division of Experimental Surgery, McGill University, Montreal, Quebec, Canada; Department of Surgery, McGill University, Montreal, Quebec, Canada; Institute for Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
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5
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Zagury-Orly I, Solinski MA, Nguyen LH, Young M, Drozdowski V, Bain PA, Gantwerker EA. What is the Current State of Extended Reality Use in Otolaryngology Training? A Scoping Review. Laryngoscope 2023; 133:227-234. [PMID: 35548939 DOI: 10.1002/lary.30174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To map current literature on the educational use of extended reality (XR) in Otolaryngology-Head and Neck Surgery (OHNS) to inform teaching and research. STUDY DESIGN Scoping Review. METHODS A scoping review was conducted, identifying literature through MEDLINE, Ovid Embase, and Web of Science databases. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist. Studies were included if they involved OHNS trainees or medical students who used XR for an educational purpose in OHNS. XR was defined as: fully-immersive virtual reality (VR) using head-mounted displays (HMDs), non-immersive and semi-immersive VR, augmented reality (AR), or mixed reality (MR). Data on device use were extracted, and educational outcomes were analyzed according to Kirkpatrick's evaluation framework. RESULTS Of the 1,434 unique abstracts identified, 40 articles were included. All articles reported on VR; none discussed AR or MR. Twenty-nine articles were categorized as semi-immersive, none used occlusive HMDs therefore, none met modern definitions of immersive VR. Most studies (29 of 40) targeted temporal bone surgery. Using the Kirkpatrick four-level evaluation model, all studies were limited to level-1 (learner reaction) or level-2 (knowledge or skill performance). CONCLUSIONS Current educational applications of XR in OHNS are limited to VR, do not fully immerse participants and do not assess higher-level learning outcomes. The educational OHNS community would benefit from a shared definition for VR technology, assessment of skills transfer (level-3 and higher), and deliberate testing of AR, MR, and procedures beyond temporal bone surgery. Laryngoscope, 133:227-234, 2023.
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Affiliation(s)
- Ivry Zagury-Orly
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mark A Solinski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Lily Hp Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Meredith Young
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Veronica Drozdowski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric A Gantwerker
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Kim SY, Park H, Kim H, Kim J, Seo K. Technostress causes cognitive overload in high-stress people: Eye tracking analysis in a virtual kiosk test. Inf Process Manag 2022; 59:103093. [PMID: 36119755 PMCID: PMC9464304 DOI: 10.1016/j.ipm.2022.103093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/12/2022] [Accepted: 09/03/2022] [Indexed: 11/05/2022]
Abstract
In the midst of the COVID-19 pandemic, the use of non-face-to-face information and communication technology (ICT) such as kiosks has increased. While kiosks are useful overall, those who do not adapt well to these technologies experience technostress. The two most serious technostressors are inclusion and overload issues, which indicate a sense of inferiority due to a perceived inability to use ICT well and a sense of being overwhelmed by too much information, respectively. This study investigated the different effects of hybrid technostress-induced by both inclusion and overload issues-on the cognitive load among low-stress and high-stress people when using kiosks to complete daily life tasks. We developed a 'virtual kiosk test' to evaluate participants' cognitive load with eye tracking features and performance features when ordering burgers, sides, and drinks using the kiosk. Twelve low-stress participants and 13 high-stress participants performed the virtual kiosk test. As a result, regarding eye tracking features, high-stress participants generated a larger number of blinks, a longer scanpath length, a more distracted heatmap, and a more complex gaze plot than low-stress participants. Regarding performance features, high-stress participants took significantly longer to order and made more errors than low-stress participants. A support-vector machine (SVM) using both eye tracking features (i.e., number of blinks, scanpath length) and a performance feature (i.e., time to completion) best differentiated between low-stress and high-stress participants (89% accuracy, 100% sensitivity, 83.3% specificity, 75% precision, 85.7% F1 score). Overall, under technostress, high-stress participants experienced cognitive overload and consequently decreased performance; whereas, low-stress participants felt moderate arousal and improved performance. These varying effects of technostress can be interpreted through the Yerkes-Dodson law. Based on our findings, we proposed an adaptive interface, multimodal interaction, and virtual reality training as three implications for technostress relief in non-face-to-face ICT.
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Affiliation(s)
- Se Young Kim
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, 232 Gongneung-ro, Gongneung-dong, Nowon-gu, Seoul 01811, Republic of Korea
| | - Hahyeon Park
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, 232 Gongneung-ro, Gongneung-dong, Nowon-gu, Seoul 01811, Republic of Korea
| | - Hongbum Kim
- College of Business, Gachon University, Gyeonggi-do, Republic of Korea
| | - Joon Kim
- Korea Institute of Industrial Technology, Gyeonggi-do, Republic of Korea
| | - Kyoungwon Seo
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, 232 Gongneung-ro, Gongneung-dong, Nowon-gu, Seoul 01811, Republic of Korea
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Bruening DM, Truckenmueller P, Stein C, Fuellhase J, Vajkoczy P, Picht T, Acker G. 360° 3D virtual reality operative video for the training of residents in neurosurgery. Neurosurg Focus 2022; 53:E4. [DOI: 10.3171/2022.5.focus2261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/17/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Training of residents is an essential but time-consuming and costly task in the surgical disciplines. During the coronavirus disease 2019 pandemic, surgical education became even more challenging because of the reduced caseload due to the increased shift to corona care. In this context, augmented 360° 3D virtual reality (VR) videos of surgical procedures enable effective off-site training through virtual participation in the surgery. The goal of this study was to establish and evaluate 360° 3D VR operative videos for neurosurgical training.
METHODS
Using a 360° camera, the authors recorded three standard neurosurgical procedures: a lumbar discectomy, brain metastasis resection, and clipping of an aneurysm. Combined with the stereoscopic view of the surgical microscope, 7- to 10-minute 360° 3D VR videos augmented with annotations, overlays, and commentary were created. These videos were then presented to the neurosurgical residents at the authors’ institution using a head-mounted display. Before viewing the videos, the residents were asked to fill out a questionnaire indicating their VR experience and self-assessment of surgical skills regarding the specific procedure. After watching the videos, the residents completed another questionnaire to evaluate their quality and usefulness. The parameters were scaled with a 5-point Likert scale.
RESULTS
Twenty-two residents participated in this study. The mean years of experience of the participants in neurosurgery was 3.2 years, ranging from the 1st through the 7th year of training. Most participants (86.4%) had no or less than 15 minutes of VR experience. The overall quality of the videos was rated good to very good. Immersion, the feeling of being in the operating room, was high, and almost all participants (91%) stated that 360° VR videos provide a useful addition to the neurosurgical training. VR sickness was negligible in the cohort.
CONCLUSIONS
In this study, the authors demonstrated the feasibility and high acceptance of augmented 360° 3D VR videos in neurosurgical training. Augmentation of 360° videos with complementary and interactive content has the potential to effectively support trainees in acquiring conceptual knowledge. Further studies are necessary to investigate the effectiveness of their use in improving surgical skills.
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Affiliation(s)
| | | | - Christian Stein
- Cluster of Excellence: “Matters of Activity. Image Space Material,” Humboldt University, Berlin
- gamelab.berlin, Cluster of Excellence: “Matters of Activity. Image Space Material,” Humboldt University, Berlin
| | - Josch Fuellhase
- Department of Neurosurgery, Charité–Universitätsmedizin Berlin
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité–Universitätsmedizin Berlin
| | - Thomas Picht
- Department of Neurosurgery, Charité–Universitätsmedizin Berlin
- Cluster of Excellence: “Matters of Activity. Image Space Material,” Humboldt University, Berlin
- Berlin Simulation and Training Center (BeST), Charité–Universitätsmedizin Berlin; and
| | - Gueliz Acker
- Department of Neurosurgery, Charité–Universitätsmedizin Berlin
- Berlin Institute of Health, BIH Academy, Clinician Scientist Program, Charité–Universitätsmedizin Berlin, Germany
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Growing Out of the Experience: How Subjective Experiences of Effort and Learning Influence the Use of Interleaved Practice. EDUCATIONAL PSYCHOLOGY REVIEW 2022. [DOI: 10.1007/s10648-022-09692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
In higher education, many students make poor learning strategy decisions. This, in part, results from the counterintuitive nature of effective learning strategies: they enhance long-term learning but also cost high initial effort and appear to not improve learning (immediately). This mixed-method study investigated how students make learning strategy decisions in category learning, and whether students can be supported to make effective strategy decisions through a metacognitive prompt, designed to support accurate monitoring of effort and learning. Participants (N = 150) studied painting styles through blocked and interleaved practice, rated their perceived effort and perceived learning across time, and chose between either blocked or interleaved practice. Half of the participants (N = 74) were provided with a metacognitive prompt that showed them how their subjective experiences per strategy changed across time and required them to relate these experiences to the efficacy of learning strategies. Results indicated that subjective experiences with interleaved practice improved across time: students’ perceived learning increased as their perceived effort decreased. Mediation analysis revealed that the increased feeling of learning increased the likelihood to select interleaved practice. The percentage of students who chose interleaved practice increased from 13 to 40%. Students’ learning strategy decisions, however, did not benefit from the metacognitive prompt. Qualitative results revealed that students initially had inaccurate beliefs about the efficacy of learning strategies, but on-task experiences overrode the influence of prior beliefs in learning strategy decisions. This study suggests that repeated monitoring of effort and learning have the potential to improve the use of interleaved practice.
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Bondzi-Simpson A, Lindo CJ, Hoy M, Lui JT. The Otolaryngology boot camp: a scoping review evaluating commonalities and appraisal for curriculum design and delivery. J Otolaryngol Head Neck Surg 2022; 51:23. [PMID: 35659365 PMCID: PMC9167522 DOI: 10.1186/s40463-022-00583-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 05/12/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Surgical boot camps are becoming increasingly popular in Otolaryngology-Head and Neck Surgery (OHNS) residency programs. Despite pioneering virtual reality and simulation-based surgical education, these boot camps have lacked critical appraisal. The objective of this article was to examine the adoption and utility of surgical boot camps in OHNS residency training programs around the world. DATA SOURCES Ovid Medline and PubMed databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for scoping reviews. Additionally, a grey literature search was performed. REVIEW METHODS Inclusion criteria were peer-reviewed publications and grey literature sources that reported on OHNS boot camps for the novice learner. The search was restricted to human studies published in English. Studies were excluded if they were not examining junior trainees. RESULTS A total of 551 articles were identified. Following removal of duplicates, screening, and full text review, 16 articles were included for analysis. Seven major boot camps were identified across various academic sites in the world. Most boot camps were one-day intensive camps incorporating a mixture of didactic, skill specific, and simulation sessions using an array of task trainers and high-fidelity simulators focusing on OHNS emergencies. Studies measuring trainee outcomes demonstrated improvement in trainee confidence, immediate knowledge, and skill acquisition. CONCLUSION Surgical boot camps appear to be an effective tool for short term knowledge and skill acquisition. Further studies should examine retention of skill and maintenance of confidence over longer intervals, as little is known about these lasting effects.
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Affiliation(s)
- Adom Bondzi-Simpson
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - C J Lindo
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Monica Hoy
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Justin T Lui
- Section of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada.
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Xu X. To social with social distance: a case study on a VR-enabled graduation celebration amidst the pandemic. VIRTUAL REALITY 2022; 27:1-13. [PMID: 35464641 PMCID: PMC9013491 DOI: 10.1007/s10055-022-00646-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/13/2022] [Indexed: 06/14/2023]
Abstract
This paper introduces a timely case study on a 3D virtual reality-enabled graduation celebration project that provided an alternative approach to celebrating university graduation amidst the COVID-19 pandemic. The project was carefully designed with fun, engaging, and interactive activities to compensate for the cancelation of the conventional commencement in spring 2020 due to the pandemic. More than 20 graduating students, faculty and staff members participated in a 2-h virtual reality live event appearing as 3D avatars on their own computers. Quantitative and qualitative data collected from 10 participants were analyzed for user experience, cognitive contribution, technology acceptance, and the feasibility. Results revealed that such a project was technologically sound, functionally acceptable, user-friendly, and practically implementable. The results also informed the lessons learned from the current design and the places to improve. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-022-00646-2.
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Affiliation(s)
- Xinhao Xu
- School of Information Science and Learning Technologies, University of Missouri, Columbia, MO USA
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11
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Hochstrasser K, Stoddard HA. Use of Cognitive Load Theory to Deploy Instructional Technology for Undergraduate Medical Education: a Scoping Review. MEDICAL SCIENCE EDUCATOR 2022; 32:553-559. [PMID: 35528294 PMCID: PMC9054949 DOI: 10.1007/s40670-021-01499-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Although new instructional technologies have been widely adopted, cognitive load theory (CLT) is rarely used to inform deployment of those technologies. This scoping review of published literature examined CLT use in the design of teaching technologies for medical students. Three databases were queried, and thematic characteristics were extracted. Fourteen articles met the inclusion criteria. Themes extracted were: Subjects that are inherently visual were contexts for innovations, more than half of the interventions used the CLT modality principle, and CLT-based interventions had mostly positive outcomes. CLT is advantageous for medical education, but its full scope is rarely applied. A broader range of subject areas may benefit from CLT-based teaching.
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Affiliation(s)
- Kevin Hochstrasser
- Emory University School of Medicine, MS-1020-003-1AE, 100 Woodruff Circle, P-378, Atlanta, GA 30322 USA
| | - Hugh A. Stoddard
- Emory University School of Medicine, MS-1020-003-1AE, 100 Woodruff Circle, P-378, Atlanta, GA 30322 USA
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12
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Maimon NB, Bez M, Drobot D, Molcho L, Intrator N, Kakiashvilli E, Bickel A. Continuous Monitoring of Mental Load During Virtual Simulator Training for Laparoscopic Surgery Reflects Laparoscopic Dexterity: A Comparative Study Using a Novel Wireless Device. Front Neurosci 2022; 15:694010. [PMID: 35126032 PMCID: PMC8811150 DOI: 10.3389/fnins.2021.694010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Cognitive Load Theory (CLT) relates to the efficiency with which individuals manipulate the limited capacity of working memory load. Repeated training generally results in individual performance increase and cognitive load decrease, as measured by both behavioral and neuroimaging methods. One of the known biomarkers for cognitive load is frontal theta band, measured by an EEG. Simulation-based training is an effective tool for acquiring practical skills, specifically to train new surgeons in a controlled and hazard-free environment. Measuring the cognitive load of young surgeons undergoing such training can help to determine whether they are ready to take part in a real surgery. In this study, we measured the performance of medical students and interns in a surgery simulator, while their brain activity was monitored by a single-channel EEG. Methods A total of 38 medical students and interns were divided into three groups and underwent three experiments examining their behavioral performances. The participants were performing a task while being monitored by the Simbionix LAP MENTOR™. Their brain activity was simultaneously measured using a single-channel EEG with novel signal processing (Aurora by Neurosteer®). Each experiment included three trials of a simulator task performed with laparoscopic hands. The time retention between the tasks was different in each experiment, in order to examine changes in performance and cognitive load biomarkers that occurred during the task or as a result of nighttime sleep consolidation. Results The participants’ behavioral performance improved with trial repetition in all three experiments. In Experiments 1 and 2, delta band and the novel VC9 biomarker (previously shown to correlate with cognitive load) exhibited a significant decrease in activity with trial repetition. Additionally, delta, VC9, and, to some extent, theta activity decreased with better individual performance. Discussion In correspondence with previous research, EEG markers delta, VC9, and theta (partially) decreased with lower cognitive load and higher performance; the novel biomarker, VC9, showed higher sensitivity to lower cognitive load levels. Together, these measurements may be used for the neuroimaging assessment of cognitive load while performing simulator laparoscopic tasks. This can potentially be expanded to evaluate the efficacy of different medical simulations to provide more efficient training to medical staff and measure cognitive and mental loads in real laparoscopic surgeries.
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Affiliation(s)
- Neta B. Maimon
- The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
- Neurosteer Ltd, Herzliya, Israel
- *Correspondence: Neta B. Maimon,
| | - Maxim Bez
- Medical Corps, Israel Defense Forces, Ramat Gan, Israel
| | - Denis Drobot
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Department of Surgery A, Galilee Medical Center, Nahariyya, Israel
| | | | - Nathan Intrator
- Neurosteer Ltd, Herzliya, Israel
- Blavatnik School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Eli Kakiashvilli
- Department of Surgery A, Galilee Medical Center, Nahariyya, Israel
| | - Amitai Bickel
- Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Department of Surgery A, Galilee Medical Center, Nahariyya, Israel
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Chao YP, Chuang HH, Hsin LJ, Kang CJ, Fang TJ, Li HY, Huang CG, Kuo TBJ, Yang CCH, Shyu HY, Wang SL, Shyu LY, Lee LA. Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial. JMIR Serious Games 2021; 9:e13124. [PMID: 34813485 PMCID: PMC8663656 DOI: 10.2196/13124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/02/2020] [Accepted: 09/10/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. OBJECTIVE The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. METHODS This pilot system-design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. RESULTS All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. CONCLUSIONS Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners' needs and prompted learning through the different video modules. TRIAL REGISTRATION ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641.
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Affiliation(s)
- Yi-Ping Chao
- Department of Computer Science and Information Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Hai-Hua Chuang
- Department of Family Medicine, Chang Gung Memorial Hospital, Taipei Branch & Linkou Main Branch, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Li-Jen Hsin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Chung-Jan Kang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Tuan-Jen Fang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan.,Department of Medical Biotechnology and Laboratory Science, Graduate Institute of Biomedical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Terry B J Kuo
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Cheryl C H Yang
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsin-Yih Shyu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Educational Technology, Tamkang University, New Taipei, Taiwan
| | - Shu-Ling Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Center of Teacher Education, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Liang-Yu Shyu
- Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan, Taiwan
| | - Li-Ang Lee
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Otorhinolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan.,Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan
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14
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Wainman B, Aggarwal A, Birk SK, Gill JS, Hass KS, Fenesi B. Virtual Dissection: An Interactive Anatomy Learning Tool. ANATOMICAL SCIENCES EDUCATION 2021; 14:788-798. [PMID: 33185976 DOI: 10.1002/ase.2035] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 10/13/2020] [Accepted: 11/09/2020] [Indexed: 06/11/2023]
Abstract
The novelty of three-dimensional visualization technology (3DVT), such as virtual reality (VR), has captured the interest of many educational institutions. This study's objectives were to (1) assess how VR and physical models impact anatomy learning, (2) determine the effect of visuospatial ability on anatomy learning from VR and physical models, and (3) evaluate the impact of a VR familiarization phase on learning. This within-subjects, crossover study recruited 78 undergraduate students who studied anatomical structures at both physical and VR models and were tested on their knowledge immediately and 48 hours after learning. There were no significant differences in test scores between the two modalities on both testing days. After grouping participants on visuospatial ability, low visuospatial ability learners performed significantly worse on anatomy knowledge tests compared to their high visuospatial ability counterparts when learning from VR immediately (P = 0.001, d = 1.515) and over the long-term (P = 0.003, d = 1.279). In contrast, both low and high visuospatial ability groups performed similarly well when learning from the physical model and tested immediately after learning (P = 0.067) and over the long-term (P = 0.107). These results differ from current literature which indicates that learners with low visuospatial ability are aided by 3DVT. Familiarizing participants with VR before the learning phase had no impact on learning (P = 0.967). This study demonstrated that VR may be detrimental to low visuospatial ability students, whereas physical models may allow all students, regardless of their visuospatial abilities, to learn similarly well.
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Affiliation(s)
- Bruce Wainman
- Department of Pathology and Molecular Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Education Program in Anatomy, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Akanksha Aggarwal
- Doctor of Medicine Program, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Sapriya K Birk
- Master of Public Health program, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jaskaran S Gill
- Doctor of Medicine Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katrina S Hass
- Master of Science in Biomedical Communications Program, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Fenesi
- Faculty of Education, University of Western Ontario, London, Ontario, Canada
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15
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Kaplan AD, Cruit J, Endsley M, Beers SM, Sawyer BD, Hancock PA. The Effects of Virtual Reality, Augmented Reality, and Mixed Reality as Training Enhancement Methods: A Meta-Analysis. HUMAN FACTORS 2021; 63:706-726. [PMID: 32091937 DOI: 10.1177/0018720820904229] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The objective of this meta-analysis is to explore the presently available, empirical findings on transfer of training from virtual (VR), augmented (AR), and mixed reality (MR) and determine whether such extended reality (XR)-based training is as effective as traditional training methods. BACKGROUND MR, VR, and AR have already been used as training tools in a variety of domains. However, the question of whether or not these manipulations are effective for training has not been quantitatively and conclusively answered. Evidence shows that, while extended realities can often be time-saving and cost-saving training mechanisms, their efficacy as training tools has been debated. METHOD The current body of literature was examined and all qualifying articles pertaining to transfer of training from MR, VR, and AR were included in the meta-analysis. Effect sizes were calculated to determine the effects that XR-based factors, trainee-based factors, and task-based factors had on performance measures after XR-based training. RESULTS Results showed that training in XR does not express a different outcome than training in a nonsimulated, control environment. It is equally effective at enhancing performance. CONCLUSION Across numerous studies in multiple fields, extended realities are as effective of a training mechanism as the commonly accepted methods. The value of XR then lies in providing training in circumstances, which exclude traditional methods, such as situations when danger or cost may make traditional training impossible.
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Affiliation(s)
| | | | | | | | - Ben D Sawyer
- 6243 University of Central Florida, Orlando, USA
| | - P A Hancock
- 6243 University of Central Florida, Orlando, USA
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16
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McDonald C, Davis M, Benson C. Using Evidence-Based Learning Theories to Guide the Development of Virtual Simulations. CLINICAL SOCIAL WORK JOURNAL 2021; 49:197-206. [PMID: 33967354 PMCID: PMC8090927 DOI: 10.1007/s10615-021-00809-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 06/12/2023]
Abstract
Technology-enhanced training such as virtual simulations can be effective only to the extent evidence-based principles of learning are integrated into their training platforms. Assuming skill acquisition is the target of training, programs should include time and space for repeated practice opportunities structured through evidence-based learning theories (Amodeo et al. in Adm Soc Work 33:423-438, 2009). Essential learning attributes derived from Cognitive Load Theory (Sweller in Cognit Sci 12:257-285, 1988) and the Theory of Deliberate Practice (Ericsson et al. in Psychol Rev 100:363-406, 1993) can effectively integrate into virtual simulations intended to build expertise. Virtual Home Simulation (VHS) and Virtual Motivational Interviewing (VMI) are presented in this paper as an approach to develop virtual simulations that provide child welfare workers a means to deliberately practice essential skills toward competence before entering the workforce. This paper reviews the development process, specific design aspects, and lessons learned as a guide on how to integrate effective learning attributes. Implications for using virtual simulations, including cost-benefits, measuring performance over time, and addressing training complications due to Covid-19 or similar obstacles, are also provided.
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Affiliation(s)
- Chad McDonald
- Social Research Institute, University of Utah, 395 S. 1500 E., Salt Lake City, UT 84112 USA
| | - Matt Davis
- Division of Health System Innovation & Research (HSIR), Department of Population Health Sciences, University of Utah, Williams Building, Rm 1N410, 295 Chipeta Way, Salt Lake City, UT 84108 USA
| | - Cole Benson
- Social Research Institute, University of Utah, 395 S. 1500 E., Salt Lake City, UT 84112 USA
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17
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Frithioff A, Frendø M, Pedersen DB, Sørensen MS, Wuyts Andersen SA. 3D-Printed Models for Temporal Bone Surgical Training: A Systematic Review. Otolaryngol Head Neck Surg 2021; 165:617-625. [PMID: 33650897 DOI: 10.1177/0194599821993384] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE 3D-printed models hold great potential for temporal bone surgical training as a supplement to cadaveric dissection. Nevertheless, critical knowledge on manufacturing remains scattered, and little is known about whether use of these models improves surgical performance. This systematic review aims to explore (1) methods used for manufacturing and (2) how educational evidence supports using 3D-printed temporal bone models. DATA SOURCES PubMed, Embase, the Cochrane Library, and Web of Science. REVIEW METHODS Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, relevant studies were identified and data on manufacturing and validation and/or training extracted by 2 reviewers. Quality assessment was performed using the Medical Education Research Study Quality Instrument tool; educational outcomes were determined according to Kirkpatrick's model. RESULTS The search yielded 595 studies; 36 studies were found eligible and included for analysis. The described 3D-printed models were based on computed tomography scans from patients or cadavers. Processing included manual segmentation of key structures such as the facial nerve; postprocessing, for example, consisted of removal of print material inside the model. Overall, educational quality was low, and most studies evaluated their models using only expert and/or trainee opinion (ie, Kirkpatrick level 1). Most studies reported positive attitudes toward the models and their potential for training. CONCLUSION Manufacturing and use of 3D-printed temporal bones for surgical training are widely reported in the literature. However, evidence to support their use and knowledge about both manufacturing and the effects on subsequent surgical performance are currently lacking. Therefore, stronger educational evidence and manufacturing knowhow are needed for widespread implementation of 3D-printed temporal bones in surgical curricula.
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Affiliation(s)
- Andreas Frithioff
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - Martin Frendø
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
| | - David Bue Pedersen
- Department of Mechanical Engineering, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark
| | - Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head and Neck Surgery & Audiology, Rigshospitalet, Copenhagen, Denmark.,Copenhagen Academy for Medical Education and Simulation (CAMES), Center for HR & Education, Region H, Copenhagen, Denmark
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18
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19
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Robinson DA, Piekut DT, Hasman L, Knight PA. Cadaveric Simulation Training in Cardiothoracic Surgery: A Systematic Review. ANATOMICAL SCIENCES EDUCATION 2020; 13:413-425. [PMID: 31232510 DOI: 10.1002/ase.1908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 06/19/2019] [Accepted: 06/19/2019] [Indexed: 06/09/2023]
Abstract
Simulation training has become increasingly relevant in the educational curriculum of surgical trainees. The types of simulation models used, goals of simulation training, and an objective assessment of its utility and effectiveness are highly variable. The role and effectiveness of cadaveric simulation in cardiothoracic surgical training has not been well established. The objective of this study was to evaluate the current medical literature available on the utility and the effectiveness of cadaveric simulation in cardiothoracic surgical residency training. A literature search was performed using PubMed, Cochrane Library, Embase, Scopus, and CINAHL from inception to February 2019. Of the 362 citations obtained, 23 articles were identified and retrieved for full review, yielding ten eligible articles that were included for analysis. One additional study was identified and included in the analysis. Extraction of data from the selected articles was performed using predetermined data fields, including study design, study participants, simulation task, performance metrics, and costs. Most of these studies were only descriptive of a cadaveric or perfused cadaveric simulation model that could be used to augment clinical operative training in cardiothoracic surgery. There is a paucity of evidence in the literature that specifically evaluates the utility and the efficacy of cadavers in cardiothoracic surgery training. Of the few studies that have been published in the literature, cadaveric simulation does seem to have a role in cardiothoracic surgery training beyond simply learning basic skills. Additional research in this area is needed.
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Affiliation(s)
- Davida A Robinson
- Division of Cardiac Surgery, Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Diane T Piekut
- Department of Neuroscience, School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Linda Hasman
- Division of Research and Clinical Information Services, University of Rochester, Rochester, New York
| | - Peter A Knight
- Division of Cardiac Surgery, Department of Surgery, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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20
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Andersen SAW, Frendø M, Guldager M, Sørensen MS. Understanding the effects of structured self-assessment in directed, self-regulated simulation-based training of mastoidectomy: A mixed methods study. J Otol 2019; 15:117-123. [PMID: 33293910 PMCID: PMC7691825 DOI: 10.1016/j.joto.2019.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 11/30/2022] Open
Abstract
Objective Self-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance. This study aims to explore the mechanisms underlying the positive effects of a structured self-assessment intervention during simulation-based training of mastoidectomy. Methods A prospective, educational cohort study of a novice training program consisting of directed, self-regulated learning with distributed practice (5x3 procedures) in a virtual reality temporal bone simulator. The intervention consisted of structured self-assessment after each procedure using a rating form supported by small videos. Semi-structured telephone interviews upon completion of training were conducted with 13 out of 15 participants. Interviews were analysed using directed content analysis and triangulated with quantitative data on secondary task reaction time for cognitive load estimation and participants’ self-assessment scores. Results Six major themes were identified in the interviews: goal-directed behaviour, use of learning supports for scaffolding of the training, cognitive engagement, motivation from self-assessment, self-assessment bias, and feedback on self-assessment (validation). Participants seemed to self-regulate their learning by forming individual sub-goals and strategies within the overall goal of the procedure. They scaffolded their learning through the available learning supports. Finally, structured self-assessment was reported to increase the participants’ cognitive engagement, which was further supported by a quantitative increase in cognitive load. Conclusions Structured self-assessment in simulation-based surgical training of mastoidectomy seems to promote cognitive engagement and motivation in the learning task and to facilitate self-regulated learning.
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Affiliation(s)
- Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.,The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark. Rigshospitalet, Afsnit 5404, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Martin Frendø
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.,The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark. Rigshospitalet, Afsnit 5404, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Mads Guldager
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.,The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for HR, the Capital Region of Denmark. Rigshospitalet, Afsnit 5404, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
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21
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Cognitive load and performance in immersive virtual reality versus conventional virtual reality simulation training of laparoscopic surgery: a randomized trial. Surg Endosc 2019; 34:1244-1252. [PMID: 31172325 DOI: 10.1007/s00464-019-06887-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 05/31/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Virtual reality simulators combined with head-mounted displays enable highly immersive virtual reality (VR) for surgical skills training, potentially bridging the gap between the simulation environment and real-life operating room conditions. However, the increased complexity of the learning situation in immersive VR could potentially induce high cognitive load thereby inhibiting performance and learning. This study aims to compare cognitive load and performance in immersive VR and conventional VR simulation training. METHODS A randomized controlled trial of residents (n = 31) performing laparoscopic salpingectomies with an ectopic pregnancy in either immersive VR or conventional VR simulation. Cognitive load was estimated by secondary-task reaction time at baseline, and during nonstressor and stressor phases of the procedure. Simulator metrics were used to evaluate performance. RESULTS Cognitive load was increased by 66% and 58% during immersive VR and conventional VR simulation, respectively (p < 0.001), compared to baseline. A light stressor induced a further increase in cognitive load by 15.2% and a severe stressor by 43.1% in the immersive VR group compared to 23% (severe stressor) in the conventional VR group. Immersive VR also caused a significantly worse performance on most simulator metrics. CONCLUSION Immersive VR simulation training induces a higher cognitive load and results in a poorer performance than conventional VR simulation training in laparoscopy. High extraneous load and element interactivity in the immersive VR are suggested as mechanisms explaining this finding. However, immersive VR offers some potential advantages over conventional VR such as more real-life conditions but we only recommend introducing immersive VR in surgical skills training after initial training in conventional VR.
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22
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Nestel D, Konge L. Celebrating scholarship in healthcare simulation: Medical teacher turns 40. MEDICAL TEACHER 2018; 40:649-651. [PMID: 29944053 DOI: 10.1080/0142159x.2018.1473563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Debra Nestel
- a Monash Institute for Health & Clinical Education , Monash University , Clayton , Australia
| | - Lars Konge
- b University of Copenhagen and Copenhagen Academy for Medical Education and Simulation (CAMES) , Copenhagen , Denmark
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