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Schöbel T, Schuschke L, Youssef Y, Rotzoll D, Theopold J, Osterhoff G. Immersive virtual reality in orthopedic surgery as elective subject for medical students : First experiences in curricular teaching. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:369-378. [PMID: 38575780 PMCID: PMC11052777 DOI: 10.1007/s00132-024-04491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Virtual reality (VR) simulators have been introduced for skills training in various medical disciplines to create an approximately realistic environment without the risk of patient harm and have improved to more immersive VR (iVR) simulators at affordable costs. There is evidence that training on VR simulators improves technical skills but its use in orthopedic training programs and especially in curricular teaching sessions for medical students are currently not well established. The aim of this study was to describe the implementation of a VR operating theater as an elective course for undergraduate medical students and to evaluate its effect on student learning. METHODS An elective course for 12 students was implemented during the summer semester of 2023. Using Oculus Quest 2 headsets (Reality Labs, Meta Platforms, USA) and controllers and the PrecisionOS platform, they were able to train five different surgical procedures. The courses were accompanied by weekly topic discussions and instructional videos. Students were assigned to two groups: group VR vs. group non-VR. The groups were switched after 5 weeks. User feedback and performance development (theoretical and procedural surgical knowledge) after VR training were assessed using three questionnaires. RESULTS The students highly appreciated the implementation of VR training into their curriculum and 91% stated that they would opt for further VR training. All students stated that VR training improved their understanding of surgical procedures and that it should be obligatory in surgical training for undergraduate medical students. After 5 weeks of training, students in the VR group achieved significantly better results (100 out of maximum 180 points) than the non-VR group (70 points, p = 0.0495) in procedural surgical knowledge. After completion of the VR training the VR group achieved 106 points and the non-VR group 104 points (p = 0.8564). The procedural knowledge for non-VR group after 5 weeks significantly improved after VR training from 70 to 106 points (p = 0.0087). CONCLUSION The iVR can be easily integrated into the curriculum of medical students and is highly appreciated by the participants. The iVR statistically improves the procedural knowledge of surgical steps compared to conventional teaching methods. Further implementation of iVR training in curricular teaching of medical students should be considered.
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Affiliation(s)
- Tobias Schöbel
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Leonard Schuschke
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Yasmin Youssef
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Daisy Rotzoll
- Skills and Simulation Centre LernKlinik Leipzig, Faculty of Medicine, University of Leipzig, Liebigstraße 23/25, 04103, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Khoriati AA, Shahid Z, Fok M, Frank RM, Voss A, D'Hooghe P, Imam MA. Artificial intelligence and the orthopaedic surgeon: A review of the literature and potential applications for future practice: Current concepts. J ISAKOS 2024; 9:227-233. [PMID: 37949113 DOI: 10.1016/j.jisako.2023.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Al-Achraf Khoriati
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK.
| | - Zuhaib Shahid
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK.
| | - Margaret Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam Rd, High West, Hong Kong, China; Asia Pacific Orthopaedic Association, 57000, Malaysia.
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Joint Preservation Program, University of Colorado School of Medicine, 12631 E 17th Ave, Mail Stop B202, Aurora, CO 80045, USA.
| | - Andreas Voss
- Sporthopaedicum Regensburg, Street, Hildegard-von-Bingen-Straße 1, 93053, Regensburg, Germany.
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Aspire Zone, Sportscity Street 1, P.O. Box 29222, Doha, Qatar
| | - Mohamed A Imam
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK; Smart Health Centre, University of East London, University Way, London, E16 2RD, United Kingdom.
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Rahman OF, Kunze KN, Yao K, Kwiecien SY, Ranawat AS, Banffy MB, Kelly BT, Galano GJ. Hip Arthroscopy Simulator Training With Immersive Virtual Reality Has Similar Effectiveness to Nonimmersive Virtual Reality. Arthroscopy 2024:S0749-8063(24)00207-X. [PMID: 38513878 DOI: 10.1016/j.arthro.2024.02.042] [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] [Received: 08/23/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To (1) compare the efficacy of immersive virtual reality (iVR) to nonimmersive virtual reality (non-iVR) training in hip arthroscopy on procedural and knowledge-based skills acquisition and (2) evaluate the relative cost of each platform. METHODS Fourteen orthopaedic surgery residents were randomized to simulation training utilizing an iVR Hip Arthroscopy Simulator (n = 7; PrecisionOS) or non-iVR simulator (n = 7; ArthroS Hip VR; VirtaMed). After training, performance was assessed on a cadaver by 4 expert hip arthroscopists through arthroscopic video review of a diagnostic hip arthroscopy. Performance was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and Arthroscopic Surgery Skill Evaluation Tool (ASSET) scores. A cost analysis was performed using the transfer effectiveness ratio (TER) and a direct cost comparison of iVR to non-iVR. RESULTS Demographic characteristics did not differ between treatment arms or by training level, hip arthroscopy experience, or prior simulator use. No significant differences were observed in OSATS and ASSET scores between iVR and non-iVR cohorts (OSATS: iVR 19.6 ± 4.4, non-iVR 21.0 ± 4.1, P = .55; ASSET: iVR 23.7 ± 4.5, non-iVR 25.8 ± 4.8, P = .43). The absolute TER was 0.06 and there was a 132-fold cost difference of iVR to non-iVR. CONCLUSIONS Hip arthroscopy simulator training with iVR had similar performance results to non-iVR for technical skill and procedural knowledge acquisition after expert arthroscopic video assessment. The iVR platform had similar effectiveness in transfer of skill compared to non-iVR with a 132 times cost differential. CLINICAL RELEVANCE: Due to the accessibility, effectiveness, and relative affordability, iVR training may be beneficial in the future of safe arthroscopic hip training.
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Affiliation(s)
- Omar F Rahman
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A.; Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A..
| | - Kyle N Kunze
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kaisen Yao
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
| | - Susan Y Kwiecien
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
| | - Anil S Ranawat
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Michael B Banffy
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
| | - Bryan T Kelly
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Gregory J Galano
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
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Kenanidis E, Boutos P, Voulgaris G, Zgouridou A, Gkoura E, Gamie Z, Papagiannakis G, Tsiridis E. Effectiveness of virtual reality compared to video training on acetabular cup and femoral stem implantation accuracy in total hip arthroplasty among medical students: a randomised controlled trial. INTERNATIONAL ORTHOPAEDICS 2024; 48:625-633. [PMID: 37993676 PMCID: PMC10901922 DOI: 10.1007/s00264-023-06038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Virtual reality (VR) training effectiveness in improving hip arthroplasty surgical skills requires further evaluation. We hypothesised VR training could improve accuracy and the time taken by medical students compared to a control group with only video teaching. METHODS This single-centre randomized controlled clinical trial collected data from March to June 2023. Surgically naïve volunteer undergraduate medical students performed three sessions on a VR training platform, either cup (VR-Cup=Control-Stem) or stem (VR-Stem=Control-Cup) implantation. The primary outcome was the mean difference between predefined cup inclination (60°) and stem anteversion (20°) compared to the actual implanted values in sawbones between VR and control groups. Secondary outcomes were task completion time and mistake number between the groups. RESULTS A total of 101 students participated (VR-Cup 47, VR-Stem 54). Groups did not significantly differ concerning age (p = 0.879), gender (p = 0.408), study year (p = 0.938), previous VR use (p = 0.269) and baseline medical and procedural knowledge. The VR-Cup implanted the cup closer to the intended target (p < 0.001) and faster than the Control-Cup group (p = 0.113). The VR-Stem implanted the stem closer to the intended target (p = 0.008) but not faster than the Control-Cup group (p = 0.661). Stem retroversion was commoner in the Control-Stem than in the VR-Stem group (p = 0.016). CONCLUSIONS VR training resulted in higher rates of accurate procedure completion, reduced time and fewer errors compared to video teaching. VR training is an effective method for improving skill acquisition in THA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05807828.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece.
| | - Panagiotis Boutos
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Grigorios Voulgaris
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Aikaterini Zgouridou
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Eleni Gkoura
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Zakareya Gamie
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - George Papagiannakis
- Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Greece
- Department of Computer Science, University of Crete, Heraklion, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
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Meng L, Liu X, Ni J, Shen P, Jiao F. An investigation for the efficacy of teaching model of combining virtual simulation and real experiment for clinical microbiology examination. Front Med (Lausanne) 2024; 11:1255088. [PMID: 38449889 PMCID: PMC10915005 DOI: 10.3389/fmed.2024.1255088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
Background As a convenient teaching tool, virtual simulation experiment technology had been widely utilized in the field of medical education. However, virtual learning could not fully replace the benefits of in-person instruction. Therefore, finding ways to integrate both methods was crucial for achieving optimal educational outcomes. The objective of this study was to compare the effectiveness of the self-built virtual simulation and design experiment combining teaching mode and the traditional experimental teaching mode in the clinical microbiology examination experiment teaching. Methods This study was conducted at Shandong First Medical University in China. The experimental group consisted of 100 third-year students from the grade 2020 majoring in medical examination technology, who underwent an innovative teaching model combining virtual and real experiments. The control group comprised of 100 third-year students from the grade 2019 in the same major, who received traditional experimental teaching model. In this study, we referred to grade 2020 as cohort 2020 and grade 2019 cohort 2019. The performance of both groups was assessed via experimental and theoretical testing. Meanwhile, survey questionnaires were administered to evaluate the efficacy of the innovative experimental teaching model and students' level of satisfaction with it. Cohort 2020 conducted a survey for modules 1 to 4, while cohort 2019 only conducted a survey for module 4, as detailed in the Appendix. Results The majority of students in the experimental group expressed satisfaction with the teaching model that combined virtual and real experiments, as evidenced by their superior performance on both experimental operational skills (87.54 ± 8.93 vs. 82.39 ± 10.55) and theoretical knowledge tests (83.65 ± 9.02 vs. 80.18 ± 8.24) compared to those in the control group. Conclusion The combination of virtual simulation experiment and design experiment in the microbiological examination of clinical specimens represented an effective pedagogical approach. The instructional approach had the potential to incite a passion for learning, enhance proficiency in standardized experimental techniques, foster the ability to integrate theory with practice, and cultivate clinical reasoning skills.
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Affiliation(s)
| | | | | | | | - Fengping Jiao
- School of Public Health, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
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Wan T, Liu K, Li B, Wang X. Effectiveness of immersive virtual reality in orthognathic surgical education: A randomized controlled trial. J Dent Educ 2024; 88:109-117. [PMID: 37800654 DOI: 10.1002/jdd.13380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the efficacy of an iVR surgical training system for orthognathic surgery training in medical students. METHODS This study comprised 20 fifth year medical students who were randomly assigned to the VR or traditional group for orthognathic surgical education. All participants were initially provided a lecture on orthognathic surgery. The VR group then received 10 educational sessions using the self-developed iVR training system, whereas the traditional group received 10 sessions using technical manuals and annotated operation videos. These sessions were 40-min long in both the groups. Before the evaluation, the traditional group completed one session using the training and assessment modes to become familiar with the iVR training system. The score in the assessment mode, time to complete the procedure, number of instrument selection errors, number of prompts given by the system, number of positional and angular errors, and number of timeouts during each step were recorded to evaluate the learning effect. RESULTS The VR group achieved higher scores than the traditional group (94.67 vs. 87.65). Compared with the control group, the VR group completed the procedure more quickly, with fewer instrument selection and angular errors. No difference in the number of prompts given by the system was observed between the two groups. CONCLUSIONS The iVR surgical training system showed a better learning effect than the traditional learning method for orthognathic surgery. The iVR surgical training system may have utility as a supplement and potential substitute for the traditional surgical training method.
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Affiliation(s)
- Teng Wan
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Kai Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Biao Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
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Yi WS, Rouhi AD, Duffy CC, Ghanem YK, Williams NN, Dumon KR. A Systematic Review of Immersive Virtual Reality for Nontechnical Skills Training in Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:25-36. [PMID: 38036388 DOI: 10.1016/j.jsurg.2023.11.012] [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: 02/26/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Immersive virtual reality (IVR) can be utilized to provide low cost and easily accessible simulation on all aspects of surgical education. In addition to technical skills training in surgery, IVR simulation has been utilized for nontechnical skills training in domains such as clinical decision-making and pre-operative planning. This systematic review examines the current literature on the effectiveness of IVR for nontechnical skill acquisition in surgical education. DESIGN A literature search was performed using MEDLINE, EMBASE, and Web of Science for primary studies published between January 1, 1995 and February 9, 2022. Four reviewers screened titles, abstracts, full texts, extracted data, and analyzed included studies to answer 5 key questions: How is IVR being utilized in nontechnical skills surgical education? What is the methodological quality of studies? What technologies are being utilized? What metrics are reported? What are the findings of these studies? RESULTS The literature search yielded 2340 citations, with 12 articles included for qualitative synthesis. Of included articles, 33% focused on clinical decision-making and 67% on anatomy/pre-operative planning. Motion sickness was a recorded metric in 25% of studies, with an aggregate incidence of 13% (11/87). An application score was reported in 33% and time to completion in 16.7%. A commercially developed application was utilized in 25%, while 75% employed a noncommercial application. The Oculus Rift was used in 41.7% of studies, HTC Vive in 25%, Samsung Gear in 16.7% of studies, Google Daydream in 8%, and 1 study did not report. The mean Medical Education Research Quality Instrument (MERSQI) score was 10.3 ± 2.3 (out of 18). In all studies researching clinical decision-making, participants preferred IVR to conventional teaching methods and in a nonrandomized control study it was found to be more effective. Averaged across all studies, mean scores were 4.33 for enjoyment, 4.16 for utility, 4.11 for usability, and 3.73 for immersion on a 5-point Likert scale. CONCLUSIONS The IVR nontechnical skills applications for surgical education are designed for clinical decision-making or anatomy/pre-operative planning. These applications are primarily noncommercially produced and rely upon a diverse array of HMDs for content delivery, suggesting that development is primarily coming from within academia and still without clarity on optimal utilization of the technology. Excitingly, users find these applications to be immersive, enjoyable, usable, and of utility in learning. Although a few studies suggest that IVR is additive or superior to conventional teaching or imaging methods, the data is mixed and derived from studies with weak design. Motion sickness with IVR remains a complication of IVR use needing further study to determine the cause and means of mitigation.
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Affiliation(s)
- William S Yi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armaun D Rouhi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caoimhe C Duffy
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yazid K Ghanem
- Department of Surgery, Cooper University Hospital, Camden, New Jersey
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania.
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Kuhn AW, Yu JK, Gerull KM, Silverman RM, Aleem AW. Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives. JB JS Open Access 2024; 9:e23.00142. [PMID: 38511201 PMCID: PMC10950179 DOI: 10.2106/jbjs.oa.23.00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background The demonstrated benefits of virtual reality (VR) in orthopaedic surgical training are numerous. However, it is relatively unknown how best to implement VR into an already established orthopaedic resident education curriculum and how trainees will engage and use these technologies longitudinally. Methods This was an exploratory, qualitative research study performed in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. Orthopaedic surgery residents at a single institution were recruited during the 2022 to 2023 academic year. Semistructured interviews were conducted. Data were analyzed through grounded theory methodology, beginning with open coding, followed by axial coding, and concluding with selective coding that describes orthopaedic surgery residents' current perceptions of VR as a training tool. Results Six residents participated in interviews before thematic saturation was achieved. Average interview length was 13:27 (±2:59) minutes. Residents felt that currently, VR is most useful for interns and junior residents as an educational adjunct for learning anatomy, surgical exposures, and the steps of a procedure in a risk- and judgment-free arena. There seems to be a "ceiling effect" with VR given current technological limitations, and residents remarked that there is an associated "opportunity cost" with using VR technology. Some residents may find it more time-efficient to study texts, videos, or surgical guides rather than use VR. Cost (limited number of headsets) and technological barriers (i.e., hardware, software, and Wi-Fi issues) were some of the described barriers to VR utilization. Residents felt that there needs to be dedicated technological support to help with these issues. At this time, given these limitations of VR, many preferred VR as an optional educational adjunct rather than as a required curricular tool or assessment of surgical competency. Conclusions There is current utility for VR in orthopaedic surgical training. Future technological advances may make VR more central to resident education. This study describes resident perceptions about the technology and best use practices for the technology. Level of Evidence Qualitative Study, Level V Evidence.
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Affiliation(s)
- Andrew W. Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Justin K. Yu
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Katherine M. Gerull
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Richard M. Silverman
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alexander W. Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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Woodall WJ, Chang EH, Toy S, Lee DR, Sherman JH. Does Extended Reality Simulation Improve Surgical/Procedural Learning and Patient Outcomes When Compared With Standard Training Methods?: A Systematic Review. Simul Healthc 2024; 19:S98-S111. [PMID: 38240622 DOI: 10.1097/sih.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The use of extended reality (XR) technologies, including virtual, augmented, and mixed reality, has increased within surgical and procedural training programs. Few studies have assessed experiential learning- and patient-based outcomes using XR compared with standard training methods. METHODS As a working group for the Society for Simulation in Healthcare, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a PICO strategy to perform a systematic review of 4238 articles to assess the effectiveness of XR technologies compared with standard training methods. Outcomes were grouped into knowledge, time-to-completion, technical proficiency, reactions, and patient outcomes. Because of study heterogeneity, a meta-analysis was not feasible. RESULTS Thirty-two studies met eligibility criteria: 18 randomized controlled trials, 7 comparative studies, and 7 systematic reviews. Outcomes of most studies included Kirkpatrick levels of evidence I-III (reactions, knowledge, and behavior), while few reported level IV outcomes (patient). The overall risk of bias was low. With few exceptions, included studies showed XR technology to be more effective than standard training methods in improving objective skills and performance, shortening procedure time, and receiving more positive learner ratings. However, XR use did not show significant differences in gained knowledge. CONCLUSIONS Surgical or procedural XR training may improve technical skill development among trainees and is generally favored over standard training methods. However, there should be an additional focus on how skill development translates to clinically relevant outcomes. We recommend longitudinal studies to examine retention and transfer of training to clinical settings, methods to improve timely, adaptive feedback for deliberate practice, and cost analyses.
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Affiliation(s)
- William J Woodall
- From the Medical College of Georgia (W.J.W.), Augusta, GA; Department of Otolaryngology (E.H.C.), University of Arizona, Tucson, AZ; Departments of Basic Science Education and Health Systems & Implementation Science (S.T.), Virginia Tech Carilion School of Medicine, Roanoke, VA; University of Michigan School of Nursing (D.R.L.), Ann Arbor, MI; and WVU Rockefeller Neuroscience Institute (J.H.S.), Morgantown, WV
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Co M, Chiu S, Billy Cheung HH. Extended reality in surgical education: A systematic review. Surgery 2023; 174:1175-1183. [PMID: 37640664 DOI: 10.1016/j.surg.2023.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/06/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND This review aims to evaluate the effectiveness of extended reality-based training in surgical education. METHODS This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total of 33 studies were included in the qualitative analysis. Nine studies evaluated the effectiveness of virtual reality-based training against no substitutional training. Seven studies looked at training for laparoscopic surgery, and the results were contradicting. Two studies focused on orthopedics training, and the outcomes were positive. Fourteen studies compared the outcomes of virtual reality-based training to conventional didactic teaching, all demonstrating superior outcomes for virtual reality-based training. Nine studies compared the outcomes of virtual reality simulation training to dry lab simulation training. The inferior outcomes of virtual reality simulation training were demonstrated by 5 studies for laparoscopic surgery, 1 study for arthroscopic procedures, 1 study for robotic surgery, and 1 study for dental procedures. One study found potential benefits of virtual reality simulation training on orthopedics surgeries. One study found virtual reality simulation training to be superior to cadaveric training, and 3 studies found augmented reality and virtual reality-based training to be comparable to supervised operative opportunities. CONCLUSION Extended reality-based training is a potentially useful modality to serve as an adjunct to the current physical surgical training.
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Affiliation(s)
- Michael Co
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China.
| | - Shirley Chiu
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China
| | - Ho Hung Billy Cheung
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China
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11
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Plancher KD, Morrey BF, McMahon GT, Ruch DS, Petterson SC. AOA Critical Issues Symposium: Leadership and Education During and After COVID-19: Back to the Future or a New Normal. J Bone Joint Surg Am 2023; 105:1560-1564. [PMID: 37220193 DOI: 10.2106/jbjs.22.01356] [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] [Indexed: 05/25/2023]
Abstract
ABSTRACT The devastating impact of COVID-19 has reshaped how we lead and train our future surgeons in the field of orthopaedics. Overnight, leaders in our field had to dramatically shift their mindset to continue to lead a hospital, department, journal, or residency or fellowship program in the face of an unprecedented level of adversity in the history of the United States. This symposium discusses the role of physician leadership during and after a pandemic, as well as the adoption of technology for training surgeons in the field of orthopaedics.
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Affiliation(s)
- K D Plancher
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
- Weill Cornell Medical College, New York, NY
| | - B F Morrey
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
- Joe R. & Teresa Lozano Long School of Medicine, San Antonio, Texas
| | - G T McMahon
- Accreditation Council for Continuing Medical Education, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - D S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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12
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Jacobs C, Vaidya K, Medwell L, Old T, Joiner R. Case study of virtual reality sepsis management- instructional design and ITEM outcomes. J Vis Commun Med 2023; 46:168-177. [PMID: 37990908 DOI: 10.1080/17453054.2023.2280611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/23/2023] [Indexed: 11/23/2023]
Abstract
This case study focuses on the instructional design and outcomes of a virtual reality (VR) application for sepsis management in healthcare education. The instructional design of the VR sepsis application follows five principles adapted from Merrill's instructional design theory and Bloom's taxonomy. The VR simulation is structured to provide a coherent and realistic experience, with instructional materials and feedback incorporated to guide and support the learners. A pilot study was conducted with medical students on clinical placement. Participants experienced the VR sepsis simulation and completed a questionnaire using the Immersive Technology Evaluation Measure (ITEM) to assess their immersion, intrinsic motivation, cognitive load, system usability, and debrief feedback. Descriptive analysis of the data showed median scores indicating high immersion and presence, intrinsic motivation, and perceived learning. However, participants reported a moderately high cognitive load. Comparison with a neutral response to ITEM suggested that users had a significantly higher user experience (p < 0.05) in all domains. This case study highlights the potential of VR in healthcare education and its application in sepsis management. The findings suggest that the instructional design principles used in the VR application can effectively engage learners and provide a realistic learning experience. Further research and evaluation are necessary to assess the impact of VR on learning outcomes and its integration into healthcare education settings.
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Affiliation(s)
- Chris Jacobs
- Department for Health, University of Bath, Bath, UK
- Great Western Hospital, Swindon, UK
| | | | | | - Tim Old
- Great Western Hospital, Swindon, UK
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13
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Cate G, Barnes J, Cherney S, Stambough J, Bumpass D, Barnes CL, Dickinson KJ. Current status of virtual reality simulation education for orthopedic residents: the need for a change in focus. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:46. [PMID: 38013875 PMCID: PMC10032253 DOI: 10.1007/s44186-023-00120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
Introduction Advances in technology are changing surgical education. Simulation provides an important adjunct to operative experience. This pedagogy has arguably become more important in light of the COVID-19 pandemic, with resultant reduction in operative exposure for trainees. Virtual reality (VR) simulators may provide significant contribution to experiential learning; however, much of the investigative focus to date has, correctly, been on establishing validity evidence for these constructs. The aim of this work was to perform a scoping review to assess the current status of VR simulation education to determine curricular development efforts for orthopedic residents. Methods With a trained medical librarian, searches of PubMed, EMBASE, and Web of Science were conducted for all articles in the last 10 years (September 2011-September 2021). Controlled vocabulary Medical Subject Headings (MeSH) terms and natural language developed with subject matter experts describing virtual reality or VR simulation and orthopedic training were used. Two trained reviewers evaluated all abstracts for inclusion. Exclusion criteria were all articles that did not assess VR simulation education involving orthopedic residents. Data were extracted from the included full-text articles including: study design, type of participants, type of VR simulation, simulated orthopedic skill, type of educational event, learner assessment including Kirkpatrick's level, assessment of quality using the Medical Education Research Study Quality Instrument (MERSQI), and level of effectiveness (LoE). Results Initial search identified 1,394 articles, of which 61 were included in the final qualitative synthesis. The majority (54%) were published in 2019- 2021, 49% in Europe. The commonest VR simulator was ArthroS (23%) and the commonest simulated skill was knee arthroscopy (33%). The majority of studies (70%) focused on simulator validation. Twenty-three studies described an educational module or curriculum, and of the 21 (34%) educational modules, 43% were one-off events. Most modules (18/21, 86%) assessed learners at Kirkpatrick level 2. With regard to methodological quality, 44% of studies had MERSQI 11.5-15 and 89% of studies had LoE of 2. Two studies had LoE of 3. Conclusion Current literature pertaining to VR training for orthopedic residents is focused on establishing validity and rarely forms part of a curriculum. Where the focus is education, the majority are discrete educational modules and do not teach a comprehensive amalgam of orthopedic skills. This suggests focus is needed to embed VR simulation training within formal curricula efforts guided by the work of Kern, and assess the efficacy of these against patient outcomes.
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Affiliation(s)
- Graham Cate
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jack Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Steven Cherney
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jeffrey Stambough
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - David Bumpass
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - C. Lowry Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Karen J. Dickinson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR USA
- Office of Interprofessional Education, University of Arkansas for Medical Sciences, Little Rock, USA
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14
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Application of Virtual Reality Systems in Bone Trauma Procedures. Medicina (B Aires) 2023; 59:medicina59030562. [PMID: 36984563 PMCID: PMC10058640 DOI: 10.3390/medicina59030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Objectives: Bone fractures contribute significantly to the global disease and disability burden and are associated with a high and escalating incidence and tremendous economic consequences. The increasingly challenging climate of orthopaedic training and practice re-echoes the established potential of leveraging computer-based reality technologies to support patient-specific simulations for procedural teaching and surgical precision. Unfortunately, despite the recognised potential of virtual reality technologies in orthopaedic surgery, its adoption and integration, particularly in fracture procedures, have lagged behind other surgical specialities. We aimed to review the available virtual reality systems adapted for orthopaedic trauma procedures. Materials and Methods: We performed an extensive literature search in Medline (PubMed), Science Direct, SpringerLink, and Google Scholar and presented a narrative synthesis of the state of the art on virtual reality systems for bone trauma procedures. Results: We categorised existing simulation modalities into those for fracture fixation techniques, drilling procedures, and prosthetic design and implantation and described the important technical features, as well as their clinical validity and applications. Conclusions: Over the past decade, an increasing number of high- and low-fidelity virtual reality systems for bone trauma procedures have been introduced, demonstrating important benefits with regard to improving procedural teaching and learning, preoperative planning and rehearsal, intraoperative precision and efficiency, and postoperative outcomes. However, further technical developments in line with industry benchmarks and metrics are needed in addition to more standardised and rigorous clinical validation.
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15
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Zhang J, Lu V, Khanduja V. The impact of extended reality on surgery: a scoping review. INTERNATIONAL ORTHOPAEDICS 2023; 47:611-621. [PMID: 36645474 PMCID: PMC9841146 DOI: 10.1007/s00264-022-05663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Extended reality (XR) is defined as a spectrum of technologies that range from purely virtual environments to enhanced real-world environments. In the past two decades, XR-assisted surgery has seen an increase in its use and also in research and development. This scoping review aims to map out the historical trends in these technologies and their future prospects, with an emphasis on the reported outcomes and ethical considerations on the use of these technologies. METHODS A systematic search of PubMed, Scopus, and Embase for literature related to XR-assisted surgery and telesurgery was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies, peer-reviewed articles that described procedures performed by surgeons on human subjects and cadavers, as well as studies describing general surgical education, were included. Non-surgical procedures, bedside procedures, veterinary procedures, procedures performed by medical students, and review articles were excluded. Studies were classified into the following categories: impact on surgery (pre-operative planning and intra-operative navigation/guidance), impact on the patient (pain and anxiety), and impact on the surgeon (surgical training and surgeon confidence). RESULTS One hundred and sixty-eight studies were included for analysis. Thirty-one studies investigated the use of XR for pre-operative planning concluded that virtual reality (VR) enhanced the surgeon's spatial awareness of important anatomical landmarks. This leads to shorter operating sessions and decreases surgical insult. Forty-nine studies explored the use of XR for intra-operative planning. They noted that augmented reality (AR) headsets highlight key landmarks, as well as important structures to avoid, which lowers the chance of accidental surgical trauma. Eleven studies investigated patients' pain and noted that VR is able to generate a meditative state. This is beneficial for patients, as it reduces the need for analgesics. Ten studies commented on patient anxiety, suggesting that VR is unsuccessful at altering patients' physiological parameters such as mean arterial blood pressure or cortisol levels. Sixty studies investigated surgical training whilst seven studies suggested that the use of XR-assisted technology increased surgeon confidence. CONCLUSION The growth of XR-assisted surgery is driven by advances in hardware and software. Whilst augmented virtuality and mixed reality are underexplored, the use of VR is growing especially in the fields of surgical training and pre-operative planning. Real-time intra-operative guidance is key for surgical precision, which is being supplemented with AR technology. XR-assisted surgery is likely to undertake a greater role in the near future, given the effect of COVID-19 limiting physical presence and the increasing complexity of surgical procedures.
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Affiliation(s)
- James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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16
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Wan T, Liu K, Li B, Wang X. Validity of an immersive virtual reality training system for orthognathic surgical education. Front Pediatr 2023; 11:1133456. [PMID: 37033170 PMCID: PMC10078956 DOI: 10.3389/fped.2023.1133456] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Virtual reality (VR) has been proven an important supplement for surgical education in medical students. However, studies on immersive VR (iVR) simulation in orthognathic surgical education are limited. This study aimed to assess the validity of the iVR surgical training system for orthognathic surgery. Participants completed questionnaires at the end of the course to assess the validity of the training system. The questionnaires included questions on the experience of using the iVR system and surgical authenticity. Seven experienced surgeons and seven inexperienced students were recruited in this study to use our self-developed iVR training system for orthognathic surgery. The participants showed strong agreement to the fidelity of our training system (4.35 out of 5), including the virtual environment, instruments, anatomy structures, and surgical procedures. The participants also strongly agreed that the iVR technique was essential in imparting surgical education. However, most of the participants experienced some degree of dizziness or fatigue after 1 h of using the system. The iVR training system is a new method for imparting education about orthognathic surgery. The iVR training system can act as a supplement and potential substitute of the traditional surgical training method.
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Affiliation(s)
- Teng Wan
- Department of Oral and Craniomaxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Kai Liu
- Department of Oral and Craniomaxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
| | - Biao Li
- Department of Oral and Craniomaxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
- Correspondence: Xudong Wang Biao Li
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Clinical Research Center of Stomatology, Shanghai, China
- Correspondence: Xudong Wang Biao Li
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Shi H, Lu P, Yu D, Wang J, Wang Z, Zhuang B, Shao C, Liu C, Liu B. The training of wrist arthroscopy. Front Med (Lausanne) 2022; 9:947459. [PMID: 36590938 PMCID: PMC9800421 DOI: 10.3389/fmed.2022.947459] [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: 05/18/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
The wrist is a complex joint that bridges the hand to the forearm. Patients with wrist disorders increasingly prefer minimally invasive procedures for wrist joint diagnosis and treatment. Wrist arthroscopy offers direct visualization of the structures of the joint anatomy and existing disease processes while causing minimal damage to surrounding soft tissue. However, it requires a high level of technical ability for wrist arthroscopy practitioners. Therefore, an improved focus on wrist arthroscopy training combining new educational media and traditional practice should aid in the development of novel wrist arthroscopy training mode. This article aims to describe the status of wrist training and evaluation systems and introduce a new progressive wrist training system.
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Affiliation(s)
- Haifei Shi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Pan Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,Pan Lu
| | - Dongdong Yu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jiwen Wang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Zhenhua Wang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Baotang Zhuang
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Chao Shao
- China Academy of Space Technology, Beijing Institute of Control Engineering, Beijing, China
| | - Chang Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Xicheng District, Beijing, China
| | - Bo Liu
- Department of Hand Surgery, Beijing Ji Shui Tan Hospital, Xicheng District, Beijing, China,*Correspondence: Bo Liu
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18
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McKinney B, Dbeis A, Lamb A, Frousiakis P, Sweet S. Virtual Reality Training in Unicompartmental Knee Arthroplasty: A Randomized, Blinded Trial. JOURNAL OF SURGICAL EDUCATION 2022; 79:1526-1535. [PMID: 35863958 DOI: 10.1016/j.jsurg.2022.06.008] [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: 11/17/2021] [Revised: 02/09/2022] [Accepted: 06/12/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of immersive virtual reality training in orthopedic surgery education in comparison to the standard technique guide for fixed-bearing medial unicompartmental knee arthroplasty DESIGN: Participants included 22 orthopedic surgery residents who were randomized to undergo fixed-bearing medial unicompartmental knee arthroplasty (UKA) surgical training with either an immersive virtual reality technology or by studying the traditional technique guide. Participants were randomized within their training year via block randomization. Participants then performed a medial UKA on a SawBone model using standard industry system surgical trays and equipment. Proficiency, timing, number of errors made, and subjective data were obtained during and after the SawBone procedure. A blinded observer was utilized to obtain objective data. SETTING Community Memorial Health System, a primary clinical care institution in Ventura, California. PARTICIPANTS Twenty-two orthopedic surgery residents were randomly selected. There were 7 PGY-1 residents (3 TG, 4 VR), 7 PGY-2s (4 TG, 3 VR), 3 PGY-3s (1 TG, 2 VR), 3 PGY-4s (2 TG, 1 VR), and 2 PGY-5s (1 TG, 1 VR) in total. Eligibility criteria were 1) an active orthopedic surgery resident, 2) no prior immersive VR surgical training, and 3) no prior experience with the Zimmer PPK implants or its technique guide. All participants completed the study. RESULTS Residents were randomized evenly in the virtual reality (n = 11) and technique guide groups (n = 11). Analysis showed that residents who trained with the immersive VR executed significantly more steps correctly (33 vs. 27, p < 0.01) and completed their procedure in significantly faster time (26.7 vs. 35.4 minutes, p < 0.01). They also scored higher in all global assessment categories reaching significance in 4 of 5 categories. Subjective questionnaire responses demonstrated positive feedback within both groups with a trend toward virtual reality. No adverse events were recorded. CONCLUSIONS Immersive virtual reality was more effective than traditional training for the participants of this study. There are numerous potential applications of this technology and it provides an alternative learning modality to accommodate different learning styles.
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Affiliation(s)
- Brandon McKinney
- Orthopedic Surgery Resident, Graduate Medical Education, Community Memorial Hospital, Ventura, California
| | - Ammer Dbeis
- Orthopedic Surgery Resident, Graduate Medical Department, Community Memorial Hospital, Ventura, California.
| | - Ashley Lamb
- Orthopedic Surgery Trauma Fellow, Department of Orthopedic Surgery, University of Southern California, Los Angeles, California
| | - Petros Frousiakis
- Orthopedic Surgery Faculty, Department of Orthopedic Surgery, Community Memorial Hospital, Los Angeles, California
| | - Stephan Sweet
- Orthopedic Surgery Faculty, Department of Orthopedic Surgery, Community Memorial Hospital, Los Angeles, California
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Berthold DP, Muench LN, Rupp MC, Siebenlist S, Cote MP, Mazzocca AD, Quindlen K. Head-Mounted Display Virtual Reality Is Effective in Orthopaedic Training: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1843-e1849. [PMID: 36312724 PMCID: PMC9596866 DOI: 10.1016/j.asmr.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To conduct a systematic review to determine the efficacy of head-mounted display (HMD) virtual reality (VR) in orthopaedic surgical training. Methods A thorough search was conducted on PubMed for articles published between January 2000 and August 2020. Studies were included if they (1) concerned orthopaedic surgery, (2) dealt with an HMD VR device, (3) the technology was being used for training purposes, and (4) was a randomized control trial (RCT). Results Eight articles met the inclusion criteria. Analysis of the 8 RCTs reveals 6 of the 8 demonstrating HMD VR to be a superior training method to traditional-based training modules. However, in the remaining 2 articles, authors found no significant difference between the VR group and controls, but showed at least equivalent ability to train novice surgeons. Conclusions RCTs show promising evidence that HMD VR is an efficacious tool in surgical training for orthopaedic procedures, with most randomized clinical trials showing improvement in novice students/surgeons compared with controls. Clinical Relevance As VR technology advances, so must the research directed at determining the efficacy of such technologies at educating our novice surgeons. RCTs are already demonstrating the role HMD VR can play in the education of novice orthopaedic surgeons.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
- Address correspondence to Daniel P. Berthold, M.D., Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Lukas N. Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut, Storrs, Connecticut, U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Kevin Quindlen
- Department of Orthopaedic Surgery, University of Connecticut, Storrs, Connecticut, U.S.A
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20
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Evaluation of a Slipped Capital Femoral Epiphysis Virtual Reality Surgical Simulation for the Orthopaedic Trainee. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00020. [PMID: 35467580 PMCID: PMC9042586 DOI: 10.5435/jaaosglobal-d-22-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to compare outcomes between orthopaedic trainees using various preoperative training platforms (physical simulation [PS], virtual reality [VR], and reading/videos) in a slipped capital femoral epiphysis model.
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21
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Wu Q, Wang Y, Lu L, Chen Y, Long H, Wang J. Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice. Front Med (Lausanne) 2022; 9:855403. [PMID: 35433717 PMCID: PMC9006810 DOI: 10.3389/fmed.2022.855403] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/10/2022] [Indexed: 01/05/2023] Open
Abstract
Virtual simulation (VS) as an emerging interactive pedagogical strategy has been paid more and more attentions in the undergraduate medical education. Because of the fast development of modern computer simulation technologies, more and more advanced and emerging VS-based instructional practices are constantly increasing to promote medical education in diverse forms. In order to describe an overview of the current trends in VS-based medical teaching and learning, this scoping review presented a worldwide analysis of 92 recently published articles of VS in the undergraduate medical teaching and learning. The results indicated that 98% of included articles were from Europe, North America, and Asia, suggesting a possible inequity in digital medical education. Half (52%) studies reported the immersive virtual reality (VR) application. Evidence for educational effectiveness of VS in medical students’ knowledge or skills was sufficient as per Kirkpatrick’s model of outcome evaluation. Recently, VS has been widely integrated in surgical procedural training, emergency and pediatric emergency medicine training, teaching of basic medical sciences, medical radiation and imaging, puncture or catheterization training, interprofessional medical education, and other case-based learning experiences. Some challenges, such as accessibility of VS instructional resources, lack of infrastructure, “decoupling” users from reality, as well as how to increase students’ motivation and engagement, should be addressed.
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Affiliation(s)
- Qingming Wu
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
- Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Yubin Wang
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Lili Lu
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Yong Chen
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Hui Long
- Tianyou Hospital, Wuhan University of Science and Technology, Wuhan, China
| | - Jun Wang
- College of Medicine, Wuhan University of Science and Technology, Wuhan, China
- *Correspondence: Jun Wang,
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22
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Mitigating Surgical Skill Decay in Orthopaedics Using Virtual Simulation Learning. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202110000-00010. [PMID: 34637404 DOI: 10.5435/jaaosglobal-d-21-00193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The COVID-19 pandemic has interrupted orthopaedic training structures for both surgeons and trainees. The concept of skill decay must be considered during inactivity of elective practice. The purpose of this study was to provide an evidence-based curriculum in association with immersive virtual reality (iVR) to prevent skill decay during periods of training cessation and beyond. METHODS A review of pertinent literature for orthopaedic surgical skill decay was performed. Early experience by faculty instructors and residency and fellowship program directors was gathered from multiple institutions with experience in virtual training methods including iVR. A proposed curriculum for cognitive and manual skill acquisition during COVID-19 was produced from qualitative narrative group opinion. RESULTS Skill decay can occur on the order of days to months and is dependent on the initial skill level. A novel curriculum for structured continuing medical education during and after periods of surgical disruption including e-learning, virtual meetings, and iVR simulators was produced from expert opinion and based on competency-based curriculum standards. CONCLUSION Skill decay mitigation strategies should use best available evidence technologies and course structures that satisfy advanced learning concepts. The virtual curriculum including iVR simulators may provide cost-effective solutions to training.
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Mao RQ, Lan L, Kay J, Lohre R, Ayeni OR, Goel DP, Sa DD. Immersive Virtual Reality for Surgical Training: A Systematic Review. J Surg Res 2021; 268:40-58. [PMID: 34284320 DOI: 10.1016/j.jss.2021.06.045] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/18/2021] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Immersive virtual reality (iVR) simulators provide accessible, low cost, realistic training adjuncts in time and financially constrained systems. With increasing evidence and utilization of this technology by training programs, clarity on the effect of global skill training should be provided. This systematic review examines the current literature on the effectiveness of iVR for surgical skills acquisition in medical students, residents, and staff surgeons. METHODS A literature search was performed on MEDLINE, EMBASE, CENTRAL, Web of Science and PsycInfo for primary studies published between January 1, 2000 and January 26, 2021. Two reviewers independently screened titles, abstracts, and full texts, extracted data, and assessed quality and strength of evidence using the Medical Education Research Quality Instrument (MERSQI) and Cochrane methodology. Results were qualitatively synthesized, and descriptive statistics were calculated. RESULTS The literature search yielded 9650 citations, with 17 articles included for qualitative synthesis. The mean (SD) MERSQI score was 11.7 (1.9) out of 18. In total, 307 participants completed training in four disciplines. Immersive VR-trained groups performed 18% to 43% faster on procedural time to completion compared to control (pooled standardized mean difference = -0.90 [95% CI=-1.33 to -047, I2=1%, P < 0.0001]). Immersive VR trainees also demonstrated greater post-intervention scores on procedural checklists and greater implant placement accuracy compared to control. CONCLUSIONS Immersive VR incorporation into surgical training programs is supported by high-quality, albeit heterogeneous, studies demonstrating improved procedural times, task completion, and accuracy, positive user ratings, and cost-effectiveness.
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Affiliation(s)
- Randi Q Mao
- Michael G. DeGroote School of Medicine, McMaster University, ON, Hamilton, Canada.
| | - Lucy Lan
- Michael G. DeGroote School of Medicine, McMaster University, ON, Hamilton, Canada.
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
| | - Ryan Lohre
- Department of Orthopaedics, University of British Columbia, BC, Vancouver, Canada.
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
| | - Danny P Goel
- Department of Orthopaedics, University of British Columbia, BC, Vancouver, Canada.
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Hamilton, Canada.
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Mittwede PN. CORR Insights®: Surgical Skill Can be Objectively Measured From Fluoroscopic Images Using a Novel Image-based Decision Error Analysis (IDEA) Score. Clin Orthop Relat Res 2021; 479:1395-1397. [PMID: 33543877 PMCID: PMC8133197 DOI: 10.1097/corr.0000000000001660] [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: 12/27/2020] [Accepted: 01/12/2021] [Indexed: 01/31/2023]
Affiliation(s)
- Peter N Mittwede
- P. N. Mittwede, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Berthold DP, Imhoff AB, Mazzocca AD. Virtual Reality in der Gelenkchirurgie. ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-020-00426-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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