Pretraining of basic skills on a virtual reality vitreoretinal simulator: A waste of time

Enhancing Ophthalmic Care: The Transformative Potential of Digital Twins in Healthcare

This literature review explores the emerging role of digital twin (DT) technology in ophthalmology, emphasizing its potential to revolutionize personalized medicine. DTs integrate diverse data sources, including genetic, environmental, and real-time patient data, to create dynamic, predictive models that enhance risk assessment, surgical planning, and postoperative care. The review highlights vital case studies demonstrating the application of DTs in improving the early detection and management of diseases such as glaucoma and age-related macular degeneration. While implementing DTs presents challenges, including data integration and privacy concerns, the potential benefits, such as improved patient outcomes and cost savings, position DTs as a valuable tool in the future of ophthalmic care. The review underscores the need for further research to address these challenges and fully realize the potential of DTs in clinical practice.

Efficacy of Simulator-Based Slit Lamp Training for Medical Students: A Prospective, Randomized Trial

INTRODUCTION

Simulation training has an important role in medical education. In ophthalmology, simulation-based training has been shown to be significantly effective for surgical and diagnostic training in direct and indirect ophthalmoscopy. In this study, we analysed the effects of simulator-based slit lamp training.

METHODS

In this prospective controlled trial, medical students in their eighth semester at Saarland University Medical Center (n = 24) who had attended a 1-week ophthalmological internship were randomized into two groups: The traditional group (n = 12) was examined directly after the 1-week internship; the simulator group (n = 12) was trained with the slit lamp simulator before passing an objective structured clinical examination (OSCE). A masked ophthalmological faculty trainer assessed the students' slit lamp skills (maximum total score 42 points [pts]): preparation (5 pts), clinical examination (9.5 pts), assessment of findings (9.5 pts), diagnosis (3 pts), commentary on the examination approach (8 pts), measurement of structures (2 pts) and recognition of five diagnoses (5 pts). All students completed post-assessment surveys. Examination grades and survey responses were compared between the groups.

RESULTS

The overall performance of the slit lamp OSCE was significantly better (p < 0.001) in the simulator group than in the traditional group (29.75 [7.88] vs. 17.00 [4.75]) with significantly higher scores for the preparation and assessment of slit lamp controls (5.0 [0.0] vs. 3.0 [3.5]; p = 0.008) and localization of relevant structures (6.75 [3.13] vs. 4.0 [1.5]; p = 0.008). Consistently higher scores, but not significant, were assigned for the description of structures found (4.5 [3.38] vs. 3.25 [2.13]; p = 0.09) and the correct diagnosis (3.0 [0.0] vs. 3.0 [0.0]; p = 0.48). Surveys reflected the students' subjectively perceived knowledge gain during the simulator training for slit lamp illumination techniques (p = 0.002), recognition (p < 0.001), and assessment of the correct localization of pathologies (p < 0.001).

CONCLUSION

Slit lamp examination is an important diagnostic method in ophthalmology. Simulator-based training improved students' examination techniques for localizing anatomical structures and pathological lesions. The transfer of theoretical knowledge into practice can be achieved in a stress-free atmosphere.

A validated test has been developed for assessment of manual small incision cataract surgery skills using virtual reality simulation

This study investigates the validity evidence of metrics used for the assessment of surgical skills for Manual Small Incision Cataract Surgery (MSICS) in a virtual reality simulator. MSICS surgery is a low-cost, low-technology cataract surgery technique, which is widely used in low- and middle-income countries. However, there is a lack of cataract surgeons globally, and efficient and evidence-based training of new surgeons is needed. In order to investigate the validity of simulator metrics, we included three groups of participants: (1) MSICS novices who were ophthalmologists with no cataract surgery experience, (2) MSICS novices who were experienced phacoemulsification cataract surgeons, but with no MSICS experience, and (3) experienced phacoemulsification and MSICS surgeons. The evaluation included 11 steps of the MSICS procedure, and all simulator metrics for those steps were reviewed. Of the 55 initial metrics, 30 showed high positive discriminative ability. A test passing score of 20 out of 30 was established, and one of 15 novices with no MSICS experience (mean score 15.5) and 7 out of 10 experienced MSICS surgeons (mean score 22.7) passed the test. We have developed and established validity evidence for a test for MSICS skills in a virtual reality simulator for future use in proficiency-based training and evidence-based testing of training interventions.

Modern Educational Simulation-Based Tools Among Residents of Ophthalmology: A Narrative Review

INTRODUCTION

With no specific overview on simulation-based training for educational purposes among residents in ophthalmology, this narrative review attempts to highlight the current literature on modern educational simulation-based tools used to educate residents in ophthalmology.

METHODS

We searched databases Web of Science and PubMed between March 15 and July 21, 2022. Relevant and accessible articles and abstracts published after 2006 and in English only were included.

RESULTS

Simulation-based cataract surgery is associated with better outcomes in the operating room and faster surgeries. Construct validity has been established across different procedures and levels in simulation-based cataract surgery and simulation-based vitreoretinal surgery. Other simulation-based procedures indicate promising results but in general lack evidence-based validity.

DISCUSSION

This narrative review highlights and evaluates the current and relevant literature of modern educational simulation-based tools to train ophthalmology residents in different fundamental skills like simulation-based ophthalmoscopy and complex surgical procedures like simulation-based cataract surgery and vitreoretinal surgery. Some studies attempt to develop simulators for the use in education of ophthalmology residents. Other studies strive to establish validity of the respective procedures or modern education tools and some studies investigate the effect of simulation-based training. The most validated modern educational simulation-based tool is the Eyesi Surgical Simulator (VRmagic, Germany). However, other modern educational simulation-based tools have also been evaluated, including the HelpMeSee Eye Surgery Simulator (HelpMeSee Inc., New York, USA) and the MicroVisTouch Surgical Simulator (ImmersiveTouch, USA).

CONCLUSION

Simulation-based training has already been established for residents in ophthalmology to benefit the most from skill-demanding procedures resulting in better learning and better patient handling. Future studies should aim to validate more simulation-based procedures for the teaching of ophthalmology residents so that the evidence is kept at a high standard.

Virtual Simulation in Undergraduate Medical Education: A Scoping Review of Recent Practice

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.