Screen-Based Simulation, Virtual Reality, and Haptic Simulators

The impact of surgical simulation and training technologies on general surgery education

The landscape of general surgery education has undergone a significant transformation over the past few years, driven in large part by the advent of surgical simulation and training technologies. These innovative tools have revolutionized the way surgeons are trained, allowing for a more immersive, interactive, and effective learning experience. In this review, we will explore the impact of surgical simulation and training technologies on general surgery education, highlighting their benefits, challenges, and future directions. Enhancing the technical proficiency of surgical residents is one of the main benefits of surgical simulation and training technologies. By providing a realistic and controlled environment, With the use of simulations, residents may hone their surgical skills without compromising patient safety. Research has consistently demonstrated that training with simulations enhances surgical skills., reduces errors, and enhances overall performance. Furthermore, simulators can be programmed to mimic a wide range of surgical scenarios, enabling residents to cultivate the essential critical thinking and decision-making abilities required to manage intricate surgical cases. Another area of development is incorporating simulation-based training into the wider surgical curriculum. As simulation technologies become more widespread, they will need to be incorporated into the fabric of surgical education, rather than simply serving as an adjunct to traditional training methods. This will require a fundamental shift in the way surgical education is delivered, with a greater emphasis on simulation-based training and assessment.

Comparison of discussion-based and simulation-based learning methods using the Gas Man® on knowledge of the uptake and distribution of inhalation anesthetics of anesthesia resident: A randomized controlled trial

Background and Aims

Inhalation anesthetics is basic knowledge that must be mastered by an anesthesiologist. Lack of competencies can result in higher morbidity and mortality in anesthesiology practice. Various learning methods were developed to improve understanding and retention. With the advancement of technology, the utilization of screen-based simulation (SBS) using applications is common, such as the Gas Man® application, to help students understand physiology, pathophysiology, and kinetic inhalation anesthetic agents. The primary objective of this study was to compare the knowledge improvement of anesthesia residents between the simulation-based and discussion-based learning methods on the uptake and distribution of anesthetic inhalation. The secondary objective was to compare the satisfaction levels of participants in both learning methods.

Material and Methods

This study is a randomized controlled trial involving anesthesiology and intensive care residents from the Faculty of Medicine, Universitas Indonesia (FKUI) 2022-2023. The participants were randomized into two groups (simulation and discussion groups). A senior attending anesthesiologist led the discussion. The participants answered a pretest, followed by a 1-hour lecture about inhalation gas. Lastly, participants answered a posttest and filled in the satisfaction survey. Statistical analyses used the Mann-Whitney test to compare the two groups. The Wilcoxon test was used to compare the knowledge improvement between the two groups.

Results

Thirty-eight residents underwent simulation-based (n = 19) and discussion-based (n = 19) learning methods. The simulation group demonstrated a median (interquartile range) posttest score of 80 (76.67-83.33) compared with the discussion group with a score of 50 (40-66.67) (P value <0.05). More than half of the participants in both groups answered "satisfied."

Conclusion

The simulation-based learning method using the Gas Man® application performed better than the discussion-based learning method on increasing knowledge of the uptake and distribution of inhalation anesthetics in anesthesia residents.

Creation of a Virtual Reality Telesimulation Program in Response to Mandatory COVID-19 Social Distancing During the Pandemic: A Primer for Those considering VR Simulation and Application to a Group of Physicians Naive to Virtual Reality

The COVID-19 pandemic necessitated the closure of traditional simulation centers, prompting innovative solutions for medical education. Drawing from prior studies, which advocated for telesimulation and virtual reality (VR) as alternatives, this article explores the development and implementation of VR simulation in medical training. Leveraging the Acadicus® VR platform, a VR simulation solution was created, enabling interactive scenarios simulating pediatric critical care situations. Thirty-one diverse scenarios were designed and executed over an 8-month period, involving pediatric and emergency medicine residents and fellows. The development process involved creating lifelike mannequins and dynamic cardiac waveforms, enhancing realism and spontaneity. Using VR headsets and streaming technology, participants engaged in immersive scenarios remotely. Performance evaluation used a modified version of the Tool for Resuscitation Assessment Using Computer Simulation, revealing comparable outcomes across different training levels and specialties. Participant feedback underscored the immersive nature of VR simulation, offering enhanced realism and in-depth debriefing opportunities compared with traditional mannequin-based simulation. However, limitations such as the lack of haptic feedback and the need for better integration with existing simulation center infrastructure were noted. Cost-effectiveness emerged as a significant advantage of VR simulation, with lower upfront costs compared with traditional simulation centers. VR simulation also demonstrated versatility in staging training across various hospital settings, offering a more comprehensive learning experience. Although acknowledging the need for further research to measure skill acquisition and retention, this study highlights the potential of VR simulation as an adjunctive modality in medical education.

Virtual Reality Single-Port Sleeve Gastrectomy Training Decreases Physical and Mental Workload in Novice Surgeons: An Exploratory Study

BACKGROUND

Novice surgeons experience high levels of physical and mental workload during the early stages of their curriculum and clinical practice. Laparoscopic sleeve gastrectomy is the first bariatric procedure worldwide. Feasibility and safety of single-port sleeve gastrectomy (SPSG) has been demonstrated. An immersive virtual reality (VR) simulation was developed to provide a repetitive exercise to learn this novel technique. The primary objective of this study was to evaluate the impact of the VR training tool on mental and physical workload in novice surgeons. The secondary objective included an evaluation of the VR simulator.

METHODS

A monocentric-controlled trial was conducted. Ten participants were divided into two groups, the VR group and the control group (without VR training). Surgery residents participated in a first real case of SPSG and a second case 1 month later. The VR group underwent a VR training between the two surgeries. Mental and physical loads were assessed with self-assessment questionnaires: NASA-TLX, Borg scale, and manikin discomfort test. The VR simulator was evaluated through presence, cybersickness, and usability questionnaires.

RESULTS

This study showed a decrease of the mental demand and effort dimensions of NASA-TLX between the first and the second surgery in the VR group (P < .05). During the second surgery, a marginally significant difference was shown concerning the mental demand between the two groups. Postural discomfort of the VR group decreased with practice (P < .01), mainly between the first and the second surgery (P < .05). Furthermore, participants characterized the VR simulator as realistic, usable, and very useful to learned surgery.

CONCLUSION

This exploratory study showed an improvement in mental and physical workload when novice surgeons trained with VR (repetitive practice, gesture improvement, reduction of stress, etc.). Virtual reality appears to be a promising perspective for surgical training.

Recent Advances in Technology and Its Applications to Pediatric Emergency Care

Advances in technology are continuously transforming medical care, including pediatric emergency medicine. The increasing adoption of point-of-care ultrasound examination can improve timely diagnoses without radiation and aids the performance of common procedures. The recent dramatic increase in electronic health record adoption offers an opportunity for enhanced clinical decision-making support. Simulation training and advances in technologies can provide continued proficiency training despite decreasing opportunities for pediatric procedures and cardiorespiratory resuscitation performance. This article reviews these and other recent advances in technology that have had the greatest impact on the current practice of pediatric emergency medicine.

Provider-Focused Intervention to Promote Comprehensive Screening for Adolescent Idiopathic Scoliosis by Primary Care Pediatricians

Screening can detect adolescent idiopathic scoliosis (AIS). The objective was to determine if computer-based simulation (CBS) and computerized clinical decision-support systems (CCDSS) would improve primary care providers' AIS screening exams as noted in their documentation. All participants received AIS screening CBS training. Participants were then randomized to receive either CCDSS when an eligible patient was seen (intervention arm) or no further intervention (comparison arm). Eligible patients' documentation was analyzed looking for a complete AIS screening exam. Over the span of 17 weeks, 1051 eligible patients were seen; 468 by providers in the intervention arm, 583 in the comparison arm. In all, 292/468 (62%) of eligible patients seen in the intervention arm and 0/583 (0%) in the comparison arm had a complete AIS screening exam documented. Compared with single CBS training alone, repeated exposure to CCDSS after CBS training resulted in improved documentation of the screening exam for AIS.