Evaluating the didactic value of 3D visualization in otosurgery

[Interactive electronic visualization formats in student teaching]

BACKGROUND

In the context of contact restrictions, conventional teaching is currently in need of optimization and expansion. The range of digital teaching formats in student training is very heterogeneous and their effectiveness uncertain. This study aims to investigate the extent to which an electronic ward round can be used as an alternative to the conventional ENT attendance practical course, and whether the use of electronic teaching formats has an influence on the quality of teaching.

MATERIALS AND METHODS

Instead of regular attendance practicals, bedside teaching took place once a week in real time as a video stream via tablet. A total of 43 students in the seventh semester (winter semester 2020/2021) were included in the prospective study. Evaluation forms were used to examine the subjective didactic value of different visualization formats for the students. Examination results from previous years were used for comparison.

RESULTS

The majority of students reported knowledge gain from the electronic rounds (93.02%) and that they were a good alternative to the traditional attendance clerkship (69.77%). The quality of the video and audio transmission as well as the comprehensibility of the case studies presented were consistently rated as good to very good. The students' examination results tended to be slightly worse in the test group compared to the control students of previous years.

CONCLUSION

Integration of innovative interactive visualization options into teaching shows promising prospects as a supplement to conventional face-to-face teaching. The results of this study can contribute to the further expansion of digital teaching. Scaling up this model could be considered especially in countries with limited availability of face-to-face teaching.

[Multidimensional formats of surgical anatomy in otorhinolaryngology student teaching-a comparison of effectivity]

BACKGROUND

Technological change in healthcare and the digital transformation of teaching require innovations in student teaching in medicine. New technologies are needed to enable the delivery and use of diverse teaching and learning formats by educational institutions independent of time and place. The aim of this study is to analyze the effectiveness of different multidimensional formats in student teaching in surgical ENT medical anatomy.

MATERIALS AND METHODS

During the summer semester 2022 and winter semester 2022/2023, the digital teaching and learning program was expanded by testing different visualization formats (3D glasses, cardboards, or VR glasses) with students in the context of a highly standardized surgical procedure, namely cochlear implantation. A pre- and post-intervention knowledge assessment was carried out in all groups, followed by an evaluation.

RESULTS

Of 183 students, 91 students fully participated in the study. The post-intervention knowledge assessment showed a significant increase in correct answers regardless of visualization format. In a direct comparison, the operating room (OR) group answered correctly significantly more often than the cardboard group (p = 0.0424). The majority of students would like to see 3D teaching as an integral part of the teaching program (87.9%) and more streaming of live surgeries (93.4%). They see the use of the various technologies as a very good addition to conventional surgical teaching (72.5%), as good visualization (89%) increases retention (74.7%) and motivation (81.3%).

CONCLUSION

Application and use of new visualization technologies in everyday clinical practice is a promising approach to expanding student training. Mobile, interactive, and personalized technical formats can be adapted to the learning behavior of students. Last but not least, the use of new media influences learning motivation. An expansion of digital teaching and learning formats can be expressly recommended on the basis of this study.

Effect of teaching tools in spatial understanding in health science education: a systematic review

Background

The concept of spatial orientation is integral to health education. Students studying to be healthcare professionals use their visual intelligence to develop 3D mental models from 2D images, like X-rays, MRI, and CT scans, which exerts a heavy cognitive load on them. Innovative teaching tools and technologies are being developed to improve students' learning experiences. However, the impact of these teaching modalities on spatial understanding is not often evaluated. This systematic review aims to investigate current literature to identify which teaching tools and techniques are intended to improve the 3D sense of students and how these tools impact learners' spatial understanding.

Methods

The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines were followed for the systematic review. Four databases were searched with multiple search terms. The articles were screened based on inclusion and exclusion criteria and assessed for quality.

Results

Nineteen articles were eligible for our systematic review. Teaching tools focused on improving spatial concepts can be grouped into five categories. The review findings reveal that the experimental groups have performed equally well or significantly better in tests and tasks with access to the teaching tool than the control groups.

Conclusion

Our review investigated the current literature to identify and categorize teaching tools shown to improve spatial understanding in healthcare professionals. The teaching tools identified in our review showed improvement in measured, and perceived spatial intelligence. However, a wide variation exists among the teaching tools and assessment techniques. We also identified knowledge gaps and future research opportunities.

Telepresence for surgical assistance and training using eXtended reality during and after pandemic periods

Existing challenges in surgical education (See one, do one, teach one) as well as the COVID-19 pandemic make it necessary to develop new ways for surgical training. Therefore, this work describes the implementation of a scalable remote solution called "TeleSTAR" using immersive, interactive and augmented reality elements which enhances surgical training in the operating room. The system uses a full digital surgical microscope in the context of Ear-Nose-Throat surgery. The microscope is equipped with a modular software augmented reality interface consisting an interactive annotation mode to mark anatomical landmarks using a touch device, an experimental intraoperative image-based stereo-spectral algorithm unit to measure anatomical details and highlight tissue characteristics. The new educational tool was evaluated and tested during the broadcast of three live XR-based three-dimensional cochlear implant surgeries. The system was able to scale to five different remote locations in parallel with low latency and offering a separate two-dimensional YouTube stream with a higher latency. In total more than 150 persons were trained including healthcare professionals, biomedical engineers and medical students.

Accessing the stapedius muscle via novel surgical retrofacial approach during cochlear implantation surgery: Intraoperative results on feasibility and safety

Human stapedius muscle (SM) can be directly and safely accessed via retrofacial approach, opening new approaches to directly measure the electrically evoked stapedius reflex threshold (eSRT). The measurement of the SM activity via direct surgical access represents a potential tool for objective eSRT fitting of cochlear implants (CI), increasing the benefit experienced by the CI users and leading to new perspectives in the development of smart implantable neurostimulators. 3D middle-ear reconstructions created after manual segmentation and related SM accessibility metrics were evaluated before the CI surgery for 16 candidates with assessed stapedius reflex. Retrofacial approach to access the SM was performed after facial recess exposure. In cases of poor exposition of SM, the access was performed anteriorly to the FN via drilling of the pyramidal eminence (PE). The total access rate of the SM via both the retrofacial and anterior approach of the FN was 100%. In 81.2% of cases (13/16), the retrofacial approach allowed to access the SM on previously categorized well exposed (8/8), partially exposed (4/5), and wholly concealed (1/3) SM with respect to FN. Following intraoperative evaluation in the remaining 18.8% (3/16), the SM was accessed anteriorly via drilling of the PE. Exposure of SM with respect to the FN and the sigmoid sinus’s prominence was a predictor for the suitable surgical approach. The retrofacial approach offers feasible and reproducible access to the SM belly, opening direct access to electromyographic sensing of the eSRT. Surgical planner tools can quantitatively assist pre-surgical assessment.

[Interactive intraoperative annotation of surgical landmarks in student education to support learning efficiency and motivation]

BACKGROUND

The development of technological innovations has not only changed social life and the healthcare system, but also affects medical education. The aim of this pilot study was to evaluate whether students, when observing a microsurgical procedure of the temporal bone, gain an additional understanding of the anatomical structures and surgical site when visualization is used that provides identical views for the surgeon and viewer in 3D.

MATERIALS AND METHODS

During regular attendance tutorials, students were randomly assigned to three different groups: control group, 2D group, or 3D group. Evaluation questionnaires and intraoperative student annotation of the surgical view were used to assess the subjective didactic value of different visualization formats and resultant learning experiences for the students.

RESULTS

A total of 47 students were included in the investigations during conventional attendance tutorials. The majority indicated a high added value of the 3D visualization in terms of method (70%) and vividness (80%) compared to the 2D group and self-study; 69% of the students fully agreed with the statement that 2D and 3D visualization increases learning motivation and is a very good way to improve recognition of anatomical topography and structures.

CONCLUSION

New interactive visualization options in teaching promote learning efficiency and motivation among students. Especially 3D visualization and intraoperative annotation of the surgical view by the student is a useful didactic tool and increases the quality of clinical teaching. It supports the perception of anatomical topography and enables more focused surgical training.

Dr. Howard A. Kelly's The Stereo Clinic: health science pedagogy and the egalitarian future of 3D clinical visualization

This article situates emerging three-dimensional (3D) visualization technologies in the health sciences within the broader historical context of the stereoscope. Although 3D visualization technologies enhance pedagogy and deepen student engagement, they are generally cost-prohibitive and therefore inaccessible for many institutions. In light of this issue, the authors consider the work of American gynecologist and founding member of The Johns Hopkins Hospital in Baltimore, Maryland, Dr. Howard Atwood Kelly (1858-1943). A monumental work, Kelly's The Stereo Clinic is a multivolume publication whose focal point was the stereoscope, an image-viewing device that can be seen as a prototype for present-day 3D technologies. Each installment presents a step-by-step overview of a specific surgical procedure using a didactic narrative and corresponding stereoscopic images that illustrate the clinical practices. Significantly, Kelly understood The Stereo Clinic as an egalitarian project that provided high-quality educational resources to students and practicing physicians who did not have access to world-class clinical suites and teaching institutions. Furthermore, he viewed The Stereo Clinic as a remedy to the commonplace frustrations of medical education, such as crowded surgical suites, and the hazards of in-person observation. The Stereo Clinic is an important case study because it reveals a medical profession at the turn of the twentieth century preoccupied with 3D visualization. Inventive clinicians such as Kelly did not only advocate for this technology on the strength of its pedagogical value; they also articulated the equalitarian nature of this medium and produced 3D technology accessible to a wide audience.

Accessing the Stapedius Muscle Via Novel Surgical Retrofacial Approach: A Cadaveric Feasibility Study

HYPOTHESIS

Despite the complete embodiment of the stapedius muscle (SM) into the pyramidal eminence, it is possible to safely gain access to the SM belly via a retrofacial approach. This presents a novel approach to directly measure the electrically evoked stapedius reflex threshold (eSRT).

BACKGROUND

Objective fitting of maximum comfortable loudness levels for cochlear implant users can improve the benefit introduced by the device. Sensing SM activity via direct surgical access represents a potential tool for objective eSRT fitting.

METHODS

Eighteen human temporal bones (TBs) were used. Micro-computed tomography was performed for six TBs. Standard computed tomography for six TBs. Manual 3D-segmentation of the relevant middle and inner ear anatomy was performed on 12 TBs. Mastoidectomy and posterior tympanotomy allowed the access to middle ear of all 18 the TBs. Once identified the mastoidal segment of the facial nerve (FN), the retrofacial access to the SM was drilled.

RESULTS

The total access rate was 72.2%. Only in the first three cases the posterior semi-circular canal was hit. The SM access was identified posterior to the FN at a 4 ± 0.78 mm distance from the stapes' head, almost halfway to the chorda tympani's branching point along the FN direction. The drilling depth to access the SM posterior to the external surface of FN on average was 2 ± 0.30 mm. The exposure took on average of 5 to 8 minutes.

CONCLUSIONS

The retrofacial approach seems to offer a feasible and reproducible access to the SM belly opening an avenue to electromyographic sensing of eSRT.

[Teaching during the COVID-19 pandemic: how do medical students evaluate interactive video-based distance bedside teaching in otorhinolaryngology?]

Hintergrund

Der Beginn der ersten SARS-CoV-2-Pandemie-Welle im März 2020 erforderte erhebliche Umstellungsmaßnahmen in der medizinischen Lehre mit vollständigem Verzicht auf direkten Kontakt von Studierenden und Patienten. Vor diesem Hintergrund wurde das Lehrformat „Unterricht am Patienten“ (UaP) als interaktiver, videobasierter Distanzunterricht am Patienten etabliert und durchgeführt.

Fragestellung

Ziel der Studie war die Erfassung der studentischen Beurteilung dieses Lehrkonzeptes im Fach Hals-Nasen-Ohren-Heilkunde.

Material und Methoden

Die Live-Übertragung erfolgte aus einem HNO-Untersuchungsraum zu den im Hörsaal befindlichen Studierenden, welche mit den Patienten interagieren konnten. Makro-, mikro- und endoskopische Untersuchungsbefunde wurden in Echtzeit in den Hörsaal übertragen. Die Evaluation erfolgte anhand eines Online-Fragebogens, welcher 13 geschlossene Fragen (Likert-Skala) beinhaltete, sowie als offenes Feedback in freier Textform.

Ergebnisse

Die Rücklaufquote lag bei 16,8 % (42 von 250 Studierenden). Davon hatten 85,7 % einen positiven Gesamteindruck, und Tenor war, dass das Konzept angesichts der Umstände gut umgesetzt wurde. Dennoch könne auf einen direkten Patientenkontakt eher nicht verzichtet werden, auch wenn eine teilweise Kompensation durch Videoschaltung möglich sei. Insgesamt wurde das Lehrkonzept als lehrreich empfunden, und die Studierenden konnten sich vorstellen, zukünftig häufiger auch ein solches UaP-Lehrkonzept zu nutzen.

Schlussfolgerung

Dieses Lehrkonzept kann den direkten Patientenkontakt nicht ersetzen, stellt jedoch speziell im HNO-Gebiet eine gute Alternative dar, wenn durch pandemiebedingte Umstände ein „klassischer“ UaP nicht möglich ist. Aspekte des interaktiven, videobasierten Distanzunterrichts am Patienten könnten auch zukünftig in andere Lehrformate integriert werden.

Interactive live-stream surgery contributes to surgical education in the context of contact restrictions

BACKGROUND

Attendance teaching is the predominant teaching method at universities but needs to be questioned in the context of digital transformation. This study establishes and evaluates a method to accomplish electronic learning to supplement traditional attendance courses.

MATERIALS AND METHODS

Surgery was transmitted in real-time conditions via an online live stream from the surgical theater. Visualization was transferred from a fully digital surgical microscope, an endoscope or an environmental camera in high definition quality. Students were able to participate at home from their personal computer. After following the surgery, they participated in an online-evaluation.

RESULTS

A total of 65 students participated in the live stream. The majority of students (61.54%) indicated a significant subjective increase in knowledge after participation. The majority of students (53.85%) indicated that live surgeries should be offered as a permanent component in addition to classroom teaching. Likewise, a broader offer was desired by many students (63.08%).

CONCLUSIONS

Live streaming of surgery is a promising approach as an alternative or supplement to traditional attendance teaching. An expansion of digital teaching can be explicitly supported on the basis of this study.

Simulation-Based Estimation of the Number of Cameras Required for 3D Reconstruction in a Narrow-Baseline Multi-Camera Setup

Graphical visualization systems are a common clinical tool for displaying digital images and three-dimensional volumetric data. These systems provide a broad spectrum of information to support physicians in their clinical routine. For example, the field of radiology enjoys unrestricted options for interaction with the data, since information is pre-recorded and available entirely in digital form. However, some fields, such as microsurgery, do not benefit from this yet. Microscopes, endoscopes, and laparoscopes show the surgical site as it is. To allow free data manipulation and information fusion, 3D digitization of surgical sites is required. We aimed to find the number of cameras needed to add this functionality to surgical microscopes. For this, we performed in silico simulations of the 3D reconstruction of representative models of microsurgical sites with different numbers of cameras in narrow-baseline setups. Our results show that eight independent camera views are preferable, while at least four are necessary for a digital surgical site. In most cases, eight cameras allow the reconstruction of over 99% of the visible part. With four cameras, still over 95% can be achieved. This answers one of the key questions for the development of a prototype microscope. In future, such a system can provide functionality which is unattainable today.

[Electronic learning for otorhinolaryngology students using the content management system ILIAS]

BACKGROUND

With increasing access to online teaching materials, traditional teaching methods at universities need to be questioned in the context of digital transformation. The aim of this study was to evaluate whether electronic learning may serve as or replace conventional internship in otorhinolaryngology.

MATERIALS AND METHODS

A completely digital electronic learning concept was created and made available at the online learning platform ILIAS. Students were introduced to the program. Four learning units (neck [I], pharynx/larynx [II], nose [III], ear [IV]) were set up, with a topic-related multiple-choice test at the end of each unit. The students took part in the evaluation before and after completion of the course.

RESULTS

A total of 105 students participated in the evaluation before and 85 students after the electronic learning program. After completing the courses, the majority of students (52.94%) stated to be more satisfied with the content and the presentation of the learning sequences as well as with their own self-control concerning learning pace and time management compared to the situation before completing the program (34.29%; p < 0.0001). The majority of students (54.12%) stated that they would appreciate the electronic learning program in addition to practical internship.

CONCLUSION

The electronic learning program is a promising approach to supplement traditional learning and internships. An expansion of digital teaching proposals should be supported based on this study.