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Albrecht T, Fehre N, Ramackers W, Nikendei C, Offergeld C. "Seeing inside out": revealing the effectiveness of otoscopy training in virtual reality enhanced practical exams - a randomized controlled trial. BMC MEDICAL EDUCATION 2024; 24:439. [PMID: 38649953 PMCID: PMC11036670 DOI: 10.1186/s12909-024-05385-3] [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: 09/17/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND The study aimed to assess the impact of different training modalities on otoscopy performance during a practical exam using a high-fidelity simulator and to determine if objective evaluation of otoscopy is feasible using a simulator that records insertion depth and tympanic membrane coverage. METHODS Participants were assigned to one of four groups: control and three intervention groups with varying training approaches. Participants received otoscopy training and then were assessed through a practical exam on a high-fidelity simulator that uses virtual reality to visualize the ear canal and middle ear. Performance was evaluated using a modified Objective Structured Assessment of Technical Skills checklist and Integrated Procedural Performance Instrument checklist. Insertion depth, tympanic membrane coverage, and correct diagnosis were recorded. Data were tested for normal distribution using the Shapiro-Wilk test. One-way ANOVA and, for non-normally distributed data, Kruskal-Wallis test combined with Dunn's test for multiple comparisons were used. Interrater reliability was assessed using Cohen's κ and Intraclass correlation coefficient. RESULTS All groups rated their training sessions positively. Performance on the OSATS checklist was similar among groups. IPPI scores indicated comparable patient handling skills. The feedback group examined larger tympanic membrane areas and had higher rates of correct diagnosis. The correct insertion depth was rarely achieved by all participants. Interrater reliability for OSATS was strong. IPPI reliability showed good correlation. CONCLUSION Regardless of training modality, participants perceived learning improvement and skill acquisition. Feedback improved examination performance, indicating simulator-guided training enhances skills. High-fidelity simulator usage in exams provides an objective assessment of performance.
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Affiliation(s)
- Tobias Albrecht
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center - University of Tuebingen, Tuebingen, Germany.
| | - Nathalie Fehre
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Wolf Ramackers
- Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
| | - Christoph Nikendei
- Department for General Internal Medicine and Psychosomatics, Medical Center - University of Heidelberg, Heidelberg, Germany
| | - Christian Offergeld
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Center - University of Freiburg, Freiburg, Germany
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Teles de Campos S, Boskoski I, Voiosu T, Arvanitakis M, Costamagna G, Devière J. Face and content validity of a biological papilla designed for the Boškoski-Costamagna ERCP simulator. Gastrointest Endosc 2023; 98:822-829.e1. [PMID: 37390863 DOI: 10.1016/j.gie.2023.06.014] [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: 03/23/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND AND AIMS A biological papilla made of chicken heart tissue, incorporated into the Boškoski-Costamagna ERCP Trainer simulator, was recently designed to allow training in sphincterotomy. This study aimed to evaluate the face and content validity of this tool. METHOD Participants from 2 groups (nonexperienced and experienced [<600 or >600 lifetime ERCPs, respectively]) were invited to perform standardized assignments on the model: sphincterotomy and precut for both groups and papillectomy for the experienced group. Following these assignments, all participants filled out a questionnaire to rate their appreciation of the realism of the model, and experienced endoscopists were also asked to evaluate its didactic value using a 5-point Likert scale. RESULTS A total of 19 participants were included (nonexperienced, n = 10; experienced, n = 9). Parameters regarding the realism of the tool in terms of general appearance, sphincterotomy, precut, and papillectomy were overall considered realistic (4 of 5), with good agreement rates in terms of overall realism between groups. Experienced operators reported the highest realism for "positioning the scope and needle-knife in the field of view" and "during precut," "cutting in small increments during precut," and "controlling the scope during papillectomy," and they highly agreed that this papilla should be included for training novice and intermediate trainees in sphincterotomy, precut, and papillectomy. CONCLUSIONS Our results show good face validity and excellent content validity of this biological papilla combined with the Boškoski-Costamagna ERCP Trainer. This new tool provides a useful, inexpensive, versatile, and easy tool for training regarding sphincterotomy, precut, and papillectomy. Future studies should explore whether including this model in real-life training improves the learning curve of endoscopy trainees.
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Affiliation(s)
- Sara Teles de Campos
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre de Bruxelles, Brussels, Belgium.
| | - Ivo Boskoski
- Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
| | - Theodor Voiosu
- Gastroenterology Department, Colentina Clinical Hospital, Carol Davila Faculty of Medicine, Bucharest, Romania
| | - Marianna Arvanitakis
- Université Libre de Bruxelles, Brussels, Belgium; Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasmus University Hospital, Brussels, Belgium
| | - Guido Costamagna
- Gastroenterology and Digestive Endoscopy, Fondazione Policlinico Gemelli, Rome, Italy
| | - Jacques Devière
- Gastroenterology Department, Digestive Unit, Champalimaud Foundation, Lisbon, Portugal; Université Libre de Bruxelles, Brussels, Belgium; Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasmus University Hospital, Brussels, Belgium
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Gomindes AR, Adeeko ES, Khatri C, Ahmed I, Sehdev S, Carlos WJ, Ward T, Leverington J, Debenham L, Metcalfe A, Ward J. Use of Virtual Reality in the Education of Orthopaedic Procedures: A Randomised Control Study in Early Validation of a Novel Virtual Reality Simulator. Cureus 2023; 15:e45943. [PMID: 37885489 PMCID: PMC10599600 DOI: 10.7759/cureus.45943] [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] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Background Virtual reality (VR) simulation is a potential solution to the barriers surgical trainees are facing. There needs to be validation for its implementation within current training. We aimed to compare VR simulation to traditional methods in acquiring surgical skills for a TFN-ADVANCED™ Proximal Femoral Nailing System (TFNA; DePuy Synthes, Auckland, New Zealand) femoral nailing system. Methods Thirty-one surgical trainees were randomised to two groups: traditional-training group (control group) and a VR-training group (intervention group) for insertion of a short cephalomedullary TFNA nail. Both groups then inserted the same TFNA system into saw-bone femurs. Surveys evaluated validity of the relevant activities, perception of simulation, confidence, stress and anxiety. The primary outcomes were tip-apex distance (TAD) and user anxiety/confidence levels. Secondary outcomes included number of screw- and nail-guidewire insertion attempts, the time taken to complete and user validity of the VR system. Results There was no statistical difference in TAD between the intervention and control groups (9mm vs 15mm, p=0.0734). The only TAD at risk of cut-out was in the control group (25mm). There was no statistical difference in time taken (2547.5ss vs 2395ss, p=0.668), nail guide-wire attempts (two for both groups, p=0.355) and screw guide-wire attempts (one for both groups, p=0.702). The control group versus intervention had higher anxiety levels (50% vs 33%) and had lower confidence (61% vs 84%). Interpretation There was no objective difference in performance on a saw-bone model between groups. However, this VR simulator resulted in more confidence and lower anxiety levels whilst performing a simulated TFNA. Whilst further studies with larger sample sizes and exploration of transfer validity to the operating theatre are required, this study does indicate potential benefits of VR within surgical training.
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Affiliation(s)
- Austin R Gomindes
- School of Medical and Dental Sciences, University of Birmingham, Birmingham, GBR
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | | | - Chetan Khatri
- Trauma and Orthopaedics, University of Warwick, Warwick, GBR
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | - Imran Ahmed
- Trauma and Orthopaedics, University of Warwick, Warwick, GBR
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | - Simran Sehdev
- Trauma and Orthopaedics, University of Warwick, Warwick, GBR
| | - William John Carlos
- Trauma and Orthopaedics, University of Warwick, Warwick, GBR
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | - Thomas Ward
- Trauma and Orthopaedics, University of Warwick, Warwick, GBR
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | - James Leverington
- Trauma and Orthopaedics, University of Warwick, Warwick, GBR
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | - Luke Debenham
- Trauma and Orthopaedics, University of Warwick, Warwick, GBR
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, GBR
| | - Andrew Metcalfe
- Trauma and Orthopaedics, University of Warwick, Warwick, GBR
| | - Jayne Ward
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire, Coventry, GBR
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[Use of virtual reality in ENT teaching: an alternative to the conventional anatomic model]. HNO 2023; 71:106-113. [PMID: 36477392 PMCID: PMC9734900 DOI: 10.1007/s00106-022-01252-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Assessment of the middle ear requires a complex three-dimensional understanding, the teaching of which is just as important for curricular teaching as for further medical training. OBJECTIVE The extent to which virtual reality (VR) can be used as an alternative to conventional educational methods for teaching anatomy, physiology, and pathology was examined. The objective was to evaluate a VR-supported teaching method in comparison to conventional learning on an anatomic model. METHODS The study was conducted as a prospective two-arm single-center trial in the summer semester of 2021 at the University Hospital of Freiburg. During a seminar on the topic of the middle ear, 177 students were randomly assigned to either a control or a study group. Demographic data were collected in advance and a quantitative evaluation regarding competence and personal attitude was performed. After processing the models, the groups were formatively tested and the results were analyzed comparatively. Ultimately, crossover of the models enabled a qualitative comparative evaluation of the models and a renewed quantitative evaluation was carried out. RESULTS No significant differences between the groups were identified in the formative testing. The evaluations demonstrated increased self-assessment of knowledge competence, a tendency towards a highly positive attitude towards the VR method after completion of the course, and generally beneficial subjective aspects of the VR model. In addition, there was a positive effect and a positive perception of the delivery of anatomic content. CONCLUSION Use of VR is suitable as an alternative to conventional teaching methods in curricular ENT teaching. The current evidence demonstrates the equality of VR and indicates its great potential for future educational tasks.
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Salcedo D, Regan J, Aebersold M, Lee D, Darr A, Davis K, Berrocal Y. Frequently Used Conceptual Frameworks and Design Principles for Extended Reality in Health Professions Education. MEDICAL SCIENCE EDUCATOR 2022; 32:1587-1595. [PMID: 36532382 PMCID: PMC9755380 DOI: 10.1007/s40670-022-01620-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 06/17/2023]
Abstract
Health professions education (HPE) has witnessed a dramatic increase in the use of extended reality (XR), but there is limited evidence that conceptual frameworks are being effectively employed in the design and implementation of XR. This paper introduces commonly utilized conceptual frameworks that can support the integration of XR into the learning process and design principles that can be helpful for the development and evaluation of XR educational applications. Each framework and design principle is summarized briefly, followed by a description of its applicability to XR for HPE and an example of such application.
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Affiliation(s)
- Daniel Salcedo
- Case Western Reserve University School of Medicine, Cleveland, OH 44106 USA
| | - Jenna Regan
- Department of Health Sciences Education and Pathology, University of Illinois College of Medicine, Peoria, IL 61605 USA
| | | | - Deborah Lee
- University of Michigan School of Nursing, Ann Arbor, MI 48106 USA
| | - Andrew Darr
- Department of Health Sciences Education and Pathology, University of Illinois College of Medicine, Peoria, IL 61605 USA
| | - Katie Davis
- University of Michigan School of Nursing, Ann Arbor, MI 48106 USA
| | - Yerko Berrocal
- Alice L. Walton School of Medicine, Bentonville, AR 72712 USA
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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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