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Wang J, Li W, Dun A, Zhong N, Ye Z. 3D visualization technology for Learning human anatomy among medical students and residents: a meta- and regression analysis. BMC MEDICAL EDUCATION 2024; 24:461. [PMID: 38671399 PMCID: PMC11055294 DOI: 10.1186/s12909-024-05403-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND 3D visualization technology applies computers and other devices to create a realistic virtual world for individuals with various sensory experiences such as 3D vision, touch, and smell to gain a more effective understanding of the relationships between real spatial structures and organizations. The purpose of this study was to comprehensively evaluate the effectiveness of 3D visualization technology in human anatomy teaching/training and explore the potential factors that affect the training effects to better guide the teaching of classroom/laboratory anatomy. METHODS We conducted a meta-analysis of randomized controlled studies on teaching human anatomy using 3D visualization technology. We extensively searched three authoritative databases, PubMed, Web of Science, and Embase; the main outcomes were the participants' test scores and satisfaction, while the secondary outcomes were time consumption and enjoyment. Heterogeneity by I² was statistically determined because I²> 50%; therefore, a random-effects model was employed, using data processing software such as RevMan, Stata, and VOSviewer to process data, apply standardized mean difference and 95% confidence interval, and subgroup analysis to evaluate test results, and then conduct research through sensitivity analysis and meta-regression analysis. RESULTS Thirty-nine randomized controlled trials (2,959 participants) were screened and included in this study. The system analysis of the main results showed that compared with other methods, including data from all regions 3D visualization technology moderately improved test scores as well as satisfaction and enjoyment; however, the time that students took to complete the test was not significantly reduced. Meta-regression analysis also showed that regional factorsaffected test scores, whereas other factors had no significant impact. When the literature from China was excluded, the satisfaction and happiness of the 3D virtual-reality group were statistically significant compared to those of the traditional group; however, the test results and time consumption were not statistically significant. CONCLUSION 3D visualization technology is an effective way to improve learners' satisfaction with and enjoyment of human anatomical learning, but it cannot reduce the time required for testers to complete the test. 3D visualization technology may struggle to improve the testers' scores. The literature test results from China are more prone to positive results and affected by regional bias.
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Affiliation(s)
- Junming Wang
- Department of Health Management, The First Affiliated Hospital, Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, 250013, Jinan, Shandong, China
- School of clinical and basic medicine, Shandong First Medical University, Jinan, China
| | - Wenjun Li
- Department of Health Management, The First Affiliated Hospital, Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, 250013, Jinan, Shandong, China
- School of clinical and basic medicine, Shandong First Medical University, Jinan, China
| | - Aishe Dun
- School of Stomatology, Shandong First Medical University, Jinan, China
| | - Ning Zhong
- Department of Health Management, The First Affiliated Hospital, Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, 250013, Jinan, Shandong, China.
| | - Zhen Ye
- Department of Health Management, The First Affiliated Hospital, Shandong Provincial Qianfoshan Hospital, Shandong First Medical University, 250013, Jinan, Shandong, China.
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Stan C, Vesa D, Tănase MI, Bulmaci M, Pop S, Rădeanu DG, Cosgarea M, Maniu A. Can Non-Virtual Reality Simulation Improve Surgical Training in Endoscopic Sinus Surgery? A Literature Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:637-646. [PMID: 37360838 PMCID: PMC10290466 DOI: 10.2147/amep.s406537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
Simulation in endoscopic sinus surgery allows residents to learn anatomy, to achieve the correct handling of various rhinological instruments, and to practice different surgical procedures. Physically or non-virtual reality models are the main items in endoscopic sinus surgery simulation. The objective of this review is to identify and make a descriptive analysis of non-virtual endoscopic sinus surgery simulators which have been proposed for training. As a new state of the art, surgical simulators are developed continuously, so they can be used to learn basic endoscopic surgery skills by repetitive maneuvers, permitting detection of surgical error and incidents without risk for the patient. Of all training physical models, the ovine model stands out because of the similarities of the sinonasal pathways, the wide availability, and the low costs. Considering the similar nature of the tissues involved, the techniques and surgical instruments can be used almost interchangeably with minimal differences. Every surgical technique studied until now has a degree of risk and the only aspects that consistently reduced the number of complications are training, repetition, and hands-on experience.
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Affiliation(s)
- Constantin Stan
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
- Department of Surgical Clinical, “Dunărea de Jos” University, Faculty of Medicine and Pharmacy, Galați, România
| | - Doiniţa Vesa
- Department of Surgical Clinical, “Dunărea de Jos” University, Faculty of Medicine and Pharmacy, Galați, România
| | - Mihai Ionuț Tănase
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Mara Bulmaci
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Sever Pop
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Doinel Gheorghe Rădeanu
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Marcel Cosgarea
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Alma Maniu
- Department of ENT, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, România
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Berges AJ, Vedula SS, Chara A, Hager GD, Ishii M, Malpani A. Eye Tracking and Motion Data Predict Endoscopic Sinus Surgery Skill. Laryngoscope 2023; 133:500-505. [PMID: 35357011 PMCID: PMC9825109 DOI: 10.1002/lary.30121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Endoscopic surgery has a considerable learning curve due to dissociation of the visual-motor axes, coupled with decreased tactile feedback and mobility. In particular, endoscopic sinus surgery (ESS) lacks objective skill assessment metrics to provide specific feedback to trainees. This study aims to identify summary metrics from eye tracking, endoscope motion, and tool motion to objectively assess surgeons' ESS skill. METHODS In this cross-sectional study, expert and novice surgeons performed ESS tasks of inserting an endoscope and tool into a cadaveric nose, touching an anatomical landmark, and withdrawing the endoscope and tool out of the nose. Tool and endoscope motion were collected using an electromagnetic tracker, and eye gaze was tracked using an infrared camera. Three expert surgeons provided binary assessments of low/high skill. 20 summary statistics were calculated for eye, tool, and endoscope motion and used in logistic regression models to predict surgical skill. RESULTS 14 metrics (10 eye gaze, 2 tool motion, and 2 endoscope motion) were significantly different between surgeons with low and high skill. Models to predict skill for 6/9 ESS tasks had an AUC >0.95. A combined model of all tasks (AUC 0.95, PPV 0.93, NPV 0.89) included metrics from eye tracking data and endoscope motion, indicating that these metrics are transferable across tasks. CONCLUSIONS Eye gaze, endoscope, and tool motion data can provide an objective and accurate measurement of ESS surgical performance. Incorporation of these algorithmic techniques intraoperatively could allow for automated skill assessment for trainees learning endoscopic surgery. LEVEL OF EVIDENCE N/A Laryngoscope, 133:500-505, 2023.
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Affiliation(s)
| | | | | | | | - Masaru Ishii
- Johns Hopkins Department of Otolaryngology–Head and Neck Surgery
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4
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Zagury-Orly I, Solinski MA, Nguyen LH, Young M, Drozdowski V, Bain PA, Gantwerker EA. What is the Current State of Extended Reality Use in Otolaryngology Training? A Scoping Review. Laryngoscope 2023; 133:227-234. [PMID: 35548939 DOI: 10.1002/lary.30174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To map current literature on the educational use of extended reality (XR) in Otolaryngology-Head and Neck Surgery (OHNS) to inform teaching and research. STUDY DESIGN Scoping Review. METHODS A scoping review was conducted, identifying literature through MEDLINE, Ovid Embase, and Web of Science databases. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist. Studies were included if they involved OHNS trainees or medical students who used XR for an educational purpose in OHNS. XR was defined as: fully-immersive virtual reality (VR) using head-mounted displays (HMDs), non-immersive and semi-immersive VR, augmented reality (AR), or mixed reality (MR). Data on device use were extracted, and educational outcomes were analyzed according to Kirkpatrick's evaluation framework. RESULTS Of the 1,434 unique abstracts identified, 40 articles were included. All articles reported on VR; none discussed AR or MR. Twenty-nine articles were categorized as semi-immersive, none used occlusive HMDs therefore, none met modern definitions of immersive VR. Most studies (29 of 40) targeted temporal bone surgery. Using the Kirkpatrick four-level evaluation model, all studies were limited to level-1 (learner reaction) or level-2 (knowledge or skill performance). CONCLUSIONS Current educational applications of XR in OHNS are limited to VR, do not fully immerse participants and do not assess higher-level learning outcomes. The educational OHNS community would benefit from a shared definition for VR technology, assessment of skills transfer (level-3 and higher), and deliberate testing of AR, MR, and procedures beyond temporal bone surgery. Laryngoscope, 133:227-234, 2023.
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Affiliation(s)
- Ivry Zagury-Orly
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mark A Solinski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Lily Hp Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Meredith Young
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Veronica Drozdowski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric A Gantwerker
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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5
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Timonen T, Dietz A, Linder P, Lehtimäki A, Löppönen H, Elomaa AP, Iso-Mustajärvi M. The effect of virtual reality on temporal bone anatomy evaluation and performance. Eur Arch Otorhinolaryngol 2022; 279:4303-4312. [PMID: 34837519 PMCID: PMC9363303 DOI: 10.1007/s00405-021-07183-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE There is only limited data on the application of virtual reality (VR) for the evaluation of temporal bone anatomy. The aim of the present study was to compare the VR environment to traditional cross-sectional viewing of computed tomography images in a simulated preoperative planning setting in novice and expert surgeons. METHODS A novice (n = 5) and an expert group (n = 5), based on their otosurgery experience, were created. The participants were asked to identify 24 anatomical landmarks, perform 11 distance measurements between surgically relevant anatomical structures and 10 fiducial markers on five cadaver temporal bones in both VR environment and cross-sectional viewings in PACS interface. The data on performance time and user-experience (i.e., subjective validation) were collected. RESULTS The novice group made significantly more errors (p < 0.001) and with significantly longer performance time (p = 0.001) in cross-sectional viewing than the expert group. In the VR environment, there was no significant differences (errors and time) between the groups. The performance of novices improved faster in the VR. The novices showed significantly faster task performance (p = 0.003) and a trend towards fewer errors (p = 0.054) in VR compared to cross-sectional viewing. No such difference between the methods were observed in the expert group. The mean overall scores of user-experience were significantly higher for VR than cross-sectional viewing in both groups (p < 0.001). CONCLUSION In the VR environment, novices performed the anatomical evaluation of temporal bone faster and with fewer errors than in the traditional cross-sectional viewing, which supports its efficiency for the evaluation of complex anatomy.
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Affiliation(s)
- Tomi Timonen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland.
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Aarno Dietz
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pia Linder
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
| | - Antti Lehtimäki
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Heikki Löppönen
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Microsurgery Centre of Eastern Finland, Kuopio, Finland
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Matti Iso-Mustajärvi
- Department of Otorhinolaryngology, Kuopio University Hospital, Puijonlaaksontie 2, 70210 Kuopio, PL 100, 70029, Kuopio, Finland
- Microsurgery Centre of Eastern Finland, Kuopio, Finland
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Hatcher AR, Pearson AS, Platt KM. A quality improvement apprenticeship: Gross anatomy in the time of Covid-19. ANATOMICAL SCIENCES EDUCATION 2022; 15:970-979. [PMID: 35892188 PMCID: PMC9353286 DOI: 10.1002/ase.2212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 07/05/2022] [Accepted: 07/23/2022] [Indexed: 06/15/2023]
Abstract
The study of anatomy is a team-driven field in which anatomy instruction occurs in small groups in the laboratory with one faculty member guiding students through each anatomical region. One laboratory experience may include several small group instructors in one simultaneous learning session. In comparison, the education of future gross anatomists often happens in an apprenticeship model, where the optimal learning outcomes are met through training with an experienced mentor. It was the vision of the authors to further their education through initiating an inter-institutional exchange to apprentice with innovative mentors in order to bring new ideas back to their own gross anatomy courses. The Southeastern Conference, a consortium of the Universities in the Southern region of the United States often associated with intercollegiate sports, has a host of academic initiatives in addition to the athletic emphasis. The Southeastern Conference Faculty Travel Program is one mechanism by which the organization promotes scholarly excellence. In this case, the Faculty Travel Program provided a way for authors from the University of Kentucky to visit a nearby institution, Vanderbilt University, and learn from like-minded anatomy educators, with the goal of incorporating changes in their courses geared toward quality improvement. After this implementation, positive themes emerged in the student feedback on course evaluations. However, the collaboration was interrupted by the onset of the Covid-19 pandemic. This article examines the strengths of interinstitutional apprenticeship and the benefits of such practices in a time of accelerated change in anatomical instruction.
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Affiliation(s)
- April R. Hatcher
- Department of Neuroscience, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
| | - A. Scott Pearson
- Department of SurgeryVanderbilt University School of Medicine, Vanderbilt UniversityNashvilleTennesseeUSA
| | - Kristen M. Platt
- Department of Neuroscience, College of MedicineUniversity of KentuckyLexingtonKentuckyUSA
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7
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Pößneck A, Ludwig AA, Burgert O, Nowatius E, Maass H, Çakmak HK, Dietz A. [Development and evaluation of a simulator for endoscopic sinus surgery]. Laryngorhinootologie 2022; 101:805-813. [PMID: 35724676 DOI: 10.1055/a-1841-6328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Endoscopic surgical procedures have been established as gold standard in sinus surgery. Challenges for surgical training have been addressed by the use of virtual reality (VR) simulators. To date, a number of simulators have been developed. However, previous studies regarding their training effects investigated only medically pretrained subjects or the time course of training outcomes has not been reported. METHODS A computer tomography (CT) dataset was segmented manually. A three-dimensional polygonal surface model was generated and textured using original photographic material. Interaction with the virtual environment was performed using a haptic input device. For the investigation of training outcomes with the simulator, the parameters duration and the number of errors were recorded. Ten subjects completed a training consisting of five runs on ten consecutive days. RESULTS Within the whole exercise period, four subjects reduced the duration of intervention by more than 60%. Four subjects reduced the number of errors by more than 60%. Eight out of 10 subjects showed an improvement with respect to both parameters. On median, the duration of the procedure was reduced by 46 seconds and the number of errors by 191. The statistical analysis between the two parameters showed a positive correlation. CONCLUSION Our data suggests that training on the FESS-simulator considerably improves the performance even in inexperienced subjects, both in terms of duration and accuracy of the procedure.
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Affiliation(s)
- Antje Pößneck
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany.,Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), dienst KNO, Brussel, Belgium
| | | | - Oliver Burgert
- Fakultät für Informatik, Hochschule Reutlingen, Reutlingen, Germany
| | - Edgar Nowatius
- zwonull media - Büro für Kommunikation, Leipzig, Germany
| | - Heiko Maass
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Hüseyin Kemal Çakmak
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Andreas Dietz
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Plastische Operationen, Universität Leipzig, Leipzig, Germany
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Chytas D, Salmas M, Demesticha T, Troupis TG. The important role of interaction when virtual reality is used for anatomy education. ANATOMICAL SCIENCES EDUCATION 2022; 15:636-637. [PMID: 34762353 DOI: 10.1002/ase.2154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/28/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Dimitrios Chytas
- Department of Anatomy, School of Physiotherapy, University of Peloponnese, Sparta, Greece
| | - Marios Salmas
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Theano Demesticha
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodore G Troupis
- Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Tudor Car L, Kyaw BM, Teo A, Fox TE, Vimalesvaran S, Apfelbacher C, Kemp S, Chavannes N. Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review. JMIR Serious Games 2022; 10:e29594. [PMID: 35416789 PMCID: PMC9047880 DOI: 10.2196/29594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/20/2021] [Accepted: 12/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Extended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence. OBJECTIVE Our aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education. METHODS We conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RESULTS Of the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (100%), and AR (73%). Knowledge was the most common outcome reported in studies on screen-based VR (80%) and VR serious games (58%). Less common outcomes included participants' attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement or self-efficacy beliefs, emotional state, competency developed, and patient outcomes. At least one form of validity evidence was found in approximately half of the studies on VR simulators (55%), VR patient simulations (56%), VR serious games (58%), and AR (55%) and in a quarter of the studies on screen-based VR (27%). Most studies used assessment methods that were implemented in a nondigital format, such as paper-based written exercises or in-person assessments where examiners observed performance (72%). CONCLUSIONS RCTs on VR and AR in medical education report a restricted range of outcomes, mostly skills and knowledge. The studies largely report immediate postintervention outcome data and use assessment methods that are in a nondigital format. Future RCTs should include a broader set of outcomes, report on the validity evidence of the measurement instruments used, and explore the use of assessments that are implemented digitally.
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Affiliation(s)
- Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Bhone Myint Kyaw
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Andrew Teo
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Tatiana Erlikh Fox
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Department of Internal Medicine, Onze Lieve Vrouwen Gasthuis, Amsterdam, Netherlands
| | - Sunitha Vimalesvaran
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Magdegurg, Germany.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sandra Kemp
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, Australia
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
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10
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Nakai K, Terada S, Takahara A, Hage D, Tubbs RS, Iwanaga J. Anatomy education for medical students in a virtual reality workspace: A pilot study. Clin Anat 2021; 35:40-44. [PMID: 34487367 DOI: 10.1002/ca.23783] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 09/02/2021] [Indexed: 01/17/2023]
Abstract
The COVID-19 pandemic has posed a challenge for many medical schools, as they have had to adjust their curricula into an online format. This was particularly problematic for anatomy courses as in person dissections have historically been preferred for providing students with a three-dimensional learning environment. In this study, we aim to share our experience with conducting anatomy lectures for medical student using a virtual reality (VR) workspace. Additionally, we discuss the advantages of using VR and expand on how it may be used to improve students' understanding of anatomy in comparison to various other online lecture formats. To do this, we utilized a post-lecture survey to gain feedback from the medical students that participated in a VR anatomy workspace. We found that many of our participants expressed that having access to their course material from anywhere and anytime via a virtual space, and being able to manipulate anatomical structures by moving and modifying them provided the student with a strong advantage. Although there are still limitations, we hope that our experience will assist other anatomy teachers with improving their lecture methods, especially during the pandemic.
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Affiliation(s)
- Kohga Nakai
- Tokushima University Faculty of Medicine, Tokushima, Japan.,OCD Co., Ltd., Tokyo, Japan
| | - Satoshi Terada
- OCD Co., Ltd., Tokyo, Japan.,Japan Community Health Care Organization (JCHO) Mishima General Hospital, Mishima City, Japan
| | - Ayaka Takahara
- OCD Co., Ltd., Tokyo, Japan.,Chiba University School of Medicine, Chiba, Japan
| | - Dany Hage
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA.,Department of Anatomical Sciences, St. George's University, St. George, Grenada.,Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Department of Neurology, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Japan
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11
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Pagella F, Emanuelli E, Benazzo M, Pusateri A, Ugolini S, Melegatti M, Ciorba A, Pelucchi S. Are sinonasal dissection courses a valid instrument for endoscopic sinus surgeons? A report on 7-years of experience. ACTA ACUST UNITED AC 2021; 40:415-420. [PMID: 33558769 PMCID: PMC7889255 DOI: 10.14639/0392-100x-n0705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/30/2020] [Indexed: 11/23/2022]
Abstract
Sinonasal dissection courses have been reported to be effective in teaching sinonasal anatomy to trainees, and in improving surgical skills for trained surgeons. Between 2013 and 2019, a standardised structured questionnaire was handed out to 130 participants of 8 sinonasal dissection courses. Each questionnaire included questions about the medical equipment the surgeons were fitted, and the problems encountered during the dissection.The majority of the participants, regardless of their experience and age, considered uncinectomy and anterior ethmoidectomy as the simplest parts of the dissection, whereas the most complicated step was the approach to the frontal sinus. All participants considered the dissection course as a useful way to improve their medical skills while performing an endoscopic surgery procedure, such as their anatomical knowledge, and confidence with instrumentation and the dissection. Sinonasal dissection courses can be considered to be useful for both trainees and trained surgeons. Improving anatomical knowledge can reduce the occurrence of complications, especially in endoscopic surgery.
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Affiliation(s)
- Fabio Pagella
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Enzo Emanuelli
- Department of Neuroscience, Institute of Otorhinolaryngology, University Hospital of Padova, Italy
| | - Marco Benazzo
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Alessandro Pusateri
- ENT and Skull-Base Surgery Department, Department of Neurosciences, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Sara Ugolini
- ENT Department, I.R.C.C.S. Policlinico San Matteo-University of Pavia, Italy.,ENT Department, University of Pavia, Italy
| | - Michela Melegatti
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
| | - Andrea Ciorba
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neuroscience and Rehabilitation, University Hospital of Ferrara, Italy
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12
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Progeny fitness determines the performance of the parasitoid Therophilus javanus, a prospective biocontrol agent against the legume pod borer. Sci Rep 2021; 11:8990. [PMID: 33903703 PMCID: PMC8076171 DOI: 10.1038/s41598-021-88644-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/07/2021] [Indexed: 11/25/2022] Open
Abstract
Therophilus javanus (Bhat & Gupta) is an exotic larval endoparasitoid newly imported from Asia into Africa as a classical biological control agent against the pod borer Maruca vitrata (Fabricius). The parasitoid preference for the five larval instars of M. vitrata and their influence on progeny sex ratio were assessed together with the impact of larval host age at the time of oviposition on development time, mother longevity and offspring production. In a choice situation, female parasitoids preferred to oviposit in the first three larval instars. The development of immature stages of the parasitoid was observed inside three-day-old hosts, whereby the first two larval instars of T. javanus completed their development as endoparasites and the third larval instar as ectoparasite. The development time was faster when first larval instars (two- and three-day-old) of the host caterpillars were parasitized compared to second larval instar (four-day-old). The highest proportion of daughters (0.51) was observed when females were provided with four-day-old hosts. The lowest intrinsic rate of increase (r) (0.21 ± 0.01), the lowest rate of increase (λ) (1.23 ± 0.01), and the lowest net reproductive rate (Ro) (35.93 ± 6.51) were recorded on four-day-old hosts. These results are discussed in the light of optimizing mass rearing and release strategies.
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13
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Iwanaga J, Loukas M, Dumont AS, Tubbs RS. A review of anatomy education during and after the COVID-19 pandemic: Revisiting traditional and modern methods to achieve future innovation. Clin Anat 2021; 34:108-114. [PMID: 32681805 PMCID: PMC7404762 DOI: 10.1002/ca.23655] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/15/2020] [Indexed: 12/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had enormous effects on anatomy education. During the pandemic, students have had no access to cadavers, which has been the principal way to learn anatomy since the 17th century. As it is difficult to predict future access to cadavers for students or in-person classes, anatomy educators are encouraged to revisit all possible teaching methods in order to develop innovations. Here, we review anatomy education methods to apply to current and future education.
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Affiliation(s)
- Joe Iwanaga
- Department of NeurosurgeryTulane University School of MedicineNew OrleansLouisianaUSA
- Department of NeurologyTulane University School of MedicineNew OrleansLouisianaUSA
- Dental and Oral Medical CenterKurume University School of MedicineFukuokaJapan
- Department of AnatomyKurume University School of MedicineFukuokaJapan
| | - Marios Loukas
- Department of AnatomyUniversity of Warmia and MazuryOlsztynPoland
- Department of Anatomical SciencesSt. George's UniversitySt. George'sGrenada
| | - Aaron S. Dumont
- Department of NeurosurgeryTulane University School of MedicineNew OrleansLouisianaUSA
| | - R. Shane Tubbs
- Department of NeurosurgeryTulane University School of MedicineNew OrleansLouisianaUSA
- Department of Structural & Cellular BiologyTulane University School of MedicineNew OrleansLouisianaUSA
- Department of Neurosurgery and Ochsner Neuroscience InstituteOchsner Health SystemNew OrleansLouisianaUSA
- Department of Anatomical SciencesSt. George's UniversitySt. George'sGrenada
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14
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Karbasi Z, Niakan Kalhori SR. Application and evaluation of virtual technologies for anatomy education to medical students: A review. Med J Islam Repub Iran 2020; 34:163. [PMID: 33816362 PMCID: PMC8004573 DOI: 10.47176/mjiri.34.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Indexed: 11/26/2022] Open
Abstract
To learn anatomy, medical students need to look at body structures and manipulate anatomical structures. Simulation-based education is a promising opportunity for the upgrade and sharing of knowledge. The purpose of this review is to investigate the evaluation of virtual technologies in teaching anatomy to medical students.
Methods: In this review, we searched PubMed, Web of Sciences, Scopus, and Embase for relevant articles in November 2018. Information retrieval was done without time limitation. The search was based on the following keywords: virtual reality, medical education, and anatomy. Results: 2483 articles were identified by searching databases. Finally, the fulltext of 12 articles was reviewed. The results of the review showed that virtual technologies had been used to train internal human anatomy, ear anatomy, nose anatomy, temporal bone anatomy, surgical anatomy, neuroanatomy, and cardiac anatomy. Conclusion: Virtual reality, augmented reality, and games can enhance students' anatomical learning skills and are proper alternatives to traditional methods in case of no access to the cadavers and mannequin.
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Affiliation(s)
- Zahra Karbasi
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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15
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Zhao J, Xu X, Jiang H, Ding Y. The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies. BMC MEDICAL EDUCATION 2020; 20:127. [PMID: 32334594 PMCID: PMC7183109 DOI: 10.1186/s12909-020-1994-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/04/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Virtual reality (VR) is an innovation that permits the individual to discover and operate within three-dimensional (3D) environment to gain practical understanding. This research aimed to examine the general efficiency of VR for teaching medical anatomy. METHODS We executed a meta-analysis of randomized controlled studies of the performance of VR anatomy education. We browsed five databases from the year 1990 to 2019. Ultimately, 15 randomized controlled trials with a teaching outcome measure analysis were included. Two authors separately chose studies, extracted information, and examined the risk of bias. The primary outcomes were examination scores of the students. Secondary outcomes were the degrees of satisfaction of the students. Random-effects models were used for the pooled evaluations of scores and satisfaction degrees. Standardized mean difference (SMD) was applied to assess the systematic results. The heterogeneity was determined by I2 statistics, and then was investigated by meta-regression and subgroup analyses. RESULTS In this review, we screened and included fifteen randomized controlled researches (816 students). The pooled analysis of primary outcomes showed that VR improves test scores moderately compared with other approaches (standardized mean difference [SMD] = 0.53; 95% Confidence Interval [CI] 0.09-0.97, p < 0.05; I2 = 87.8%). The high homogeneity indicated that the studies were different from each other. Therefore, we carried out meta-regression as well as subgroup analyses using seven variables (year, country, learners, course, intervention, comparator, and duration). We found that VR improves post-intervention test score of anatomy compared with other types of teaching methods. CONCLUSIONS The finding confirms that VR may act as an efficient way to improve the learners' level of anatomy knowledge. Future research should assess other factors like degree of satisfaction, cost-effectiveness, and adverse reactions when evaluating the teaching effectiveness of VR in anatomy.
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Affiliation(s)
| | - Xinliang Xu
- Department of Traumatic Surgery, Jining No.1 Peoples Hospital, Jining, China
| | - Hualin Jiang
- Health Science Center, Xi'an Jiaotong University, Xian, China.
| | - Yi Ding
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xian, China.
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16
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Tornari C, Tedla M, Surda P. Rhinology: Simulation Training (Part 1). CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00272-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Abstract
Purpose of Review
Recently, there has been an expansion of novel technologies in simulation training. Different models target different aspects of training. The aim of this review was to examine existing evidence about training simulators in rhinology, their incorporation into real training programmes and translation of these skills into the operating room. The first part focuses on the virtual and augmented reality simulators. The second part describes the role of physical (i.e. non-computer-based) models of endoscopic sinus surgery.
Recent Findings
Virtual reality simulators are still evolving and facing challenges due to their inherent cost and lack of realism in terms of the type of haptic feedback they provide. On the other hand, augmented reality seems to be a promising platform with a growing number of applications in preoperative planning, intraoperative navigation and education. Limitations in validity, registration error and level of evidence prevent the adoption of augmented reality on a wider scale or in clinical practice.
Summary
Simulation training is a maturing field that shows reasonable evidence for a number of models. The incorporation of these models into real training programmes requires further evaluation to ensure that training opportunities are being maximized.
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17
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Lubner RJ, Barber SR, Knoll RM, Kempfle J, Lee DJ, Reinshagen KL, Remenschneider AK, Kozin ED. Transcanal Computed Tomography Views for Transcanal Endoscopic Lateral Skull Base Surgery: Pilot Cadaveric Study. J Neurol Surg B Skull Base 2019; 82:338-344. [PMID: 34026410 DOI: 10.1055/s-0039-3400219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022] Open
Abstract
Objective Transcanal endoscopic operative approaches provide for a minimally invasive surgical portal to the lateral skull base. Traditional preoperative imaging evaluation involves computed tomography (CT) acquisition in the axial and coronal planes that are not optimized for the transcanal surgical corridor. Herein, we describe a novel CT-based "transcanal view" for preoperative surgical planning and intraoperative navigation. Study Design Present study is a cadaveric imaging study. Methods Cadaveric temporal bones ( n = 6) from three specimens underwent high-resolution CT (0.625 mm slice thickness). Using three-dimensional (3D) Slicer 4.8, reformatted "transcanal" views in the plane of the external auditory canal (EAC) were created. Axial and coronal reformats were used to compare and measure distances between anatomic structures in the plane of the EAC. Results The degree of oblique tilt for transcanal CT reformats was 6.67 ± 1.78 degrees to align the EAC in axial and coronal planes. Anticipated critical landmarks were identified easily using the transcanal view. Mean values were 8.68 ± 0.38 mm for annulus diameter, 9.5 ± 0.93 mm for isthmus diameter, 10.27 ± 0.73 mm for distance between annulus and isthmus, 2.95 ± 0.13 mm for distance between annulus and stapes capitulum, 5.12 ± 0.35 mm for distance between annulus and mastoid facial nerve, and 19.54 ± 1.22 mm for EAC length. Conclusion This study is the first to illustrate a novel "transcanal" CT sequence intended for endoscopic lateral skull base surgery. Future studies may address how incorporation of a transcanal CT reformat may influence surgical decision making.
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Affiliation(s)
- Rory J Lubner
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Samuel R Barber
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, University of Arizona College of Medicine, Tucson, Arizona, United States
| | - Renata M Knoll
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Judith Kempfle
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Daniel J Lee
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
| | - Katherine L Reinshagen
- Department of Radiology, Massachusetts Eye and Ear, Boston, Massachusetts, United States
| | - Aaron K Remenschneider
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States.,Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, Massachusetts, United States
| | - Elliott D Kozin
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, United States
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18
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Stephenson ED, Farquhar DR, Masood MM, Capra G, Kimple A, Ebert CS, Thorp BD, Zanation AM. Blinded Evaluation of Endoscopic Skill and Instructability After Implementation of an Endoscopic Simulation Experience. Am J Rhinol Allergy 2019; 33:681-690. [DOI: 10.1177/1945892419860973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Interest in endoscopic simulation is increasing. Past studies have used virtual reality or nonhuman models or residents with varying experience. Our aim was to evaluate the effect of simulation on procedural and psychomotor competence of medical students—surgical novices—performing endoscopic tasks on human cadavers and assess student perceptions. Methods Students (n = 22) completed a baseline sinus model skill evaluation graded by 2 blinded Rhinology fellows. Intervention and control groups with equal baselines were assigned. Intervention students practiced endoscopic tasks on the model for 45 minutes minimum over 2 weeks. All students reviewed sinus anatomy/disease and sinus surgery materials. The final cadaver evaluation was similar to the baseline. Fellows graded students on anatomy identification (sinuses, turbinates), psychomotor (navigation, camera alignment, instrument handling), and timed procedural (sinus object retrieval) skills, confidence, and instructability via fellow-guided frontal balloon placement. Results Participants included 16 males (72.7%) and 6 females (27.3%). Intervention and control groups contained 10 (45.4%) and 12 (54.6%) students, respectively. Intervention group final “Total Psychomotor” scores were higher (10.1/15 vs 7.8/15, P = .0231). “Surgical confidence” was 3.3/5 versus 2.5/5, and “Instructability” was 3.9/5 versus 3.4/5 in intervention versus control groups, respectively ( P < .050). Multivariate regression analysis demonstrated superior psychomotor skills, navigation, and confidence in the intervention group ( P < .036). Activity perception scores were higher in intervention students versus controls, 26.13 versus 18.36/40 ( P = .022). Conclusion In surgical novices, endoscopic simulation leads to superior endoscopic navigation and task performance in cadavers. This simulation presents a novel method for incorporating Otolaryngology simulation in medical student education.
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Affiliation(s)
- Elizabeth D. Stephenson
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Douglas R. Farquhar
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Maheer M. Masood
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gregory Capra
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adam Kimple
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Charles S. Ebert
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Brian D. Thorp
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Adam M. Zanation
- Department of Otolaryngology—Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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19
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Triepels CPR, Smeets CFA, Notten KJB, Kruitwagen RFPM, Futterer JJ, Vergeldt TFM, Van Kuijk SMJ. Does three-dimensional anatomy improve student understanding? Clin Anat 2019; 33:25-33. [PMID: 31087400 PMCID: PMC6916638 DOI: 10.1002/ca.23405] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 05/06/2019] [Accepted: 05/09/2019] [Indexed: 12/03/2022]
Abstract
We aim to provide an overview of the various digital three‐dimensional visualizations used for learning anatomy and to assess whether these improve medical students' understanding of anatomy compared to traditional learning methods. Furthermore, we evaluate the attitudes of the users of three‐dimensional visualizations. We included articles that compared advanced newer three‐dimensional anatomy visualization methods (i.e., virtual reality, augmented reality, and computer‐based three‐dimensional visualizations) to traditional methods that have been used for a long time (i.e., cadaver and textbooks) with regard to users' understanding of anatomy. Of the 1,148 articles identified, 21 articles reported data on the effectiveness of using three‐dimensional visualization methods compared to two‐dimensional methods. Twelve articles found that three‐dimensional visualization is a significantly more effective learning method compared to traditional methods, whereas nine articles did not find that three‐dimensional visualization was a significantly more effective method. In general, based on these articles, medical students prefer to use three‐dimensional visualizations to learn anatomy. In most of the articles, using three‐dimensional visualization was shown to be a more effective method to gain anatomical knowledge compared to traditional methods. Besides that, students are motivated and interested in using these new visualization methods for learning anatomical structures. Clin. Anat. 32:25–33, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Charlotte P R Triepels
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Carlijn F A Smeets
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Kim J B Notten
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Roy F P M Kruitwagen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Center+, Maastricht, The Netherlands.,GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jurgen J Futterer
- Department of Radiology and Nuclear Medicine, Radboud UMC, Nijmegen, The Netherlands
| | - Tineke F M Vergeldt
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sander M J Van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre+, Maastricht, The Netherlands
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20
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Kim DH, Kim Y, Park JS, Kim SW. Virtual Reality Simulators for Endoscopic Sinus and Skull Base Surgery: The Present and Future. Clin Exp Otorhinolaryngol 2018; 12:12-17. [PMID: 30326700 PMCID: PMC6315210 DOI: 10.21053/ceo.2018.00906] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/24/2018] [Indexed: 01/01/2023] Open
Abstract
Endoscopic sinus and skull base surgeries are minimally invasive surgical techniques that reduce postoperative symptoms and complications and enhance patients’ quality of life. However, to ensure excellent surgical outcomes after such interventions, intimate familiarity with important landmarks and high-level endoscope manipulation skills are essential. Cadaver training is one possible option, but cadavers are expensive, scarce, and nonreusable and cadaver work requires specialized equipment and staff. In addition, it is difficult to mimic specific diseases using cadavers. Virtual reality simulators can create a computerized environment in which the patient’s anatomy is reproduced and interaction with endoscopic handling and realistic haptic feedback is possible. Moreover, they can be used to present scenarios that improve trainees’ skills and confidence. Therefore, virtual simulator training can be implemented at all levels of surgical education. This review introduces the current literature on virtual reality training for endoscopic sinus and skull base surgeons, and discusses the direction of future developments.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yeonji Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae-Sung Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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21
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Chen PG, Bassiouni A, Taylor CB, Psaltis AJ, Alrasheed A, Wrobel B, Tewfik MA, McMains KC. Teaching Residents Frontal Sinus Anatomy Using a Novel 3-Dimensional Conceptualization Planning Software-Based Module. Am J Rhinol Allergy 2018; 32:526-532. [PMID: 30229679 DOI: 10.1177/1945892418801264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The Frontal Sinus Masterclass (FSMC) is an effective method for teaching frontal sinus anatomy. A third party developed new software using the same 3-dimensional building block concept. The authors sought to determine whether the use of the software for the educational module yielded similar results to the original FSMC, which used wooden blocks. METHODS The study was performed at a sinus course for residents. A precourse test assessed the ability to decipher frontal sinus anatomy prior to the course. Computed tomography (CT) scans of the sinuses were evaluated in triplanar view, and participants attempted to reconstruct the anatomy using the new software. Subsequently, the course instructor explained the anatomy and showed a short corresponding surgical video of the frontal sinusotomy. Cases progressed in anatomical difficulty and inflammatory load. A postcourse test determined knowledge after the course. RESULTS In sum, 50 residents completed the pre- and postcourse tests. Overall scores increased from 60.5% to 65.2% ( P = .004). Subanalysis also demonstrated improved ability to locate the frontal drainage pathway from 32.5% to 46% ( P = .011) and label the frontal recess cell structures from 64% to 67.6% ( P = .045). CONCLUSION There is minimal literature on proven methods for teaching frontal sinus anatomy. Objectively, participants of the modified FSMC simulation training using new software improved their ability to recognize cells of the frontal recess on CT scans. They especially exhibited better localization of the frontal sinus drainage pathway. Subjectively, participants reported benefit from the course and felt they would be better surgeons.
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Affiliation(s)
- Philip G Chen
- 1 Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Ahmed Bassiouni
- 2 Department of Otolaryngology - Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Christine B Taylor
- 1 Department of Otolaryngology - Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, Texas
| | - Alkis J Psaltis
- 2 Department of Otolaryngology - Head and Neck Surgery, University of Adelaide, Adelaide, South Australia, Australia
| | - Abdulaziz Alrasheed
- 3 Department of Otolaryngology, King Abdulaziz University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Bozena Wrobel
- 4 Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California
| | - Marc A Tewfik
- 5 Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
| | - K Christopher McMains
- 6 Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland
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22
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Stew B, Kao SST, Dharmawardana N, Ooi EH. A systematic review of validated sinus surgery simulators. Clin Otolaryngol 2018; 43:812-822. [PMID: 29247602 DOI: 10.1111/coa.13052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Simulation provides a safe and effective opportunity to develop surgical skills. A variety of endoscopic sinus surgery (ESS) simulators has been described in the literature. Validation of these simulators allows for effective utilisation in training. OBJECTIVE OF REVIEW To conduct a systematic review of the published literature to analyse the evidence for validated ESS simulation. SEARCH STRATEGY Pubmed, Embase, Cochrane and Cinahl were searched from inception of the databases to 11 January 2017. EVALUATION METHOD Twelve thousand five hundred and sixteen articles were retrieved of which 10 112 were screened following the removal of duplicates. Thirty-eight full-text articles were reviewed after meeting search criteria. Evidence of face, content, construct, discriminant and predictive validity was extracted. RESULTS Twenty articles were included in the analysis describing 12 ESS simulators. Eleven of these simulators had undergone validation: 3 virtual reality, 7 physical bench models and 1 cadaveric simulator. Seven of the simulators were shown to have face validity, 7 had construct validity and 1 had predictive validity. None of the simulators demonstrated discriminate validity. CONCLUSION This systematic review demonstrates that a number of ESS simulators have been comprehensively validated. Many of the validation processes, however, lack standardisation in outcome reporting, thus limiting a meta-analysis comparison between simulators.
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Affiliation(s)
- B Stew
- ENT Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
| | - S S-T Kao
- ENT Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
| | - N Dharmawardana
- ENT Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia
| | - E H Ooi
- ENT Head and Neck Surgery, Flinders Medical Centre, Bedford Park, SA, Australia.,Department of Surgery, Flinders University, Adelaide, SA, Australia
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23
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Favier V, Zemiti N, Caravaca Mora O, Subsol G, Captier G, Lebrun R, Crampette L, Mondain M, Gilles B. Geometric and mechanical evaluation of 3D-printing materials for skull base anatomical education and endoscopic surgery simulation - A first step to create reliable customized simulators. PLoS One 2017; 12:e0189486. [PMID: 29252993 PMCID: PMC5734742 DOI: 10.1371/journal.pone.0189486] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Endoscopic skull base surgery allows minimal invasive therapy through the nostrils to treat infectious or tumorous diseases. Surgical and anatomical education in this field is limited by the lack of validated training models in terms of geometric and mechanical accuracy. We choose to evaluate several consumer-grade materials to create a patient-specific 3D-printed skull base model for anatomical learning and surgical training. METHODS Four 3D-printed consumer-grade materials were compared to human cadaver bone: calcium sulfate hemihydrate (named Multicolor), polyamide, resin and polycarbonate. We compared the geometric accuracy, forces required to break thin walls of materials and forces required during drilling. RESULTS All materials had an acceptable global geometric accuracy (from 0.083mm to 0.203mm of global error). Local accuracy was better in polycarbonate (0.09mm) and polyamide (0.15mm) than in Multicolor (0.90mm) and resin (0.86mm). Resin and polyamide thin walls were not broken at 200N. Forces needed to break Multicolor thin walls were 1.6-3.5 times higher than in bone. For polycarbonate, forces applied were 1.6-2.5 times higher. Polycarbonate had a mode of fracture similar to the cadaver bone. Forces applied on materials during drilling followed a normal distribution except for the polyamide which was melted. Energy spent during drilling was respectively 1.6 and 2.6 times higher on bone than on PC and Multicolor. CONCLUSION Polycarbonate is a good substitute of human cadaver bone for skull base surgery simulation. Thanks to short lead times and reasonable production costs, patient-specific 3D printed models can be used in clinical practice for pre-operative training, improving patient safety.
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Affiliation(s)
- Valentin Favier
- Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
- ENT department, University Hospital of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Nabil Zemiti
- LIRMM, DEXTER team, CNRS, Montpellier University, Montpellier, France
| | | | - Gérard Subsol
- Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
| | - Guillaume Captier
- Anatomy laboratory, School of Medicine, Montpellier University, Montpellier, France
| | - Renaud Lebrun
- Evolutionary Sciences Institute of Montpellier, MRI-ISEM, University of Montpellier, Montpellier, France
| | - Louis Crampette
- ENT department, University Hospital of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Michel Mondain
- ENT department, University Hospital of Montpellier, Gui de Chauliac Hospital, Montpellier, France
| | - Benjamin Gilles
- Montpellier Laboratory of Informatics, Robotics and Microelectonics (LIRMM), ICAR team, French National Centre for Scientific Research (CNRS), Montpellier University, Montpellier, France
- AnatoScope SA, Montpellier, France
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Abstract
The convergence of technology and medicine has led to many advances in surgical training. Novel surgical simulators have led to significantly improved skills of graduating surgeons, leading to decreased time to proficiency, improved efficiency, decreased errors, and improvement in patient safety. Endoscopic sinus surgery poses a steep learning curve given the complex 3-dimensional anatomy of the nasal and paranasal cavities, and the necessary visual-spatial motor skills and bimanual dexterity. This article focuses on surgical simulation in rhinological training and how innovative high-fidelity and low-fidelity simulators can maximize resident training and improve procedural skills before operating in the live environment.
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Affiliation(s)
- Andrew Y Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 14067, USA
| | - Marvin P Fried
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 14067, USA
| | - Marc Gibber
- Department of Otorhinolaryngology-Head and Neck Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 3400 Bainbridge Avenue, 3rd Floor, Bronx, NY 14067, USA.
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Scaperotti M, Gil N, Downs I, Jeyakumar A, Liu A, Chan J, Bonner J, Kelly MS, Nosanchuk JD, Cohen HW, Jerschow E. Development and Evaluation of a Web-Based Dermatology Teaching Tool for Preclinical Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2017; 13:10619. [PMID: 30800820 PMCID: PMC6338178 DOI: 10.15766/mep_2374-8265.10619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/01/2017] [Indexed: 05/28/2023]
Abstract
INTRODUCTION There is growing interest in, and emphasis on, electronic teaching tools in medicine. Despite relevant testing on the United States Medical Licensing Examination (USMLE), American medical schools offer limited training in skin disorders. Teaching visual topics like dermatology in classroom formats is challenging. We hypothesized that an electronic module would enhance students' dermatology competency. METHODS A self-directed, case-based module was created. To test its efficacy, 40 medical students were randomized to have module access (interventional group) or none (conventional group). Learning outcomes were compared using a multiple-choice exam, including questions relevant and irrelevant to the module. Outcomes included proportions of correctly answered module questions (module scores) and nonmodule questions (nonmodule scores). Difference scores were calculated: (module score) - (nonmodule score). Positive values indicated that knowledge of module questions surpassed that of nonmodule questions. If there were a training effect, the interventional group's difference score should exceed that of the conventional group. RESULTS The interventional group scored significantly higher than did the conventional group on module questions-75% (interquartile range [IQR], 69-88) versus 50% (IQR, 38-63), p < .001-and nonmodule questions-85% (IQR, 69-92) versus 69% (IQR, 54-77), p = .02. The Hodges-Lehman median difference estimate of the training effect was 13.0 (95% confidence interval, 0.5-25.5). DISCUSSION This e-module is effective at enhancing students' competency in dermatology while emphasizing detailed pathophysiology that prepares them for USMLE Step 1. A module-based curriculum may enhance learning in supplement to traditional teaching modalities.
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Affiliation(s)
| | - Nelson Gil
- Medical Student, Medical Scientist Training Program, Albert Einstein College of Medicine
| | - Ian Downs
- Senior Medical Student, Albert Einstein College of Medicine
| | | | - Andy Liu
- Recent Graduate, Albert Einstein College of Medicine
| | - Jimmy Chan
- Recent Graduate, Albert Einstein College of Medicine
| | - Joseph Bonner
- Independent Communications Consultant in Higher Education
| | - Mary S. Kelly
- Associate Professor, Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine
| | - Joshua D. Nosanchuk
- Professor, Departments of Internal Medicine and Microbiology & Immunology, Albert Einstein College of Medicine
- Assistant Dean for Students, Albert Einstein College of Medicine
| | - Hillel W. Cohen
- Professor, Department of Epidemiology & Population Health, Albert Einstein College of Medicine
| | - Elina Jerschow
- Associate Professor, Department of Medicine (Allergy & Immunology), Albert Einstein College of Medicine
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Stepan K, Zeiger J, Hanchuk S, Del Signore A, Shrivastava R, Govindaraj S, Iloreta A. Immersive virtual reality as a teaching tool for neuroanatomy. Int Forum Allergy Rhinol 2017; 7:1006-1013. [PMID: 28719062 DOI: 10.1002/alr.21986] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 05/21/2017] [Accepted: 06/13/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Three-dimensional (3D) computer modeling and interactive virtual reality (VR) simulation are validated teaching techniques used throughout medical disciplines. Little objective data exists supporting its use in teaching clinical anatomy. Learner motivation is thought to limit the rate of utilization of such novel technologies. The purpose of this study is to evaluate the effectiveness, satisfaction, and motivation associated with immersive VR simulation in teaching medical students neuroanatomy. METHODS Images of normal cerebral anatomy were reconstructed from human Digital Imaging and Communications in Medicine (DICOM) computed tomography (CT) imaging and magnetic resonance imaging (MRI) into 3D VR formats compatible with the Oculus Rift VR System, a head-mounted display with tracking capabilities allowing for an immersive VR experience. The ventricular system and cerebral vasculature were highlighted and labeled to create a focused interactive model. We conducted a randomized controlled study with 66 medical students (33 in both the control and experimental groups). Pertinent neuroanatomical structures were studied using either online textbooks or the VR interactive model, respectively. We then evaluated the students' anatomy knowledge, educational experience, and motivation (using the Instructional Materials Motivation Survey [IMMS], a previously validated assessment). RESULTS There was no significant difference in anatomy knowledge between the 2 groups on preintervention, postintervention, or retention quizzes. The VR group found the learning experience to be significantly more engaging, enjoyable, and useful (all p < 0.01) and scored significantly higher on the motivation assessment (p < 0.01). CONCLUSION Immersive VR educational tools awarded a more positive learner experience and enhanced student motivation. However, the technology was equally as effective as the traditional text books in teaching neuroanatomy.
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Affiliation(s)
- Katelyn Stepan
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Joshua Zeiger
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Stephanie Hanchuk
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Satish Govindaraj
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alfred Iloreta
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
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Dharmawardana N, Ruthenbeck G, Woods C, Elmiyeh B, Diment L, Ooi EH, Reynolds K, Carney AS. Validation of virtual-reality-based simulations for endoscopic sinus surgery. Clin Otolaryngol 2016; 40:569-79. [PMID: 25809675 DOI: 10.1111/coa.12414] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Virtual reality (VR) simulators provide an alternative to real patients for practicing surgical skills but require validation to ensure accuracy. Here, we validate the use of a virtual reality sinus surgery simulator with haptic feedback for training in Otorhinolaryngology - Head & Neck Surgery (OHNS). METHODS Participants were recruited from final-year medical students, interns, resident medical officers (RMOs), OHNS registrars and consultants. All participants completed an online questionnaire after performing four separate simulation tasks. These were then used to assess face, content and construct validity. anova with post hoc correlation was used for statistical analysis. RESULTS The following groups were compared: (i) medical students/interns, (ii) RMOs, (iii) registrars and (iv) consultants. Face validity results had a statistically significant (P < 0.05) difference between the consultant group and others, while there was no significant difference between medical student/intern and RMOs. Variability within groups was not significant. Content validity results based on consultant scoring and comments indicated that the simulations need further development in several areas to be effective for registrar-level teaching. However, students, interns and RMOs indicated that the simulations provide a useful tool for learning OHNS-related anatomy and as an introduction to ENT-specific procedures. CONCLUSIONS The VR simulations have been validated for teaching sinus anatomy and nasendoscopy to medical students, interns and RMOs. However, they require further development before they can be regarded as a valid tool for more advanced surgical training.
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Affiliation(s)
| | - G Ruthenbeck
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - C Woods
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - B Elmiyeh
- Flinders Medical Centre, Adelaide, Australia
| | - L Diment
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - E H Ooi
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - K Reynolds
- Medical Device Research Institute, Flinders University, Adelaide, Australia
| | - A S Carney
- Flinders Medical Centre, Adelaide, Australia.,Medical Device Research Institute, Flinders University, Adelaide, Australia
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Yammine K, Violato C. A meta-analysis of the educational effectiveness of three-dimensional visualization technologies in teaching anatomy. ANATOMICAL SCIENCES EDUCATION 2015; 8:525-38. [PMID: 25557582 DOI: 10.1002/ase.1510] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/12/2014] [Accepted: 12/04/2014] [Indexed: 05/16/2023]
Abstract
Many medical graduates are deficient in anatomy knowledge and perhaps below the standards for safe medical practice. Three-dimensional visualization technology (3DVT) has been advanced as a promising tool to enhance anatomy knowledge. The purpose of this review is to conduct a meta-analysis of the effectiveness of 3DVT in teaching and learning anatomy compared to all teaching methods. The primary outcomes were scores of anatomy knowledge tests expressed as factual or spatial knowledge percentage means. Secondary outcomes were perception scores of the learners. Thirty-six studies met the inclusion criteria including 28 (78%) randomized studies. Based on 2,226 participants including 2,128 from studies with comparison groups, 3DVTs (1) resulted in higher (d = 0.30, 95%CI: 0.02-0.62) factual knowledge, (2) yielded significant better results (d = 0.50, 95%CI: 0.20-0.80) in spatial knowledge acquisition, and (3) produced significant increase in user satisfaction (d = 0.28, 95%CI = 0.12-0.44) and in learners' perception of the effectiveness of the learning tool (d = 0.28, 95%CI = 0.14-0.43). The total mean scores (out of five) and ±SDs for QUESTS's Quality and Strength dimensions were 4.38 (±SD 1.3) and 3.3 (±SD 1.7), respectively. The results have high internal validity, for the improved outcomes of 3DVTs compared to other methods of anatomy teaching. Given that anatomy teaching and learning in the modern medical school appears to be approaching a crisis, 3DVT can be a potential solution to the problem of inadequate anatomy pedagogy.
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Affiliation(s)
- Kaissar Yammine
- Foot and Hand Clinic, Emirates Hospital, Dubai, United Arab Emirates
- Center for Evidence-Based Sports and Orthopedic Research, Emirates Hospital, Dubai
| | - Claudio Violato
- Department of Medical Education, University Ambrosiana, Free University of Milan, Milan, Italy
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
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Piromchai P, Avery A, Laopaiboon M, Kennedy G, O'Leary S. Virtual reality training for improving the skills needed for performing surgery of the ear, nose or throat. Cochrane Database Syst Rev 2015; 2015:CD010198. [PMID: 26352008 PMCID: PMC9233923 DOI: 10.1002/14651858.cd010198.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Virtual reality simulation uses computer-generated imagery to present a simulated training environment for learners. This review seeks to examine whether there is evidence to support the introduction of virtual reality surgical simulation into ear, nose and throat surgical training programmes. OBJECTIVES 1. To assess whether surgeons undertaking virtual reality simulation-based training achieve surgical ('patient') outcomes that are at least as good as, or better than, those achieved through conventional training methods.2. To assess whether there is evidence from either the operating theatre, or from controlled (simulation centre-based) environments, that virtual reality-based surgical training leads to surgical skills that are comparable to, or better than, those achieved through conventional training. SEARCH METHODS The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 6); PubMed; EMBASE; ERIC; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 27 July 2015. SELECTION CRITERIA We included all randomised controlled trials and controlled trials comparing virtual reality training and any other method of training in ear, nose or throat surgery. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. We evaluated both technical and non-technical aspects of skill competency. MAIN RESULTS We included nine studies involving 210 participants. Out of these, four studies (involving 61 residents) assessed technical skills in the operating theatre (primary outcomes). Five studies (comprising 149 residents and medical students) assessed technical skills in controlled environments (secondary outcomes). The majority of the trials were at high risk of bias. We assessed the GRADE quality of evidence for most outcomes across studies as 'low'. Operating theatre environment (primary outcomes) In the operating theatre, there were no studies that examined two of three primary outcomes: real world patient outcomes and acquisition of non-technical skills. The third primary outcome (technical skills in the operating theatre) was evaluated in two studies comparing virtual reality endoscopic sinus surgery training with conventional training. In one study, psychomotor skill (which relates to operative technique or the physical co-ordination associated with instrument handling) was assessed on a 10-point scale. A second study evaluated the procedural outcome of time-on-task. The virtual reality group performance was significantly better, with a better psychomotor score (mean difference (MD) 1.66, 95% CI 0.52 to 2.81; 10-point scale) and a shorter time taken to complete the operation (MD -5.50 minutes, 95% CI -9.97 to -1.03). Controlled training environments (secondary outcomes) In a controlled environment five studies evaluated the technical skills of surgical trainees (one study) and medical students (three studies). One study was excluded from the analysis. Surgical trainees: One study (80 participants) evaluated the technical performance of surgical trainees during temporal bone surgery, where the outcome was the quality of the final dissection. There was no difference in the end-product scores between virtual reality and cadaveric temporal bone training. Medical students: Two other studies (40 participants) evaluated technical skills achieved by medical students in the temporal bone laboratory. Learners' knowledge of the flow of the operative procedure (procedural score) was better after virtual reality than conventional training (SMD 1.11, 95% CI 0.44 to 1.79). There was also a significant difference in end-product score between the virtual reality and conventional training groups (SMD 2.60, 95% CI 1.71 to 3.49). One study (17 participants) revealed that medical students acquired anatomical knowledge (on a scale of 0 to 10) better during virtual reality than during conventional training (MD 4.3, 95% CI 2.05 to 6.55). No studies in a controlled training environment assessed non-technical skills. AUTHORS' CONCLUSIONS There is limited evidence to support the inclusion of virtual reality surgical simulation into surgical training programmes, on the basis that it can allow trainees to develop technical skills that are at least as good as those achieved through conventional training. Further investigations are required to determine whether virtual reality training is associated with better real world outcomes for patients and the development of non-technical skills. Virtual reality simulation may be considered as an additional learning tool for medical students.
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Affiliation(s)
- Patorn Piromchai
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
- Faculty of Medicine, Khon Kaen UniversityDepartment of OtolaryngologyKhon KaenThailand40002
| | - Alex Avery
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Gregor Kennedy
- University of MelbourneCentre for the Study of Higher EducationParkvilleVictoriaAustralia3052
| | - Stephen O'Leary
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
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Caswell FR, Venkatesh A, Denison AR. Twelve tips for enhancing anatomy teaching and learning using radiology. MEDICAL TEACHER 2015; 37:1067-1071. [PMID: 25909851 DOI: 10.3109/0142159x.2015.1029896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Anatomy is a keystone of many healthcare curricula and its understanding fundamental to patient care. The close relationship between clinical radiology and anatomy is well recognised and expanding. Imaging resources can be effectively integrated alongside traditional methods for learning anatomy in a resource efficient manner in order to enhance anatomy teaching. The following 12 tips have been divided into imaging tips, clinical tips and educational tips and offer practical advice and suggestions for designing and integrating radiological resources across the curriculum.
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Michael M, Abboudi H, Ker J, Shamim Khan M, Dasgupta P, Ahmed K. Performance of technology-driven simulators for medical students—a systematic review. J Surg Res 2014; 192:531-43. [DOI: 10.1016/j.jss.2014.06.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/07/2014] [Accepted: 06/24/2014] [Indexed: 11/27/2022]
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Affiliation(s)
- S Gupta
- Guy’s and St Thomas’ NHS Trust
| | | | - F Salim
- Guy’s and St Thomas’ NHS Trust
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Saba SC, Pacella SJ, Miller SH, Dobke MK. Competency versus performance in plastic surgery: navigating through new technologies and medical devices. Clin Plast Surg 2012; 39:513-20. [PMID: 23036301 DOI: 10.1016/j.cps.2012.07.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The purpose of this article is to examine how plastic surgeons learn to use novel technology in their practices. In addition, a critical evaluation of current teaching methods as they relate to surgeon competence in these new technologies is discussed.
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Affiliation(s)
- Salim C Saba
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of California at San Diego, MS 8890, 200 West Arbor Drive, San Diego, CA 92103, USA.
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Javia L, Deutsch ES. A Systematic Review of Simulators in Otolaryngology. Otolaryngol Head Neck Surg 2012; 147:999-1011. [DOI: 10.1177/0194599812462007] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To conduct a systematic review of published articles that describe simulators that could be used in otolaryngology for education, skill acquisition, and/or skill improvement. Data Sources Ovid and Embase databases searched July 14, 2011. Review Methods Three hundred fifty-three abstracts were independently reviewed by both authors, then 154 eligible articles were reviewed by both authors, and 95 articles were categorized by organ system (eg, otologic); type of simulator (eg, physical, virtual); whether the simulator was a prototype, could be purchased, or was constructed; validation; and level of learning assessment. Discrepancies were resolved by re-review and discussion. Results In addition to 11 overview articles, 28 articles described 16 otology simulators, most of which are virtual and prototypes. Ninteen articles described 10 sinus/rhinology simulators; most are virtual surgery simulators and prototypes. Eight articles described 8 oral cavity simulators, and 8 articles described neck simulators. Seventeen articles described 13 bronchoscopy simulators; several are full-body high-technology manikins adapted from other purposes. Five articles described eclectic simulators, including some for learning nontechnical and teamwork skills. Half of the simulators have been validated. Learning levels were often not assessed or assessment was limited to the learners’ perceptions. Conclusion A wide variety of simulators are available or under development. Lack of unified validation concepts and limited descriptions restricted our ability to assess model characteristics, availability, and validation. Simulators are emerging as powerful tools to facilitate learning; this review may provide a platform for discussion and refinement of the information reported and analyzed in evaluating simulators.
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Affiliation(s)
- Luv Javia
- Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Department of Otorhinolaryngology/Head and Neck Surgery, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ellen S. Deutsch
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Curcio DF, Behlau M, Barros MD, Smith RL. Laryngeal support device enhances the learning of laryngeal anatomy and voice physiology. ANATOMICAL SCIENCES EDUCATION 2012; 5:241-245. [PMID: 22467229 DOI: 10.1002/ase.1276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 02/05/2012] [Accepted: 02/29/2012] [Indexed: 05/31/2023]
Abstract
Multidisciplinary cooperation in health care requires a solid knowledge in the basic sciences for a common ground of communication. In speech pathology, these fundamentals improve the accuracy of descriptive diagnoses and support the development of new therapeutic techniques and strategies. The aim of this study is to briefly discuss the benefits of hands-on education on laryngeal anatomy and voice physiology in Brazilian graduate programs in speech pathology, as well as to describe a simple prototype that can be used as a useful educational tool for this purpose. The laryngeal anatomic support device was designed to provide a vertical frame to hold human or mammalian larynges with no preservation treatment, with the goal of allowing good visualization of the vocal folds during artificial phonation. The device was designed to provide the user the ability to manipulate the soft and cartilaginous structures of the larynx with near-natural biomechanical properties. The description of the project is detailed to allow the reproduction of this simple and inexpensive device. It may be used as an experimental feature in a variety of settings, from high-school programs to experimental research methods, and may suit a wide array of different educational models.
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Affiliation(s)
- Daniella Franco Curcio
- Department of Morphology, Santa Casa School of Medical Sciences of São Paulo, São Paulo, Brazil.
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A virtual-reality subtotal tonsillectomy simulator. The Journal of Laryngology & Otology 2012; 126 Suppl 2:S8-13. [DOI: 10.1017/s0022215112000199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectives:To develop a virtual-reality subtotal tonsillectomy simulation for surgical training.Materials and Methods:Computer models of a male patient's head and throat, and the surgical instrument, were created. These models were combined with custom-built simulation software. Recently developed tissue simulation technology that exploits recent developments in programmable graphics processing units was used to model tonsillar tissue in a way that allows surgical interaction whilst providing accurate tactile feedback. Current real-time rendering techniques were used to provide realistic visuals. Iterative refinements were made to the simulation, and in particular the tissue simulation, in consultation with relevantly experienced surgeons.Results:We have used newly developed tissue simulation technology to developed a novel virtual-reality subtotal tonsillectomy simulation for surgical training, the first of its kind.Conclusion:Early feedback suggests that this simulator can help surgeons to rapidly acquire subtotal tonsillectomy surgical skills in a risk-free and realistic virtual environment.
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Utilization and dissection for endoscopic sinus surgery training in the residency program. J Craniofac Surg 2011; 21:1715-8. [PMID: 21119406 DOI: 10.1097/scs.0b013e3181f3c73b] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To develop an animal cadaver model that would allow residents to learn functional endoscopic sinus surgery as a complementary model. STUDY DESIGN Prospective experimental study. PATIENTS AND METHODS Two of our first-year residents were included in the study, and each operated on 5 sheep noses. All the routine steps of endoscopic sinus surgery were performed, except for sphenoidotomy, and their success and complication scores were recorded. The residents' performance for maxillary antrostomy, ethmoidectomy, and frontal sinusotomy in sheep cadaver noses were evaluated by the authors. Predissection and postdissection computer tomography assessed the completeness of dissection. Images were analyzed for maxillary antrostomy, frontal sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells. The first and last 5 sides of residents were analyzed together as the first 10 sides (group 1) and last 10 sides (group 2). RESULTS Group 2 had significantly better outcomes for frontal sinusotomy and ethmoidectomy (P = 0.011 and P = 0.003, respectively). The mean duration of procedures for group 1 was 15.7 minutes and that for group 2 was 10.3 minutes (P = 0.000). The difference was not significant between the 2 groups when comparing the success rates of maxillary antrostomy and the complication rates (P > 0.05). CONCLUSIONS The nasal cavity of the sheep is anatomically similar to the human nasal cavity, and the model using sheep cadaver for endoscopic sinus surgery training is a cost-effective and useful model for the first step of the learning curve.
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Abstract
OBJECTIVES Computer-based medical simulation has recently been adopted as a new method of medical education. This paper reviews the uses of medical simulation within the ENT specialty, and reports how such simulation is used in Al-Ahsa College of Medicine, Saudi Arabia. METHODS We review our use of a simulation laboratory in ENT training. Students are taught ENT anatomy using physical models, ear diseases using physical models, and ENT examination by watching video recordings, and are taught the principles of common ENT surgery using a computerised mannequin (for laryngoscopy and bronchoscopy). A haptic temporal bone surgery simulator is used for mastoidectomy and functional endoscopic sinus surgery training, and a mannequin for cricothyrotomy and tracheotomy training. CONCLUSION The use of such simulation methods has greatly improved our students' perception and comprehension.
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Strauss G, Limpert E, Fischer M, Hofer M, Kubisch C, Krüger A, Dietz A, Meixensberger J, Trantakis C, Strauss M, Preim B. [Virtual endoscopy of the nose and paranasal sinuses in real-time. Surgical planning system "Sinus endoscopy" (SPS-SE)]. HNO 2009; 57:789-96. [PMID: 19636516 DOI: 10.1007/s00106-009-1977-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PROBLEM The aim of this study was the development and clinical evaluation of a new method for virtual endoscopy of the nose and paranasal sinuses. MATERIAL AND METHODS The surgical planning system "sinus endoscopy" (SPS-SE) was completely newly developed. The surfaces of the CT images are represented with direct volume rendering (raycasting) which allows a sufficiently high image repetition frequency with the movement of the virtual endoscopy and material effects for a natural appearance were added. Detail accuracy of the virtual illustrations was examined with the help of a picture-statistic comparison between optical and the virtual endoscopy. The evaluation of the system by the patients and physicians was made with a validated questionnaire. RESULTS The deviations from defined landmarks of virtual in comparison to optical endoscopy are between 1.4 mm and 11.1 mm. Manoeuvering the virtual endoscope was found to be better than with the optical endoscope but the important parameters for visualization were similar. The accuracy of volume rendering, the high variability of scaling of the anatomical borders and orientation were judged to be negative factors. Altogether there was a balanced opinion from the ENT surgeons but without exception patients judged the system positively. DISCUSSION This investigation proved the efficiency of SPS-SE for three-dimensional real time reconstruction of high-resolution CT data of the nose and paranasal sinuses. However, some modifications are necessary before introduction into routine use.
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Affiliation(s)
- G Strauss
- Klinik und Poliklinik für HNO-Heilkunde/Plastische Operationen, Innovation Center Computer Assisted Surgery, Universität Leipzig, Liebigstrasse 10-14, 04103, Leipzig.
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Zuckerman JD, Wise SK, Rogers GA, Senior BA, Schlosser RJ, DelGaudio JM. The utility of cadaver dissection in endoscopic sinus surgery training courses. Am J Rhinol Allergy 2009; 23:218-24. [PMID: 19401053 DOI: 10.2500/ajra.2009.23.3297] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Understanding paranasal sinus anatomy is crucial for successful outcomes in endoscopic sinus surgery (ESS). This study was designed to evaluate subjective and objective differences in ESS cadaver dissections among participants of varying experience levels in association with the use of image guidance and computer-aided technologies in a physician training cadaver dissection laboratory. METHODS Participants in a 2-day cadaver dissection course completed daily predissection surveys evaluating subjective comfort with ESS. Pre- and postdissection computer tomography (CT) scans assessed completeness of dissection. Images were analyzed for maxillary antrostomy, frontal and sphenoid sinusotomy, residual ethmoid cells and partitions, and residual frontal recess cells. RESULTS Fifty-one sides were dissected. Participant comfort increased significantly from day 1 to 2 for overall ESS (p = 0.001) and for individual sinuses (p < 0.001 to p = 0.047). Participants with more years in practice had fewer unopened ethmoid cells (p = 0.015) and frontal recess cells (p = 0.014) on dissection day 1. Participants with increased comfort in ethmoid dissection had fewer retained ethmoid partitions on day 1 (p = 0.017). Observed differences on dissection day 1 for unopened ethmoid and frontal recess cells and retained ethmoid partitions were not present on day 2. No significant differences were found based on use of image guidance for any parameter. CONCLUSION Surgeons with increased comfort and more years in practice had more complete endoscopic cadaver dissections initially. Differences among participants diminished on dissection day 2, indicating the ability to review postdissection CT scans may improve surgeon comfort level and completeness of dissection.
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Affiliation(s)
- Jodi D Zuckerman
- Department of Otolaryngology-Head and Neck Surgery, Emory University, Atlanta, Georgia 30322, USA
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