Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized educational trial

Haptic simulators accelerate laparoscopic simulator training, but skills are not transferable to a non-haptic simulator: a randomized trial

BACKGROUND

Laparoscopy requires specific psychomotor skills and can be challenging to learn. Most proficiency-based laparoscopic training programs have used non-haptic virtual reality simulators; however, haptic simulators can provide the tactile sensations that the surgeon would experience in the operating room. The objective was to investigate the effect of adding haptic simulators to a proficiency-based laparoscopy training program.

METHODS

A randomized controlled trial was designed where residents (n = 36) were randomized to proficiency-based laparoscopic simulator training using haptic or non-haptic simulators. Subsequently, participants from the haptic group completed a follow-up test, where they had to reach proficiency again using the non-haptic simulator. Participants from the non-haptic group returned to train until reaching proficiency again using the non-haptic simulator.

RESULTS

Mean completion times during the intervention were 120 min (SD 38.7 min) and 183 min (SD 66.3 min) for the haptic group and the non-haptic group, respectively (p = 0.001). The mean times to proficiency during the follow-up test were 107 min (SD 41.0 min) and 58 min (SD 23.7 min) for the haptic and the non-haptic group, respectively (p < 0.001). The haptic group was not faster to reach proficiency in the follow-up test than during the intervention (p = 0.22). In contrast, the non-haptic group reached the required proficiency level significantly faster in the follow-up test (p < 0.001).

CONCLUSION

Haptic virtual reality simulators reduce the time to reach proficiency compared to non-haptic simulators. However, the acquired skills are not transferable to the conventional non-haptic setting.

The Use of Feedback in Improving the Knowledge, Attitudes and Skills of Medical Students: a Systematic Review and Meta-analysis of Randomized Controlled Trials

This study aims to investigate the effectiveness of the use of different feedback modalities in improving the knowledge, attitudes, and skills of medical students compared to students receiving no feedback or unstructured feedback. A systematic review and meta-analysis of randomized controlled trials was conducted based on a search of the Cochrane, ERIC, PubMed, Scopus, and Web of Science databases. A total of 26 studies were included for the systematic review and 13 for the meta-analysis. The meta-analysis revealed that the use of feedback was associated with better results compared to control groups (SMD = 0.80 [0.56-1.04], p < 0.001), and also when only high-quality studies were included (SMD = 0.86 [0.56-1.16], p < 0.001). Our findings revealed high heterogeneity in the use of feedback in medical education. However, the results of most of the studies and of the meta-analysis were positive, showing that feedback had a positive influence on the education-learning process of the students. PROSPERO registration: CRD42018112688.

Virtual Reality as an Affirmative Spin-Off to Laparoscopic Training: An Updated Review

Latest advancements in science lead to drastic improvements in patient health care. Techniques and technology evolved in surgery over the years have resulted in the improvement of patient outcomes by leaps and bounds. Open surgeries previously done for procedures like appendectomy and cholecystectomy evolved into laparoscopic minimally invasive procedures. Such procedures pose few challenges to the surgeons, like lack of tissue feedback and fulcrum effect of the abdominal wall. But training surgeons for such an advanced skill is still following conventional methods. These procedures can be effectively trained using Virtual Reality (VR), which can simulate operations outside the operating room (OR). To maximize the outcomes of VR training, knowledge on various strategies affecting the skills acquisition and retention in VR training is essential. This review collected information from PubMed, EMBASE, Cochrane Library (CENTRAL) databases. Data from the previous ten years are included in the review. This included documents, clinical trials, meta-analysis, randomized controlled trials, reviews, systematic reviews, letters to editors, and grey literature. After an advanced Medical Subject Headings (MeSH) search, we got 59,532 results, and after the application of filters, 189 results showed up. Out of these, studies that were not exclusively relevant to the use of VR in laparoscopic surgery were manually excluded, and a total of 35 articles were included in the study. VR is found to be an excellent training modality with promising outcomes. It helps the surgeons perform the surgery accurately at a faster pace and improves confidence and multitasking ability in OR. Instructor feedback from mentors and deliberate practice of trainees, and early introduction of haptics in VR resulted in the most effective outcomes of the VR training. Box trainers are also compared with VR trainers as they are the cheaper modalities of training. However, this area needs more research to conclude if box trainers can act as a cheaper alternative to VR training providing similar outcomes.

Assessment of online teaching as an adjunct to medical education in the backdrop of COVID-19 lockdown in a developing country - An online survey

PURPOSE

The aim of this study was to assess awareness about online classes and to assess if they can aid learning in the field of medicine amid lockdown.

METHODS

Online survey comprising a questionnaire related to the aspects of online teaching was undertaken. There were 16 questions, and responses were collected from undergraduates, postgraduates, and the teaching faculties.

RESULTS

Online classes were viewed favorably by the vast majority of respondents. Out of 412 respondents 79.9% actively attended the classes. While 42% felt the timings were inappropriate as they clashed with duty hours, a set of 35% had difficulty understanding the content and most of them were undergraduates. Poor internet connection was a main hindrance identified. In total, 69.2% respondents were happy with the feasibility of the classes and believed these classes had the advantage of being economical as they offered exposure to national and international faculty from the comfort of their homes.

CONCLUSION

Conducting online classes on a national scale is a herculean task for a developing country because of poor internet connectivity and deficient access to high-speed broadband services. Nevertheless, their popularity among students during the current crisis shows that it is a very pragmatic and feasible teaching option and can definitely supplement traditional classroom teaching.

The Use of Virtual Reality in Podiatric Medical Education

Virtual reality in medical education is a recent development that significantly improves surgical skills, which translates to improved outcomes in the operating room (OR). The development of the Western University of Health Sciences virtual OR provides podiatric medical students basic OR knowledge and skills through performing basic surgical procedures. This new method of presenting content in podiatric medical education enhances the learning experience in a less stressful environment. The virtual reality experience allows students to gain experience without undue risk to the patient. Thus students can improve competency while focusing on the experience instead of the potentially overwhelming OR setting.

The Applications of Virtual Reality Technology in Medical Groups Teaching

INTRODUCTION

Virtual reality is a new method for training different medical groups. Based on this technology, professionals and students of various medical sciences can determine their level of competence for medical treatment before any performance on the patient. Therefore, the aim of this study was to identify the applications of virtual reality technology for training the medical groups.

METHODS

This is a scoping review study conducted in 2016. Articles were retrieved through the search of related keywords in databases such as Pub Med, Scopus, Web of Sciences, Springer, and Google scholar. Then, after applying the entry criteria, 21 papers were selected from a total of 1343. Data extraction was done by a data collection form. The collected data were summarized and reported using content analysis technique according to the study purpose.

RESULTS

The findings of the study indicated that 11 cases (48%) have used virtual education technology for laparoscopic surgery training. Using virtual reality has improved learning in 17 (74%) studies. A higher accuracy in medical practice by people trained through VR has been reported in 20 (87%) studies.

CONCLUSION

The results indicate that the application of virtual reality capabilities plays an important role in improving the performance of different medical groups. According to the results, it can be suggested that virtual reality capabilities should be used to train different medical groups based on their individual and collective needs.

Mastering Surgical Skills Through Simulation-Based Learning: Practice Makes One Perfect

Simulation-based learning in surgery is a learning model where an environment similar to real life surgical situation is created for the trainee to learn various surgical skills. It can be used to train a new operator as well to assess his skills. This methodology helps in repetitive practice of surgical skills on nonliving things so that the operator can be near-perfect when operating on a live patient. Various models are available for learning different dermatosurgery skills.

From education to research: a journey of utilising virtual training

Background

London South Bank University (LSBU) has successfully implemented Virtual Environment for Radiotherapy Training (VERT) across the therapeutic radiography training curricula and are now supporting the use of VERT for patient education in clinical departments. A number of publications have reported on the use of VERT in education and training; more recent literature has focused on the use of VERT for patient education.

Materials and methods

The successful introduction of VERT before students’ first clinical placements resulted in the development of a ‘Pre-Clinical week’ where students practice and improve their technical skills, using the hand controls without a patient present, leading to increased confidence in clinical practice. Other examples of VERT curriculum integration at LSBU focused on the use of VERT for anatomy teaching. The more recent innovation at LSBU relevant to VERT integration has been the design, development and implementation of collaborative research projects where the aims of the studies were to explore patients’ perceptions of VERT as an information giving resource before radiotherapy delivery.

Summary

The introduction of VERT as education tool has enabled academic staff to develop a range of teaching methods to embed virtual training into the traditional classroom setting, demonstrating innovation and collaboration.

Laparoscopic skills and cognitive function are not affected in surgeons during a night shift

OBJECTIVE

To monitor surgeons' performance and cognition during night shifts.

DESIGN

Surgeons were monitored before call and on call (17-hour shift). Psychomotor performance was assessed by laparoscopic simulation and cognition by the d2 test of attention. The surgeons performed the laparoscopic simulation and the d2 test of attention at 8 a.m. before call and at 4 a.m. on call. Sleep was measured by wrist actigraphy and sleepiness by the Karolinska sleepiness scale.

SETTING

Department of Surgery at Herlev Hospital, Denmark.

PARTICIPANTS

Overall, 30 interns, residents, and attending surgeons were included and completed the study. One participant was subsequently excluded owing to myxedema.

RESULTS

The surgeons slept significantly less on call than before call. There was increasing sleepiness on call; however, no significant differences were found in the precall laparoscopic simulation values compared with on-call values. The d2 test of attention showed significantly improved values on call compared with before call.

CONCLUSION

Sleep deprivation during a 17-hour night shift did not impair surgeons' psychomotor or cognitive performance.

Operating room of the future

Development of surgical care in the 21st century is increasingly dependent on demonstrating safety, efficacy and cost effectiveness. Over the past 2 decades, the potential role of simulation in surgery has been explored with encouraging results; this can now be linked to direct improvement in the quality of care provision. Computer-assisted surgical platforms, such as robotic surgery, offer us the versatility to embrace a host of technical and technological developments. Rapid development in nanomedicine will expand the limits of operative performance through improved navigation and surgical precision. Integration of the multiple functions of the future operating room will be essential in optimising resource management. The key to bringing about the necessary paradigm shift in the design and delivery of modern surgical care is to appreciate that we now function in an information age, where the integrity of processes is driven by apt data management.