Can video games enhance surgical skills acquisition for medical students? A systematic review

Automated assessment of simulated laparoscopic surgical skill performance using deep learning

Artificial intelligence (AI) has the potential to improve healthcare and patient safety and is currently being adopted across various fields of medicine and healthcare. AI and in particular computer vision (CV) are well suited to the analysis of minimally invasive surgical simulation videos for training and performance improvement. CV techniques have rapidly improved in recent years from accurately recognizing objects, instruments, and gestures to phases of surgery and more recently to remembering past surgical steps. Lack of labeled data is a particular problem in surgery considering its complexity, as human annotation and manual assessment are both expensive in time and cost, and in most cases rely on direct intervention of clinical expertise. In this study, we introduce a newly collected simulated Laparoscopic Surgical Performance Dataset (LSPD) specifically designed to address these challenges. Unlike existing datasets that focus on instrument tracking or anatomical structure recognition, the LSPD is tailored for evaluating simulated laparoscopic surgical skill performance at various expertise levels. We provide detailed statistical analyses to identify and compare poorly performed and well-executed operations across different skill levels (novice, trainee, expert) for three specific skills: stack, bands, and tower. We employ a 3-dimensional convolutional neural network (3DCNN) with a weakly-supervised approach to classify the experience levels of surgeons. Our results show that the 3DCNN effectively distinguishes between novices, trainees, and experts, achieving an F1 score of 0.91 and an AUC of 0.92. This study highlights the value of the LSPD dataset and demonstrates the potential of leveraging 3DCNN-based and weakly-supervised approaches to automate the evaluation of surgical performance, reducing reliance on manual expert annotation and assessments. These advancements contribute to improving surgical training and performance analysis.

Investigating the impact of gaming and spatial cognition on laparoscopic surgical skills

BACKGROUND

The purpose of this study was to examine the association between video gaming experience, spatial cognition, and laparoscopic surgical skills in a cohort of 50 medical students.

METHOD

Participants were assessed for video gaming experience, spatial cognition, and laparoscopic skills. The number of hours played per week was also recorded. Structural equation modeling was used to determine the relationship between these variables.

RESULTS

Our findings revealed that video gaming experience and spatial cognition exerted a positive influence on laparoscopic skills. Interestingly, students who excessively indulged in video games without concomitant improvements in spatial cognition experienced a negative impact on their laparoscopic skills.

CONCLUSIONS

These findings underscore the potential of video gaming as a tool for improving surgical skills, but also highlight the potential downsides of excessive gaming. The positive correlation between gaming and surgical skills suggests that video games could be integrated into surgical education. Future research should focus on identifying specific video games that effectively promote visuospatial skills as well as determining the optimal balance between gaming and traditional surgical training.

Virtual reality and traditional training in surgical instrumentation: A non-inferiority comparative study

OBJECTIVE

Medical education is undergoing a profound transformation due to technological advancements. Integrating cutting-edge tools like virtual environments and computer-based simulators heralds a new era in teaching methodologies. The objective of the study is to analyze the performance and satisfaction levels of residents undergoing basic surgical skills training using virtual reality.

METHODS

The authors recruited residents from the first year in general surgery and allocated them randomly into three groups: a) Text; b) Practice and c) Virtual reality. Initially, the residents completed a pretest for an evaluation and then they were trained according to the group they were assigned to. All the residents performed a 30-minute training session. After that, they took a posttest. Both tests were composed of multiple-choice ten questions. At the end of this study, the authors determined the score by calculating the delta of the performance (Δ = posttest -pretest). After the training, all the participants filled in a five-question satisfaction questionnaire.

RESULTS

Regarding the difference between the pretest and post-test, there was no difference between groups. Only one participant (1/8) showed nausea in the virtual groups. The recommendation and satisfaction after the task were higher in the Virtual reality group compared to the Text group. There was an association between satisfaction after the exercises (VR) and recommendation score.

CONCLUSIONS

Virtual reality is safe and non-inferior to traditional surgical instrumentation training. This tool might be a practical and attractive alternative to the traditional instrumentation classes.

Virtual Reality Versus Simulation in the Management of Trauma Based Scenarios-A Systematic Review

Introduction

Simulation allows trainees to practice skills safely. It is the current gold standard method of teaching. More recently, novel methods such as virtual reality and augmented reality are being explored as possible alternative methods.

Aims

To evaluate the current evidence pertaining to simulation and virtual reality as methods of teaching in teaching trauma management.

Methods

Medline and Embase (via Ovid interface) were used to search for articles up to April 2023. A combination of the following MeSH terms were employed in the primary search string - "virtual reality," "simulation," "surgery," "trauma," and "medical education."

Results

3815 studies were initially identified. After de-duplication, 2648 articles were screened using Covidence. Forty articles underwent full text review. Thirteen studies were included in the final review with a pooled total of 489 participants. Significant heterogeneity exists in the range of participants, scenarios and parameters assessed. The overall self-reported perception of VR as a teaching modality is positive and is well accepted however objective assessment and validation is needed.

Conclusion

VR can be useful for training and evaluation of trauma-based scenarios. It is a useful adjunct but is unlikely to replace simulation at present. More robust and replicable studies with larger sample sizes are needed to evaluate the long-term integration of virtual reality and augmented reality into the medical and surgical teaching curriculum.

Exploring the Benefits of Stroboscopic Technology and Guided Visualization in Teaching Suturing Techniques to Veterinary Medicine Students

Suturing is widely regarded to be a core competency of veterinary education. With curricular requirements expanding, training interventions that improve students' suturing skills without added time would be valuable. This study evaluated the effects of stroboscopic visual resistance training, a technique using intermittent occlusion of vision, and guided visualization on suturing technique and speed. Students' anxiety levels were also assessed. Twenty-nine veterinary students with no prior surgical experience were divided into stroboscopic, visualization and control groups. Simple interrupted, simple continuous, and cruciate patterns were taught by an American College of Veterinary Surgeons (ACVS)-boarded veterinarian in week 1, and students also took an anxiety test at this time. One-hour-long tutored practice sessions were held for each group in weeks 2, 3, 4 and 6, and assessments were conducted in weeks 5 and 7. Assessments were conducted by a second ACVS-boarded veterinarian blinded to group assignments. Students in the stroboscopic training group had faster suturing times compared to students in the control group for the cruciate pattern at week 5 (p = 0.001) and week 7 (p = 0.006), and faster times compared to students in the visualization group at week 5 (p = 0.002). Students in the stroboscopic training group had faster suturing times than the control group (p = 0.005) for the simple continuous pattern at week 7. No significant differences were observed in anxiety. There was no significant difference in technique scores for any group with any pattern at any time point. Stroboscopic training may result in faster suturing times without deterioration of suturing technique.

A bench-top evaluation of the Ily® robotics assisted tele console system in ureteroscopy by medical students, residents and urologists: does prior videogaming experience help shape the learning curve?

PURPOSE

Previous studies have demonstrated an association between video-gaming experience (VGE) and improved robotics skills. We aimed to evaluate the initial learning curve for the Ily® robotics system (Sterlab, Sophia Antipolis, France) when applied to flexible ureteroscopy (FU) among both medical students and urology surgeons.

METHODS

There were two groups, surgeons and students. An initial questionnaire was completed detailing basic demographics and experience. In part one, both groups performed two simple timed tasks using an Ily® mounted single-use RAU. In part two, group 1 repeated both tasks using a hand-held FU. A subjective assessment of comfort, intuitiveness and a NASA Task Load Index were then completed.

RESULTS

There was a total of 28 participants. Among medical students with VGE (n = 9, 64%)., average calyceal inspection time was 185 ± 80 s; 133 ± 42 s; 121 ± 71 s. For non-gamers (n = 5, 36%), average times were longer at 221 ± 97 s; 134 ± 35 s; 143 ± 68 s respectively. Average calyceal inspection time for videogaming surgeons (n = 8, 57%) was 126 ± 95 s; 98 ± 40 s; 107 ± 71 s, respectively. For non-gamers average inspection times were longer at 150 ± 73 s; 114 ± 82 s; 111 ± 47 s, respectively. None of these differences achieved statistical significance. Surgeons trial speeds were, however, significantly faster by hand-held compared to RAU: by 103, 81 and 82 s respectively (p < 0.05).

CONCLUSION

These results show that ex- or current- video gamers do not have a significant advantage in time to perform FU. Any early advantage conferred to ex- or current- gamers may be rapidly overcome.

Video gamers demonstrate superior bronchoscopy skills among beginners

While previous research has explored the connection between video gaming and medical procedures, studies on the connection between video gaming and bronchoscopy techniques are lacking. This study aimed to investigate how video gaming experience influences bronchoscopy skills, particularly among beginners. This study was conducted at Fukujuji Hospital from January 2021 to October 2023. Twenty-three participants were assigned to the inexperienced group, and eighteen participants were assigned to the experienced group. The observational time during bronchoscopy, measured using a simulator, and the playing time of SPLATOON 2 (NINTENDO Co. Ltd., Japan) were analyzed. Video gaming skills were assessed based on game completion time, with shorter times indicating faster task completion. Participants were also divided into gamer and nongamer subgroups for further comparisons. A moderate linear relationship existed between bronchoscopic observation time and game completion time in the inexperienced group (r = 0.453, p = 0.030). However, no correlation was found in the experienced group (r = 0.268, p = 0.283). Among the inexperienced group, the gamer subgroup (n = 12) exhibited significantly shorter bronchoscopic observation times than did the nongamer subgroup (n = 11) (median [range]: 200 [129-229] s) vs. 281 [184-342] s, p = 0.005). This study demonstrated a relationship between bronchoscopy technique and video gaming skills among individuals with little bronchoscopy experience.

Development of laparoscopic skills in skills-naïve trainees using self-directed learning with take-home laparoscopic trainer boxes

Background

To determine if take home laparoscopic trainer boxes with only self-directed learning can develop laparoscopic skills in surgically naive learners.

Methods

74 starting PGY1 OB/Gyn residents and OB/Gyn clerkship medical students volunteered for the study. Learners performed a laparoscopic peg transfer task with only task instructions and no additional training. Initial tasks were recorded and scored. The participants took home a laparoscopic trainer box for 3 weeks to practice without guidance and returned to perform the same task for a second/final score. Initial and final scores were compared for improvement. This improvement was compared to practice and variables such as demographics, surgical interest, comfort with laparoscopy, and past experiences.

Results

Mean peg transfer task scores improved from 287 (SD = 136) seconds to 193 (SD = 79) seconds (p < 0.001). Score improvement showed a positive correlation with number of home practice sessions with a linear regression R2 of 0.134 (p = 0.001). More practice resulted in larger increases in comfort levels, and higher comfort levels correlated with better final task scores with a linear regression R2 of 0.152 (p < 0.001). Interest in a surgical specialty had no impact on final scores or improvement. Playing a musical instrument and having two or more dexterity-based hobbies was associated with a better baseline score (p = 0.032 and p = 0.033 respectively), but no difference in the final scores or score improvement. No other past experiences impacted scores.

Conclusions

Our study demonstrates that the use of home laparoscopic box trainers can develop laparoscopic skills in surgical novices even without formal guidance or curriculum.

A national perspective on exposure to essential surgical procedures among medical trainees in Nigeria: a cross-sectional survey and recommendations

BACKGROUND

In sub-Saharan Africa, recent graduates from medical school provide more direct surgical and procedural care to patients than their counterparts from the Global North. Nigeria has no nationally representative data on the procedures performed by trainees before graduation from medical school and their confidence in performing these procedures upon graduation has also not been evaluated.

METHODS

We performed an internet-based, cross-sectional survey of recent medical school graduates from 15 accredited Federal, State, and private Nigerian medical schools spanning six geopolitical zones. Essential surgical procedures, bedside interventions and three Bellwether procedures were incorporated into the survey. Self-reported confidence immediately after graduation was calculated and compared using cumulative confidence scores with subgroup analysis of results by type and location of institution. Qualitative analysis of free text recommendations by participants was performed using the constant comparative method in grounded theory.

RESULTS

Four hundred ninety-nine recent graduates from 6 geopolitical zones participated, representing 15 out of a total of 44 medical schools in Nigeria. Male to female ratio was 2:1, and most respondents (59%) graduated from Federal institutions. Students had greatest practical mean exposure to bedside procedures like intravenous access and passing urethral foley catheters and were most confident performing these. Less than 23% had performed over 10 of any of the assessed procedures. They had least exposures to chest tube insertion (0.24/person), caesarean Sect. (0.12/person), and laparotomy (0.09/person). Recent graduates from Federal institutions had less procedural exposure in urethral catheterization (p < 0.001), reduction (p = 0.035), and debridement (p < 0.035). Respondents that studied in the underserved North-East and North-West performed the highest median number of procedures prior to graduation. Cumulative confidence scores were low across all graduates (maximum 25/60), but highest in graduates from Northern Nigeria and private institutions. Graduates recommended prioritizing medical students over senior trainees, using simulation-based training and constructive individualized non-toxic feedback from faculty.

CONCLUSION

Nigerian medical students have poor exposure to procedures and low confidence in performing basic procedures after graduation. More attention should be placed on training for essential surgeries and procedures in medical schools.

Exploring the use of driving simulation to improve robotic surgery simulator training: an observational case-control study

The correlation between driving skills and the ability to perform robotic surgery have not yet been discussed. Therefore, this study aimed to investigate the impact of driving skills on learning robotic surgery using a driving simulator and a robotic simulator. Sixty robot- and simulator-naïve participants were recruited: 30 with a driver's license and 30 without a driver's license. All participants completed a test on the driving simulator and learned four tasks using a robotic surgical simulator (dV-Trainer). On the driving simulator, the lap time in the driver's license group (D-Group) was significantly lower than that in the non-driver's license group (ND-Group) [217.93 ± 42.79 s vs. 271.24 ± 46.63 s, P < 0.001]. The average number of tires off track in the D-Group was lower than that in the ND-Group (0.13 ± 0.35 vs. 0.57 ± 0.63, P = 0.002). The baseline score of the D-Group on the robotic simulator was higher than that of the ND-Group (467.53 ± 107.62 vs. 385.53 ± 136.30, P = 0.022). In the Pick-and-Place-Clutching, Peg-Board-2, and Thread-the-Rings-1 tasks, the learning curve of the D-Group was steeper than that of the ND-Group. However, no significant difference was observed in the Match-Board-2 task. According to the lap time ranking, participants in the top tertile had a steeper learning curve than those in the bottom tertile, especially for the Pick-and-Place-Clutching and Peg-Board-2 tasks (P < 0.05). Significant differences were also found in the baseline and final stages of the Thread-the-Rings-1 task and in the initial stage of the Match-Board-2 task (P < 0.05). Students with a driver's license or better performance in racing games had more success in learning robotic surgery. Driving simulators may promote robotic surgery training.

Video gaming improves robotic surgery simulator success: a multi-clinic study on robotic skills

We aimed to investigate the effects of video game habits, duration of experience, and training in different surgical clinics on the success of robotic surgery simulators. In this prospective, observational, comparative, and multi-clinical study, all participants played Temple Run and Piano Tiles 2™ mobile games for 1 month, after answering a questionnaire including their sociodemographic characteristics, surgical experience, and past and current video game experience. At the end of the period, participants experienced four different robotic surgery simulator tasks (Camera Targeting 1, Energy Switching 1, Ring and Rail 2, Vertical Defect Suturing) in da Vinci® Skills Simulator™. Additionally, sociodemographic data were statistically analyzed with mobile game scores and 13 different performance scores obtained from the simulator. All robotic surgery simulator skill applications were carried out at Ege University Hospital in Izmir. All surgical residents in the general surgery, urology, and pediatric surgery clinics were included in the study. Sixty of the sixty-four participants in total completed all the processes. Four participants were excluded from the study. When clinical performances were compared, it was seen that the general surgery clinic performed better than other clinics in two parameters (overall score, time to complete) of the 'Camera Targeting' task (p = 0.01 and p = 0.006). Participants with mobile phone games experience were successful in the 'Energy Switching' task with less misapplied energy time (p = 0.039). Participants with high scores in Piano Tiles 2™ were more successful in the 'Energy Switching' task and completed the 'Ring Rail' task with fewer movements (p < 0.05). Participants with more surgical and laparoscopic surgery experience scored higher in the 'Camera Targeting' and 'Energy Switching' tasks and completed the assignments with less movement. Again, these participants completed the 'Vertical Defect Suturing' task faster and the 'Ring Rail' task with less movement. In addition, participants with more laparoscopy experience scored higher in the 'Ring Rail' task (p < 0.05). In this study, we showed the effect of recent gaming experience on robotic surgery abilities along with previous video game experience. For surgeons and surgeon candidates in robotic surgery training, the importance of video game-based learning techniques will increase when combined with rapidly developing simulation technologies.ClinicalTrials.gov Identifier: NCT05510960.

Key Competences for Lifelong Learning through the “Animal Crossing: New Horizons” Video Game

The growth and impact of video games in education at an international level is a reality. Research shows that gamers can increase their knowledge, skills, and behavioural flexibility. However, there has been no in-depth research into the relationship between current video games and the key competences for lifelong learning set out by the European Commission. This research focuses on learning acquisition through playing the popular game “Animal Crossing: New Horizons”. The Communicative Methodology has been used in this research through, on the one hand, use of the Social Impact in Social Media (SISM) method involving the analysis of 1000 comments posted on the social network Twitter and, on the other hand, through communicative inter, sanviews with five gamers and a family member of a user. The results show that the Animal Crossing video game promotes learning achievements regarding literacy, multilingualism, mathematical skills, digital competence, social skills, citizenship, entrepreneurship, and cultural awareness.

A comprehensive model to understand and assess the motivational background of video game use: The Gaming Motivation Inventory (GMI)

BACKGROUND AND AIMS

The popularity of video gaming has generated significant interest in research methods to examine motivations for gaming. Current measures of gaming motives are limited by lack of scope and/or their applicability to specific game genres only. We aimed to create a comprehensive motivation inventory applicable to any gaming genre and to evaluate its psychometric properties in a large sample of highly engaged video gamers.

METHODS

Stage 1 of this project involved a systematic review that generated the items for the Gaming Motivation Inventory (GMI). Stages 2-4 involved an evaluation of the psychometric properties of the GMI. A sample of 14,740 video gamers (89.3% male; mean age 24.1 years) were recruited via an online survey promoted by a popular gaming magazine.

RESULTS

In Stage 2, twenty-six gaming motives were identified, which clustered into six higher-order dimensions (Mastery, Immersion/Escapism, Competition, Stimulation, Social, Habit/Boredom). In Stage 3, construct validity of the six higher-order motives was assessed by associations with gaming-related, personality, and psychological variables. In Stage 4, the relationships between motives and depression symptoms and gaming disorder symptoms were explored. Although gaming motives had weak associations with gaming genres, they were moderately related to variables such as competitiveness, sociability, and positive and negative affect. Gaming disorder symptoms were directly predicted by depression symptoms and indirectly via Immersion/Escapism, Habit/Boredom, and Competition motives.

DISCUSSION AND CONCLUSIONS

These findings support the notion that motives are one of the primary causes of gaming behavior and play an important role in predicting its problematic nature. The GMI is a psychometrically valid tool that will be useful for gaining insights into factors underlying gaming behaviors.

Development and Validation of a Virtual Reality Simulator for Robot-Assisted Minimally Invasive Liver Surgery Training

The value of kinematic data for skill assessment is being investigated. This is the first virtual reality simulator developed for liver surgery. This simulator was coded in C++ using PhysX and FleX with a novel cutting algorithm and used a patient data-derived model and two instruments functioning as ultrasonic shears. The simulator was evaluated by nine expert surgeons and nine surgical novices. Each participant performed a simulated metastasectomy after training. Kinematic data were collected for the instrument position. Each participant completed a survey. The expert participants had a mean age of 47 years and 9/9 were certified in surgery. Novices had a mean age of 30 years and 0/9 were certified surgeons. The mean path length (novice 0.76 ± 0.20 m vs. expert 0.46 ± 0.16 m, p = 0.008), movements (138 ± 45 vs. 84 ± 32, p = 0.043) and time (174 ± 44 s vs. 102 ± 42 s, p = 0.004) were significantly different for the two participant groups. There were no significant differences in activating the instrument (107 ± 25 vs. 109 ± 53). Participants considered the simulator realistic (6.5/7) (face validity), appropriate for education (5/7) (content validity) with an effective interface (6/7), consistent motion (5/7) and realistic soft tissue behavior (5/7). This study showed that the simulator differentiates between experts and novices. Simulation may be an effective way to obtain kinematic data.

Laparoscopic and Robot-Assisted Hepatic Surgery: An Historical Review

Hepatic surgery is a rapidly expanding component of abdominal surgery and is performed for a wide range of indications. The introduction of laparoscopic cholecystectomy in 1987 was a major change in abdominal surgery. Laparoscopic surgery was widely and rapidly adopted throughout the world for cholecystectomy initially and then applied to a variety of other procedures. Laparoscopic surgery became regularly applied to hepatic surgery, including segmental and major resections as well as organ donation. Many operations progressed from open surgery to laparoscopy to robot-assisted surgery, including colon resection, pancreatectomy, splenectomy thyroidectomy, adrenalectomy, prostatectomy, gastrectomy, and others. It is difficult to prove a data-based benefit using robot-assisted surgery, although laparoscopic and robot-assisted surgery of the liver are not inferior regarding major outcomes. When laparoscopic surgery initially became popular, many had concerns about its use to treat malignancies. Robot-assisted surgery is being used to treat a variety of benign and malignant conditions, and studies have shown no deterioration in outcomes. Robot-assisted surgery for the treatment of malignancies has become accepted and is now being used at more centers. The outcomes after robot-assisted surgery depend on its use at specialized centers, the surgeon's personal experience backed up by extensive training and maintenance of international registries. Robot-assisted hepatic surgery has been shown to be associated with slightly less intraoperative blood loss and shorter hospital lengths of stay compared to open surgery. Oncologic outcomes have been maintained, and some studies show higher rates of R0 resections. Patients who need surgery for liver lesions should identify a surgeon they trust and should not be concerned with the specific operative approach used. The growth of robot-assisted surgery of the liver has occurred in a stepwise approach which is very different from the frenzy that was seen with the introduction of laparoscopic cholecystectomy. This approach allowed the identification of areas for improvement, many of which are at the nexus of engineering and medicine. Further improvements in robot-assisted surgery depend on the combined efforts of engineers and surgeons.

The role of informational feedback as a game mechanic on user perceptions, attitudes and the intention to continue using a gamified Health Behaviour Change Support System

Gamification's widespread application across industries has demonstrated its usefulness as a user engagement strategy. In the healthcare sector, the impact of lifestyle diseases has seen the need for modifying health-related behaviours. Health Behaviour Change Support Systems (HBCSS) enhanced with gamification features seek to help users achieve their health related goals. Adapting the Technology Acceptance Model, the role of informational feedback as a game mechanic in influencing perceptions, attitudes and continued usage intentions towards the gamified HBCSS is assessed. The results show a strong influence of attitude towards informational feedback afforded on the continued use intentions of the user.

Development of Surface EMG Game Control Interface for Persons with Upper Limb Functional Impairments

In recent years, surface Electromyography (sEMG) signals have been effectively applied in various fields such as control interfaces, prosthetics, and rehabilitation. We propose a neck rotation estimation from EMG and apply the signal estimate as a game control interface that can be used by people with disabilities or patients with functional impairment of the upper limb. This paper utilizes an equation estimation and a machine learning model to translate the signals into corresponding neck rotations. For testing, we designed two custom-made game scenes, a dynamic 1D object interception and a 2D maze scenery, in Unity 3D to be controlled by sEMG signal in real-time. Twenty-two (22) test subjects (mean age 27.95, std 13.24) participated in the experiment to verify the usability of the interface. From object interception, subjects reported stable control inferred from intercepted objects more than 73% accurately. In a 2D maze, a comparison of male and female subjects reported a completion time of 98.84 s. ± 50.2 and 112.75 s. ± 44.2, respectively, without a significant difference in the mean of the one-way ANOVA (p = 0.519). The results confirmed the usefulness of neck sEMG of sternocleidomastoid (SCM) as a control interface with little or no calibration required. Control models using equations indicate intuitive direction and speed control, while machine learning schemes offer a more stable directional control. Control interfaces can be applied in several areas that involve neck activities, e.g., robot control and rehabilitation, as well as game interfaces, to enable entertainment for people with disabilities.

Pretraining of basic skills on a virtual reality vitreoretinal simulator: A waste of time

PURPOSE

To investigate whether pretraining of basic skills in virtual vitreoretinal surgery affected the performance curve when proceeding to procedure-specific modules.

METHODS

This study was a prospective, randomized, controlled, two-centre study. Medical students were randomized into two groups: Group 1 pretrained basic psycho-motor skills (Navigation Training level 2 and Bimanual Training level 3) until they reached their performance curve plateau. Hereafter, both groups trained on the procedure-specific modules (Posterior Hyaloid level 3 and ILM Peeling level 3) until they reached their performance curve plateau. Plateau was defined as three consecutive sessions with the same score with an acceptable variation. The primary outcome was time used to reach performance curve plateau in the procedure-specific modules.

RESULTS

A total of 68 medical students were included, and equally randomized into two groups. The participants in Group 1 used a median time of 88 minutes to reach plateau in the basic skills modules but did not differ from Group 2 in time to reach plateau on the procedure-specific modules (183 min versus 210 min, p = 0.40) or in the amplitude of plateau. Group 1 and 2 differed significantly in the starting score of ILM peeling level 3 (0 (0-0) versus 3.5 (0-75), p = 0.03).

CONCLUSION

We were not able to show positive skill transfer from basic skills training to the procedure-specific modules in time, starting score or amplitude of plateau. Thus, we recommend that aspiring vitreoretinal surgeons proceed directly to simulation-based training of procedures instead of spending valuable training time on basic skills training.

Gamification and Game-Based Strategies for Dermatology Education: Narrative Review

BACKGROUND

Game-based approaches, or gamification, are popular learning strategies in medical education for health care providers and patients alike. Gamification has taken the form of serious educational games and simulations to enable learners to rehearse skills and knowledge in a safe environment. Dermatology learners in particular may benefit from gamification methods, given the visual and procedural nature of the field.

OBJECTIVE

This narrative review surveys current applications of gamification within general medical training, in the education of dermatology students, and in dermatology patient outreach.

METHODS

A literature search was performed using PubMed, Google Scholar, and ResearchGate to access and review relevant medical education- and dermatology-related gamification studies published in peer-reviewed journals. Two independent researchers with education and experience in dermatology screened publications to select studies featuring a diversity of gamification approaches and study subjects for in-depth examination.

RESULTS

A total of 6 general medical education-related and 7 dermatology-specific gamification studies were selected. Gamification generally increased motivation and engagement, improved reinforcement of learning objectives, and contributed to more enjoyable and positive educational experiences compared to traditional modes of instruction. Enhancing examination scores, building confidence, and developing stronger team dynamics were additional benefits for medical trainees. Despite the abundance of gamification studies in general medical education, comparatively few instances were specific to dermatology learning, although large organizations such as the American Academy of Dermatology have begun to implement these strategies nationally. Gamification may also a provide promising alternative means of diversifying patient education and outreach methods, especially for self-identification of malignant melanoma.

CONCLUSIONS

Serious games and simulations in general medical education have successfully increased learner motivation, enjoyment, and performance. In limited preliminary studies, gamified approaches to dermatology-specific medical education enhanced diagnostic accuracy and interest in the field. Game-based interventions in patient-focused educational pilot studies surrounding melanoma detection demonstrated similar efficacy and knowledge benefits. However, small study participant numbers and large variability in outcome measures may indicate decreased generalizability of findings regarding the current impact of gamification approaches, and further investigation in this area is warranted. Additionally, some relevant studies may have been omitted by the simplified literature search strategy of this narrative review. This could be expanded upon in a secondary systematic review of gamified educational platforms.