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Kuemmerli C, Linke K, Daume D, Germann N, Peterli R, Müller-Stich B, Klasen JM. The PLET (Portable Laparoscopic Endo-Trainer) study: a randomized controlled trial of home- versus hospital-based surgical training. Langenbecks Arch Surg 2024; 409:186. [PMID: 38869683 PMCID: PMC11176216 DOI: 10.1007/s00423-024-03375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE The purpose of this study was to assess the effect of training with a personal, portable laparoscopic endo-trainer (PLET) on residents' laparoscopic skills. METHODS The study took place at a tertiary-care academic university hospital in Switzerland. All participants were randomized to either a home- or hospital-based PLET training group, and surgical skill performance was assessed using five laparoscopic exercises. 24 surgical residents, 13 females and 11 males, were enrolled at any training stage. Nine residents completed the assessments. Endpoints consisted of subjective and objective assessment ratings as well as exercise time and qualitative data up to 12 weeks. The primary outcome was the difference in exercise time and secondary outcomes included performance scores as well as qualitative data. RESULTS The hospital-based training group performed exercises number 1, 3 and 4 faster at 12 weeks than at baseline (p = .003, < 0.001 and 0.024). Surgical skill performance was not statistically significantly different in any of the endpoints between the hospital- and home-based training groups at 12 weeks. Both the subjective and objective assessment ratings significantly improved in the hospital-based training group between baseline and 12 weeks (p = .006 and 0.003, respectively). There was no statistically significant improvement in exercise time as well as subjective and objective assessment ratings over time in the home-based training group. The qualitative data suggested that participants who were randomized to the hospital-based training group wished to have the PLET at home and vice versa. Several participants across groups lacked motivation because of their workload or time constraints, though most believed the COVID-19 pandemic had no influence on their motivation or the time they had for training. CONCLUSION The PLET enhances laparoscopic surgical skills over time in a hospital-based training setting. In order to understand and optimize motivational factors, further research is needed. TRIAL REGISTRATION This trial was retrospectively registered on clinicaltrials.gov (NCT06301230).
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Affiliation(s)
- Christoph Kuemmerli
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Katja Linke
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Diana Daume
- Department of General Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Ralph Peterli
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Beat Müller-Stich
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland
| | - Jennifer M Klasen
- Department of Visceral Surgery, Clarunis University Digestive Health Care Center Basel, Spitalstrasse 21, Basel, 4031, Switzerland.
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Yan Q, Wu X, Shi J, Shi B. Does dynamic navigation assisted student training improve the accuracy of dental implant placement by postgraduate dental students: an in vitro study. BMC Oral Health 2024; 24:600. [PMID: 38778313 PMCID: PMC11112919 DOI: 10.1186/s12903-024-04324-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To assess the accuracy of implant placement in models and satisfaction in dynamic navigation assisted postgraduate dental students training. METHODS Postgraduate dental students who had at least one year of dental clinical practice with no experience in dental implant surgeries were included. Students were instructed to make treatment plans in the dynamic navigation system. Each student placed two maxillary right incisors, using freehand approach at first and then under dynamic navigation. The implant position was compared with treatment plan. Factors influencing the accuracy of implants placed under dynamic navigation were analyzed. Student acceptance towards the training and use of dynamic navigation was recorded using a questionnaire. RESULTS A total of 21 students placed 42 implants. For freehand implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 3.79 mm, 4.32 mm, and 10.08°. For dynamic guided implant placement, the median entry point deviation, apex point deviation, and implant axis deviation was 1.29 mm, 1.25 mm, and 4.89° (p < 0.001). The accuracy of dynamic guided implant was not influenced by student gender or familiarity with computer games. All students were satisfied with the training. CONCLUSIONS Dynamic navigation system assisted students in improving the accuracy of implant placement and was well accepted by students.
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Affiliation(s)
- Qi Yan
- Department of Oral Implantology, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology and Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xinyu Wu
- Department of Oral Implantology, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology and Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Junyu Shi
- Department of Oral and Maxillo-Facial Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China.
| | - Bin Shi
- Department of Oral Implantology, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology and Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Ruggiero N, L'Huillier JC, Marine N, Burns O, Mawani F, Sanders LTM, Abbas A, Adams TM, Santos BF, Wirengard YR, Rosser JB. Perceptions of Competition-Based Learning After a Brief Experience at a National Surgical Meeting. Surg Innov 2023; 30:720-727. [PMID: 37831491 DOI: 10.1177/15533506231207438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Competition-based learning (CBL) facilitates learning through competitions. At the 2022 & 2023 Annual SAGES meetings, we evaluated a CBL experience (TOP GUN Shootout) developed from a modified version of the previously validated TOP GUN Laparoscopic Skills and Suturing Program. The project sought to evaluate the TOP GUN Shootout's (TGS) ability to enhance participant engagement in pursuit of laparoscopic surgical skills. METHODS Participants competed in the TGS. Their scores (time and errors) were recorded for: Fundamentals of Laparoscopic Surgery Peg Pass, Cup Drop Task, and Intracorporeal Suturing. All participants completed a 10-question satisfaction survey on a 7-point Likert scale, with questions assessing 3 domains: (1) capability/confidence in MIS skill performance prior to the competition; (2) applicability and satisfaction with TGS's capacity to develop MIS skills; and (3) interest in seeking additional MIS training and appropriateness of CBL in MIS training. Descriptive statistics were used to evaluate these areas. RESULTS Overall, 121 participants completed the TGS, of whom 84 (69%) completed the satisfaction survey. The average age was 32.9 years, 67% were males. On average (+/- SD), participant satisfaction was 5.04 (+/- 2.08) for Domain 1, 6.20 (+/- 1.28) for Domain 2, and 6.58 (+/- .95) for Domain 3. CONCLUSION Participants described an overall lack of confidence in their MIS skills prior to the 2022-2023 Annual SAGES conference. Participants felt that this brief CBL experience, aided in the development of their MIS skills. Furthermore, this brief CBL experience may inspire learners to seek out further training of their MIS skills.
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Affiliation(s)
- Nicco Ruggiero
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Joseph C L'Huillier
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Nigel Marine
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Owen Burns
- Washington and Lee University, Lexington, VA, USA
| | - Farrah Mawani
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | | | - Adam Abbas
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Timothy M Adams
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Byron F Santos
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA
| | - Yana R Wirengard
- Department of Surgery, Contra Costa Health Services, Martinez, CA, USA
| | - James Butch Rosser
- Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
- Department of Surgery, Gila Regional Medical Center, Silver City, NM, USA
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Oo AM, Vallabhajosyula R. Perceived effectiveness of an innovative mobile-based serious game on the improvement of soft skills in minimally invasive surgical training. Asian J Endosc Surg 2023; 16:41-49. [PMID: 36594159 DOI: 10.1111/ases.13115] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/19/2022] [Accepted: 07/21/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Soft skills have a pertinent role for the quality and efficient outcomes in minimally invasive surgical procedures that are difficult to practice due to time constraints, limited resources, and other logistical reasons. The literature says that serious games serve as better resources for learning soft skills but needs evaluation from stakeholders. This study explores the perceived effectiveness of serious gaming intervention as a learning tool to improve communication, collaborative skills among the residents in surgery, house officers and junior doctors. METHOD A total of nine participants volunteered to take part in the exploratory study. During the study, the participants responded to a pre-test quiz, followed by exploration of the game and a post-test quiz. The perceived perceptions on the effectiveness of the gaming intervention were collected on a five-point Likert scale questionnaire with open-ended questions. RESULTS There was no significant difference in pre-test and post-test scores on communication and collaborative skills. Among the three themes, there was significant effect of usefulness of the application of improvement of soft skills (90% response); however, technicalities should be addressed (50% of responses). The qualitative feedback renders that, better graphics, tutorial run, user-friendly interface and controls, and enhanced 3D environment would enhance the efficacy of the prototype. CONCLUSION An innovative mobile-based serious gaming intervention was developed and tested for its effectiveness as a resource to develop soft skills among surgeons in training. The results indicate that gamified interventions can serve as educational resources and supplement the self-directed learning in surgical education.
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Affiliation(s)
- Aung Myint Oo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Oberoi KPS, Caine AD, Schwartzman J, Livingston DH, Merchant AM, Kunac A. Surgical Skills Olympiad: A 4-Year Experience in a General Surgery Residency Program. Surg J (N Y) 2021; 7:e222-e225. [PMID: 34466660 PMCID: PMC8390299 DOI: 10.1055/s-0041-1733991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background
The acquisition of operative skills is the critical defining component of general surgery training. Performing simulated tasks has been shown to increase a resident's technical skills. As such, we devised the Surgical Skills Olympiad, an annual simulation-based skills competition. We examined our 4-year experience with the Olympiad at a large academic general surgery residency program.
Objective
This study aimed to use competition to motivate trainees to increase the time they spent practicing basic surgical skills, resulting in improved performance over time.
Methods
Teams were formed from members of each postgraduate year (PGY) class. Competition tasks were level specific: knot tying for PGY-1, basic laparoscopy for PGY-2, handsewn bowel anastomosis for PGY-3, vascular anastomosis for PGY-4, and advanced laparoscopy for PGY-5. Task scores over a 4-year period (2014–2017) were analyzed and a survey of participating teaching faculty was conducted.
Results
Ten faculty members responded to the survey, for a response rate of 63%. A total of 50% respondents felt that the caliber of surgical skills increased since the Olympiad was implemented. Ninety percent agreed that the Olympiad was beneficial for residents to assess their skills against their peers. Over 4 years, there was an improvement in scores for suturing task, advanced laparoscopy, and bowel anastomosis (
p
< 0.05 for all three).
Conclusion
A residency-wide surgical skills competition can improve resident performance in technical tasks and promote faculty engagement in resident skills training.
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Affiliation(s)
- Kurun P S Oberoi
- Division of General/Minimally Invasive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Akia D Caine
- Division of General/Minimally Invasive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jacob Schwartzman
- Division of General/Minimally Invasive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - David H Livingston
- Division of Trauma and Surgical Critical Care, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Aziz M Merchant
- Division of General/Minimally Invasive Surgery, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Anastasia Kunac
- Division of Trauma and Surgical Critical Care, Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
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Zhan Y, Wang M, Cheng X, Li Y, Shi X, Liu F. Evaluation of a dynamic navigation system for training students in dental implant placement. J Dent Educ 2020; 85:120-127. [PMID: 32914421 DOI: 10.1002/jdd.12399] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/09/2020] [Accepted: 08/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Computer-guided simulation systems may offer a novel training approach in many surgical fields. This study aimed to compare dental students' learning progress in dental implants placement between a dynamic navigation system and a traditional training method using a simulation model. METHODS Senior dental students with no implant placement experience were randomly assigned to implant placement training using a dynamic navigation system or a traditional freehand protocol. After training, 3-dimensional (3D) deviation at implant platform, 3D deviation at implant apex, and deviation of implant axis between the planned and placed implant positions were measured using superimposed cone beam computed tomography scans. RESULTS Six students were trained in this study. Students showed significantly greater improvement in implant placement after training using the dynamic navigation system than after using the traditional freehand protocol. Overall deviation of implant axis (P < 0.001) and 3D apex deviation (P = 0.014) improved with training using the dynamic navigation system, but differences in 3D platform deviation (P = 0.513) were not statistically significant. CONCLUSIONS A dynamic navigation system may be a useful teaching tool in the early development of clinical skills in implant placement for the novice practitioners. Novice practitioners exhibited significant improvement in angulation deviation across implant placement attempts with dynamic navigation system training.
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Affiliation(s)
- Yalin Zhan
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Miaozhen Wang
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xueyuan Cheng
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yi Li
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Xiaorui Shi
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Feng Liu
- First Clinical Division, Peking University School and Hospital of Stomatology, Beijing, China.,National Clinical Research Center for Oral Diseases, Beijing, China.,National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing, China.,Beijing Key Laboratory of Digital Stomatology, Beijing, China
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Abstract
Technological advances have been the main driver of enhancing human–computer interaction and interactive simulations have experienced exponential growth in recent years. However, visual and auditory channels are usually the only ones considered for educational simulations even though the sense of touch is also an important one. Touch allows us to recognize and interact with our surroundings. A common way to develop a visuo-haptic simulation in the area of interactive systems is by using a graphic and physics-based engine orchestrated with a haptic rendering framework. However, new solutions, such as professional game engines, have enabled the development of high-quality applications in much shorter time. In this paper, a novel architecture for fast development of interactive visuo-haptic applications in game engines is discussed. To validate the proposed architecture, the Haptic Device Integration for Unity (HaDIU) plugin was implemented. Simulations were implemented to verify the operability of haptic devices. Each scenario was properly modelled and has different haptic objectives. Furthermore, to validate that the usage of this approach provides better visualizations than an existing single purpose application, an experimental study was performed. Results suggest that by using this approach faster development of interactive visuo-haptic simulators can be achieved than using traditional techniques.
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IJgosse W, van Goor H, Rosman C, Luursema JM. Construct Validity of a Serious Game for Laparoscopic Skills Training: Validation Study. JMIR Serious Games 2020; 8:e17222. [PMID: 32379051 PMCID: PMC7243133 DOI: 10.2196/17222] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/27/2020] [Accepted: 03/23/2020] [Indexed: 01/19/2023] Open
Abstract
Background Surgical residents underutilize opportunities for traditional laparoscopic simulation training. Serious gaming may increase residents’ motivation to practice laparoscopic skills. However, little is known about the effectiveness of serious gaming for laparoscopic skills training. Objective The aim of this study was to establish construct validity for the laparoscopic serious game Underground. Methods All study participants completed 2 levels of Underground. Performance for 2 novel variables (time and error) was compared between novices (n=65, prior experience <10 laparoscopic procedures), intermediates (n=26, prior experience 10-100 laparoscopic procedures), and experts (n=20, prior experience >100 laparoscopic procedures) using analysis of covariance. We corrected for gender and video game experience. Results Controlling for gender and video game experience, the effects of prior laparoscopic experience on the time variable differed significantly (F2,106=4.77, P=.01). Both experts and intermediates outperformed novices in terms of task completion speed; experts did not outperform intermediates. A similar trend was seen for the rate of gameplay errors. Both gender (F1,106=14.42, P<.001 in favor of men) and prior video game experience (F1,106=5.20, P=.03 in favor of experienced gamers) modulated the time variable. Conclusions We established construct validity for the laparoscopic serious game Underground. Serious gaming may aid laparoscopic skills development. Previous gaming experience and gender also influenced Underground performance. The in-game performance metrics were not suitable for statistical evaluation. To unlock the full potential of serious gaming for training, a more formal approach to performance metric development is needed.
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Affiliation(s)
- Wouter IJgosse
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - Camiel Rosman
- Department of Surgery, Radboud University Medical Center, Nijmegen, Netherlands
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Golob Deeb J, Bencharit S, Carrico CK, Lukic M, Hawkins D, Rener-Sitar K, Deeb GR. Exploring training dental implant placement using computer-guided implant navigation system for predoctoral students: A pilot study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2019; 23:415-423. [PMID: 31141291 DOI: 10.1111/eje.12447] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 05/23/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Recent computer-guided dynamic navigation systems promise a novel training approach for implant surgery. This study aimed to examine learning progress in placement of dental implants among dental students using dynamic navigation on a simulation model. MATERIALS AND METHODS Senior students with no implant placement experience were randomly assigned five implant placement attempts involving either three maxillary or four mandibular implants distributed in the anterior/posterior, and left/right segments. Implant placement was planned using a Navident Dynamic Guidance system. Surgical time was recorded. Horizontal, vertical and angulation discrepancies between the planned and placed implant positions were measured using superimposed CBCT scans. Data were analysed with repeated measures regression with Tukey's adjusted pairwise comparisons (α = 0.05). RESULTS Fourteen students participated, with a mean age of 26.1 years and equal males and females. Mean time for implant placement was associated with attempt number (P < 0.001), implant site (P = 0.010) and marginally related to gender (P = 0.061). Students had a significant reduction in time from their first attempt to their second (10.6 vs 7.6 minutes; adjusted P < 0.001) then plateaued. Overall 3D angulation (P < 0.001) and 2D vertical apex deviation (P = 0.014) improved with each attempt, but changes in lateral 2D (P = 0.513) and overall 3D apex deviations (P = 0.784) were not statistically significant. Implant sites were associated with lateral 2D, 2D vertical and overall 3D apex deviation (P < 0.001). DISCUSSION Males were marginally faster than females, had slightly lower overall 3D angulation, and reported higher proficiency with video games. Novice operators improved significantly in speed and angulation deviation within the first three attempts of placing implants using dynamic navigation. CONCLUSION Computer-aided dynamic implant navigation systems can improve implant surgical training in novice population.
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Affiliation(s)
- Janina Golob Deeb
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sompop Bencharit
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Biomedical Engineering, School of Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caroline K Carrico
- Oral Health Promotion and Community Outreach, Oral Health Research Core, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marija Lukic
- Division for Dental Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel Hawkins
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ksenija Rener-Sitar
- Division for Dental Medicine, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
- Department of Prosthodontics, University Dental Clinics, University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - George R Deeb
- School of Dentistry, Department of Oral and Maxillofacial Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Awan O, Dey C, Salts H, Brian J, Fotos J, Royston E, Braileanu M, Ghobadi E, Powell J, Chung C, Auffermann W. Making Learning Fun: Gaming in Radiology Education. Acad Radiol 2019; 26:1127-1136. [PMID: 31005406 DOI: 10.1016/j.acra.2019.02.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 01/01/2023]
Abstract
With continued technologic advances, it is not surprising that gaming techniques are increasingly being used in radiology residency programs. This comprehensive review on gaming in radiology education offers insight into the importance of gaming, types of games and principles utilized in gaming, as well as applications that are inherent in artificial intelligence and continued medical education. The advantages and disadvantages of gaming will be considered, as well as barriers to successful adoption of gaming.
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Affiliation(s)
- Omer Awan
- University of Maryland School of Medicine, 655 W. Baltimore Street, Baltimore, MD, 21201.
| | - Courtney Dey
- Eastern Virginia Medical School, Norfolk, Virginia.
| | - Hayden Salts
- Eastern Virginia Medical School, Norfolk, Virginia.
| | - James Brian
- Penn State Hershey Medical Center, Hershey, Pennsylvania.
| | - Joseph Fotos
- Penn State Hershey Medical Center, Hershey, Pennsylvania.
| | | | | | | | - Jason Powell
- Wake Forest Baptist Health, Winston-Salem, North Carolina.
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Booth R, Sinclair B, McMurray J, Strudwick G, Watson G, Ladak H, Zwarenstein M, McBride S, Chan R, Brennan L. Evaluating a Serious Gaming Electronic Medication Administration Record System Among Nursing Students: Protocol for a Pragmatic Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e138. [PMID: 29807885 PMCID: PMC5996180 DOI: 10.2196/resprot.9601] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/02/2018] [Accepted: 04/02/2018] [Indexed: 11/17/2022] Open
Abstract
Background Although electronic medication administration record systems have been implemented in settings where nurses work, nursing students commonly lack robust learning opportunities to practice the skills and workflow of digitalized medication administration during their formative education. As a result, nursing students’ performance in administering medication facilitated by technology is often poor. Serious gaming has been recommended as a possible intervention to improve nursing students’ performance with electronic medication administration in nursing education. Objective The objectives of this study are to examine whether the use of a gamified electronic medication administration simulator (1) improves nursing students’ attention to medication administration safety within simulated practice, (2) increases student self-efficacy and knowledge of the medication administration process, and (3) improves motivational and cognitive processing attributes related to student learning in a technology-enabled environment. Methods This study comprised the development of a gamified electronic medication administration record simulator and its evaluation in 2 phases. Phase 1 consists of a prospective, pragmatic randomized controlled trial with second-year baccalaureate nursing students at a Canadian university. Phase 2 consists of qualitative focus group interviews with a cross-section of nursing student participants. Results The gamified medication administration simulator has been developed, and data collection is currently under way. Conclusions If the gamified electronic medication administration simulator is found to be effective, it could be used to support other health professional simulated education and scaled more widely in nursing education programs. Trial Registration ClinicalTrials.gov NCT03219151; https://clinicaltrials.gov/show/NCT03219151 (Archived by WebCite at http://www.webcitation.org/6yjBROoDt) Registered Report Identifier RR1-10.2196/9601
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Affiliation(s)
- Richard Booth
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Barbara Sinclair
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Josephine McMurray
- Business Technology Management/Health Studies, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Gillian Strudwick
- Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gavan Watson
- Teaching Support Centre, Western University, London, ON, Canada
| | - Hanif Ladak
- Department of Medical Biophysics, Faculty of Engineering, Western University, London, ON, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Susan McBride
- School of Nursing, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Ryan Chan
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Laura Brennan
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, ON, Canada
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Haubruck P, Nickel F, Ober J, Walker T, Bergdolt C, Friedrich M, Müller-Stich BP, Forchheim F, Fischer C, Schmidmaier G, Tanner MC. Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial. J Med Internet Res 2018; 20:e195. [PMID: 29784634 PMCID: PMC5987048 DOI: 10.2196/jmir.9956] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. OBJECTIVE The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). METHODS In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module "Thoracocentesis" discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants' performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. RESULTS A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I50=7.0] points; control group: 30.5 [I50=8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. CONCLUSIONS The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. TRIAL REGISTRATION German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg).
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Affiliation(s)
- Patrick Haubruck
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Julian Ober
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Tilman Walker
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Bergdolt
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mirco Friedrich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Franziska Forchheim
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Fischer
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Gerhard Schmidmaier
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael C Tanner
- Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Cagiltay NE, Berker M. Technology-enhanced surgical education: attitudes and perceptions of the endoscopic surgery community in Turkey. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2018; 5:32-38. [DOI: 10.1136/bmjstel-2017-000238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/03/2022]
Abstract
The education programme of surgery has unique problems. In this study, first, a literature review is conducted to cover the studies found in the literature reporting on the problems of surgical education. Additionally, a survey study is conducted with 31 participants, who are either currently enrolled in endoscopic surgery education programmes in Turkey or are experts in the field. Supportively semistructured individual interviews are also conducted with five participants. These data are collected to better understand the instructional methods being used, their problems and the participants’ preferred methods to be used. Additionally, the participants’ attitudes are also investigated regarding the use of new technologies to enhance the current education programmes. The results indicate that, in Turkey, surgical education programmes are still mostly offered in traditional ways while other educational methods are used in an extremely limited manner. In general, the authors emphasise that more research needs to be conducted to better understand the characteristics of the medical students and develop standards for surgical education programmes, educational tools specific for related surgical domains and guidelines for the curriculum integration. The results of this study aimed to guide the instructional system designers for the endoscopic surgery education programmes.
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Abstract
Haptic devices have been highly valued in virtual training environments in the medical field. Nevertheless, the principal challenges to develop these environments are the complexity to model the virtual elements and to provide proper haptic feedback during tasks. In this study, it was decided to take advantage of NVIDIA PhysX physics engine to produce a fast and effortless process in the creation of a virtual training environment for suturing tasks. Although PhysX correctly deploys collisions between solid and deformable objects in the graphical environment, it does not send this information to the developers environment to provide haptic rendering. Therefore, in this article, a “simplified method” was proposed to facilitate the detection of collisions between rigid and deformable bodies. This simplified method allows the calculation of haptic feedback to be displayed, and it avoids complexity and high computational costs. Additionally, an architecture to facilitate the integration of haptic devices was designed. The study case proposed in this work was the development of an application to perform a suturing task, SutureHap. The system was tested by volunteers from different areas and senior medical students. The latter pointed out that SutureHap is very promising, and it could be a useful tool to develop surgical skills. Finally, participants agreed that the use of the elements in the environment is reasonably intuitive, and all of them stated that they would recommend the simulator.
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Affiliation(s)
- Eusebio Ricardez
- Instituto Politecnico Nacional, ESIME Culhuacan, Coyoacan, Ciudad de Mexico, Mexico
| | - Julieta Noguez
- Instituto Tecnologico y de Estudios Superiores de Monterrey Campus Ciudad de Mexico, Tlalpan, Ciudad de Mexico, Mexico
| | - Luis Neri
- Instituto Tecnologico y de Estudios Superiores de Monterrey Campus Ciudad de Mexico, Tlalpan, Ciudad de Mexico, Mexico
| | - David Escobar-Castillejos
- Instituto Tecnologico y de Estudios Superiores de Monterrey Campus Ciudad de Mexico, Tlalpan, Ciudad de Mexico, Mexico
| | - Lourdes Munoz
- Instituto Tecnologico y de Estudios Superiores de Monterrey Campus Santa Fe, Alvaro Obregon, Ciudad de Mexico, Mexico
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Graafland M, Bemelman WA, Schijven MP. Game-based training improves the surgeon's situational awareness in the operation room: a randomized controlled trial. Surg Endosc 2017; 31:4093-4101. [PMID: 28281117 PMCID: PMC5636911 DOI: 10.1007/s00464-017-5456-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/03/2017] [Indexed: 01/26/2023]
Abstract
Background Equipment-related malfunctions directly relate to one-fourth of the adverse events in the surgical theater. A serious game trains residents to recognize and respond to equipment problems in minimally invasive surgery (MIS). These include disturbed vision, gas transport, electrocautery, and pathophysiological disturbances. This randomized controlled trial explores whether game-based training improves surgical residents’ response to equipment-related problems during surgery. Methods Thirty-one surgical residents with no previous experience in MIS took part in a standardized basic laparoscopy training course. Fifteen residents were randomly assigned to the game-enhanced curriculum (intervention) and sixteen were assigned to the regular curriculum (control). Participants performed a MIS task in a live anesthetized pig model, during which three standardized equipment malfunction scenarios occurred. Observers recorded the problems recognized and solved, time, and participants’ technical performance. Results Twenty-four participants completed the post-test (n = 12 per group). The intervention group solved more problems than the control group (59 vs. 33%, p = 0.029). The intervention group also recognized a larger proportion of problems, although this parameter was non-significant (67 vs. 42%, p = 0.14). Random effects modeling showed a significant improved game performance per participant over time. Conclusions Surgical residents, who play for only 1 h on a custom-made serious game, respond significantly better to equipment-related problems during surgery than residents trained by a standard training curriculum. These results imply that entertaining serious games can indeed be considered for use in official training for surgeons and other medical specialists.
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Affiliation(s)
- Maurits Graafland
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Marlies P Schijven
- Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
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Kowalewski KF, Hendrie JD, Schmidt MW, Proctor T, Paul S, Garrow CR, Kenngott HG, Müller-Stich BP, Nickel F. Validation of the mobile serious game application Touch Surgery™ for cognitive training and assessment of laparoscopic cholecystectomy. Surg Endosc 2017; 31:4058-4066. [PMID: 28281111 DOI: 10.1007/s00464-017-5452-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/03/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Touch Surgery™ (TS) is a serious gaming application for cognitive task simulation and rehearsal of key steps in surgical procedures. The aim was to establish face, content, and construct validity of TS for laparoscopic cholecystectomy (LC). Furthermore, learning curves with TS and a virtual reality (VR) trainer were compared in a randomized trial. METHODS The performance of medical students and general surgeons was compared for all three modules of LC in TS to establish construct validity. Questionnaires assessed face and content validity. For analysis of learning curves, students were randomized to train on VR or TS first, and then switched to the other training modality. Performance data were recorded. RESULTS 54 Surgeons and 51 medical students completed the validation study. Surgeons outperformed students with TS: patient preparation (students = 45.0 ± 19.1%; surgeons = 57.3 ± 15.2%; p < 0.001), access and laparoscopy (students = 70.2 ± 10.9%; surgeons = 75.9 ± 9.7%; p = 0.008) and LC (students = 69.8 ± 12.4%; surgeons = 77.7 ± 9.6%; p < 0.001). Both groups agreed that TS was a highly useful and realistic application. 46 students were randomized for learning curve analysis. It took them 2-4 attempts to reach a 100% score with TS. Training with TS first did not improve students' performance on the VR trainer; however, students who trained with VR first scored significantly higher in module 3 of TS. CONCLUSION TS is an accepted serious gaming application for learning cognitive aspects of LC with established construct, face, and content validity. There appeared to be a synergy between TS and the VR trainer. Therefore, the two training modalities should accompany one another in a multimodal training approach to laparoscopy.
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Affiliation(s)
- Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Jonathan D Hendrie
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Mona W Schmidt
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Tanja Proctor
- Department of Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Sai Paul
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Carly R Garrow
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hannes G Kenngott
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Beat P Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Overtoom EM, Jansen FW, van Santbrink EJP, Schraffordt Koops SE, Veersema S, Schreuder HWR. Training in Basic Laparoscopic Surgical Skills: Residents Opinion of the New Nintendo Wii-U Laparoscopic Simulator. JOURNAL OF SURGICAL EDUCATION 2017; 74:352-359. [PMID: 27789193 DOI: 10.1016/j.jsurg.2016.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 08/27/2016] [Accepted: 10/01/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Serious games are new in the field of laparoscopic surgical training. We evaluate the residents׳ opinion of a new laparoscopic simulator for the Nintendo Wii-U platform. DESIGN Prospective questionnaire study. Participants received a standardized introduction and completed level 3 and 4 of the game "Underground." They filled out a questionnaire concerning demographics and their opinion on realism, usefulness, suitability, haptic feedback, and home training-use of the game. SETTING Two tertiary teaching hospitals. PARTICIPANTS Obstetrics and gynaecology residents postgraduate year 1 to 6 (n = 59) from several European countries. RESULTS Subjects (n = 59) were divided into 2 groups based on laparoscopic experience: Group A (n = 38) and Group B (n = 21). The realism of different aspects of the game received mean scores around 3 on a 5-point Likert scale. The hand-eye coordination was regarded most useful for training with a mean of 3.92 (standard deviation 0.93) and the game was considered most suitable for residents in the first part of their postgraduate training with a mean of 3.73 (standard deviation 0.97). Both groups differed especially concerning their opinion of the usefulness of the game as a training tool. CONCLUSIONS Most residents liked the new serious game for the Nintendo Wii-U. The usefulness and suitability as a laparoscopic training tool were rated at an acceptable to high level. However, the game does require improvements such as inclusion of a good scoring system before it can be integrated in resident training curricula.
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Affiliation(s)
- Evelien M Overtoom
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank-Willem Jansen
- Department of Gynaecology, Leiden University Medical Center, Leiden, the Netherlands; Faculty of Mechanical Engineering, Delft University of Technology, Delft, the Netherlands
| | | | | | - Sebastiaan Veersema
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Henk W R Schreuder
- Department of Gynaecology and Reproductive Medicine, University Medical Center Utrecht, Utrecht, the Netherlands; UMC Utrecht Cancer Centre, Department of Gynaecologic Oncology, University Medical Center Utrecht, Utrecht, the Netherlands.
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Gostlow H, Marlow N, Babidge W, Maddern G. Systematic Review of Voluntary Participation in Simulation-Based Laparoscopic Skills Training: Motivators and Barriers for Surgical Trainee Attendance. JOURNAL OF SURGICAL EDUCATION 2017; 74:306-318. [PMID: 27836238 DOI: 10.1016/j.jsurg.2016.10.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 09/06/2016] [Accepted: 10/06/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To examine and report on evidence relating to surgical trainees' voluntary participation in simulation-based laparoscopic skills training. Specifically, the underlying motivators, enablers, and barriers faced by surgical trainees with regard to attending training sessions on a regular basis. DESIGN A systematic search of the literature (PubMed; CINAHL; EMBASE; Cochrane Collaboration) was conducted between May and July 2015. Studies were included on whether they reported on surgical trainee attendance at voluntary, simulation-based laparoscopic skills training sessions, in addition to qualitative data regarding participant's perceived barriers and motivators influencing their decision to attend such training. Factors affecting a trainee's motivation were categorized as either intrinsic (internal) or extrinsic (external). RESULTS Two randomised control trials and 7 case series' met our inclusion criteria. Included studies were small and generally poor quality. Overall, voluntary simulation-based laparoscopic skills training was not well attended. Intrinsic motivators included clearly defined personal performance goals and relevance to clinical practice. Extrinsic motivators included clinical responsibilities and available free time, simulator location close to clinical training, and setting obligatory assessments or mandated training sessions. The effect of each of these factors was variable, and largely dependent on the individual trainee. The greatest reported barrier to attending voluntary training was the lack of available free time. CONCLUSION Although data quality is limited, it can be seen that providing unrestricted access to simulator equipment is not effective in motivating surgical trainees to voluntarily participate in simulation-based laparoscopic skills training. To successfully encourage participation, consideration needs to be given to the factors influencing motivation to attend training. Further research, including better designed randomised control trials and large-scale surveys, is required to provide more definitive answers to the degree in which various incentives influence trainees' motivations and actual attendance rates.
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Affiliation(s)
- Hannah Gostlow
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Nicholas Marlow
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Wendy Babidge
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - Guy Maddern
- Division of Surgery, University of Adelaide, The Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia.
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Friedrich M, Bergdolt C, Haubruck P, Bruckner T, Kowalewski KF, Müller-Stich BP, Tanner MC, Nickel F. App-based serious gaming for training of chest tube insertion: study protocol for a randomized controlled trial. Trials 2017; 18:56. [PMID: 28166840 PMCID: PMC5294773 DOI: 10.1186/s13063-017-1799-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 01/14/2017] [Indexed: 11/18/2022] Open
Abstract
Background Chest tube insertion is a standard intervention for management of various injuries of the thorax. Quick and accurate execution facilitates efficient therapy without further complications. Here, we propose a new training concept comprised of e-learning elements as well as continuous rating using an objective structured assessment of technical skills (OSATS) tool. The study protocol is presented for a randomized trial to evaluate e-learning with app-based serious gaming for chest drain insertion. Methods The proposed randomized trial will be carried out at the Department of Orthopedics and Traumatology at Heidelberg University in the context of regular curricular teaching for medical students (n = 90, 3rd to 6th year). The intervention group will use e-learning with the serious gaming app Touch Surgery (TM) for chest drain insertion, whereas the control group uses serious gaming for an unrelated procedure. Primary endpoint is operative performance of chest drain insertion in a porcine cadaveric model according to OSATS. Discussion The randomized trial will help determine the value of e-learning with the serious gaming app Touch Surgery (TM) for chest drain insertion by using the OSATS score. The study will improve surgical training for trauma situations. Trial registration Trial Registration Number, DRKS00009994. Registered on 27 May 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1799-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mirco Friedrich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Christian Bergdolt
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, HTRG - Heidelberg Trauma Research Group, University of Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany
| | - Patrick Haubruck
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, HTRG - Heidelberg Trauma Research Group, University of Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany
| | - Thomas Bruckner
- Institute for Medical Biometry and Informatics, University of Heidelberg, Im Neuenheimer Feld 305, Heidelberg, 69120, Germany
| | - Karl-Friedrich Kowalewski
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany
| | - Michael C Tanner
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, HTRG - Heidelberg Trauma Research Group, University of Heidelberg, Schlierbacher Landstrasse 200a, Heidelberg, 69118, Germany
| | - Felix Nickel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, Heidelberg, 69120, Germany.
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El-Beheiry M, McCreery G, Schlachta CM. A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first-year surgical residents' simulation curriculum. Surg Endosc 2016; 31:1643-1650. [PMID: 27572069 DOI: 10.1007/s00464-016-5152-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/23/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND The objective of this study was to assess the effect of a serious game skills competition on voluntary usage of a laparoscopic simulator among first-year surgical residents' standard simulation curriculum. METHODS With research ethics board approval, informed consent was obtained from first-year surgical residents enrolled in an introductory surgical simulation curriculum. The class of 2013 served as a control cohort following the standard curriculum which mandates completion of six laparoscopic simulator skill tasks. For the 2014 competition cohort, the only change introduced was the biweekly and monthly posting of a leader board of the top three and ten fastest peg transfer times. Entry surveys were administered assessing attitudes towards simulation-based training and competition. Cohorts were observed for 5 months. RESULTS There were 24 and 25 residents in the control and competition cohorts, respectively. The competition cohort overwhelmingly (76 %) stated that they were not motivated to deliberate practice by competition. Median total simulator usage time was 132 min (IQR = 214) in the competition cohort compared to 89 (IQR = 170) in the control cohort. The competition cohort completed their course requirements significantly earlier than the control cohort (χ 2 = 6.5, p = 0.01). There was a significantly greater proportion of residents continuing to use the simulator voluntarily after completing their course requirements in the competition cohort (44 vs. 4 %; p = 0.002). Residents in the competition cohort were significantly faster at peg transfer (194 ± 66 vs. 233 ± 53 s, 95 % CI of difference = 4-74 s; p = 0.03) and significantly decreased their completion time by 33 ± 54 s (95 % CI 10-56 s; paired t test, p = 0.007). CONCLUSIONS A simple serious games skills competition increased voluntary usage and performance on a laparoscopic simulator, despite a majority of participants reporting they were not motivated by competition. Future directions should endeavour to examine other serious gaming modalities to further engage trainees in simulated skills development.
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Affiliation(s)
- Mostafa El-Beheiry
- CSTAR, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON, N6A 0A5, Canada.
| | - Greig McCreery
- CSTAR, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON, N6A 0A5, Canada
| | - Christopher M Schlachta
- CSTAR, London Health Sciences Centre, University Hospital, 339 Windermere Road, London, ON, N6A 0A5, Canada
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Graafland M, Ten Cate O, van Seventer JP, Schraagen JMC, Schijven MP. Mapping the Demand for Serious Games in Postgraduate Medical Education Using the Entrustable Professional Activities Framework. Games Health J 2015; 4:381-6. [PMID: 26287929 DOI: 10.1089/g4h.2014.0129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Serious games are potentially powerful tools for residency training and increasingly attract attention from medical educators. At present, serious games have little evidence-based relations with competency-based medical education, which may impede their incorporation into residency training programs. The aim of this study was to identify highly valued entrustable professional activities (EPAs) to support designers in the development of new, serious games built on a valid needs-assessment. MATERIALS AND METHODS All 149 licensed medical specialists from seven specialties in one academic hospital participated in seven different Delphi expert panels. They filled out a two-round Delphi survey, aimed at identifying the most valuable EPAs in their respective curricula. Specialists were asked to name the most highly valued EPA in their area in the first Delphi round. In the second round, the generated responses were presented and ranked according to priority by the medical specialists. RESULTS Sixty-two EPAs were identified as valuable training subjects throughout five specialties. Eleven EPAs--"management of trauma patient," "chest tube placement," "laparoscopic cholecystectomy," "assessment of vital signs," "airway management," "induction of general anesthesia," "assessment of suicidal patient," "psychiatric assessment," "gastroscopy," "colonoscopy," and "resuscitation of emergency patients"--were consistently given a high score. CONCLUSIONS The future medical specialist is an active learner, comfortable with digital techniques and learning strategies such as serious gaming. In order to maximize the impact and acceptance of new serious games, it is vital to select the most relevant training subjects. Although some serious games have already targeted top-priority EPAs, plenty of opportunities remain.
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Affiliation(s)
| | - Olle Ten Cate
- 2 Centre for Research and Development of Education, University Medical Centre , Utrecht, The Netherlands
- 3 University of California San Francisco School of Medicine , San Francisco, California
| | - Jan-Pieter van Seventer
- 4 University of Applied Sciences , Utrecht, The Netherlands
- 5 Dutch Game Garden , Utrecht, The Netherlands
| | - Jan Maarten C Schraagen
- 6 Netherlands Organisation for Applied Scientific Research TNO , Soesterberg, The Netherlands
- 7 University of Twente , Enschede, The Netherlands
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Laparoscopic suturing learning curve in an open versus closed box trainer. Surg Endosc 2015; 30:315-22. [PMID: 25939742 PMCID: PMC4710670 DOI: 10.1007/s00464-015-4211-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 04/08/2015] [Indexed: 01/22/2023]
Abstract
Background The aim of this study was to examine the influence of training under direct vision prior to training with indirect vision on the learning curve of the laparoscopic suture task. Methods Novices were randomized in two groups. Group 1 performed three suturing tasks in a transparent laparoscopic box trainer under direct vision followed by three suturing tasks in a standard non-transparent laparoscopic box trainer equipped with a 0° laparoscope. Group 2 performed six suturing tasks in a standard laparoscopic box trainer. Performance time, motion analysis parameters (economy of movements) and interaction force parameters (tissue handling) were measured. Participants completed a questionnaire assessing: self-perceived dexterity before and after the training, their experienced frustration and the difficulty of the training. Results A total of 34 participants were included, one was excluded because of incomplete training. Group 1 used significantly less time to complete the total of six tasks (27 %). At the end of the training, there were no differences in motion or force parameters between the two groups. Group 2 rated their self-perceived dexterity after the training significantly lower than before the training and also reported significantly higher levels of frustration compared to group 1. Both groups rated the difficulty of the training similar. Conclusion Novices benefit from starting their training of difficult basic laparoscopic skills, e.g., suturing, in a transparent box trainer without camera. It takes less time to complete the tasks, and they get less frustrated by the training with the same results on their economy of movements and tissue handling skills.
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Graafland M, Vollebergh MF, Lagarde SM, van Haperen M, Bemelman WA, Schijven MP. A Serious Game Can Be a Valid Method to Train Clinical Decision-Making in Surgery. World J Surg 2014; 38:3056-62. [DOI: 10.1007/s00268-014-2743-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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The effects of video games on laparoscopic simulator skills. Am J Surg 2014; 208:151-6. [DOI: 10.1016/j.amjsurg.2013.11.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/23/2013] [Accepted: 11/22/2013] [Indexed: 11/20/2022]
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Xiao D, Jakimowicz JJ, Albayrak A, Buzink SN, Botden SMBI, Goossens RHM. Face, content, and construct validity of a novel portable ergonomic simulator for basic laparoscopic skills. JOURNAL OF SURGICAL EDUCATION 2014; 71:65-72. [PMID: 24411426 DOI: 10.1016/j.jsurg.2013.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/05/2013] [Accepted: 05/20/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Laparoscopic skills can be improved effectively through laparoscopic simulation. The purpose of this study was to verify the face and content validity of a new portable Ergonomic Laparoscopic Skills simulator (Ergo-Lap simulator) and assess the construct validity of the Ergo-Lap simulator in 4 basic skills tasks. DESIGN Four tasks were evaluated: 2 different translocation exercises (a basic bimanual exercise and a challenging single-handed exercise), an exercise involving tissue manipulation under tension, and a needle-handling exercise. Task performance was analyzed according to speed and accuracy. The participants rated the usability and didactic value of each task and the Ergo-Lap simulator along a 5-point Likert scale. SETTING Institutional academic medical center with its affiliated general surgery residency. PARTICIPANTS Forty-six participants were allotted into 2 groups: a Novice group (n = 26, <10 clinical laparoscopic procedures) and an Experienced group (n = 20, >50 clinical laparoscopic procedures). RESULTS The Experienced group completed all tasks in less time than the Novice group did (p < 0.001, Mann-Whitney U test). The Experienced group also completed tasks 1, 2, and 4 with fewer errors than the Novice group did (p < 0.05). Of the Novice participants, 96% considered that the present Ergo-Lap simulator could encourage more frequent practice of laparoscopic skills. In addition, 92% would like to purchase this simulator. All of the experienced participants confirmed that the Ergo-Lap simulator was easy to use and useful for practicing basic laparoscopic skills in an ergonomic manner. Most (95%) of these respondents would recommend this simulator to other surgical trainees. CONCLUSIONS This Ergo-Lap simulator with multiple tasks was rated as a useful training tool that can distinguish between various levels of laparoscopic expertise. The Ergo-Lap simulator is also an inexpensive alternative, which surgical trainees could use to update their skills in the skills laboratory, at home, or in the office.
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Affiliation(s)
- Dongjuan Xiao
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands.
| | - Jack J Jakimowicz
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands; Department of Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands; Department of Research and Education, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Armagan Albayrak
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Sonja N Buzink
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands
| | - Sanne M B I Botden
- Department of Surgery, Máxima Medical Centre, Veldhoven, the Netherlands
| | - Richard H M Goossens
- Industrial Design Engineering, Delft University of Technology, Delft, the Netherlands; Department of Neuroscience, Erasmus MC, Rotterdam, the Netherlands
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Akl EA, Kairouz VF, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel C, Schünemann H. Educational games for health professionals. Cochrane Database Syst Rev 2013; 2013:CD006411. [PMID: 23543543 PMCID: PMC7389433 DOI: 10.1002/14651858.cd006411.pub4] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The use of games as an educational strategy has the potential to improve health professionals' performance (e.g. adherence to standards of care) through improving their knowledge, skills and attitudes. OBJECTIVES The objective was to assess the effect of educational games on health professionals' performance, knowledge, skills, attitude and satisfaction, and on patient outcomes. SEARCH METHODS We searched the following databases in January 2012: MEDLINE, AMED, CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, EPOC Register, ERIC, Proquest Dissertations & Theses Database, and PsycINFO. Related reviews were sought in DARE and the above named databases. Database searches identified 1546 citations. We also screened the reference lists of included studies in relevant reviews, contacted authors of relevant papers and reviews, and searched ISI Web of Science for papers citing studies included in the review. These search methods identified an additional 62 unique citations for a total of 1608 for this update. SELECTION CRITERIA We included randomized controlled trials (RCT), controlled clinical trials (CCT), controlled before and after (CBA) and interrupted time-series analysis (ITS). Study participants were qualified health professionals or in postgraduate training. The intervention was an educational game with "a form of competitive activity or sport played according to rules". DATA COLLECTION AND ANALYSIS Using a standardized data form we extracted data on methodological quality, participants, interventions and outcomes of interest that included patient outcomes, professional behavior (process of care outcomes), and professional's knowledge, skills, attitude and satisfaction. MAIN RESULTS The search strategy identified a total of 2079 unique citations. Out of 84 potentially eligible citations, we included two RCTs. The game evaluated in the first study used as a reinforcement technique, was based on the television game show "Family Feud" and focused on infection control. The study did not assess any patient or process of care outcomes. The group that was randomized to the game had statistically higher scores on the knowledge test (P = 0.02). The second study compared game-based learning ("Snakes and Ladders" board game) with traditional case-based learning of stroke prevention and management. The effect on knowledge was not statistically different between the two groups immediately and 3 months after the intervention. The level of reported enjoyment was higher in the game-based group. AUTHORS' CONCLUSIONS The findings of this systematic review neither confirm nor refute the utility of games as a teaching strategy for health professionals. There is a need for additional high-quality research to explore the impact of educational games on patient and performance outcomes.
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Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Riad El Solh St, Beirut, Lebanon.
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27
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Learning curve on the TrEndo laparoscopic simulator compared to an expert level. Surg Endosc 2013; 27:2934-9. [DOI: 10.1007/s00464-013-2859-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 01/28/2013] [Indexed: 12/17/2022]
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28
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Akl EA, Sackett KM, Erdley WS, Mustafa RA, Fiander M, Gabriel C, Schünemann H. Educational games for health professionals. Cochrane Database Syst Rev 2013:CD006411. [PMID: 23440807 DOI: 10.1002/14651858.cd006411.pub3] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The use of games as an educational strategy has the potential to improve health professionals' performance (e.g. adherence to standards of care) through improving their knowledge, skills and attitudes. OBJECTIVES The objective was to assess the effect of educational games on health professionals' performance, knowledge, skills, attitude and satisfaction, and on patient outcomes. SEARCH METHODS We searched the following databases in January 2012: MEDLINE, AMED, CINAHL, Cochrane Central Database of Controlled Trials, EMBASE, EPOC Register, ERIC, Proquest Dissertations & Theses Database, and PsycINFO. Related reviews were sought in DARE and the above named databases. Database searches identified 1546 citations. We also screened the reference lists of included studies in relevant reviews, contacted authors of relevant papers and reviews, and searched ISI Web of Science for papers citing studies included in the review. These search methods identified an additional 62 unique citations for a total of 1608 for this update. SELECTION CRITERIA We included randomized controlled trials (RCT), controlled clinical trials (CCT), controlled before and after (CBA) and interrupted time-series analysis (ITS). Study participants were qualified health professionals or in postgraduate training. The intervention was an educational game with "a form of competitive activity or sport played according to rules". DATA COLLECTION AND ANALYSIS Using a standardized data form we extracted data on methodological quality, participants, interventions and outcomes of interest that included patient outcomes, professional behavior (process of care outcomes), and professional's knowledge, skills, attitude and satisfaction. MAIN RESULTS The search strategy identified a total of 2079 unique citations. Out of 84 potentially eligible citations, we included two RCTs. The game evaluated in the first study used as a reinforcement technique, was based on the television game show "Family Feud" and focused on infection control. The study did not assess any patient or process of care outcomes. The group that was randomized to the game had statistically higher scores on the knowledge test (P = 0.02). The second study compared game-based learning ("Snakes and Ladders" board game) with traditional case-based learning of stroke prevention and management. The effect on knowledge was not statistically different between the two groups immediately and 3 months after the intervention. The level of reported enjoyment was higher in the game-based group. AUTHORS' CONCLUSIONS The findings of this systematic review neither confirm nor refute the utility of games as a teaching strategy for health professionals. There is a need for additional high-quality research to explore the impact of educational games on patient and performance outcomes.
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Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Graafland M, Schraagen JM, Schijven MP. Systematic review of serious games for medical education and surgical skills training. Br J Surg 2012; 99:1322-30. [PMID: 22961509 DOI: 10.1002/bjs.8819] [Citation(s) in RCA: 215] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
The application of digital games for training medical professionals is on the rise. So-called ‘serious’ games form training tools that provide a challenging simulated environment, ideal for future surgical training. Ultimately, serious games are directed at reducing medical error and subsequent healthcare costs. The aim was to review current serious games for training medical professionals and to evaluate the validity testing of such games.
Methods
PubMed, Embase, the Cochrane Database of Systematic Reviews, PsychInfo and CINAHL were searched using predefined inclusion criteria for available studies up to April 2012. The primary endpoint was validation according to current criteria.
Results
A total of 25 articles were identified, describing a total of 30 serious games. The games were divided into two categories: those developed for specific educational purposes (17) and commercial games also useful for developing skills relevant to medical personnel (13). Pooling of data was not performed owing to the heterogeneity of study designs and serious games. Six serious games were identified that had a process of validation. Of these six, three games were developed for team training in critical care and triage, and three were commercially available games applied to train laparoscopic psychomotor skills. None of the serious games had completed a full validation process for the purpose of use.
Conclusion
Blended and interactive learning by means of serious games may be applied to train both technical and non-technical skills relevant to the surgical field. Games developed or used for this purpose need validation before integration into surgical teaching curricula.
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Affiliation(s)
- M Graafland
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - J M Schraagen
- Netherlands Organization for Applied Scientific Research, Soesterberg, The Netherlands
| | - M P Schijven
- Department of Surgery, Academic Medical Centre, Amsterdam, The Netherlands
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van Empel PJ, Verdam MGE, Strypet M, van Rijssen LB, Huirne JA, Scheele F, Bonjer HJ, Meijerink WJ. Voluntary autonomous simulator based training in minimally invasive surgery, residents' compliance and reflection. JOURNAL OF SURGICAL EDUCATION 2012; 69:564-570. [PMID: 22677599 DOI: 10.1016/j.jsurg.2012.04.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2011] [Revised: 12/15/2011] [Accepted: 04/10/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Knot tying and suturing skills in minimally invasive surgery (MIS) differ markedly from those in open surgery. Appropriate MIS training is mandatory before implementation into practice. The Advanced Suturing Course (ASC) is a structured simulator based training course that includes a 6-week autonomous training period at home on a traditional laparoscopic box trainer. Previous research did not demonstrate a significant progress in laparoscopic skills after this training period. This study aims to identify factors determining autonomous training on a laparoscopic box trainer at home. METHODS Residents (n = 97) attending 1 of 7 ASC courses between January 2009 and June 2011 were consecutively included. After 6 weeks of autonomous, training a questionnaire was completed. A random subgroup of 30 residents was requested to keep a time log. All residents received an online survey after attending the ASC. We performed outcome comparison to examine the accuracy of individual responses. RESULTS Out of 97 residents, the main motives for noncompliant autonomous training included a lack of (training) time after working hours (n = 80, 83.3%), preferred practice time during working hours (n = 76, 31.6%), or another surgical interest than MIS (n = 79, 15.2%). Previously set training goals would encourage autonomous training according to 27.8% (n = 18) of residents. Thirty participants submitted a time log and reported an average 76.5-minute weekly training time. All residents confirmed that autonomous home practice on a laparoscopic box trainer is valuable. CONCLUSIONS Autonomous practice should be structured and inclusive of adequate and sufficient feedback points. A minimally required practice time should be set. An obligatory assessment, including corresponding consequence should be conducted. Compliance herewith may result in increased voluntary (autonomous) simulator based (laparoscopic) training by residents.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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31
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Tjiam IM, Schout BMA, Hendrikx AJ, Muijtjens AM, Scherpbier AJ, Witjes JA, Van Der Vleuten CP. Program for laparoscopic urological skills assessment: Setting certification standards for residents. MINIM INVASIV THER 2012; 22:26-32. [DOI: 10.3109/13645706.2012.686918] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Mayer I. Towards a Comprehensive Methodology for the Research and Evaluation of Serious Games. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.procs.2012.10.075] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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van Empel PJ, van der Veer WM, van Rijssen LB, Cuesta MA, Scheele F, Bonjer HJ, Meijerink WJ. Mapping the maze of minimally invasive surgery simulators. J Laparoendosc Adv Surg Tech A 2011; 22:51-60. [PMID: 22145607 DOI: 10.1089/lap.2010.0467] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Conforming to, among other considerations, legal and ethical concerns for patient safety, there is an increasing demand to assess a surgeon's skills prior to performance in the operating room in pursuit of higher-quality treatment. Training in minimally invasive surgery (MIS) must therefore be intensified, including team training. New methods to train and assess minimally invasive surgical skills are gaining interest. The goal of this review is to provide instructors with an overview of available MIS training tools. In this review, we discuss currently available simulators for MIS training. Applicability, validity, and construction of simulators are reviewed. Also, some of the leading training programs and assessment methods in MIS are reviewed. METHODS A literature search was performed on studies evaluating surgical task performance on a simulator, reviewing satisfaction with laparoscopic training programs, or validating simulators or assessment methods. RESULTS Simulators may be divided into simple box trainers and computer-based systems, such as virtual and augmented simulators. All have advantages and disadvantages. An overview is provided of currently available training systems, validity, trainee assessment, and the importance of training programs in MIS. CONCLUSIONS No simulator yet provides the ability to train the entire set of required psychomotor skills or procedures for MIS. A multiyear training program combining various simulators for multiple-level training, including team training, should be constructed.
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Affiliation(s)
- Pieter J van Empel
- Department of Surgery, VU University Medical Centre, Amsterdam, The Netherlands.
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Schreuder HW, van Hove PD, Janse JA, Verheijen RR, Stassen LP, Dankelman J. An “Intermediate Curriculum” for Advanced Laparoscopic Skills Training with Virtual Reality Simulation. J Minim Invasive Gynecol 2011; 18:597-606. [DOI: 10.1016/j.jmig.2011.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 05/23/2011] [Accepted: 05/26/2011] [Indexed: 01/22/2023]
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Schreuder HWR, Oei G, Maas M, Borleffs JCC, Schijven MP. Implementation of simulation in surgical practice: minimally invasive surgery has taken the lead: the Dutch experience. MEDICAL TEACHER 2011; 33:105-115. [PMID: 21275542 DOI: 10.3109/0142159x.2011.550967] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Minimal invasive techniques are rapidly becoming standard surgical techniques for many surgical procedures. To develop the skills necessary to apply these techniques, box trainers and/or inanimate models may be used, but these trainers lack the possibility of inherent objective classification of results. In the past decade, virtual reality (VR) trainers were introduced for training minimal invasive techniques. Minimally invasive surgery (MIS) is, by nature, very suitable for this type of training. The specific psychomotor skills and eye-hand coordination needed for MIS can be mastered largely using VR simulation techniques. It is also possible to transfer skills learned on a simulator to real operations, resulting in error reduction and shortening of procedural operating time. The authors aim to enlighten the process of gaining acceptance in the Netherlands for novel training techniques. The Dutch Societies of Surgery, Obstetrics and Gynecology, and Urology each developed individual training curricula for MIS using simulation techniques, to be implemented in daily practice. The ultimate goal is to improve patient safety. The authors outline the opinions of actors involved, such as different simulators, surgical trainees, surgeons, surgical societies, hospital boards, government, and the public. The actual implementation of nationwide training curricula for MIS is, however, a challenging step.
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Affiliation(s)
- Henk W R Schreuder
- ivision of Women and Baby, Department of Gynecologic Surgery and Oncology, University Medical Centre Utrecht, PO Box 85500, Room F05-126, 3508 GA, Utrecht, The Netherlands.
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