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Mok TN, Chen J, Pan J, Ming WK, He Q, Sin TH, Deng J, Li J, Zha Z. Use of a Virtual Reality Simulator for Tendon Repair Training: Randomized Controlled Trial. JMIR Serious Games 2021; 9:e27544. [PMID: 34255649 PMCID: PMC8314161 DOI: 10.2196/27544] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/20/2021] [Accepted: 05/14/2021] [Indexed: 01/19/2023] Open
Abstract
Background Virtual reality (VR) simulators have become widespread tools for training medical students and residents in medical schools. Students using VR simulators are provided with a 3D human model to observe the details by using multiple senses and they can participate in an environment that is similar to reality. Objective The aim of this study was to promote a new approach consisting of a shared and independent study platform for medical orthopedic students, to compare traditional tendon repair training with VR simulation of tendon repair, and to evaluate future applications of VR simulation in the academic medical field. Methods In this study, 121 participants were randomly allocated to VR or control groups. The participants in the VR group studied the tendon repair technique via the VR simulator, while the control group followed traditional tendon repair teaching methods. The final assessment for the medical students involved performing tendon repair with the “Kessler tendon repair with 2 interrupted tendon repair knots” (KS) method and the “Bunnell tendon repair with figure 8 tendon repair” (BS) method on a synthetic model. The operative performance was evaluated using the global rating scale. Results Of the 121 participants, 117 participants finished the assessment and 4 participants were lost to follow-up. The overall performance (a total score of 35) of the VR group using the KS method and the BS method was significantly higher (P<.001) than that of the control group. Thus, participants who received VR simulator training had a significantly higher score on the global rating scale than those who received traditional tendon repair training (P<.001). Conclusions Our study shows that compared with the traditional tendon repair method, the VR simulator for learning tendon suturing resulted in a significant improvement of the medical students in the time in motion, flow of operation, and knowledge of the procedure. Therefore, VR simulator development in the future would most likely be beneficial for medical education and clinical practice. Trial Registration Chinese Clinical Trial Registry ChiCTR2100046648; http://www.chictr.org.cn/hvshowproject.aspx?id=90180
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Affiliation(s)
- Tsz-Ngai Mok
- Institute of Orthopedics Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Junyuan Chen
- Institute of Orthopedics Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jinghua Pan
- Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Wai-Kit Ming
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Qiyu He
- Pediatric Cardiac Surgery Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Tat-Hang Sin
- Institute of Orthopedics Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jialin Deng
- Institute of Orthopedics Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jieruo Li
- Institute of Orthopedics Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhengang Zha
- Institute of Orthopedics Diseases and Center for Joint Surgery and Sports Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Maniam P, Schnell P, Dan L, Portelli R, Erolin C, Mountain R, Wilkinson T. Exploration of temporal bone anatomy using mixed reality (HoloLens): development of a mixed reality anatomy teaching resource prototype. J Vis Commun Med 2019; 43:17-26. [PMID: 31645155 DOI: 10.1080/17453054.2019.1671813] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Mixed reality (MR), a technology which supplements the real world with virtual objects, is increasingly becoming available as a teaching tool in medical education. The Microsoft HoloLens device allows operators to experience MR using a head-mounted device without interfering with their physical reality, stimulating a realistic learning experience using virtual objects. This project aimed to develop a MR anatomy teaching application with HoloLens for exploring the anatomy of the temporal bone. The educational application was developed from a multidisciplinary collaboration between undergraduate and postgraduate students across several academic disciplines with Medtronic, a medical technology company. 3D anatomical models were built using ZBrush and Blender, while the HoloLens1 application was developed using Windows 10, Visual Studio 2017, Unity and Mixed Reality Toolkit (MRTK). Modules developed within the application included a basic HoloLens tutorial, a virtual temporal bone with surgical anatomy landmarks and free drilling of the temporal bone. The basic tutorial allows the operator to adapt to the MR environment prior to exploring the anatomical landmarks of the 3D temporal bone. The free drilling of the temporal bone using vertex displacement and texture stretching replicates a real-time bone drilling experience and allows the operator to explore the anatomical relationship between different otological structures.
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Affiliation(s)
- Pavithran Maniam
- School of Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Philipp Schnell
- Department of Computing, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Lilly Dan
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Rony Portelli
- Department of Computing, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Caroline Erolin
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Rodney Mountain
- Department of Otolaryngology, Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Tracey Wilkinson
- Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, United Kingdom
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Andersen SAW, Mikkelsen PT, Sørensen MS. Expert sampling of VR simulator metrics for automated assessment of mastoidectomy performance. Laryngoscope 2019; 129:2170-2177. [DOI: 10.1002/lary.27798] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/08/2018] [Accepted: 12/19/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Steven Arild Wuyts Andersen
- Department of Otorhinolaryngology—Head & Neck Surgery Rigshospitalet
- The Simulation Centre at Rigshospitalet, Copenhagen Academy for Medical Education and Simulation (CAMES)Centre for HR, the Capital Region of Denmark Copenhagen
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The Effect of a Distributed Virtual Reality Simulation Training Program on Dissection Mastoidectomy Performance. Otol Neurotol 2018; 39:1277-1284. [DOI: 10.1097/mao.0000000000002031] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Unger B, Sepehri N, Rampersad V, Pisa J, Michael Gousseau, Hochman JB. Elements of virtual temporal bone surgery: Manipulandum format may be more important to surgeons than haptic device force capabilities. Laryngoscope Investig Otolaryngol 2017; 2:358-362. [PMID: 29299508 PMCID: PMC5743167 DOI: 10.1002/lio2.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/28/2017] [Accepted: 09/16/2017] [Indexed: 11/08/2022] Open
Abstract
Background Temporal bone simulations are critiqued for poor drill‐bone interaction. This project appraises the import of increasing haptic device and manipulandum fidelity on the perceived realism of drilling a virtual temporal bone. Virtual surgical contact forces rely on haptic device fidelity and are transmitted through a manipulandum. With identical software, both device hardware and manipulandum may each contribute to realism. We compare the three degrees of freedom (DOF), 3N Geomagic Touch (3D Systems, SC) to a 6DOF, 5.5N HD2 (Quanser, ON) with the both standard (“HD2–Standard”) and in‐house customized otic drill manipulandum (“HD2–Modified”). Methods Six otologic surgeons performed three virtual mastoidectomy surgeries on a temporal bone surgical simulator. The HD2 manipulandum was modified for attached otic drill with gravity compensation and requisite mechanical modifications. Surgeons, in random order, performed the dissection with the different hardware platforms. Results Two‐tailed t‐tests demonstrate that for the acoustic properties of each simulation, the HD2–Modified manipulandum was favored (p ≤ 0.0004). For overall similarity of bone, both HD2–Standard (p ≤ 0.05) HD2–Modified (p ≤ 0.03)) were favored over the Geomagic; however they were not appreciably different when directly compared to each other. There was no preference for increasing haptic device fidelity in virtual drill bone interaction. In forced rank, users favored the HD2–Modified in osseus, vibrational and overall realism, as well as being preferred for education and preoperative rehearsal (p ≤ 0.0164). Conclusion Increasing manipulandum realism was favored. However surprisingly, there was no preference for increased device fidelity, illustrating incremental stiffness had nominal impact. There may be a ceiling to drill bone interaction in virtual haptic simulation. Level of Evidence 2b.
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Affiliation(s)
- Bertram Unger
- Department of Medical Education University of Manitoba Winnipeg Manitoba Canada
| | - Nariman Sepehri
- Faculty of Engineering University of Manitoba Winnipeg Manitoba Canada
| | - Vivek Rampersad
- Department of Otolaryngology-Head and Neck Surgery University of Manitoba Winnipeg Manitoba Canada
| | - Justyn Pisa
- Department of Otolaryngology-Head and Neck Surgery Health Sciences Centre Winnipeg Manitoba Canada
| | - Michael Gousseau
- Faculty of Medicine University of Manitoba Winnipeg Manitoba Canada
| | - Jordan B Hochman
- Department of Otolaryngology-Head and Neck Surgery University of Manitoba Winnipeg Manitoba Canada
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Creighton FX, Feng AL, Goyal N, Emerick K, Deschler D. Chicken thigh microvascular training model improves resident surgical skills. Laryngoscope Investig Otolaryngol 2017; 2:471-474. [PMID: 29299526 PMCID: PMC5743170 DOI: 10.1002/lio2.94] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 07/22/2017] [Accepted: 07/27/2017] [Indexed: 12/02/2022] Open
Abstract
Objectives Microsurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high‐fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills. Study Design Validation study Methods Thirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model. Anastomoses were video‐recorded and the time required for trainees to complete the first stitch of their first anastomosis was compared to the time required for the first stitch of their last anastomosis. Comparison of first and last stitch times was completed using a paired student t‐test. All participants completed a survey regarding their experience with the simulator. Results There was a statistically significant decrease between the time required for the first stitch (235 s, 95%CI 198–272 s) compared to last stitch (120 s, 95%CI 92–149 s), and an average 48.7% (115 s) decrease in time (p < 0.001). Junior (PGY 2/3) and senior (PGY 4/5) residents had similar decreases in time, 49.1% and 48.21%, respectively. One hundred percent of residents felt they improved during the session and 92% of residents agreed or strongly agreed that their final stitch was better than their last stitch. All residents agreed or strongly agreed that the simulation is realistic, effective in teaching the procedure, and would translate to improved intraoperative performance. Conclusions The chicken thigh model demonstrates objective improvements in resident microvascular surgical skills. Level of Evidence NA
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Affiliation(s)
- Francis X Creighton
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Allen L Feng
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Neerav Goyal
- Department of Otolaryngology Penn State Medical School Hershey Pennsylvania U.S.A
| | - Kevin Emerick
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
| | - Daniel Deschler
- Department of Otolaryngology Harvard Medical School, Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
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Copson B, Wijewickrema S, Zhou Y, Piromchai P, Briggs R, Bailey J, Kennedy G, O'Leary S. Supporting skill acquisition in cochlear implant surgery through virtual reality simulation. Cochlear Implants Int 2017; 18:89-96. [DOI: 10.1080/14670100.2017.1289299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bridget Copson
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
| | | | - Yun Zhou
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
| | - Patorn Piromchai
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
- Department of Otorhinolaryngology, Khon Kaen University, Thailand
| | - Robert Briggs
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
| | - James Bailey
- Department of Computing and Information Systems, University of Melbourne, Australia
| | - Gregor Kennedy
- Melbourne Centre for the Study of Higher Education, University of Melbourne, Australia
| | - Stephen O'Leary
- Department of Surgery (Otolaryngology), University of Melbourne, Australia
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Andersen SAW, Mikkelsen PT, Konge L, Cayé-Thomasen P, Sørensen MS. Cognitive Load in Mastoidectomy Skills Training: Virtual Reality Simulation and Traditional Dissection Compared. JOURNAL OF SURGICAL EDUCATION 2016; 73:45-50. [PMID: 26481267 DOI: 10.1016/j.jsurg.2015.09.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/10/2015] [Accepted: 09/11/2015] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The cognitive load (CL) theoretical framework suggests that working memory is limited, which has implications for learning and skills acquisition. Complex learning situations such as surgical skills training can potentially induce a cognitive overload, inhibiting learning. This study aims to compare CL in traditional cadaveric dissection training and virtual reality (VR) simulation training of mastoidectomy. DESIGN A prospective, crossover study. Participants performed cadaveric dissection before VR simulation of the procedure or vice versa. CL was estimated by secondary-task reaction time testing at baseline and during the procedure in both training modalities. SETTING The national Danish temporal bone course. PARTICIPANTS A total of 40 novice otorhinolaryngology residents. RESULTS Reaction time was increased by 20% in VR simulation training and 55% in cadaveric dissection training of mastoidectomy compared with baseline measurements. Traditional dissection training increased CL significantly more than VR simulation training (p < 0.001). CONCLUSIONS VR simulation training imposed a lower CL than traditional cadaveric dissection training of mastoidectomy. Learning complex surgical skills can be a challenge for the novice and mastoidectomy skills training could potentially be optimized by employing VR simulation training first because of the lower CL. Traditional dissection training could then be used to supplement skills training after basic competencies have been acquired in the VR simulation.
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Affiliation(s)
| | | | - Lars Konge
- Center for Clinical Education, Center for HR, The Capital Region of Denmark, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Mads Sølvsten Sørensen
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark
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Andersen SAW, Foghsgaard S, Konge L, Cayé-Thomasen P, Sørensen MS. The effect of self-directed virtual reality simulation on dissection training performance in mastoidectomy. Laryngoscope 2015; 126:1883-8. [PMID: 26452157 DOI: 10.1002/lary.25710] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/18/2015] [Accepted: 09/03/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS To establish the effect of self-directed virtual reality (VR) simulation training on cadaveric dissection training performance in mastoidectomy and the transferability of skills acquired in VR simulation training to the cadaveric dissection training setting. STUDY DESIGN Prospective study. METHODS Two cohorts of 20 novice otorhinolaryngology residents received either self-directed VR simulation training before cadaveric dissection training or vice versa. Cadaveric and VR simulation performances were assessed using final-product analysis with three blinded expert raters. RESULTS The group receiving VR simulation training before cadaveric dissection had a mean final-product score of 14.9 (95 % confidence interval [CI] [12.9-16.9]) compared with 9.8 (95% CI [8.4-11.1]) in the group not receiving VR simulation training before cadaveric dissection. This 52% increase in performance was statistically significantly (P < 0.0001). A single dissection mastoidectomy did not increase VR simulation performance (P = 0.22). CONCLUSIONS Two hours of self-directed VR simulation training was effective in increasing cadaveric dissection mastoidectomy performance and suggests that mastoidectomy skills are transferable from VR simulation to the traditional dissection setting. Virtual reality simulation training can therefore be employed to optimize training, and can spare the use of donated material and instructional resources for more advanced training after basic competencies have been acquired in the VR simulation environment. LEVEL OF EVIDENCE NA. Laryngoscope, 126:1883-1888, 2016.
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Affiliation(s)
| | - Søren Foghsgaard
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet
| | - Lars Konge
- Center for Clinical Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Per Cayé-Thomasen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rigshospitalet
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Piromchai P, Avery A, Laopaiboon M, Kennedy G, O'Leary S. Virtual reality training for improving the skills needed for performing surgery of the ear, nose or throat. Cochrane Database Syst Rev 2015; 2015:CD010198. [PMID: 26352008 PMCID: PMC9233923 DOI: 10.1002/14651858.cd010198.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Virtual reality simulation uses computer-generated imagery to present a simulated training environment for learners. This review seeks to examine whether there is evidence to support the introduction of virtual reality surgical simulation into ear, nose and throat surgical training programmes. OBJECTIVES 1. To assess whether surgeons undertaking virtual reality simulation-based training achieve surgical ('patient') outcomes that are at least as good as, or better than, those achieved through conventional training methods.2. To assess whether there is evidence from either the operating theatre, or from controlled (simulation centre-based) environments, that virtual reality-based surgical training leads to surgical skills that are comparable to, or better than, those achieved through conventional training. SEARCH METHODS The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 6); PubMed; EMBASE; ERIC; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 27 July 2015. SELECTION CRITERIA We included all randomised controlled trials and controlled trials comparing virtual reality training and any other method of training in ear, nose or throat surgery. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. We evaluated both technical and non-technical aspects of skill competency. MAIN RESULTS We included nine studies involving 210 participants. Out of these, four studies (involving 61 residents) assessed technical skills in the operating theatre (primary outcomes). Five studies (comprising 149 residents and medical students) assessed technical skills in controlled environments (secondary outcomes). The majority of the trials were at high risk of bias. We assessed the GRADE quality of evidence for most outcomes across studies as 'low'. Operating theatre environment (primary outcomes) In the operating theatre, there were no studies that examined two of three primary outcomes: real world patient outcomes and acquisition of non-technical skills. The third primary outcome (technical skills in the operating theatre) was evaluated in two studies comparing virtual reality endoscopic sinus surgery training with conventional training. In one study, psychomotor skill (which relates to operative technique or the physical co-ordination associated with instrument handling) was assessed on a 10-point scale. A second study evaluated the procedural outcome of time-on-task. The virtual reality group performance was significantly better, with a better psychomotor score (mean difference (MD) 1.66, 95% CI 0.52 to 2.81; 10-point scale) and a shorter time taken to complete the operation (MD -5.50 minutes, 95% CI -9.97 to -1.03). Controlled training environments (secondary outcomes) In a controlled environment five studies evaluated the technical skills of surgical trainees (one study) and medical students (three studies). One study was excluded from the analysis. Surgical trainees: One study (80 participants) evaluated the technical performance of surgical trainees during temporal bone surgery, where the outcome was the quality of the final dissection. There was no difference in the end-product scores between virtual reality and cadaveric temporal bone training. Medical students: Two other studies (40 participants) evaluated technical skills achieved by medical students in the temporal bone laboratory. Learners' knowledge of the flow of the operative procedure (procedural score) was better after virtual reality than conventional training (SMD 1.11, 95% CI 0.44 to 1.79). There was also a significant difference in end-product score between the virtual reality and conventional training groups (SMD 2.60, 95% CI 1.71 to 3.49). One study (17 participants) revealed that medical students acquired anatomical knowledge (on a scale of 0 to 10) better during virtual reality than during conventional training (MD 4.3, 95% CI 2.05 to 6.55). No studies in a controlled training environment assessed non-technical skills. AUTHORS' CONCLUSIONS There is limited evidence to support the inclusion of virtual reality surgical simulation into surgical training programmes, on the basis that it can allow trainees to develop technical skills that are at least as good as those achieved through conventional training. Further investigations are required to determine whether virtual reality training is associated with better real world outcomes for patients and the development of non-technical skills. Virtual reality simulation may be considered as an additional learning tool for medical students.
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Affiliation(s)
- Patorn Piromchai
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
- Faculty of Medicine, Khon Kaen UniversityDepartment of OtolaryngologyKhon KaenThailand40002
| | - Alex Avery
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Gregor Kennedy
- University of MelbourneCentre for the Study of Higher EducationParkvilleVictoriaAustralia3052
| | - Stephen O'Leary
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
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Naik SM, Naik MS, Bains NK. Cadaveric temporal bone dissection: is it obsolete today? Int Arch Otorhinolaryngol 2013; 18:63-7. [PMID: 25992066 PMCID: PMC4296941 DOI: 10.1055/s-0033-1351681] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/10/2013] [Indexed: 11/03/2022] Open
Abstract
Introduction Traditionally, surgical training in otology, is imparted by dissecting harvested human cadaveric temporal bones. However, maintenance of a cadaveric temporal bone laboratory is expensive and carries risk of exposure to infection. In recent times, other modalities of training are gaining ground and are likely to eventually replace cadaveric temporal bone dissection altogether. Objectives Other alternative methods of training are emerging. New technology like simulation and virtual reality as high-fidelity, safer alternatives, are making rapid strides as teaching tools. Other options are the use of animal temporal bones as teaching tools. The advantages of these are compared. Data Synthesis None of these modalities can replicate the innumerable anatomical variations which are a characteristic feature of the human temporal bone. A novice surgeon not only needs exposure to surgical anatomy and it's variations but also needs to develop hand-eye coordination skills to gain expertise. Conclusion Deliberate practice on human cadaveric temporal bones only, will confer both mastery in anatomy and surgical technique. The human cadaveric temporal bone is ideal simulator for training in otology.
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Affiliation(s)
- Sulabha M Naik
- Department of ENT, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Mahendra S Naik
- Department of ENT, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Nainjot Kaur Bains
- Department of ENT, M.M. Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
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Stredney D, Rezai AR, Prevedello DM, Elder JB, Kerwin T, Hittle B, Wiet GJ. Translating the simulation of procedural drilling techniques for interactive neurosurgical training. Neurosurgery 2013; 73 Suppl 1:74-80. [PMID: 24051887 PMCID: PMC4117341 DOI: 10.1227/neu.0000000000000092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Through previous efforts we have developed a fully virtual environment to provide procedural training of otologic surgical technique. The virtual environment is based on high-resolution volumetric data of the regional anatomy. These volumetric data help drive an interactive multisensory, ie, visual (stereo), aural (stereo), and tactile, simulation environment. Subsequently, we have extended our efforts to support the training of neurosurgical procedural technique as part of the Congress of Neurological Surgeons simulation initiative. OBJECTIVE To deliberately study the integration of simulation technologies into the neurosurgical curriculum and to determine their efficacy in teaching minimally invasive cranial and skull base approaches. METHODS We discuss issues of biofidelity and our methods to provide objective, quantitative and automated assessment for the residents. RESULTS We conclude with a discussion of our experiences by reporting preliminary formative pilot studies and proposed approaches to take the simulation to the next level through additional validation studies. CONCLUSION We have presented our efforts to translate an otologic simulation environment for use in the neurosurgical curriculum. We have demonstrated the initial proof of principles and define the steps to integrate and validate the system as an adjuvant to the neurosurgical curriculum.
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Affiliation(s)
- Don Stredney
- *Department of Otolaryngology and §Department of Neurological Surgery, The Ohio State University, Columbus, Ohio; ‡Ohio Supercomputer Center, Columbus, Ohio; ¶Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio
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Stredney D, Rezai AR, Prevedello DM, Elder JB, Kerwin T, Hittle B, Wiet GJ. Translating the Simulation of Procedural Drilling Techniques for Interactive Neurosurgical Training. Neurosurgery 2013. [DOI: 10.1093/neurosurgery/73.suppl_1.s74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND:
Through previous efforts we have developed a fully virtual environment to provide procedural training of otologic surgical technique. The virtual environment is based on high-resolution volumetric data of the regional anatomy. These volumetric data help drive an interactive multisensory, ie, visual (stereo), aural (stereo), and tactile, simulation environment. Subsequently, we have extended our efforts to support the training of neurosurgical procedural technique as part of the Congress of Neurological Surgeons simulation initiative.
OBJECTIVE:
To deliberately study the integration of simulation technologies into the neurosurgical curriculum and to determine their efficacy in teaching minimally invasive cranial and skull base approaches.
METHODS:
We discuss issues of biofidelity and our methods to provide objective, quantitative and automated assessment for the residents.
RESULTS:
We conclude with a discussion of our experiences by reporting preliminary formative pilot studies and proposed approaches to take the simulation to the next level through additional validation studies.
CONCLUSION:
We have presented our efforts to translate an otologic simulation environment for use in the neurosurgical curriculum. We have demonstrated the initial proof of principles and define the steps to integrate and validate the system as an adjuvant to the neurosurgical curriculum.
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Affiliation(s)
| | - Ali R. Rezai
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio
| | | | - J. Bradley Elder
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio
| | - Thomas Kerwin
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio
| | - Bradley Hittle
- Department of Neurological Surgery, The Ohio State University, Columbus, Ohio
| | - Gregory J. Wiet
- Department of Otolaryngology
- Ohio Supercomputer Center, Columbus, Ohio
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Abstract
This article focuses on key issues surrounding the needs and application of simulation technologies for technical skills training in otolaryngology. The discussion includes an overview of key topics in training and learning, the application of these issues in simulation environments, and the subsequent applications of these simulation environments to otolaryngology. Examples of past applications are presented, with discussion of how the interplay of cultural changes in surgical training in general along with the rapid advancements in technology have shaped and influenced their adoption and adaptation. The authors conclude with emerging trends and potential influences advanced simulation and training will have on technical skills training in otolaryngology.
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Affiliation(s)
- Gregory J. Wiet
- The Ohio State University Departments of Otolaryngology and Biomedical Informatics
| | - Don Stredney
- The Ohio State University Departments of Otolaryngology and Biomedical Informatics
- Ohio Supercomputer Center
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Zhao YC, Kennedy G, Yukawa K, Pyman B, O'Leary S. Improving temporal bone dissection using self-directed virtual reality simulation: results of a randomized blinded control trial. Otolaryngol Head Neck Surg 2010; 144:357-64. [PMID: 21493196 DOI: 10.1177/0194599810391624] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE A significant benefit of virtual reality (VR) simulation is the ability to provide self-direct learning for trainees. This study aims to determine whether there are any differences in performance of cadaver temporal bone dissections between novices who received traditional teaching methods and those who received unsupervised self-directed learning in a VR temporal bone simulator. STUDY DESIGN Randomized blinded control trial. SETTING Royal Victorian Eye and Ear Hospital. SUBJECTS Twenty novice trainees. METHODS After receiving an hour lecture, participants were randomized into 2 groups to receive an additional 2 hours of training via traditional teaching methods or self-directed learning using a VR simulator with automated guidance. The simulation environment presented participants with structured training tasks, which were accompanied by real-time computer-generated feedback as well as real operative videos and photos. After the training, trainees were asked to perform a cortical mastoidectomy on a cadaveric temporal bone. The dissection was videotaped and assessed by 3 otologists blinded to participants' teaching group. RESULTS The overall performance scores of the simulator-based training group were significantly higher than those of the traditional training group (67% vs 29%; P < .001), with an intraclass correlation coefficient of 0.93, indicating excellent interrater reliability. Using other assessments of performance, such as injury size, the VR simulator-based training group also performed better than the traditional group. CONCLUSIONS This study indicates that self-directed learning on VR simulators can be used to improve performance on cadaver dissection in novice trainees compared with traditional teaching methods alone.
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Affiliation(s)
- Yi Chen Zhao
- Department of Otolaryngology, University of Melbourne, Victoria, Australia.
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Wan D, Wiet GJ, Welling DB, Kerwin T, Stredney D. Creating a cross-institutional grading scale for temporal bone dissection. Laryngoscope 2010; 120:1422-7. [PMID: 20564671 DOI: 10.1002/lary.20957] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS There is increasing interest in objective assessment of surgeon competence. In the field of otolaryngology, several surgical training programs, including The Ohio State University, the University of Toronto, and Stanford University, have pursued standardized criteria to rate their trainees' performance in the initial steps of temporal bone dissection (complete mastoidectomy with facial recess approach). Although these assessment metrics require the completion of similar basic components integral to successful temporal bone dissection, certain listed criteria are unique to each institution. Our aim was to establish a more standardized set of criteria that can be used across different institutions to objectively assess temporal bone dissection. We translated these new criteria into automated metrics in our temporal bone dissection simulator to achieve even more objective grading of temporal bone dissections. STUDY DESIGN Cross-sectional study/survey. METHODS The temporal bone assessment criteria developed by each of the three aforementioned institutions were compiled into an all-encompassing scale. This compilation was sent out as an online survey to members of the American Neurotology Society and American Otological Society with instructions to rate the importance of each criterion. RESULTS Criteria that were ranked by >70% of respondents as either "very important" or "important" were used to create the new, cross-institutional scale for the objective assessment of temporal bone dissection. CONCLUSIONS The new assessment scale and its eventual incorporation into the temporal bone surgical simulator will enhance the objectivity of currently existing methods to evaluate surgical performance across different institutions.
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Affiliation(s)
- Dinah Wan
- Ohio State University College of Medicine, Columbus, Ohio, USA
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