Influence of medical student career aims on ophthalmic surgical simulator performance (part of the international forum for ophthalmic simulation studies)

QUIET PLEASE! Effect of distraction on simulated posterior segment surgical performance

PURPOSE

To determine the effect of distraction on posterior segment surgical performance using a virtual reality simulator in expert and novice ophthalmic surgeons.

METHODS

Twenty subjects were given 6 min to read an unpublished research paper and then were randomized into two groups. Group 1 subjects were allowed 3 min to complete a standardized vitreoretinal simulated task undistracted. Group 2 subjects were asked six questions on the research paper whilst completing the same task. Each subject then performed the alternate scenario. Finally, all participants were asked six questions on the research paper whilst not operating.

RESULTS

There was no evidence of a difference in the odometer values (p = 0.127), cognitive task score (p = 0.390) or overall surgical task scores (p = 0.113) between the two groups. The time taken by the distracted group was significantly greater (95% CI -26.03 to -1.67, t-test p = 0.028).

CONCLUSION

Distraction significantly increases the time taken to perform a simulated vitreoretinal surgical task for all grades of surgeon. More studies are required to understand the impact on different types of distraction on surgical performance.

Effect of fine-motor-skill activities on surgical simulator performance

PURPOSE

To determine the effect of fine motor activity and nondominant-hand training on cataract surgical simulator (Eyesi) performance.

SETTING

Departments of Ophthalmology, University of Iowa, and Veterans Affairs Health Care Systems, Iowa City, Iowa, USA.

DESIGN

Prospective controlled trial.

METHODS

Medical students completed a questionnaire and baseline microsurgical dexterity evaluation using the following 3 surgical simulator tasks: navigation, forceps, and bimanual. Participants were randomized to control (16) or intervention (17) consisting of writing, completing a labyrinth, eating, and brushing teeth once per day with their nondominant hand. Participants returned 4 weeks after baseline evaluation for follow-up simulator testing.

RESULTS

Of the 33 students, regular video game players had greater baseline scores than nonplayers on navigation (P = .021) and bimanual tasks (P = .089). All participants showed statistically significant improvements in all 3 tasks at follow-up after a single baseline evaluation on the surgical simulator (navigation: P = .004; forceps: P < .001; bimanual: P = .004). Nondominant-hand training with daily activities did not show statistically significant differences for dominant hands or nondominant hands. The intervention group (n = 17) trended toward greater improvement than the control group (n = 16) in navigation (14.78 versus 7.06; P = .445) and bimanual tasks (15.2 versus 6.0; P = .324) at follow-up.

CONCLUSIONS

Regular video game play enhanced baseline microsurgical performance measured on the surgical simulator. Simulation performance improved significantly in the intervention group and control group after 1 session on the simulator. Although not statistically significant, training the nondominant hand with daily activities showed a trend toward improved navigation and bimanual performance.

Comparison of training effect on tremor using 2 training modules

PURPOSE

To compare training effect of 2 training models-a surgical simulator anti-tremor module and a paper version-on tremor and time-to-task completion.

SETTING

Ophthalmology Department, Veterans Affairs Boston Healthcare System, Jamaica Plain, Massachusetts, USA.

DESIGN

Prospective crossover study.

METHODS

Trainees completed simulator and paper training modules (baseline test, 3 training sessions, posttraining test, and final test) with their dominant and nondominant hands. The change in tremor, number of paper errors, and time-to-task completion in dominant and nondominant hands were compared. The 2 training modules were compared using nonparametric tests.

RESULTS

The study comprised 19 trainees. There was a moderate correlation between average tremor values (simulator, 3-dimensional module) and paper errors (paper, 2-dimensional module) (Spearman ⍴ = 0.35, P < .0001). Practice on the simulator or paper modules did not reduce tremor significantly from baseline to final tasks for both hands combined (P = .12, simulator; P = .2, paper). Practice on the training modules improved time-to-task completion in the simulator module and paper module (both P < .0001). The improvement in time from baseline to final tasks was greater in the nondominant hands in the simulator module (improvement 64.5% over baseline time) than in the paper module (53.6% over baseline time).

CONCLUSION

Practice might not reduce tremor but improved the outcome measure of time, and results suggest that trainees can learn to compensate for tremor in both hands, which is important in bimanual microsurgery.