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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: 3] [Impact Index Per Article: 3.0] [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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Toale C, Morris M, Kavanagh DO. Training and assessment using the LapSim laparoscopic simulator: a scoping review of validity evidence. Surg Endosc 2023; 37:1658-1671. [PMID: 36123545 DOI: 10.1007/s00464-022-09593-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/25/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The LapSim (Surgical Science, Sweden) laparoscopic simulator is a high-fidelity virtual reality simulator for use in endoscopic surgical training. This review critiques the current validity evidence for the LapSim laparoscopic simulator, specifically with respect to its potential use as a tool and method of training and assessment in surgery. METHODS A scoping review of the MEDLINE (PubMed), EMBASE, Cochrane and Web of Science databases was conducted in accordance with PRISMA guidelines (2020)-scoping review extension. Articles were included if they presented validity evidence for the use of the LapSim in operative skill training or assessment, in accordance with Messick's validity framework. European Association of Endoscopic Surgeons (EAES) guidelines (2005) were used to provide recommendations for the use of the LapSim in operative performance training and assessments. RESULTS Forty-nine articles were included. An EAES level 2 recommendation was provided with regard to the internal consistency reliability of automated performance metrics in assessing performance. An EAES recommendation of 2 was awarded with respect to the ability of the LapSim to discriminate based on case volume and overall laparoscopic experience (relationships with other variables). Performance assessment metrics on the LapSim correlate with improved performance in the operating room (EAES level of recommendation 1-consequential validity). CONCLUSION The LapSim has accumulated substantial evidence supporting the validity of its use in surgical training and assessment. Future studies should explore the relationship between the achievement of performance benchmarks on the LapSim and subsequent patient outcomes, and interrogate the benefits of implementing virtual reality simulation training and assessment curricula in post-graduate surgical training programmes.
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Affiliation(s)
- Conor Toale
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St Stephen's Green, Dublin 2, D02 YN77, Ireland.
| | - Marie Morris
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St Stephen's Green, Dublin 2, D02 YN77, Ireland
| | - Dara O Kavanagh
- Department of Surgical Affairs, Royal College of Surgeons in Ireland, 121 St Stephen's Green, Dublin 2, D02 YN77, Ireland
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Acquisition of robotic surgical skills does not require laparoscopic training: a randomized controlled trial. Surg Endosc 2022; 36:7325-7333. [DOI: 10.1007/s00464-022-09118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 02/07/2022] [Indexed: 10/18/2022]
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Lefor AK, Harada K, Kawahira H, Mitsuishi M. The effect of simulator fidelity on procedure skill training: a literature review. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:97-106. [PMID: 32425176 PMCID: PMC7246118 DOI: 10.5116/ijme.5ea6.ae73] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 04/27/2020] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To evaluate the effect of simulator fidelity on procedure skill training through a review of existing studies. METHODS MEDLINE, OVID and EMBASE databases were searched between January 1990 and January 2019. Search terms included "simulator fidelity and comparison" and "low fidelity" and "high fidelity" and "comparison" and "simulator". Author classification of low- and high-fidelity was used for non-laparoscopic procedures. Laparoscopic simulators are classified using a proposed schema. All included studies used a randomized methodology with two or more groups and were written in English. Data was abstracted to a standard data sheet and critically appraised from 17 eligible full papers. RESULTS Of 17 studies, eight were for laparoscopic and nine for other skill training. Studies employed evaluation methodologies, including subjective and objective measures. The evaluation was conducted once in 13/17 studies and before-after in 4/17. Didactic training only or control groups were used in 5/17 studies, while 10/17 studies included two groups only. Skill acquisition and simulator fidelity were different for the level of training in 1/17 studies. Simulation training was followed by clinical evaluation or a live animal evaluation in 3/17 studies. Low-fidelity training was not inferior to training with a high-fidelity simulator in 15/17 studies. CONCLUSIONS Procedure skill after training with low fidelity simulators was not inferior to skill after training with high fidelity simulators in 15/17 studies. Some data suggest that the effectiveness of different fidelity simulators depends on the level of training of participants and requires further study.
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Affiliation(s)
- Alan Kawarai Lefor
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Kanako Harada
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Kawahira
- Jichi Medical Simulation Center, Jichi Medical University, Tochigi, Japan
| | - Mamoru Mitsuishi
- Department of Bioengineering, School of Engineering, The University of Tokyo, Tokyo, Japan
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Training and qualification in gynecological minimal access surgery: A systematic review. Best Pract Res Clin Obstet Gynaecol 2019; 59:2-11. [PMID: 30857979 DOI: 10.1016/j.bpobgyn.2019.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 01/08/2023]
Abstract
Minimally invasive surgery demands specific endoscopic psychomotor skills that are usually acquired outside the operating theatre. We present the results of a systematic analysis to identify how simulation is used during training and qualification in minimal access surgery to improve gynecologist's surgical skills. We found that despite the availability of simulation tools along with methods for training and testing specific endoscopic psychomotor and technical skills, there is no clear evidence of the superiority of one tool or method over the others in skill acquisition. However, prospective studies show that well-guided training courses combined with different trainers and methods improve significantly surgeon's laparoscopic skills and suturing ability, which are unforgettable over time. However, this proficiency could deteriorate over time when it is solely learned and executed on simulation trainers. Structured curricula including theory, simulation, and live-surgery seem to be the best option for trainees. More research in this field is needed.
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Bickerton R, Nassimizadeh AK, Ahmed S. Three-dimensional endoscopy: The future of nasoendoscopic training. Laryngoscope 2019; 129:1280-1285. [PMID: 30628084 DOI: 10.1002/lary.27812] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/03/2018] [Accepted: 12/26/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Three-dimensional (3D) endoscopy is an emerging tool in surgery that provides real-time depth perception. Its benefits have been investigated in surgical training, but the current literature lacks significant objective outcome data. We aimed to objectively compare the efficacy of two-dimensional (2D) versus 3D high-definition endoscopes in novice users. STUDY DESIGN Prospective, randomized crossover study. METHODS Ninety-two novice medical students who used both 2D and 3D endoscopes to complete two validated tasks in a box trainer participated in the study. Time taken and error rates were measured, and subjective data were collected. RESULTS Wilcoxon tests showed 3D technology was significantly faster than 2D (78 vs. 95 seconds, P = .004), and errors per task were significantly lower (3 vs. 5, P < .001). Sixty-nine percent of participants preferred the 3D endoscope. CONCLUSIONS 3D high-definition endoscopy could be instrumental in training the next generation of endoscopic surgeons. Further research is required in a clinical setting. LEVEL OF EVIDENCE 2b Laryngoscope, 129:1280-1285, 2019.
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Affiliation(s)
| | - Abdul-Karim Nassimizadeh
- Department of Ear, Nose and Throat (ENT) Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Shahzada Ahmed
- Department of Ear, Nose and Throat (ENT) Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Virtual Reality Simulation in Nontechnical Skills Training for Healthcare Professionals. ACTA ACUST UNITED AC 2019; 14:188-194. [DOI: 10.1097/sih.0000000000000347] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Peers versus Pros: Feedback using standards in simulation training. Am J Surg 2018; 216:1223-1229. [PMID: 30082027 DOI: 10.1016/j.amjsurg.2018.07.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/23/2018] [Accepted: 07/27/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Creating and updating expert performance-based standards for simulators is labor intensive and requires the regular availability of expert surgeons. We investigated how peer performance based standards compare to expert performance based standards. METHODS One hundred medical students took part in a four-session laparoscopic basic skills simulator training course. Performance for the FLS videotrainer tasks were compared between students who received feedback based on either peer standards, expert standards or no feedback at all (control group). RESULTS No difference in performance between our feedback groups was found. Compared to the control group, they were 18-36% faster but made 52% more errors for tasks on the FLS video trainer (U range [93.5-957], average p < .01). CONCLUSIONS We demonstrated that feedback based on peer standards is equally effective as feedback based on expert standards. The found trade-off between speed and error is not desirable and warrants further investigation.
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Mushtaq F, O’Driscoll C, Smith FCT, Wilkins D, Kapur N, Lawton R. Contributory factors in surgical incidents as delineated by a confidential reporting system. Ann R Coll Surg Engl 2018; 100:401-405. [PMID: 29543056 PMCID: PMC5956595 DOI: 10.1308/rcsann.2018.0025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2018] [Indexed: 12/20/2022] Open
Abstract
Background Confidential reporting systems play a key role in capturing information about adverse surgical events. However, the value of these systems is limited if the reports that are generated are not subjected to systematic analysis. The aim of this study was to provide the first systematic analysis of data from a novel surgical confidential reporting system to delineate contributory factors in surgical incidents and document lessons that can be learned. Methods One-hundred and forty-five patient safety incidents submitted to the UK Confidential Reporting System for Surgery over a 10-year period were analysed using an adapted version of the empirically-grounded Yorkshire Contributory Factors Framework. Results The most common factors identified as contributing to reported surgical incidents were cognitive limitations (30.09%), communication failures (16.11%) and a lack of adherence to established policies and procedures (8.81%). The analysis also revealed that adverse events were only rarely related to an isolated, single factor (20.71%) - with the majority of cases involving multiple contributory factors (79.29% of all cases had more than one contributory factor). Examination of active failures - those closest in time and space to the adverse event - pointed to frequent coupling with latent, systems-related contributory factors. Conclusions Specific patterns of errors often underlie surgical adverse events and may therefore be amenable to targeted intervention, including particular forms of training. The findings in this paper confirm the view that surgical errors tend to be multi-factorial in nature, which also necessitates a multi-disciplinary and system-wide approach to bringing about improvements.
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Affiliation(s)
- F Mushtaq
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - C O’Driscoll
- Division of Psychiatry, University College London, London, UK
| | - FCT Smith
- Faculty of Health Sciences, University of Bristol, UK
| | | | - N Kapur
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - R Lawton
- School of Psychology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford, UK
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Trudeau MO, Carrillo B, Nasr A, Gerstle JT, Azzie G. Comparison of Adult and Pediatric Surgeons: Insight into Simulation-Based Tools That May Improve Expertise Among Experts. J Laparoendosc Adv Surg Tech A 2018; 28:599-605. [DOI: 10.1089/lap.2017.0214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Brian Carrillo
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ahmed Nasr
- Department of Surgery, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Ted Gerstle
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Georges Azzie
- Division of General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
Surgery is traditionally taught by using Halsteadian principle, which includes “see one, do one, teach one”. This principle relies on sheer volume of surgical exposure rather than a specific course structure. Simulation in minimally invasive surgery allows the learner to practice new motor skills in a safe and stress free environment outside the operating room, thereby decreasing the learning curve. A non-structured exhaustive MEDLINE search was done using MeSH words: “Simulation, Urological Training, Training Models, Laparoscopy Urology, Laparoscopic Skill, Endotrainer, Surgical Simulators, Simulator Validation”. The “ Pros and Cons of simulation based training in laparoscopic urology” were studied. Results were discussed along the following lines : 1. How does skill acquisition occur? 2. Factors affecting simulator-based training. 3. Description of types of simulators and models. 4. Validating a simulator. 5. Task analysis after training on a simulator. 6. How effectively does simulation based training, translate into improved surgical performance in real time? Pros: Simulators have the ability to teach a novice basic psychomotor skills. Supervision and feedback enhance learning in a simulation-based training. They are supplements to and not a substitution for traditional method of teaching. These models can be used as a part of most of the surgical training curriculum. Cons: Cost and availability are the key issues. The cost will determine the availability of the simulators at a center and the availability in turn would determine whether a trainee will get the opportunity to use the simulator. Also, teacher training is an important aspect which would help teachers to understand the importance of simulation in student training. The domains in which it would improve and the extent to which simulation will improve surgical skills is dependent on various factors. Most simulators cannot train a surgeon to deal with anatomical and physiological variations. At present, it is not possible to re-validate all the surgeons in terms of their surgical skills, using simulators.
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Affiliation(s)
- Abhishek Gajendra Singh
- Fellow Endourology, Lapro-Robotic Surgery, Consultant Urologist, MPUH, NADIAD, Gujarat, India
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Mathews S, Brodman M, D'Angelo D, Chudnoff S, McGovern P, Kolev T, Bensinger G, Mudiraj S, Nemes A, Feldman D, Kischak P, Ascher-Walsh C. Predictors of laparoscopic simulation performance among practicing obstetrician gynecologists. Am J Obstet Gynecol 2017; 217:596.e1-596.e7. [PMID: 28712950 DOI: 10.1016/j.ajog.2017.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/22/2017] [Accepted: 07/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND While simulation training has been established as an effective method for improving laparoscopic surgical performance in surgical residents, few studies have focused on its use for attending surgeons, particularly in obstetrics and gynecology. Surgical simulation may have a role in improving and maintaining proficiency in the operating room for practicing obstetrician gynecologists. OBJECTIVE We sought to determine if parameters of performance for validated laparoscopic virtual simulation tasks correlate with surgical volume and characteristics of practicing obstetricians and gynecologists. STUDY DESIGN All gynecologists with laparoscopic privileges (n = 347) from 5 academic medical centers in New York City were required to complete a laparoscopic surgery simulation assessment. The physicians took a presimulation survey gathering physician self-reported characteristics and then performed 3 basic skills tasks (enforced peg transfer, lifting/grasping, and cutting) on the LapSim virtual reality laparoscopic simulator (Surgical Science Ltd, Gothenburg, Sweden). The association between simulation outcome scores (time, efficiency, and errors) and self-rated clinical skills measures (self-rated laparoscopic skill score or surgical volume category) were examined with regression models. RESULTS The average number of laparoscopic procedures per month was a significant predictor of total time on all 3 tasks (P = .001 for peg transfer; P = .041 for lifting and grasping; P < .001 for cutting). Average monthly laparoscopic surgical volume was a significant predictor of 2 efficiency scores in peg transfer, and all 4 efficiency scores in cutting (P = .001 to P = .015). Surgical volume was a significant predictor of errors in lifting/grasping and cutting (P < .001 for both). Self-rated laparoscopic skill level was a significant predictor of total time in all 3 tasks (P < .0001 for peg transfer; P = .009 for lifting and grasping; P < .001 for cutting) and a significant predictor of nearly all efficiency scores and errors scores in all 3 tasks. CONCLUSION In addition to total time, there was at least 1 other objective performance measure that significantly correlated with surgical volume for each of the 3 tasks. Higher-volume physicians and those with fellowship training were more confident in their laparoscopic skills. By determining simulation performance as it correlates to active physician practice, further studies may help assess skill and individualize training to maintain skill levels as case volumes fluctuate.
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Abstract
INTRODUCTION The success of war fighters and medical personnel handling traumatic injuries largely depends on the quality of training they receive before deployment. The purpose of this study was to gauge the utility of a Wide Area Virtual Environment (WAVE) as a training adjunct by comparing and evaluating student performance, measuring sense of realism, and assessing the impact on student satisfaction with their training exposure in an immersive versus a field environment. METHODS This comparative prospective cohort study examined the utility of a three-screen WAVE where subjects were immersed in the training environment with medical simulators. Standard field training commenced for the control group subjects. Medical skills, time to completion, and Team Strategies and Tools to Enhance Performance and Patient Safety objective metrics were assessed for each team (n = 94). In addition, self-efficacy questionnaires were collected for each subject (N = 470). RESULTS Medical teams received poorer overall team scores (F1,186 = 0.756, P = 0.001), took longer to complete the scenario (F1,186 = 25.15, P = 0.001), and scored lower on The National Registry of Emergency Medical Technicians trauma assessment checklist (F1,186 = 1.13, P = 0.000) in the WAVE versus the field environment. Critical thinking and realism factors within the self-efficacy questionnaires scored higher in the WAVE versus the field [(F1,466 = 8.04, P = 0.005), (F1,465 = 18.57, P = 0.000), and (F1,466 = 53.24, P = 0.000), respectively]. CONCLUSIONS Environmental and emotional stressors may negatively affect critical thinking and clinical skill performance of medical teams. However, by introducing more advanced simulation trainings with added stressors, students may be able to adapt and overcome barriers to performance found in high-stress environments.
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Neveu ME, Debras E, Niro J, Fernandez H, Panel P. Standardizing hysteroscopy teaching: development of a curriculum using the Delphi method. Surg Endosc 2017. [PMID: 28634628 DOI: 10.1007/s00464-017-5620-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hysteroscopy is performed often and in many indications but is challenging to learn. Hands-on training in live patients faces ethical, legal, and economic obstacles. Virtual reality simulation may hold promise as a hysteroscopy training tool. No validated curriculum specific in hysteroscopy exists. The aim of this study was to develop a hysteroscopy curriculum, using the Delphi method to identify skill requirements. METHODS Based on a literature review using the key words "curriculum," "simulation," and "hysteroscopy," we identified five technical and non-technical areas in which skills were required. Twenty hysteroscopy experts from different French hospital departments participated in Delphi rounds to select items in these five areas. The rounds were to be continued until 80-100% agreement was obtained for at least 60% of items. A curriculum was built based on the selected items and was evaluated in residents. RESULTS From November 2014 to April 2015, 18 of 20 invited experts participated in three Delphi rounds. Of the 51 items selected during the first round, only 25 (49%) had 80-100% agreement during the second round, and a third round was therefore conducted. During this last round, 80-100% agreement was achieved for 31 (61%) items, which were used to create the curriculum. All 14 residents tested felt that a simulator training session was acceptable and helped them to improve their skills. CONCLUSIONS We describe a simulation-based hysteroscopy curriculum focusing on skill requirements identified by a Delphi procedure. Its development allows standardization of training programs offered to residents.
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Affiliation(s)
| | - Elodie Debras
- Department of Gynecology and Obstetrics, Versailles Hospital, Le Chesnay, France
| | - Julien Niro
- Department of Gynecology and Obstetrics, Versailles Hospital, Le Chesnay, France
| | - Hervé Fernandez
- Department of Gynecology and Obstetrics, Kremlin-Bicêtre University Hospital, Le Kremlin-Bicêtre, France
| | - Pierre Panel
- Department of Gynecology and Obstetrics, Versailles Hospital, Le Chesnay, France
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Abstract
Paediatric endoscopic surgery is greatly indebted to Karl Storz for developing paediatric endoscopic instruments. In more recent years, there is an increasing interest in endoscopic surgery in neonates. Now more complex procedures are being performed, although it will take another generation before these will be more generally applied. One of the key factors to success is training. More sophisticated training models are becoming available, allowing practicing in a safe environment before putting the procedure to practice. A key question in performing complex procedures is whether such procedures should not be concentrated into centres of expertise. Finally, a critical appraisal is warranted in regard to safety of surgery in neonates, as they fail to have cerebral autoregulation. As endoscopy may add additional risk factors, close monitoring is obligatory. LEVEL OF EVIDENCE V.
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Affiliation(s)
- David C van der Zee
- Department of Pediatric Surgery, University Medical Center Utrecht, Wilhelmina Children's Hospital, KE 04.140.5, P.O. Box 85090, 3508AB Utrecht, The Netherlands.
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Shore EM, Grantcharov TP, Husslein H, Shirreff L, Dedy NJ, McDermott CD, Lefebvre GG. Validating a standardized laparoscopy curriculum for gynecology residents: a randomized controlled trial. Am J Obstet Gynecol 2016; 215:204.e1-204.e11. [PMID: 27131588 DOI: 10.1016/j.ajog.2016.04.037] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Residency programs struggle with integrating simulation training into curricula, despite evidence that simulation leads to improved operating room performance and patient outcomes. Currently, there is no standardized laparoscopic training program available for gynecology residents. OBJECTIVE The purpose of this study was to develop and validate a comprehensive ex vivo training curriculum for gynecologic laparoscopy. STUDY DESIGN In a prospective, single-blinded randomized controlled trial (Canadian Task Force Classification I) postgraduate year 1 and 2 gynecology residents were allocated randomly to receive either conventional residency training or an evidence-based laparoscopy curriculum. The 7-week curriculum consisted of cognitive didactic and interactive sessions, low-fidelity box trainer and high-fidelity virtual reality simulator technical skills, and high-fidelity team simulation. The primary outcome measure was the technical procedure score at laparoscopic salpingectomy with the use of the objective structured assessment of laparoscopic salpingectomy tool. Secondary outcome measures related to performance in multiple-choice questions and technical performance at box trainer and virtual reality simulator tasks. A sample size of 10 residents per group was planned (n = 20). Results are reported as medians (interquartile ranges), and data were compared between groups with the Mann-Whitney U, chi-square, and Fisher's exact tests (P ≤ .05). RESULTS In July 2013, 27 residents were assigned randomly (14 curriculum, 13 conventional). Both groups were similar at baseline. Twenty-one residents (10 curriculum, 11 conventional) completed the surgical procedure-based assessment in the operating room (September to December 2013). Our primary outcome indicated that curriculum-trained residents displayed superior performance at laparoscopic salpingectomy (P = .043). Secondary outcomes demonstrated that curriculum-trained residents had higher performance scores on the cognitive multiple-choice questions (P < .001), the nontechnical skills multiple-choice questions (P = .016), box trainer task time (P < .001), and all virtual reality simulator parameters. CONCLUSION Participation in a comprehensive simulation-based training curriculum for gynecologic laparoscopy leads to a superior improvement in knowledge and technical performance in the operating room compared with conventional residency training.
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Affiliation(s)
- Eliane M Shore
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada.
| | - Teodor P Grantcharov
- Department of Surgery, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Heinrich Husslein
- Department of Obstetrics and Gynaecology, Medical University of Vienna, Vienna, Austria
| | - Lindsay Shirreff
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Nicolas J Dedy
- Department of Surgery, Gold Coast University Hospital, Southport, Australia
| | - Colleen D McDermott
- Department of Obstetrics and Gynaecology, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
| | - Guylaine G Lefebvre
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto, Ontario, Canada
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Prat G, Charron C, Repesse X, Coriat P, Bailly P, L'her E, Vieillard-Baron A. The use of computerized echocardiographic simulation improves the learning curve for transesophageal hemodynamic assessment in critically ill patients. Ann Intensive Care 2016; 6:27. [PMID: 27055668 PMCID: PMC4824699 DOI: 10.1186/s13613-016-0132-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 03/21/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Our aim was to evaluate the impact of a computerized echocardiographic simulator on the learning curve for transesophageal echocardiography (TEE) hemodynamic assessment of ventilated patients in the ICU. METHODS We performed a prospective study in two university hospital medical ICUs. Using our previously validated skill assessment scoring system (/40 points), we compared learning curves obtained with (interventional group, n = 25 trainees) and without (control group, n = 31 trainees) use of a simulator in the training. Three evaluations were performed after 1 (M1), 3 (M3) and 6 months (M6) while performing two TEE examinations graded by an expert. Competency was defined as a score >35/40. RESULTS Competency was achieved after an average of 32.5 ± 10 supervised studies in the control group compared with only 13.6 ± 8.5 in the interventional group (p < 0.0001). At M6, a significant between-group difference in number of supervised TEE was observed (17 [14-28] in the control group vs. 30.5 [21.5-39.5] in the interventional group, p = 0.001). The score was significantly higher in the interventional group at M1 (32.5 [29.25-35.5] vs. 24.75 [20-30.25]; p = 0.0001), M3 (37 [33.5-38.5] vs. 32 [30.37-34.5]; p = 0.0004), but not at M6 (37.5 [33-39] vs. 36 [33.5-37.5] p = 0.24). CONCLUSION Inclusion of echocardiographic simulator sessions in a standardized curriculum may improve the learning curve for hemodynamic evaluation of ventilated ICU patients.
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Affiliation(s)
- Gwénaël Prat
- Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France. .,Centre de Simulation en Santé, Université de Bretagne Occidentale, Brest, France.
| | - Cyril Charron
- Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France
| | - Xavier Repesse
- Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France
| | - Pierre Coriat
- Hospital Pitié-Salpêtrière, Department of Anesthesiology and Critical Care, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie-Curie-Paris 6, Paris, France
| | - Pierre Bailly
- Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France.,Centre de Simulation en Santé, Université de Bretagne Occidentale, Brest, France
| | - Erwan L'her
- Medical Intensive Care Unit, University Hospital of Brest, Cavale Blanche, 29609, Brest Cedex, France.,LATIM INSERM UMR 1101, Université de Bretagne Occidentale, Brest, France.,FHU TechSan, Université de Bretagne Occidentale/Université de Rennes, Rennes, France
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Section Thorax-Vascular Disease-Abdomen-Metabolism, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Pare, 9, Avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France.,INSERM U-1018, CESP, Team 5 (EpReC, Renal and Cardiovascular Epidemiology), UVSQ, 94807, Villejuif, France
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Rodríguez-Sanjuán JC, Gómez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, López-Useros A, Gómez-Fleitas M. Laparoscopic and robot-assisted laparoscopic digestive surgery: Present and future directions. World J Gastroenterol 2016; 22:1975-2004. [PMID: 26877605 PMCID: PMC4726673 DOI: 10.3748/wjg.v22.i6.1975] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/20/2015] [Accepted: 11/30/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic surgery is applied today worldwide to most digestive procedures. In some of them, such as cholecystectomy, Nissen's fundoplication or obesity surgery, laparoscopy has become the standard in practice. In others, such as colon or gastric resection, the laparoscopic approach is frequently used and its usefulness is unquestionable. More complex procedures, such as esophageal, liver or pancreatic resections are, however, more infrequently performed, due to the high grade of skill necessary. As a result, there is less clinical evidence to support its implementation. In the recent years, robot-assisted laparoscopic surgery has been increasingly applied, again with little evidence for comparison with the conventional laparoscopic approach. This review will focus on the complex digestive procedures as well as those whose use in standard practice could be more controversial. Also novel robot-assisted procedures will be updated.
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White C, Rodger MWM, Tang T. Current understanding of learning psychomotor skills and the impact on teaching laparoscopic surgical skills. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/tog.12255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Colette White
- Royal Jubilee Maternity Services; Belfast Health and Social Care Trust; 274 Grosvenor Road Belfast BT12 6BA UK
| | - Matthew WM Rodger
- Department of Psychology; Queen's University Belfast; Belfast BT9 5BN UK
| | - Thomas Tang
- Regional Fertility Centre; Royal Jubilee Maternity Services; Belfast Health and Social Care Trust; Belfast BT12 6BA UK
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Ma M, Fallavollita P, Seelbach I, Von Der Heide AM, Euler E, Waschke J, Navab N. Personalized augmented reality for anatomy education. Clin Anat 2015; 29:446-53. [DOI: 10.1002/ca.22675] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Meng Ma
- Chair for Computer Aided Medical Procedures & Augmented Reality, Technische Universität München; Munich Germany
| | - Pascal Fallavollita
- Chair for Computer Aided Medical Procedures & Augmented Reality, Technische Universität München; Munich Germany
| | - Ina Seelbach
- Ludwig-Maximilians, Universität München; Munich Germany
| | - Anna Maria Von Der Heide
- Klinik Für Allgemeine, Unfall-, Hand- Und Plastische Chirurgie, Klinikum Der Universität München; Munich Germany
| | - Ekkehard Euler
- Klinik Für Allgemeine, Unfall-, Hand- Und Plastische Chirurgie, Klinikum Der Universität München; Munich Germany
| | - Jens Waschke
- Anatomische Anstalt Der Ludwig-Maximilians-Universität München; Munich Germany
| | - Nassir Navab
- Chair for Computer Aided Medical Procedures & Augmented Reality, Technische Universität München; Munich Germany
- Johns Hopkins University; Baltimore USA
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22
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Retrosi G, Cundy T, Haddad M, Clarke S. Motion Analysis–Based Skills Training and Assessment in Pediatric Laparoscopy: Construct, Concurrent, and Content Validity for the eoSim Simulator. J Laparoendosc Adv Surg Tech A 2015; 25:944-50. [DOI: 10.1089/lap.2015.0069] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Giuseppe Retrosi
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Thomas Cundy
- Discipline of Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Munther Haddad
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Simon Clarke
- Department of Paediatric Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
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Groenier M, Groenier KH, Miedema HAT, Broeders IAMJ. Perceptual Speed and Psychomotor Ability Predict Laparoscopic Skill Acquisition on a Simulator. JOURNAL OF SURGICAL EDUCATION 2015; 72:1224-1232. [PMID: 26341168 DOI: 10.1016/j.jsurg.2015.07.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/11/2015] [Accepted: 07/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Performing minimally invasive surgery puts high demands on a surgeon's cognitive and psychomotor abilities. Assessment of these abilities can be used to predict a surgeon's learning curve, to create individualized training programs, and ultimately in selection programs for surgical training. The aim of this study was to examine the influence of cognitive and psychomotor ability on the training duration and learning rate. DESIGN A prospective quasiexperimental field study regarding the influence of cognitive and psychomotor ability, baseline measures of time to complete task, damage to tissue, and efficiency of movement, age, and gender on the number of sessions needed to reach a predefined performance level on a laparoscopy simulator. The same variables were investigated as predictors of the learning rate. SETTING The study was performed at the Experimental Center for Technical Medicine at the University of Twente, The Netherlands. PARTICIPANTS In all, 98 novices from the Master program of Technical Medicine followed a proficiency-based basic laparoscopic skills training. RESULTS Perceptual speed (PS) predicted training duration (hazard ratio = 1.578; 95% CI = 1.084, 2.300; p = 0.017). Cognitive (b = -0.721, p = 0.014) and psychomotor ability (b = 0.182, p = 0.009) predicted the learning rate of time to complete the task. Also, the learning rate for participants with higher levels of PS was lower (b = 0.167, p = 0.036). Psychomotor ability also predicted the learning rate for damage to tissue (b = 0.194, p = 0.015) and efficiency of movement (b = 0.229, p = 0.004). Participants with better psychomotor ability outperformed other participants across all sessions on all outcome measures. CONCLUSIONS PS predicted training duration in a basic laparoscopic skills training and the learning rate for the time to complete the task. Psychomotor ability predicted the learning rate for laparoscopic skill acquisition in terms of time to complete task, damage to tissue, and efficiency of movements. These results indicate early automation of basic laparoscopic skill. Careful selection of the cognitive abilities tests is advised for use in training programs and to identify individuals who need more training.
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Affiliation(s)
- Marleen Groenier
- Department of Technical Medicine, University of Twente, Enschede, The Netherlands.
| | - Klaas H Groenier
- Department of General Practice, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Heleen A T Miedema
- Department of Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Ivo A M J Broeders
- Department of Technical Medicine, University of Twente, Enschede, The Netherlands; Department of Surgery, Meander Medical Centre, Amersfoort, The Netherlands
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Jordan A, El Haloui O, Breaud J, Chevalier D, Antomarchi J, Bongain A, Boucoiran I, Delotte J. Formation des internes de gynécologie obstétrique : évaluation d’un programme pédagogique intégrant cours théoriques et sessions pratiques sur simulateurs. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.gyobfe.2015.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Szasz P, Louridas M, Harris KA, Aggarwal R, Grantcharov TP. Assessing Technical Competence in Surgical Trainees. Ann Surg 2015; 261:1046-55. [PMID: 25119118 DOI: 10.1097/sla.0000000000000866] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Shore EM, Lefebvre GG, Husslein H, Bjerrum F, Sorensen JL, Grantcharov TP. Designing a Standardized Laparoscopy Curriculum for Gynecology Residents: A Delphi Approach. J Grad Med Educ 2015. [PMID: 26221434 PMCID: PMC4512789 DOI: 10.4300/jgme-d-14-00548.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Evidence suggests that simulation leads to improved operative skill, shorter operating room time, and better patient outcomes. Currently, no standardized laparoscopy curriculum exists for gynecology residents. OBJECTIVE To design a structured laparoscopy curriculum for gynecology residents using Delphi consensus methodology. METHODS This study began with Delphi methodology to determine expert consensus on the components of a gynecology laparoscopic skills curriculum. We generated a list of cognitive content, technical skills, and nontechnical skills for training in laparoscopic surgery, and asked 39 experts in gynecologic education to rate the items on a Likert scale (1-5) for inclusion in the curriculum. Consensus was predefined as Cronbach α of ≥0.80. We then conducted another Delphi survey with 9 experienced users of laparoscopic virtual reality simulators to delineate relevant curricular tasks. Finally, a cross-sectional design defined benchmark scores for all identified tasks, with 10 experienced gynecologic surgeons performing the identified tasks at basic, intermediate, and advanced levels. RESULTS Consensus (Cronbach α=0.85) was achieved in the first round of the curriculum Delphi, and after 2 rounds (Cronbach α=0.80) in the virtual reality curriculum Delphi. Consensus was reached for cognitive, technical, and nontechnical skills as well as for 6 virtual reality tasks. Median time and economy of movement scores defined benchmarks for all tasks. CONCLUSIONS This study used Delphi consensus to develop a comprehensive curriculum for teaching gynecologic laparoscopy. The curriculum conforms to current educational standards of proficiency-based training, and is suggested as a standard in residency programs.
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Affiliation(s)
- Eliane M. Shore
- Corresponding author: Eliane M. Shore, MD, MSc, FRCSC, St Michael’s Hospital, 30 Bond Street, Toronto, Ontario M5B 1W8 Canada, 416.864.5384,
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Luursema JM, Rovers MM, Alken A, Kengen B, van Goor H. When experts are oceans apart: comparing expert performance values for proficiency-based laparoscopic simulator training. JOURNAL OF SURGICAL EDUCATION 2015; 72:536-541. [PMID: 25572942 DOI: 10.1016/j.jsurg.2014.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 09/22/2014] [Accepted: 11/16/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Surgical training is moving away from the operating room toward simulation-based skills training facilities. This has led to the development of proficiency-based training courses in which expert performance data are used for feedback and assessment. However, few expert value data sets have been published, and no standard method for generating expert values has been adopted by the field. METHODS To investigate the effect of different proficiency value data sets on simulator training courses, we (1) compared 2 published expert performance data sets for the LapSim laparoscopic virtual-reality simulator (by van Dongen et al. and Heinrichs et al.) and (2) assessed the effect of using either set on LapSim training data obtained from 16 local residents in surgery and gynecology. RESULTS Across all simulator tasks, the experts consulted by van Dongen et al. performed better on motion efficiency, but not on duration or damage control. Applying both proficiency sets to training data collected during a basic skills laparoscopic simulator course, residents would have graduated on an average in 1.5 fewer sessions using the Heinrichs expert values compared with the van Dongen expert values. CONCLUSIONS The selection of proficiency values for proficiency-based simulator training courses affects training length, skills level assessment, and training costs. Standardized, well-controlled methods are necessary to create valid and reliable expert values for use in training and research.
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Affiliation(s)
- Jan-Maarten Luursema
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Operating Rooms, Radboud Universty Medical Center, Nijmegen, The Netherlands.
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud Universty Medical Center, Nijmegen, The Netherlands; Department of Epidemiology, Biostatistics & HTA, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alexander Alken
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas Kengen
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Nickel F, Brzoska JA, Gondan M, Rangnick HM, Chu J, Kenngott HG, Linke GR, Kadmon M, Fischer L, Müller-Stich BP. Virtual reality training versus blended learning of laparoscopic cholecystectomy: a randomized controlled trial with laparoscopic novices. Medicine (Baltimore) 2015; 94:e764. [PMID: 25997044 PMCID: PMC4602875 DOI: 10.1097/md.0000000000000764] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program.Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks.Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires.The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P < 0.001). Both groups showed equal operative performance of LC in the OSATS score (49.4 ± 10.5 vs 49.7 ± 12.0, P = 0.90). Students generally liked training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group.VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches.
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Affiliation(s)
- Felix Nickel
- From the Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany (FN, JAB, HMR, JC, HGK, GRL, MK, LF, BPM-S); and Department of Psychology, University of Copenhagen, Copenhagen, Denmark (MG)
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Performance optimization of force feedback control system in virtual vascular intervention surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:673415. [PMID: 25254063 PMCID: PMC4165566 DOI: 10.1155/2014/673415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 07/09/2014] [Accepted: 07/26/2014] [Indexed: 11/18/2022]
Abstract
In virtual surgery of minimally invasive vascular intervention, the force feedback is transmitted
through the flexible guide wire. The disturbance caused by the flexible deformation
would affect the fidelity of the VR (virtual reality) training. SMC (sliding
mode control) strategy with delayed-output observer is adopted to suppress the effect of
flexible deformation. In this study, the control performance of the strategy is assessed
when the length of guide wire between actuator and the operating point changes. The
performance assessment results demonstrate the effectiveness of the proposed method
and find the optimal length of guide wire for the force feedback control.
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Amirian I, Andersen LT, Rosenberg J, Gögenur I. Laparoscopic skills and cognitive function are not affected in surgeons during a night shift. JOURNAL OF SURGICAL EDUCATION 2014; 71:543-550. [PMID: 24813717 DOI: 10.1016/j.jsurg.2013.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/24/2013] [Accepted: 12/20/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To monitor surgeons' performance and cognition during night shifts. DESIGN Surgeons were monitored before call and on call (17-hour shift). Psychomotor performance was assessed by laparoscopic simulation and cognition by the d2 test of attention. The surgeons performed the laparoscopic simulation and the d2 test of attention at 8 a.m. before call and at 4 a.m. on call. Sleep was measured by wrist actigraphy and sleepiness by the Karolinska sleepiness scale. SETTING Department of Surgery at Herlev Hospital, Denmark. PARTICIPANTS Overall, 30 interns, residents, and attending surgeons were included and completed the study. One participant was subsequently excluded owing to myxedema. RESULTS The surgeons slept significantly less on call than before call. There was increasing sleepiness on call; however, no significant differences were found in the precall laparoscopic simulation values compared with on-call values. The d2 test of attention showed significantly improved values on call compared with before call. CONCLUSION Sleep deprivation during a 17-hour night shift did not impair surgeons' psychomotor or cognitive performance.
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Affiliation(s)
- Ilda Amirian
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - Lærke T Andersen
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Ismail Gögenur
- Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
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Luursema JM, Rovers MM, Groenier M, van Goor H. Performance variables and professional experience in simulated laparoscopy: a two-group learning curve study. JOURNAL OF SURGICAL EDUCATION 2014; 71:568-573. [PMID: 24776879 DOI: 10.1016/j.jsurg.2013.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/20/2013] [Accepted: 12/19/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Virtual reality simulators are increasingly used in laparoscopy training. Such simulators allow objective assessment of performance. However, both low-level variables and overall scores generated by the simulator can be hard to interpret. We present a method to generate intermediate performance variables and show how the resulting variables can be used to investigate the development of laparoscopic skills. DESIGN A beginner group (n = 16) and a group with intermediate laparoscopic experience (n = 9) participated in a 5-session, basic skills training course hosted by the Department of Technical Medicine at the University of Twente. Multiple simulator-generated variables were aggregated into 4 performance variables: duration, left-hand motion, right-hand motion, and damage. Differences in performance were analyzed in relation to proficiency values. RESULTS Damage performance differentiated the most between groups and proficiency values; motion performance variables differentiated the least. The more experienced group outperformed the beginner group at damage by the end of the course. CONCLUSIONS Differentiating between duration, left-hand motion, right-hand motion, and damage is a useful way to investigate laparoscopic performance development. Different performance variables follow different trajectories toward expertise. Valid and reliable clinical damage parameters are needed to investigate the relation of real-world damage to simulator damage.
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Affiliation(s)
- Jan-Maarten Luursema
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Operating Rooms, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
| | - Maroeska M Rovers
- Department of Operating Rooms, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Department of Epidemiology, Biostatistics & HTA, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Marleen Groenier
- Department of Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Groenier M, Schraagen JMC, Miedema HAT, Broeders IAJM. The role of cognitive abilities in laparoscopic simulator training. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2014; 19:203-217. [PMID: 23568181 DOI: 10.1007/s10459-013-9455-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 03/25/2013] [Indexed: 06/02/2023]
Abstract
Learning minimally invasive surgery (MIS) differs substantially from learning open surgery and trainees differ in their ability to learn MIS. Previous studies mainly focused on the role of visuo-spatial ability (VSA) on the learning curve for MIS. In the current study, the relationship between spatial memory, perceptual speed, and general reasoning ability, in addition to VSA, and performance on a MIS simulator is examined. Fifty-three laparoscopic novices were tested for cognitive aptitude. Laparoscopic performance was assessed with the LapSim simulator (Surgical Science Ltd., Gothenburg, Sweden). Participants trained multiple sessions on the simulator until proficiency was reached. Participants showed significant improvement on the time to complete the task and efficiency of movement. Performance was related to different cognitive abilities, depending on the performance measure and type of cognitive ability. No relationship between cognitive aptitude and duration of training or steepness of the learning curve was found. Cognitive aptitude mediates certain aspects of performance during training on a laparoscopic simulator. Based on the current study, we conclude that cognitive aptitude tests cannot be used for resident selection but are potentially useful for developing individualized training programs. More research will be performed to examine how cognitive aptitude testing can be used to design training programs.
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Affiliation(s)
- M Groenier
- Faculty of Science and Technology, Department of Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands,
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The impact of aptitude on the learning curve for laparoscopic suturing. Am J Surg 2013; 207:263-70. [PMID: 24468026 DOI: 10.1016/j.amjsurg.2013.08.037] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 07/23/2013] [Accepted: 08/19/2013] [Indexed: 01/03/2023]
Abstract
BACKGROUND Within surgery, several specialties demand advanced technical skills, specifically in the minimally invasive environment. METHODS Two groups of 10 medical students were recruited on the basis of their aptitude (visual-spatial ability, depth perception, and psychomotor ability). All subjects were tested consecutively using the ProMIS III simulator until they reached proficiency performing laparoscopic suturing. Simulator metrics, critical error scores, observed structured assessment of technical skills scores, and Fundamentals of Laparoscopic Surgery scores were recorded. RESULTS Group A (high aptitude) achieved proficiency after a mean of 7 attempts (range, 4-10). In group B (low aptitude), 30% achieved proficiency after a mean of 14 attempts (range, 10-16). In group B, 40% demonstrated improvement but did not attain proficiency, and 30% failed to progress. CONCLUSIONS Distinct learning curves for laparoscopic suturing can be mapped on the basis of fundamental ability. High aptitude is directly related to earlier completion of the learning curve. A proportion of subjects with low aptitude are unable to reach proficiency despite repeated attempts.
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Does Aptitude Influence the Rate at which Proficiency Is Achieved for Laparoscopic Appendectomy? J Am Coll Surg 2013; 217:1020-7. [DOI: 10.1016/j.jamcollsurg.2013.07.405] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/18/2013] [Accepted: 07/30/2013] [Indexed: 01/22/2023]
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Hedman L, Fahlstedt M, Schlickum M, Möller H, von Holst H, Felländer-Tsai L. A pilot evaluation of an educational program that offers visualizations of cervical spine injuries: medical students’ self-efficacy increases by training. Inform Health Soc Care 2013; 39:33-46. [DOI: 10.3109/17538157.2013.834343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Duarte RJ, Cury J, Oliveira LCN, Srougi M. Establishing the minimal number of virtual reality simulator training sessions necessary to develop basic laparoscopic skills competence: evaluation of the learning curve. Int Braz J Urol 2013; 39:712-9. [DOI: 10.1590/s1677-5538.ibju.2013.05.14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 05/29/2013] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Jose Cury
- Sao Paulo University Medical School, Brazil
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Access to a Simulator is Not Enough: The Benefits of Virtual Reality Training Based on Peer-Group-Derived Benchmarks—A Randomized Controlled Trial. World J Surg 2013; 37:2534-41. [DOI: 10.1007/s00268-013-2175-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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39
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Menhadji A, Abdelshehid C, Osann K, Alipanah R, Lusch A, Graversen J, Lee J, Quach S, Huynh V, Sidhom D, Gerbatsch I, Landman J, McDougall E. Tracking and Assessment of Technical Skills Acquisition Among Urology Residents for Open, Laparoscopic, and Robotic Skills Over 4 Years: Is There a Trend? J Endourol 2013; 27:783-9. [DOI: 10.1089/end.2012.0633] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Ashleigh Menhadji
- Department of Urology, University of California, Irvine, Orange, California
| | | | - Kathyrn Osann
- Department of Urology, University of California, Irvine, Orange, California
| | - Reza Alipanah
- Department of Urology, University of California, Irvine, Orange, California
| | - Achim Lusch
- Department of Urology, University of California, Irvine, Orange, California
| | - Joseph Graversen
- Department of Urology, University of California, Irvine, Orange, California
| | - Jason Lee
- Department of Urology, University of California, Irvine, Orange, California
| | - Stephen Quach
- Department of Urology, University of California, Irvine, Orange, California
| | - Victor Huynh
- Department of Urology, University of California, Irvine, Orange, California
| | - Daniel Sidhom
- Department of Urology, University of California, Irvine, Orange, California
| | - Isabelle Gerbatsch
- Department of Urology, University of California, Irvine, Orange, California
| | - Jaime Landman
- Department of Urology, University of California, Irvine, Orange, California
| | - Elspeth McDougall
- Department of Urology, University of California, Irvine, Orange, California
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New comprehensive surgical curriculum of pre-graduate surgical education. Wideochir Inne Tech Maloinwazyjne 2013; 8:200-10. [PMID: 24130633 PMCID: PMC3796719 DOI: 10.5114/wiitm.2011.33756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 12/29/2012] [Accepted: 12/29/2012] [Indexed: 01/22/2023] Open
Abstract
Introduction Surgical education has become one of the most important directions in modern surgery evolution. To meet growing need for appropriate training in laparoscopic and, even more importantly, classic surgical skills, a curriculum involving contemporary tuition methods is needed. Advanced, structuralised training, which includes advanced technologies like virtual reality training, video coaching and motivative aspects of competition, seems to be important for an adequate education programme. Material and methods In academic years 2009/2010 and 2010/2011 the Department of General, Endocrine and Transplant Surgery of the Medical University of Gdansk together with the Pomeranian Foundation for Progress in Surgery organized 4480 h of training in that area of classic (2744) and laparoscopic (1736) skills. Both groups were involved in the programme of training in which the two most important aspects were reliable evaluation of the results and effective motivation to work. Skill evaluation at different stages of the programme were based on completion time and quality measurements. Apart from that, at the end of the course, the participants completed a questionnaire on their subjective perspective on this innovative curriculum, the quality and stability of the skills they obtained. Results In both arms of the programme (laparoscopic and classic) a statistically significant improvement was obtained as early as after the second and third sessions in half of the exercises. The acquired skills were stable over time, as proved by the plateau of completion time achieved in 11 out of 12 exercises. The results of the post-training questionnaire revealed that the participants were very satisfied with the structuralised form of training and appreciated the motivational role of competition. Conclusions Contemporary surgical training should be organized as a systematic, well-evaluated and goal-oriented programme similar to the one proposed by our team. The use of contemporary training aids should be utilized in training of every surgical skill, not only laparoscopy. This form of training, associated with the component of competition, enables good and stable results to be achieved, as well as high satisfaction of trainees.
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Paschold M, Niebisch S, Kronfeld K, Herzer M, Lang H, Kneist W. Cold-start capability in virtual-reality laparoscopic camera navigation: a base for tailored training in undergraduates. Surg Endosc 2013; 27:2169-77. [DOI: 10.1007/s00464-012-2735-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 12/04/2012] [Indexed: 11/28/2022]
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42
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Perceiving haptic feedback in virtual reality simulators. Surg Endosc 2013; 27:2391-7. [DOI: 10.1007/s00464-012-2745-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/26/2012] [Indexed: 10/27/2022]
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43
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Våpenstad C, Hofstad EF, Bø LE, Chmarra MK, Kuhry E, Johnsen G, Mårvik R, Langø T. Limitations of haptic feedback devices on construct validity of the LapSim® virtual reality simulator. Surg Endosc 2012; 27:1386-96. [DOI: 10.1007/s00464-012-2621-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 09/21/2012] [Indexed: 01/22/2023]
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44
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Munro MG. Surgical simulation: where have we come from? Where are we now? Where are we going? J Minim Invasive Gynecol 2012; 19:272-83. [PMID: 22546418 DOI: 10.1016/j.jmig.2012.01.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
It is now clear to most stakeholders that acquisition of surgical psychomotor skills is best achieved outside of the clinical operating room, in the context of a simulated environment. Endoscopic simulation can be accomplished using simple "box" simulators or video trainers, and virtual reality simulation is now possible using microprocessor-controlled systems. Structured surgical training performed outside of the operating room environment is relatively new to health care, a circumstance different from the process of pilot training, in which simulation has been a mainstay for more than 75 years and in which virtual reality simulation is now the norm. Those charged with surgical education are faced with a dilemma as, while attempting to understand the basic goals of simulation, they are simultaneously faced with choice between relatively inexpensive video trainers and the often prohibitively expensive virtual reality systems. This article explores the history of simulation, reports the results of a modified systematic review of currently available systems and performance, and identifies the gaps in current research and development. It is apparent that available video trainers provide the opportunity for skill development that at present is not surpassed by virtual reality systems. In the future, there will likely be an increasing role for virtual reality; however, challenges remain that include determination of the appropriate metrics and system design, and the fiscal resources necessary for the required hardware and related software development.
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Affiliation(s)
- Malcolm G Munro
- Departments of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, and The Simulation Center, Kaiser Permenente, Los Angeles, CA, USA
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45
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Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial. Ann Surg 2012; 256:25-32. [PMID: 22664557 DOI: 10.1097/sla.0b013e318258f5aa] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To develop and validate a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery. BACKGROUND Simulators have been shown to be viable systems for teaching technical skills outside the operating room; however, integration of simulation training into comprehensive curricula remains a major challenge in modern surgical education. Currently, no curricula have been described or validated for advanced laparoscopic procedures. METHODS This prospective, single-blinded randomized controlled trial allocated 25 surgical residents to receive either conventional residency training or a comprehensive training curriculum for laparoscopic colorectal surgery. The curriculum consisted of proficiency-based psychomotor training on a virtual reality simulator, cognitive training, and participation in a cadaver lab. The primary outcome measure in this study was surgical performance in the operating room. All participants performed a laparoscopic right colectomy, which was video recorded and assessed using 2 previously validated assessment tools. Secondary outcome measures were knowledge relating to the execution of the procedure, assessed with a multiple-choice test, and technical performance on the simulator. RESULTS Curricular-trained residents demonstrated superior performance in the operating room compared with conventionally trained residents (global score 16.0 [14.5-18.0] versus 8.0 [6.0-14.5], P = 0.030; number of operative steps performed 16.0 [12.5-17.5] versus 8.0 [6.0-14.5], P = 0.021; procedure-specific score 71.1 [54.4-81.6] versus 51.1 [36.7-74.4], P = 0.122). Curricular-trained residents scored higher on the multiple-choice test (10 [9-11] versus 7.5 [5.3-7.5], P = 0.047), and outperformed conventionally trained residents in 7 of 8 tasks on the simulator. CONCLUSIONS Participation in a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery results in improved technical knowledge and improved performance in the operating room compared with conventional residency training. Reg. ID#NCT 01371136.
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Sinitsky DM, Fernando B, Berlingieri P. Establishing a curriculum for the acquisition of laparoscopic psychomotor skills in the virtual reality environment. Am J Surg 2012; 204:367-376.e1. [DOI: 10.1016/j.amjsurg.2011.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 11/09/2011] [Accepted: 11/09/2011] [Indexed: 01/22/2023]
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von Websky MW, Vitz M, Raptis DA, Rosenthal R, Clavien PA, Hahnloser D. Basic laparoscopic training using the Simbionix LAP Mentor: setting the standards in the novice group. JOURNAL OF SURGICAL EDUCATION 2012; 69:459-467. [PMID: 22677582 DOI: 10.1016/j.jsurg.2011.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 11/22/2011] [Accepted: 12/18/2011] [Indexed: 06/01/2023]
Abstract
BACKGROUND Virtual reality devices are becoming the backbone for laparoscopic training in surgery. However, without knowledge of the achievable metrics of basic training within the trainee group, these simulators cannot be used effectively. Currently, no validated task metrics of the performance of larger trainee groups are available. STUDY DESIGN From April 2004 to December 2009, we collated an extensive prospective database using the Simbionix LAP Mentor (Simbionix USA, Cleveland, Ohio) for basic laparoscopic training of novice surgeons. This database was used to determine benchmarks for basic skill exercises and procedural tasks that combine stimulus to improve and feasibility with acceptance of the training program and the goal to train for safe surgery. RESULTS In all, 18,996 task performances of 286 novice trainees were analyzed. For the basic skill exercises, the total time for correct execution ranged between 45 seconds for basic skill 3 (eye-hand coordination) and 269 seconds for basic skill 9 (object placement). For the procedural tasks, the total time for correct execution ranged between 68 seconds for procedural task 1 (clipping and cutting) and 256 seconds for procedural task 3 (dissection). The total time to task completion depended mainly on right instrument path length with high correlation to left instrument path length. Learning curve analyses of the 4 procedural tasks demonstrated performance plateaus after 10-15 repetitions. Most complications occurred during the initial repetitions of the respective task. The best quartile of performances was chosen as peer group benchmark because it provides sufficient stimulus for improvement without discouraging trainees, thus enhancing adherence to the training program. The benchmark for safety and accuracy parameters was set at a predefined level of 95% correct execution. CONCLUSIONS As experience with virtual reality (VR) training is growing, curricula must be based on benchmarks for efficient training derived from large trainee groups to optimize use of the still costly simulators. Safety parameters should be included in trainee assessment. We share a set of metrics that take into account both performance and feasibility for basic laparoscopic training of surgical novices using the Simbionix LAP Mentor.
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Affiliation(s)
- Martin W von Websky
- Department of Visceral Surgery, University Hospital of Zurich, Zurich, Switzerland
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Varas J, Mejía R, Riquelme A, Maluenda F, Buckel E, Salinas J, Martínez J, Aggarwal R, Jarufe N, Boza C. Significant transfer of surgical skills obtained with an advanced laparoscopic training program to a laparoscopic jejunojejunostomy in a live porcine model: feasibility of learning advanced laparoscopy in a general surgery residency. Surg Endosc 2012; 26:3486-94. [DOI: 10.1007/s00464-012-2391-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
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Personalized health care system with virtual reality rehabilitation and appropriate information for seniors. SENSORS 2012; 12:5502-16. [PMID: 22778598 PMCID: PMC3386697 DOI: 10.3390/s120505502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 04/11/2012] [Accepted: 04/25/2012] [Indexed: 11/24/2022]
Abstract
The concept of the information society is now a common one, as opposed to the industrial society that dominated the economy during the last years. It is assumed that all sectors should have access to information and reap its benefits. Elderly people are, in this respect, a major challenge, due to their lack of interest in technological progress and their lack of knowledge regarding the potential benefits that information society technologies might have on their lives. The Naviga Project (An Open and Adaptable Platform for the Elderly and Persons with Disability to Access the Information Society) is a European effort, whose main goal is to design and develop a technological platform allowing elder people and persons with disability to access the internet and the information society. Naviga also allows the creation of services targeted to social networks, mind training and personalized health care. In this paper we focus on the health care and information services designed on the project, the technological platform developed and details of two representative elements, the virtual reality hand rehabilitation and the health information intelligent system.
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Palter VN, Graafland M, Schijven MP, Grantcharov TP. Designing a proficiency-based, content validated virtual reality curriculum for laparoscopic colorectal surgery: A Delphi approach. Surgery 2012; 151:391-7. [PMID: 22019340 DOI: 10.1016/j.surg.2011.08.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 08/04/2011] [Indexed: 11/24/2022]
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