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Katthagen JC, Deichsel A, Schenk C, Stolberg-Stolberg J, Glasbrenner J, Raschke MJ. [Satisfaction with continuing education at a level 1 trauma center-Results of a survey and development of a competency-based continuing education concept]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:466-472. [PMID: 38498122 PMCID: PMC11096236 DOI: 10.1007/s00104-024-02067-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Structured competency-based training is one of the most frequently articulated wishes of residents. METHODS A survey of 19 residents was conducted regarding their satisfaction with the resident education at a level 1 trauma center. In this article the development of a revised competency-based education concept was carried out. RESULTS The survey reflected uncertainty as to whether the current structures could meet the requirements of the residency regulations. The improved competency-based education concept consists of clinical mentoring, competency-based catalogs of learning objectives, regular theoretical and practical workshops as well as regular and structured staff evaluations. CONCLUSION The education concept presented reflects the attempt to establish a contemporary surgical training program which will be evaluated as it progresses.
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Affiliation(s)
- J Christoph Katthagen
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Gebäude W1, 48149, Münster, Deutschland
| | - Adrian Deichsel
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Gebäude W1, 48149, Münster, Deutschland.
| | - Christian Schenk
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Gebäude W1, 48149, Münster, Deutschland
| | - Josef Stolberg-Stolberg
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Gebäude W1, 48149, Münster, Deutschland
| | - Johannes Glasbrenner
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Gebäude W1, 48149, Münster, Deutschland
| | - Michael J Raschke
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Gebäude W1, 48149, Münster, Deutschland
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Hey HWD, Foong ZNA, Yee YE, Koh TYA, Ong JTY, Goh RSN, Poon MEG, Lim JXY, Tan JHJ, Khoo ET. Virtual reality spine surgical training in Singapore: a preliminary study. Singapore Med J 2024:00077293-990000000-00114. [PMID: 38779923 DOI: 10.4103/singaporemedj.smj-2021-476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/27/2022] [Indexed: 05/25/2024]
Affiliation(s)
- Hwee Weng Dennis Hey
- University Orthopaedics, Hand and Reconstructive Microsurgery, National University Health System, Singapore
| | | | - Yang En Yee
- Faculty of Engineering, National University of Singapore, Singapore
| | | | | | | | - Mu En Glenys Poon
- University Orthopaedics, Hand and Reconstructive Microsurgery, National University Health System, Singapore
| | - Joel Xue Yi Lim
- University Orthopaedics, Hand and Reconstructive Microsurgery, National University Health System, Singapore
| | - Jiong Hao Jonathan Tan
- University Orthopaedics, Hand and Reconstructive Microsurgery, National University Health System, Singapore
| | - Eng Tat Khoo
- Engineering Design and Innovation Centre, Faculty of Engineering, National University of Singapore, Singapore
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Schöbel T, Schuschke L, Youssef Y, Rotzoll D, Theopold J, Osterhoff G. Immersive virtual reality in orthopedic surgery as elective subject for medical students : First experiences in curricular teaching. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:369-378. [PMID: 38575780 PMCID: PMC11052777 DOI: 10.1007/s00132-024-04491-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/01/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Virtual reality (VR) simulators have been introduced for skills training in various medical disciplines to create an approximately realistic environment without the risk of patient harm and have improved to more immersive VR (iVR) simulators at affordable costs. There is evidence that training on VR simulators improves technical skills but its use in orthopedic training programs and especially in curricular teaching sessions for medical students are currently not well established. The aim of this study was to describe the implementation of a VR operating theater as an elective course for undergraduate medical students and to evaluate its effect on student learning. METHODS An elective course for 12 students was implemented during the summer semester of 2023. Using Oculus Quest 2 headsets (Reality Labs, Meta Platforms, USA) and controllers and the PrecisionOS platform, they were able to train five different surgical procedures. The courses were accompanied by weekly topic discussions and instructional videos. Students were assigned to two groups: group VR vs. group non-VR. The groups were switched after 5 weeks. User feedback and performance development (theoretical and procedural surgical knowledge) after VR training were assessed using three questionnaires. RESULTS The students highly appreciated the implementation of VR training into their curriculum and 91% stated that they would opt for further VR training. All students stated that VR training improved their understanding of surgical procedures and that it should be obligatory in surgical training for undergraduate medical students. After 5 weeks of training, students in the VR group achieved significantly better results (100 out of maximum 180 points) than the non-VR group (70 points, p = 0.0495) in procedural surgical knowledge. After completion of the VR training the VR group achieved 106 points and the non-VR group 104 points (p = 0.8564). The procedural knowledge for non-VR group after 5 weeks significantly improved after VR training from 70 to 106 points (p = 0.0087). CONCLUSION The iVR can be easily integrated into the curriculum of medical students and is highly appreciated by the participants. The iVR statistically improves the procedural knowledge of surgical steps compared to conventional teaching methods. Further implementation of iVR training in curricular teaching of medical students should be considered.
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Affiliation(s)
- Tobias Schöbel
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Leonard Schuschke
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Yasmin Youssef
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Daisy Rotzoll
- Skills and Simulation Centre LernKlinik Leipzig, Faculty of Medicine, University of Leipzig, Liebigstraße 23/25, 04103, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Abensur Vuillaume L, Goffoy J, Dubois N, Almoyner N, Bardet C, Dubreucq E, Klenkenberg S, Donneau AF, Dib C, Ghuysen A. Collaborative virtual reality environment in disaster medicine: moving from single player to multiple learners. BMC MEDICAL EDUCATION 2024; 24:422. [PMID: 38641770 PMCID: PMC11031920 DOI: 10.1186/s12909-024-05429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The use of virtual reality (VR) in healthcare education is on the increase. In disaster medicine, it could be a solution to the cost and logistic constraints for a "full-scale" scenarios. However, VR is mainly designed for single players, which is not appropriate for the objectives pursued in disaster medicine. We decided to evaluate the educational value of using individual VR simulation in disaster medicine on a group of learners. METHODS The VR scenario used was a reproduction of a major train crash, with 21 victims and whose objectives were START triage and first aid techniques. The sessions were carried out in multi-participant groups with different roles (active and immersed with headset, paper triage without headset, and active for communications not immersed in the headset). Their perceived self-efficacy was assessed before (T0), after (T1) and 2 months (T2) after the training. Satisfaction and confidence in learning were also measured. RESULTS The median levels of satisfaction and confidence in learning were of 21/25 and 32/40 respectively. Their perceived self-efficacy increased significantly between T0 and T1 (p < 0.001), and remained stable until T2. The different roles of participant showed no difference in terms of satisfaction, confidence in learning or changes in perceived self-efficacy. One third of the participants agreed that the number of participants had interfered with their learning. A significant negative correlation (rS = -0.51, p = 0.002) was found between satisfaction and the fact of having been hindered by the number of participants. Around 90% of participants found the activity entertaining and found the new technologies appropriate for learning technical skills. CONCLUSIONS This first experience of VR in a group setting is satisfactory and shows its positive effects. The limitations highlighted here will enable areas of improvement to be identified for the use of VR in disaster medicine, pending the development of multi-player tools. It would now be appropriate to analyse the impact of this type of simulation on learning and its retention over time.
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Affiliation(s)
| | - Jonathan Goffoy
- Medical Simulation Center, Department of Public Health, Liège University, Liege, Belgium
| | - Nadège Dubois
- Medical Simulation Center, Department of Public Health, Liège University, Liege, Belgium
| | - Nathacha Almoyner
- Service d'Accueil Des Urgences, Hôpital Saint Louis, La Rochelle, France
| | - Cécile Bardet
- Service d'Accueil Des Urgences, Centre Hospitalier de Niort, Niort, France
| | - Evelyne Dubreucq
- Service d'Accueil Des Urgences, Hôpital TENON, APHP, Paris, France
| | - Sophie Klenkenberg
- Biostatistics and Research Methods Center (B-STAT), Liège University, Liege, Belgium
| | | | - Camille Dib
- SAMU 57, Service d'Accueil Des Urgences, CHR Metz-Thionville, Metz, France
| | - Alexandre Ghuysen
- Medical Simulation Center, Department of Public Health, Liège University, Liege, Belgium
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Rahman OF, Kunze KN, Yao K, Kwiecien SY, Ranawat AS, Banffy MB, Kelly BT, Galano GJ. Hip Arthroscopy Simulator Training With Immersive Virtual Reality Has Similar Effectiveness to Nonimmersive Virtual Reality. Arthroscopy 2024:S0749-8063(24)00207-X. [PMID: 38513878 DOI: 10.1016/j.arthro.2024.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To (1) compare the efficacy of immersive virtual reality (iVR) to nonimmersive virtual reality (non-iVR) training in hip arthroscopy on procedural and knowledge-based skills acquisition and (2) evaluate the relative cost of each platform. METHODS Fourteen orthopaedic surgery residents were randomized to simulation training utilizing an iVR Hip Arthroscopy Simulator (n = 7; PrecisionOS) or non-iVR simulator (n = 7; ArthroS Hip VR; VirtaMed). After training, performance was assessed on a cadaver by 4 expert hip arthroscopists through arthroscopic video review of a diagnostic hip arthroscopy. Performance was assessed using the Objective Structured Assessment of Technical Skills (OSATS) and Arthroscopic Surgery Skill Evaluation Tool (ASSET) scores. A cost analysis was performed using the transfer effectiveness ratio (TER) and a direct cost comparison of iVR to non-iVR. RESULTS Demographic characteristics did not differ between treatment arms or by training level, hip arthroscopy experience, or prior simulator use. No significant differences were observed in OSATS and ASSET scores between iVR and non-iVR cohorts (OSATS: iVR 19.6 ± 4.4, non-iVR 21.0 ± 4.1, P = .55; ASSET: iVR 23.7 ± 4.5, non-iVR 25.8 ± 4.8, P = .43). The absolute TER was 0.06 and there was a 132-fold cost difference of iVR to non-iVR. CONCLUSIONS Hip arthroscopy simulator training with iVR had similar performance results to non-iVR for technical skill and procedural knowledge acquisition after expert arthroscopic video assessment. The iVR platform had similar effectiveness in transfer of skill compared to non-iVR with a 132 times cost differential. CLINICAL RELEVANCE: Due to the accessibility, effectiveness, and relative affordability, iVR training may be beneficial in the future of safe arthroscopic hip training.
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Affiliation(s)
- Omar F Rahman
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A.; Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A..
| | - Kyle N Kunze
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Kaisen Yao
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
| | - Susan Y Kwiecien
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
| | - Anil S Ranawat
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Michael B Banffy
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A
| | - Bryan T Kelly
- Department of Orthopaedics, Hospital for Special Surgery, New York, New York, U.S.A
| | - Gregory J Galano
- Department of Orthopaedics, Lenox Hill Hospital-Northwell Health, New York, New York, U.S.A
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Scott-Watson M, Thornhill C, Bhattacharyya R, Spencer SJ. Evaluating the effectiveness of a low fidelity, easily available simulator to teach basic arthroscopy skills to novice learners: A prospective cohort study. Knee 2024; 47:129-138. [PMID: 38394992 DOI: 10.1016/j.knee.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/22/2023] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Arthroscopy proficiency is key to being a competent orthopaedic surgeon and acquiring arthroscopic skills takes years of exposure and diligent practice. However, today's graduating consultants have had considerably less time in operating theatre than their senior colleagues at the same point of their careers. OBJECTIVES To evaluate whether: (1) Students could improve their arthroscopic technique using a low fidelity arthroscopic training tool (2) students enjoyed the use of the simulator (3) If certain demographics correlate to performance on the simulator. METHODS Medical students who have no previous training in arthroscopy were included. A combined left- and right-handed timed run with a low-fidelity arthroscopic triangulation simulator was recorded before and after 40-minutes of practice. RESULTS 84 participants took part with an average improvement of was 66.8%. Students felt that their arthroscopic skills increased on average by 36.4%. 73 of the 84 participants gave the maximum score of 5 when asked if they enjoyed the session and 74 participants gave the maximum score of 5 as to whether they would be interested in participating in further sessions. Factors such as biological sex, video game play and sports were found to be statistically significant to performance. CONCLUSIONS This study showed a statistically significant improvement in students' arthroscopic performance with a low-fidelity arthroscopic simulator. Students found the experience useful with the vast majority indicating interest in completing further training sessions to help improve practical surgical skills. Video gamers, sports players and males were found to have a correlation with performance on the simulator.
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Affiliation(s)
- Malcolm Scott-Watson
- Glasgow University Medical Student, Wolfson Medical School Building, University Avenue, University of Glasgow, G12 8QQ, UK.
| | - Chris Thornhill
- ST3 Orthopaedic and Trauma Surgeon, Queen Elizabeth University Hospital, 1345 Govan Road, Govan G51 4TF, Glasgow, UK.
| | - Rahul Bhattacharyya
- Consultant Orthopaedic and Trauma Surgeon, NHS Lanarkshire University Hospitals, UK.
| | - Simon J Spencer
- Consultant Orthopaedic and Trauma Surgeon, Queen Elizabeth University Hospital, 1345 Govan Road, Govan G51 4TF, Glasgow, UK.
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Kenanidis E, Boutos P, Voulgaris G, Zgouridou A, Gkoura E, Gamie Z, Papagiannakis G, Tsiridis E. Effectiveness of virtual reality compared to video training on acetabular cup and femoral stem implantation accuracy in total hip arthroplasty among medical students: a randomised controlled trial. INTERNATIONAL ORTHOPAEDICS 2024; 48:625-633. [PMID: 37993676 PMCID: PMC10901922 DOI: 10.1007/s00264-023-06038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE Virtual reality (VR) training effectiveness in improving hip arthroplasty surgical skills requires further evaluation. We hypothesised VR training could improve accuracy and the time taken by medical students compared to a control group with only video teaching. METHODS This single-centre randomized controlled clinical trial collected data from March to June 2023. Surgically naïve volunteer undergraduate medical students performed three sessions on a VR training platform, either cup (VR-Cup=Control-Stem) or stem (VR-Stem=Control-Cup) implantation. The primary outcome was the mean difference between predefined cup inclination (60°) and stem anteversion (20°) compared to the actual implanted values in sawbones between VR and control groups. Secondary outcomes were task completion time and mistake number between the groups. RESULTS A total of 101 students participated (VR-Cup 47, VR-Stem 54). Groups did not significantly differ concerning age (p = 0.879), gender (p = 0.408), study year (p = 0.938), previous VR use (p = 0.269) and baseline medical and procedural knowledge. The VR-Cup implanted the cup closer to the intended target (p < 0.001) and faster than the Control-Cup group (p = 0.113). The VR-Stem implanted the stem closer to the intended target (p = 0.008) but not faster than the Control-Cup group (p = 0.661). Stem retroversion was commoner in the Control-Stem than in the VR-Stem group (p = 0.016). CONCLUSIONS VR training resulted in higher rates of accurate procedure completion, reduced time and fewer errors compared to video teaching. VR training is an effective method for improving skill acquisition in THA. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05807828.
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Affiliation(s)
- Eustathios Kenanidis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece.
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece.
| | - Panagiotis Boutos
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Grigorios Voulgaris
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Aikaterini Zgouridou
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Eleni Gkoura
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - Zakareya Gamie
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
| | - George Papagiannakis
- Institute of Computer Science, Foundation for Research and Technology (FORTH), Heraklion, Greece
- Department of Computer Science, University of Crete, Heraklion, Greece
| | - Eleftherios Tsiridis
- Academic Orthopaedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Ring Road Efkarpia, 56403, Thessaloniki, Greece
- Centre of Orthopaedic and Regenerative Medicine (CORE), Center for Interdisciplinary Research and Innovation (CIRI)-Aristotle University of Thessaloniki (AUTH), Balkan Center, Buildings A & B, Thessaloniki, 10th km Thessaloniki-Thermi Rd, P.O. Box 8318, 57001, Thessaloniki, GR, Greece
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Wan T, Liu K, Li B, Wang X. Effectiveness of immersive virtual reality in orthognathic surgical education: A randomized controlled trial. J Dent Educ 2024; 88:109-117. [PMID: 37800654 DOI: 10.1002/jdd.13380] [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: 07/10/2023] [Revised: 09/03/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the efficacy of an iVR surgical training system for orthognathic surgery training in medical students. METHODS This study comprised 20 fifth year medical students who were randomly assigned to the VR or traditional group for orthognathic surgical education. All participants were initially provided a lecture on orthognathic surgery. The VR group then received 10 educational sessions using the self-developed iVR training system, whereas the traditional group received 10 sessions using technical manuals and annotated operation videos. These sessions were 40-min long in both the groups. Before the evaluation, the traditional group completed one session using the training and assessment modes to become familiar with the iVR training system. The score in the assessment mode, time to complete the procedure, number of instrument selection errors, number of prompts given by the system, number of positional and angular errors, and number of timeouts during each step were recorded to evaluate the learning effect. RESULTS The VR group achieved higher scores than the traditional group (94.67 vs. 87.65). Compared with the control group, the VR group completed the procedure more quickly, with fewer instrument selection and angular errors. No difference in the number of prompts given by the system was observed between the two groups. CONCLUSIONS The iVR surgical training system showed a better learning effect than the traditional learning method for orthognathic surgery. The iVR surgical training system may have utility as a supplement and potential substitute for the traditional surgical training method.
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Affiliation(s)
- Teng Wan
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Kai Liu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Biao Li
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
| | - Xudong Wang
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Shanghai Research Institute of Stomatology, Shanghai, China
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Yi WS, Rouhi AD, Duffy CC, Ghanem YK, Williams NN, Dumon KR. A Systematic Review of Immersive Virtual Reality for Nontechnical Skills Training in Surgery. JOURNAL OF SURGICAL EDUCATION 2024; 81:25-36. [PMID: 38036388 DOI: 10.1016/j.jsurg.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Immersive virtual reality (IVR) can be utilized to provide low cost and easily accessible simulation on all aspects of surgical education. In addition to technical skills training in surgery, IVR simulation has been utilized for nontechnical skills training in domains such as clinical decision-making and pre-operative planning. This systematic review examines the current literature on the effectiveness of IVR for nontechnical skill acquisition in surgical education. DESIGN A literature search was performed using MEDLINE, EMBASE, and Web of Science for primary studies published between January 1, 1995 and February 9, 2022. Four reviewers screened titles, abstracts, full texts, extracted data, and analyzed included studies to answer 5 key questions: How is IVR being utilized in nontechnical skills surgical education? What is the methodological quality of studies? What technologies are being utilized? What metrics are reported? What are the findings of these studies? RESULTS The literature search yielded 2340 citations, with 12 articles included for qualitative synthesis. Of included articles, 33% focused on clinical decision-making and 67% on anatomy/pre-operative planning. Motion sickness was a recorded metric in 25% of studies, with an aggregate incidence of 13% (11/87). An application score was reported in 33% and time to completion in 16.7%. A commercially developed application was utilized in 25%, while 75% employed a noncommercial application. The Oculus Rift was used in 41.7% of studies, HTC Vive in 25%, Samsung Gear in 16.7% of studies, Google Daydream in 8%, and 1 study did not report. The mean Medical Education Research Quality Instrument (MERSQI) score was 10.3 ± 2.3 (out of 18). In all studies researching clinical decision-making, participants preferred IVR to conventional teaching methods and in a nonrandomized control study it was found to be more effective. Averaged across all studies, mean scores were 4.33 for enjoyment, 4.16 for utility, 4.11 for usability, and 3.73 for immersion on a 5-point Likert scale. CONCLUSIONS The IVR nontechnical skills applications for surgical education are designed for clinical decision-making or anatomy/pre-operative planning. These applications are primarily noncommercially produced and rely upon a diverse array of HMDs for content delivery, suggesting that development is primarily coming from within academia and still without clarity on optimal utilization of the technology. Excitingly, users find these applications to be immersive, enjoyable, usable, and of utility in learning. Although a few studies suggest that IVR is additive or superior to conventional teaching or imaging methods, the data is mixed and derived from studies with weak design. Motion sickness with IVR remains a complication of IVR use needing further study to determine the cause and means of mitigation.
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Affiliation(s)
- William S Yi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armaun D Rouhi
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caoimhe C Duffy
- Department of Anesthesiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yazid K Ghanem
- Department of Surgery, Cooper University Hospital, Camden, New Jersey
| | - Noel N Williams
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Surgical Education, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Medicine Clinical Simulation Center, University of Pennsylvania, Philadelphia, Pennsylvania.
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Kuhn AW, Yu JK, Gerull KM, Silverman RM, Aleem AW. Virtual Reality and Surgical Simulation Training for Orthopaedic Surgery Residents: A Qualitative Assessment of Trainee Perspectives. JB JS Open Access 2024; 9:e23.00142. [PMID: 38511201 PMCID: PMC10950179 DOI: 10.2106/jbjs.oa.23.00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background The demonstrated benefits of virtual reality (VR) in orthopaedic surgical training are numerous. However, it is relatively unknown how best to implement VR into an already established orthopaedic resident education curriculum and how trainees will engage and use these technologies longitudinally. Methods This was an exploratory, qualitative research study performed in accordance with Consolidated Criteria for Reporting Qualitative Research guidelines. Orthopaedic surgery residents at a single institution were recruited during the 2022 to 2023 academic year. Semistructured interviews were conducted. Data were analyzed through grounded theory methodology, beginning with open coding, followed by axial coding, and concluding with selective coding that describes orthopaedic surgery residents' current perceptions of VR as a training tool. Results Six residents participated in interviews before thematic saturation was achieved. Average interview length was 13:27 (±2:59) minutes. Residents felt that currently, VR is most useful for interns and junior residents as an educational adjunct for learning anatomy, surgical exposures, and the steps of a procedure in a risk- and judgment-free arena. There seems to be a "ceiling effect" with VR given current technological limitations, and residents remarked that there is an associated "opportunity cost" with using VR technology. Some residents may find it more time-efficient to study texts, videos, or surgical guides rather than use VR. Cost (limited number of headsets) and technological barriers (i.e., hardware, software, and Wi-Fi issues) were some of the described barriers to VR utilization. Residents felt that there needs to be dedicated technological support to help with these issues. At this time, given these limitations of VR, many preferred VR as an optional educational adjunct rather than as a required curricular tool or assessment of surgical competency. Conclusions There is current utility for VR in orthopaedic surgical training. Future technological advances may make VR more central to resident education. This study describes resident perceptions about the technology and best use practices for the technology. Level of Evidence Qualitative Study, Level V Evidence.
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Affiliation(s)
- Andrew W. Kuhn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Justin K. Yu
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Katherine M. Gerull
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Richard M. Silverman
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alexander W. Aleem
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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Woodall WJ, Chang EH, Toy S, Lee DR, Sherman JH. Does Extended Reality Simulation Improve Surgical/Procedural Learning and Patient Outcomes When Compared With Standard Training Methods?: A Systematic Review. Simul Healthc 2024; 19:S98-S111. [PMID: 38240622 DOI: 10.1097/sih.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The use of extended reality (XR) technologies, including virtual, augmented, and mixed reality, has increased within surgical and procedural training programs. Few studies have assessed experiential learning- and patient-based outcomes using XR compared with standard training methods. METHODS As a working group for the Society for Simulation in Healthcare, we used Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and a PICO strategy to perform a systematic review of 4238 articles to assess the effectiveness of XR technologies compared with standard training methods. Outcomes were grouped into knowledge, time-to-completion, technical proficiency, reactions, and patient outcomes. Because of study heterogeneity, a meta-analysis was not feasible. RESULTS Thirty-two studies met eligibility criteria: 18 randomized controlled trials, 7 comparative studies, and 7 systematic reviews. Outcomes of most studies included Kirkpatrick levels of evidence I-III (reactions, knowledge, and behavior), while few reported level IV outcomes (patient). The overall risk of bias was low. With few exceptions, included studies showed XR technology to be more effective than standard training methods in improving objective skills and performance, shortening procedure time, and receiving more positive learner ratings. However, XR use did not show significant differences in gained knowledge. CONCLUSIONS Surgical or procedural XR training may improve technical skill development among trainees and is generally favored over standard training methods. However, there should be an additional focus on how skill development translates to clinically relevant outcomes. We recommend longitudinal studies to examine retention and transfer of training to clinical settings, methods to improve timely, adaptive feedback for deliberate practice, and cost analyses.
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Affiliation(s)
- William J Woodall
- From the Medical College of Georgia (W.J.W.), Augusta, GA; Department of Otolaryngology (E.H.C.), University of Arizona, Tucson, AZ; Departments of Basic Science Education and Health Systems & Implementation Science (S.T.), Virginia Tech Carilion School of Medicine, Roanoke, VA; University of Michigan School of Nursing (D.R.L.), Ann Arbor, MI; and WVU Rockefeller Neuroscience Institute (J.H.S.), Morgantown, WV
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12
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Feenstra TM, van der Storm SL, Barsom EZ, Bonjer JH, Nieveen van Dijkum EJ, Schijven MP. Which, how, and what? Using digital tools to train surgical skills; a systematic review and meta-analysis. Surg Open Sci 2023; 16:100-110. [PMID: 37830074 PMCID: PMC10565595 DOI: 10.1016/j.sopen.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
Background Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated Which digital tools are available to train surgical skills, How these tools are used, How effective they are, and What skills they are intended to teach. Methods Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical. Results The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], P < 0.00001, I2 = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], P = 0.0001, I2 = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills. Conclusion While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula. Key message This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.
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Affiliation(s)
- Tim M. Feenstra
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Sebastiaan L. van der Storm
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
| | - Esther Z. Barsom
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
| | - Jaap H. Bonjer
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Cancer Centre Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Els J.M. Nieveen van Dijkum
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam institute for Infection and Immunity, Amsterdam, the Netherlands
| | - Marlies P. Schijven
- Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands
- Amsterdam Public Health, Digital Health, Amsterdam, the Netherlands
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13
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Edwards TC, Soussi D, Gupta S, Khan S, Patel A, Patil A, Liddle AD, Cobb JP, Logishetty K. Collaborative Team Training in Virtual Reality is Superior to Individual Learning For Performing Complex Open Surgery: A Randomized Controlled Trial. Ann Surg 2023; 278:850-857. [PMID: 37638414 PMCID: PMC10631503 DOI: 10.1097/sla.0000000000006079] [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: 08/29/2023]
Abstract
OBJECTIVE To assess whether multiplayer immersive Virtual Reality (iVR) training was superior to single-player training for the acquisition of both technical and nontechnical skills in learning complex surgery. BACKGROUND Superior teamwork in the operating room (OR) is associated with improved technical performance and clinical outcomes. iVR can successfully train OR staff individually; however, iVR team training has yet to be investigated. METHODS Forty participants were randomized to individual or team iVR training. Individually trained participants practiced alongside virtual avatar counterparts, whereas teams trained live in pairs. Both groups underwent 5 iVR training sessions over 6 weeks. Subsequently, they completed a real-life assessment in which they performed anterior approach total hip arthroplasty surgery on a high-fidelity model with real equipment in a simulated OR. Teams performed together, and individually trained participants were randomly paired up. Videos were marked by 2 blinded assessors recording the 'Non-Operative Technical Skills for Surgeons, Oxford NOn-TECHnical Skills II and Scrub Practitioners' List of Intraoperative Non-Technical Skills' scores. Secondary outcomes were procedure duration and the number of technical errors. RESULTS Teams outperformed individually trained participants for nontechnical skills in the real-world assessment (Non-Operative Technical Skills for Surgeons: 13.1±1.5 vs 10.6±1.6, P = 0.002, Non-TECHnical Skills II score: 51.7 ± 5.5 vs 42.3 ± 5.6, P = 0.001 and Scrub Practitioners' List of Intraoperative Non-Technical Skills: 10 ± 1.2 vs 7.9 ± 1.6, P = 0.004). They completed the assessment 33% faster (28.2 minutes ± 5.5 vs 41.8 ± 8.9, P < 0.001), and made fewer than half the number of technical errors (10.4 ± 6.1 vs 22.6 ± 5.4, P < 0.001). CONCLUSIONS Multiplayer training leads to faster surgery with fewer technical errors and the development of superior nontechnical skills.
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Matwala K, Shakir T, Bhan C, Chand M. The surgical metaverse. Cir Esp 2023:S2173-5077(23)00229-6. [PMID: 37984726 DOI: 10.1016/j.cireng.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/14/2023] [Indexed: 11/22/2023]
Abstract
Recent developments have seen acceleration in the development of virtual reality (VR) and augmented reality (AR) technology. Through these developments, the metaverse has emerged. Within the metaverse, users create an avatar to experience an immersive, interactive extended reality. Current front-runners in its implementation are the financial, communication and entertainment sectors. This technology, however, is receiving greater recognition in the medical world, with national and international surgical bodies acknowledging the benefits that VR and the metaverse will have on surgical training and patient care. Its versatility means that we are likely to see VR related technology become intimately woven into the fabric of surgery in the next two decade. In this article, the impact of the metaverse on the surgical field will be discussed.
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Affiliation(s)
| | - Taner Shakir
- University College London Hospital, United Kingdom.
| | - Chetan Bhan
- University College London Hospital, United Kingdom
| | - Manish Chand
- University College London Hospital, United Kingdom
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Nazzal EM, Zsidai B, Hiemstra LA, Lustig S, Samuelsson K, Musahl V. Applications of Extended Reality in Orthopaedic Surgery. J Bone Joint Surg Am 2023; 105:1721-1729. [PMID: 37713502 DOI: 10.2106/jbjs.22.00805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
➤ Extended reality is a term that encompasses different modalities, including virtual reality, augmented reality, and mixed reality.➤ Although fully immersive virtual reality has benefits for developing procedural memory and technical skills, augmented and mixed reality are more appropriate modalities for preoperative planning and intraoperative utilization.➤ Current investigations on the role of extended reality in preoperative planning and intraoperative utilization are still in the early stages, but preliminarily show that extended reality technologies can help surgeons to be more accurate and efficient.
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Affiliation(s)
- Ehab M Nazzal
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bálint Zsidai
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Laurie A Hiemstra
- Banff Sport Medicine, Banff, Alberta, Canada
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Sébastien Lustig
- Department of Orthopaedic Surgery and Sports Medicine, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, Pennsylvania
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Co M, Chiu S, Billy Cheung HH. Extended reality in surgical education: A systematic review. Surgery 2023; 174:1175-1183. [PMID: 37640664 DOI: 10.1016/j.surg.2023.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/06/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND This review aims to evaluate the effectiveness of extended reality-based training in surgical education. METHODS This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS A total of 33 studies were included in the qualitative analysis. Nine studies evaluated the effectiveness of virtual reality-based training against no substitutional training. Seven studies looked at training for laparoscopic surgery, and the results were contradicting. Two studies focused on orthopedics training, and the outcomes were positive. Fourteen studies compared the outcomes of virtual reality-based training to conventional didactic teaching, all demonstrating superior outcomes for virtual reality-based training. Nine studies compared the outcomes of virtual reality simulation training to dry lab simulation training. The inferior outcomes of virtual reality simulation training were demonstrated by 5 studies for laparoscopic surgery, 1 study for arthroscopic procedures, 1 study for robotic surgery, and 1 study for dental procedures. One study found potential benefits of virtual reality simulation training on orthopedics surgeries. One study found virtual reality simulation training to be superior to cadaveric training, and 3 studies found augmented reality and virtual reality-based training to be comparable to supervised operative opportunities. CONCLUSION Extended reality-based training is a potentially useful modality to serve as an adjunct to the current physical surgical training.
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Affiliation(s)
- Michael Co
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China.
| | - Shirley Chiu
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China
| | - Ho Hung Billy Cheung
- Centre of Education and Training, Department of Surgery, University of Hong Kong, China
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Plancher KD, Morrey BF, McMahon GT, Ruch DS, Petterson SC. AOA Critical Issues Symposium: Leadership and Education During and After COVID-19: Back to the Future or a New Normal. J Bone Joint Surg Am 2023; 105:1560-1564. [PMID: 37220193 DOI: 10.2106/jbjs.22.01356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
ABSTRACT The devastating impact of COVID-19 has reshaped how we lead and train our future surgeons in the field of orthopaedics. Overnight, leaders in our field had to dramatically shift their mindset to continue to lead a hospital, department, journal, or residency or fellowship program in the face of an unprecedented level of adversity in the history of the United States. This symposium discusses the role of physician leadership during and after a pandemic, as well as the adoption of technology for training surgeons in the field of orthopaedics.
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Affiliation(s)
- K D Plancher
- Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
- Weill Cornell Medical College, New York, NY
| | - B F Morrey
- Department of Orthopaedics, UT Health San Antonio, San Antonio, Texas
- Joe R. & Teresa Lozano Long School of Medicine, San Antonio, Texas
| | - G T McMahon
- Accreditation Council for Continuing Medical Education, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - D S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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18
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Brennan JN, Hall AJ, Baird EJ. Online case-based educational meetings can increase knowledge, skills, and widen access to surgical training:The nationwideVirtualTrauma & Orthopaedic Meetingseries. Surgeon 2023; 21:e263-e270. [PMID: 36914519 DOI: 10.1016/j.surge.2023.02.005] [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: 12/04/2022] [Revised: 02/17/2023] [Accepted: 02/22/2023] [Indexed: 03/13/2023]
Abstract
BACKGROUND Access to surgical training is challenging for undergraduate and early postgraduate trainees due to a greater focus on developing generic knowledge and skills, and a drive to recruit greater numbers into internal medicine and primary care. COVID-19 accelerated the declining access to surgical training environments. Our aims were to: 1) establish the feasibility of an online, specialty-specific, case-based surgical training series, and 2) evaluate its suitability for meeting the needs of trainees. METHODS A nationwide audience of undergraduate and early postgraduate trainees were invited to a series of bespoke online case-based educational meetings in Trauma & Orthopaedics (T&O) over a six month period. The six sessions, which simulated real-world clinical meetings, were constructed by Consultant sub-specialists and involved the presentation of cases by registrars, followed by structured discussion of basic principles, radiological interpretation, and management strategies. Mixed qualitative and quantitative analyses were conducted. RESULTS There were 131 participants (59.5% male), consisting mostly of doctors in training (58%) and medical students (37.4%). The mean quality rating was 9.0/10 (SD 1.06), further supported by qualitative analysis. 98% enjoyed the sessions, 97% reported improved knowledge of T&O, and 94% reported a direct benefit to clinical practice. There was a significant improvement in knowledge of T&O conditions, management plans, and radiological interpretation (p = <0.05). CONCLUSION Structured virtual meetings, underpinned by bespoke clinical cases, may widen access to T&O training, increase flexibility and robustness of learning opportunities, and mitigate the effects of reduced exposure on preparation for surgical careers and recruitment.
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Affiliation(s)
- Joseph N Brennan
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew J Hall
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; Department of Orthopaedics, Golden Jubilee University National Hospital, Clydebank, UK; University of Edinburgh, Edinburgh, UK.
| | - Emily J Baird
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK; Royal Hospital for Children & Young People, Edinburgh, UK
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Lin H, Liu G, Wang X, Xu Q, Guo S, Hu R. A virtual simulation-based training program on birthing positions: a randomized controlled trial. BMC Nurs 2023; 22:318. [PMID: 37715171 PMCID: PMC10503076 DOI: 10.1186/s12912-023-01491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Restricting parturient women in healthcare facilities from choosing positions that provide the greatest comfort and benefit during labor is a global barrier. Several complex factors, including caregiver preference and medical intervention, shape the limitation. Therefore, a practical need exists to train midwives on the knowledge and skills to change this condition. METHODS The study used a parallel, single-blind, randomized controlled trial at a provincial maternity and child health hospital in Fujian, China, from June 1 to December 31, 2019. The midwives in a birth suite were selected and randomly enrolled in a one-month simulation-based hybrid training or face-to-face teaching in September 2019. The four-level Kirkpatrick's model, including reaction, learning, behavior, and results, was used to evaluate training effects before and after the program. Data were analyzed with SPSS 25.0 using Student's t-test, Spearman's correlation test, Mann-Whitney U test, Wilcoxon signed-rank test, and chi-square test analysis of variance. The significance level was set at p < 0.05. RESULTS Forty-two midwives were initially randomized to either the virtual simulation group or the face-to-face group. One midwife was excluded from the analysis due to intervention discontinuation, resulting in a final analysis of 41 midwives (n1 = 21, n2 = 20). Post-intervention, the virtual simulation group exhibited higher satisfaction and learning effects compared to the face-to-face group, while the rate of perineal incision in primiparas was lower (p<0.05). No significant changes or differences were observed in self-rated behavior between the two groups (p>0.05). The virtual simulation group demonstrated an increase in non-supine birth rate (p = 0.030) and a decrease in perineal incision rate among primiparas compared to pre-intervention (p = 0.035). Moreover, knowledge performance was associated with the duration of virtual simulation (r = 0.664, p = 0.001). CONCLUSIONS Virtual simulation is a fascinating innovation that enables midwives to develop birthing positions without practicing on real pregnant women and is one solution to achieve work competency within a shortened training period.
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Affiliation(s)
- Huimin Lin
- The School of Nursing, Fujian Medical University, Fuzhou City, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fuzhou City, China
| | - Guihua Liu
- The School of Nursing, Fujian Medical University, Fuzhou City, China
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fuzhou City, China
| | - Xiaoyan Wang
- The School of Nursing, Fujian Medical University, Fuzhou City, China
| | - Qin Xu
- The School of Nursing, Fujian Medical University, Fuzhou City, China
| | - Shengbin Guo
- Fujian Maternity and Child Health Hospital, College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fuzhou City, China.
| | - Rongfang Hu
- The School of Nursing, Fujian Medical University, Fuzhou City, China.
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20
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Le A, Lambers AP, Fraval A, Hardidge A, Balakumar J. Utility assessment of virtual reality technology in orthopaedic surgical training. ANZ J Surg 2023; 93:2092-2096. [PMID: 37128774 DOI: 10.1111/ans.18501] [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: 02/27/2023] [Revised: 04/23/2023] [Accepted: 04/25/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Virtual reality (VR) has proved to be a useful technology beyond the field of surgery in areas that are highly dependent on consolidating motor tasks. Despite being reliant on these skills, the uptake of VR in orthopaedics has been extremely limited. Therefore, this study's purpose was to help assess the utility of applying this technology in teaching different experience levels of orthopaedic training. Secondary objectives were to assess enjoyability and feasibility to complete modules prior to surgery. METHODS The study explored which experience level of orthopaedic trainee benefits the most from the proposed haptic VR package. Participants completed a total hip arthroplasty module using the Fundamental Surgery package. Qualitative data was collected in the form of a post completion survey of 24 participants. Quantitative data was collected in the form of module completion time and percentage of skills completed. RESULTS 37.5% of participants rated non-training orthopaedic registrars as the experience level that would benefit the most from using VR. 88% of participants would recommend this module to a colleague and found the module very enjoyable (4.2 out of 5). 50% of participants took between 25 and 31.5 min to finish and completed between 80% and 95% of tasks in the module. CONCLUSIONS The study demonstrated that non-training orthopaedic registrars were most likely to benefit using this particular VR package. Most users found the experience to be enjoyable and would recommend it to a colleague. It was also deemed feasible to complete the module prior to performing an operation.
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Affiliation(s)
- Allan Le
- Department of Orthopaedic Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Anton Philip Lambers
- Department of Orthopaedic Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Fraval
- Department of Orthopaedic Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Andrew Hardidge
- Department of Orthopaedic Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Jitendra Balakumar
- Department of Orthopaedic Surgery, Austin Health, Melbourne, Victoria, Australia
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James HK, Griffin DR, Griffin J, Fisher JD, Pattison GTR. Ankle fracture internal fixation performed by cadaveric simulation-trained versus standard-trained orthopaedic trainees: a preliminary, multicentre randomized controlled trial. Bone Jt Open 2023; 4:594-601. [PMID: 37586708 PMCID: PMC10546066 DOI: 10.1302/2633-1462.48.bjo-2022-0144.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Aims Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. Methods We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard training. Primary outcome was fracture reduction on postoperative radiographs. Results Overall, 139 ankle fractures were fixed by 28 postgraduate year three to five trainee surgeons (mean age 29.4 years; 71% males) during ten months' follow-up. Under the intention-to-treat principle, a technically superior fixation was performed by the cadaveric-trained group compared to the standard-trained group, as measured on the first postoperative radiograph against predefined acceptability thresholds. The cadaveric-trained group used a lower intraoperative dose of radiation than the standard-trained group (mean difference 0.011 Gym2, 95% confidence interval 0.003 to 0.019; p = 0.009). There was no difference in procedure time. Conclusion Trainees randomized to cadaveric training performed better ankle fracture fixations and irradiated patients less during surgery compared to standard-trained trainees. This effect, which was previously unknown, is likely to be a consequence of the intervention. Further study is required.
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Affiliation(s)
- Hannah K. James
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Damian R. Griffin
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Joanne D. Fisher
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry, UK
| | - Giles T. R. Pattison
- Department of Trauma & Orthopaedic Surgery, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
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Crockatt WK, Confino JE, Kopydlowski NJ, Jobin CM, Levine WN. Comparing Skill Acquisition and Validity of Immersive Virtual Reality with Cadaver Laboratory Sessions in Training for Reverse Total Shoulder Arthroplasty. JB JS Open Access 2023; 8:e22.00141. [PMID: 37415724 PMCID: PMC10319363 DOI: 10.2106/jbjs.oa.22.00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Immersive virtual reality (iVR) allows surgical trainees to practice skills without risking harm to patients or the need for cadaveric training resources. However, iVR has never been directly compared with cadaver training, the longtime gold standard for surgical skill training. We aimed to compare skill acquisition using cadaver laboratory and iVR training methods for augmented baseplate implantation during reverse total shoulder arthroplasty (rTSA). Methods In a randomized controlled trial, junior orthopaedic surgery residents were assigned to a 1-hour training with either iVR or a cadaveric laboratory session with shoulder specimens. Before training, all participants viewed an overview lecture and technique video demonstrating key steps of augmented baseplate implantation for rTSA. Participants were assessed by a blinded evaluator using validated competency checklists during cadaveric glenoid baseplate implantation. Continuous and categorial variables were analyzed using the 2-sample t test and Fisher exact test. Results Fourteen junior residents (3 incoming matched postgraduate year [PGY1], 6 PGY1s, 1 PGY2, and 4 PGY3s) were randomized to training with either iVR (n = 6) or cadaver laboratory (n = 8). There were no significant differences in demographic data, previous experience with rTSA, or previous use of iVR (p > 0.05). There were no significant difference in total Objective Structured Assessment of Technical Skill score (91.2% [15.2] vs. 93.25% [6.32], -0.1406 to 0.1823, p = 0.763), Global Rating Scale score (4.708 [0.459] vs. 4.609 [0.465], -0.647 to 0.450, p = 0.699), or time to completion (546 seconds [158] vs. 591 seconds [192], -176.3 to 266.8, p = 0.655) in cadaveric glenoid baseplate implantation. Average cost of iVR hardware and a 1-year software license was $4,900, and average cost of a single cadaver laboratory was $1,268.20 per resident. Conclusions Among junior orthopaedic residents, there is similar skill acquisition when training with either cadaver laboratory or iVR. Although additional research into this field is needed, iVR may provide an important and cost-effective tool in surgical education. Clinical Relevance Emerging simulation and iVR technology simulation in surgical training programs can increase access to effective and high-level surgical training across the globe and improve quality of care.
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Affiliation(s)
- William K. Crockatt
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Jamie E. Confino
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Nathan J. Kopydlowski
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Charles M. Jobin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - William N. Levine
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
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Thomas G, Long S, Kurtzhals T, Connor E, Anderson DD, Karam M, Kowalski H. A Dedicated Simulator Training Curriculum Improves Resident Performance in Surgical Management of Pediatric Supracondylar Humerus Fractures. JB JS Open Access 2023; 8:e23.00031. [PMID: 37701678 PMCID: PMC10489481 DOI: 10.2106/jbjs.oa.23.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background The primary goal of including simulation in residency training is to improve technical skills while working outside of the operating room. Such simulation-related skill improvements have seldom been measured in the operating room. This is largely because uncontrolled variables, such as injury severity, patient comorbidity, and anatomical variation, can bias evaluation of an operating surgeon's skill. In this study, performance during the wire navigation phase of pediatric supracondylar humerus fracture fixation was quantitatively compared between 2 groups of orthopaedic residents: a standard training group consisting of residents who participated in a single simulator session of wire navigation training and an expanded training group consisting of residents who participated in a dedicated multifaceted wire navigation simulation training curriculum. Methods To evaluate performance in the operating room, the full sequence of fluoroscopic images collected during wire navigation was quantitatively analyzed. Objective performance metrics included number of fluoroscopic images acquired, duration from placement of the first wire to that of the final wire, and wire spread at the level of the fracture. These metrics were measured from 97 pediatric supracondylar humerus fracture pinning surgeries performed by 28 different orthopaedic residents. Results No differences were observed between the groups for wire spread in the final fluoroscopic images (t(94) = 0.75, p = 0.45), an important clinical objective of the surgery. Residents who received the expanded simulator training used significantly fewer fluoroscopic images (mean of 46 vs. 61 images, t(85) = 2.25, p < 0.03) and required less time from first to final wire placement (mean of 11.2 vs. 14.9 minutes, t(83) = 2.53, p = 0.013) than the standard training group. A post hoc review of Accreditation Council for Graduate Medical Education case logs for 24 cases from the standard training group and for 21 cases from the expanded training group indicated that, at the time of surgeries, residents who received expanded training had completed fewer comparable cases than residents in the standard training group (mean of 13 vs. 21, t(42) = 2.40 p = 0.02). Further regression analysis indicated that the expanded simulator training produced an effect comparable with that associated with completing 10.5 similar surgical case experiences. Conclusions This study demonstrates that training on a wire navigation simulator can lead to improved performance in the operating room on a critical skill for all orthopaedic residents. By taking fewer images and less time while maintaining sufficient pin spread, simulator-trained residents were objectively measured to have improved performance in comparison with residents who had not participated in the pediatric elbow simulator curriculum. Clinical Relevance As programs aim to provide safe and effective training for critical orthopaedic skills such as pinning a pediatric elbow, this study demonstrates a simulator curriculum that has demonstrated the transfer of skill from a learning environment to the operating room.
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Affiliation(s)
- Geb Thomas
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
| | - Steven Long
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Trevor Kurtzhals
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
| | - Emily Connor
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Donald D. Anderson
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
- Department of Industrial and Systems Engineering, The University of Iowa, Iowa City, Iowa
- Department of Biomedical Engineering, The University of Iowa, Iowa City, Iowa
| | - Matthew Karam
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
| | - Heather Kowalski
- Department of Orthopedics and Rehabilitation, The University of Iowa, Iowa City, Iowa
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Koucheki R, Lex JR, Morozova A, Ferri D, Hauer TM, Mirzaie S, Ferguson PC, Ballyk B. Immersive Virtual Reality and Cadaveric Bone are Equally Effective in Skeletal Anatomy Education: A Randomized Crossover Noninferiority Trial. JOURNAL OF SURGICAL EDUCATION 2023; 80:1028-1038. [PMID: 37150701 DOI: 10.1016/j.jsurg.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/10/2023] [Accepted: 04/09/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Immersive virtual reality (IVR) technology is transforming medical education. Our aim was to compare the effectiveness of IVR with cadaveric bone models in teaching skeletal anatomy. DESIGN A randomized crossover noninferiority trial was conducted. SETTING Anatomy laboratory of a large medical school. PARTICIPANTS Incoming first-year medical students. Participants were randomized to IVR or cadaveric groups studying upper limb skeletal anatomy, and then were crossed over to use the opposite tool, to study lower limb skeletal anatomy. Participants in both groups completed a pre-and postintervention knowledge test. The primary endpoint of the study was change in performance from the pre-to postintervention knowledge test. Surveys were completed to assess participant's impressions on IVR as an educational tool. RESULTS Fifty first-year medical students met inclusion criteria and were randomized. Among all students, the average score on the preintervention knowledge test was 14.6% (standard deviation (SD) = 18.2%) and 25.0% (SD = 17%) for upper and lower limbs, respectively. Percentage increase in scores between pre-and postintervention knowledge test, was 15.0% in the upper limb IVR group, and 16.7% for upper limb cadaveric bones (p = 0.286). For the lower limb, score increase was 22.6% in the IVR and 22.5% in the cadaveric bone group (p = 0.936). 79% of participants found that IVR was most valuable for teaching 3-dimensional orientation, anatomical relationships, and key landmarks. Majority of participants were favorable towards combination use of traditional methods and IVR technology for learning skeletal anatomy (LSM>3). CONCLUSIONS In this randomized controlled trial, there was no significant difference in knowledge after using IVR or cadaveric bones for skeletal anatomy education. These findings have further implications for medical schools that face challenges in acquiring human cadavers and cadaveric parts.
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Affiliation(s)
- Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Biomedical Engineering, Toronto, Ontario, Canada.
| | - Johnathan R Lex
- Institute of Biomedical Engineering, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada
| | - Alexandra Morozova
- Division of Anatomy, University of Toronto, Ontario, Canada; Department of Anatomy, Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Dario Ferri
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tyler M Hauer
- Institute of Biomedical Engineering, Toronto, Ontario, Canada
| | - Sarah Mirzaie
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Peter C Ferguson
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, University of Toronto, Ontario, Canada; Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Barbara Ballyk
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Anatomy, University of Toronto, Ontario, Canada
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Morscheid YP, Pouessel F. [Simulators and other tools in orthopedic-trauma surgery training]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023:10.1007/s00132-023-04394-2. [PMID: 37286622 DOI: 10.1007/s00132-023-04394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION The classic paradigm of "learning on the patient in the operating room" is more and more in conflict with the growing requirements of cost-efficient work and patient safety. With the technology available today for simulator systems, the accessibility of digital tools and the development of a metaverse as a digital meeting place result in various application scenarios and alternatives to classic orthopedic training. SIMULATORS First VR-desktop simulations in orthopedics and traumatology were developed more than 20 years ago. VR-desktop simulators consist of a computer with a video screen and a joint model. Different instruments can be paired with this system and allow haptic feedback. With innovative software, numerous training programs can be selected, and the user receives precise feedback on their performance. Immersive VR simulators have also played an increasingly important role in recent years. OTHER DIGITAL TOOLS The use of digital media such as audio and video podcasts as learning and information sources increased in the context of COVID-19. There is also an increasing number of orthopedic and trauma surgery topics on social media platforms. In all fields, however, there is a risk of the spread of misinformation. A quality standard must be maintained. EFFECTIVENESS AND UTILITY OF THE TRAINING In order to evaluate simulators and their value as a training tool, it is important to comply with various validity criteria. Transfer validity plays an essential role for clinical application. Various studies demonstrate that the skills learned on simulators can also be successfully transferred to real clinical scenarios. DISCUSSION A lack of availability, costs and high effort are limitations of classic training methods. In contrast, there are versatile use cases of VR-based simulations that are individually adapted to the trainees and cannot endanger patients. The still high acquisition costs, technical obstacles and the not yet widespread availability are limiting factors. The metaverse still offers unimaginable possibilities today to transfer VR-based applications to experimental learning methods.
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Affiliation(s)
- Yannik P Morscheid
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Gebäude 37-38, 66421, Homburg, Deutschland.
| | - Florian Pouessel
- Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, Gebäude 37-38, 66421, Homburg, Deutschland
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Pettinelli NJ, Lee AY, Lee MS, Mahatme RJ, Gillinov SM, Jimenez AE. Virtual Reality Is an Effective Tool for Learning Techniques in Arthroplasty: A Systematic Review and Meta-Analysis. JAAOS: GLOBAL RESEARCH AND REVIEWS 2023; 7. [PMCID: PMC10284329 DOI: 10.5435/jaaosglobal-d-23-00078] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
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Cate G, Barnes J, Cherney S, Stambough J, Bumpass D, Barnes CL, Dickinson KJ. Current status of virtual reality simulation education for orthopedic residents: the need for a change in focus. GLOBAL SURGICAL EDUCATION : JOURNAL OF THE ASSOCIATION FOR SURGICAL EDUCATION 2023; 2:46. [PMID: 38013875 PMCID: PMC10032253 DOI: 10.1007/s44186-023-00120-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/23/2023] [Accepted: 03/06/2023] [Indexed: 03/24/2023]
Abstract
Introduction Advances in technology are changing surgical education. Simulation provides an important adjunct to operative experience. This pedagogy has arguably become more important in light of the COVID-19 pandemic, with resultant reduction in operative exposure for trainees. Virtual reality (VR) simulators may provide significant contribution to experiential learning; however, much of the investigative focus to date has, correctly, been on establishing validity evidence for these constructs. The aim of this work was to perform a scoping review to assess the current status of VR simulation education to determine curricular development efforts for orthopedic residents. Methods With a trained medical librarian, searches of PubMed, EMBASE, and Web of Science were conducted for all articles in the last 10 years (September 2011-September 2021). Controlled vocabulary Medical Subject Headings (MeSH) terms and natural language developed with subject matter experts describing virtual reality or VR simulation and orthopedic training were used. Two trained reviewers evaluated all abstracts for inclusion. Exclusion criteria were all articles that did not assess VR simulation education involving orthopedic residents. Data were extracted from the included full-text articles including: study design, type of participants, type of VR simulation, simulated orthopedic skill, type of educational event, learner assessment including Kirkpatrick's level, assessment of quality using the Medical Education Research Study Quality Instrument (MERSQI), and level of effectiveness (LoE). Results Initial search identified 1,394 articles, of which 61 were included in the final qualitative synthesis. The majority (54%) were published in 2019- 2021, 49% in Europe. The commonest VR simulator was ArthroS (23%) and the commonest simulated skill was knee arthroscopy (33%). The majority of studies (70%) focused on simulator validation. Twenty-three studies described an educational module or curriculum, and of the 21 (34%) educational modules, 43% were one-off events. Most modules (18/21, 86%) assessed learners at Kirkpatrick level 2. With regard to methodological quality, 44% of studies had MERSQI 11.5-15 and 89% of studies had LoE of 2. Two studies had LoE of 3. Conclusion Current literature pertaining to VR training for orthopedic residents is focused on establishing validity and rarely forms part of a curriculum. Where the focus is education, the majority are discrete educational modules and do not teach a comprehensive amalgam of orthopedic skills. This suggests focus is needed to embed VR simulation training within formal curricula efforts guided by the work of Kern, and assess the efficacy of these against patient outcomes.
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Affiliation(s)
- Graham Cate
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jack Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Steven Cherney
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Jeffrey Stambough
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - David Bumpass
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - C. Lowry Barnes
- Department of Orthopedics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Karen J. Dickinson
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR USA
- Office of Interprofessional Education, University of Arkansas for Medical Sciences, Little Rock, USA
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Application of Virtual Reality Systems in Bone Trauma Procedures. Medicina (B Aires) 2023; 59:medicina59030562. [PMID: 36984563 PMCID: PMC10058640 DOI: 10.3390/medicina59030562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/02/2023] [Accepted: 03/10/2023] [Indexed: 03/18/2023] Open
Abstract
Background and Objectives: Bone fractures contribute significantly to the global disease and disability burden and are associated with a high and escalating incidence and tremendous economic consequences. The increasingly challenging climate of orthopaedic training and practice re-echoes the established potential of leveraging computer-based reality technologies to support patient-specific simulations for procedural teaching and surgical precision. Unfortunately, despite the recognised potential of virtual reality technologies in orthopaedic surgery, its adoption and integration, particularly in fracture procedures, have lagged behind other surgical specialities. We aimed to review the available virtual reality systems adapted for orthopaedic trauma procedures. Materials and Methods: We performed an extensive literature search in Medline (PubMed), Science Direct, SpringerLink, and Google Scholar and presented a narrative synthesis of the state of the art on virtual reality systems for bone trauma procedures. Results: We categorised existing simulation modalities into those for fracture fixation techniques, drilling procedures, and prosthetic design and implantation and described the important technical features, as well as their clinical validity and applications. Conclusions: Over the past decade, an increasing number of high- and low-fidelity virtual reality systems for bone trauma procedures have been introduced, demonstrating important benefits with regard to improving procedural teaching and learning, preoperative planning and rehearsal, intraoperative precision and efficiency, and postoperative outcomes. However, further technical developments in line with industry benchmarks and metrics are needed in addition to more standardised and rigorous clinical validation.
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Sun P, Zhao Y, Men J, Ma ZR, Jiang HZ, Liu CY, Feng W. Application of Virtual and Augmented Reality Technology in Hip Surgery: Systematic Review. J Med Internet Res 2023; 25:e37599. [PMID: 36651587 PMCID: PMC10039409 DOI: 10.2196/37599] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/07/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Virtual and augmented reality (VAR) represents a combination of current state-of-the-art computer and imaging technologies and has the potential to be a revolutionary technology in many surgical fields. An increasing number of investigators have developed and applied VAR in hip-related surgery with the aim of using this technology to reduce hip surgery-related complications, improve surgical success rates, and reduce surgical risks. These technologies are beginning to be widely used in hip-related preoperative operation simulation and training, intraoperative navigation tools in the operating room, and postoperative rehabilitation. OBJECTIVE With the aim of reviewing the current status of virtual reality (VR) and augmented reality (AR) in hip-related surgery and summarizing its benefits, we discussed and briefly described the applicability, advantages, limitations, and future perspectives of VR and AR techniques in hip-related surgery, such as preoperative operation simulation and training; explored the possible future applications of AR in the operating room; and discussed the bright prospects of VR and AR technologies in postoperative rehabilitation after hip surgery. METHODS We searched the PubMed and Web of Science databases using the following key search terms: ("virtual reality" OR "augmented reality") AND ("pelvis" OR "hip"). The literature on basic and clinical research related to the aforementioned key search terms, that is, studies evaluating the key factors, challenges, or problems of using of VAR technology in hip-related surgery, was collected. RESULTS A total of 40 studies and reports were included and classified into the following categories: total hip arthroplasty, hip resurfacing, femoral neck fracture, pelvic fracture, acetabular fracture, tumor, arthroscopy, and postoperative rehabilitation. Quality assessment could be performed in 30 studies. Among the clinical studies, there were 16 case series with an average score of 89 out of 100 points (89%) and 1 case report that scored 81 (SD 10.11) out of 100 points (81%) according to the Joanna Briggs Institute Critical Appraisal Checklist. Two cadaveric studies scored 85 of 100 points (85%) and 92 of 100 points (92%) according to the Quality Appraisal for Cadaveric Studies scale. CONCLUSIONS VR and AR technologies hold great promise for hip-related surgeries, especially for preoperative operation simulation and training, feasibility applications in the operating room, and postoperative rehabilitation, and have the potential to assist orthopedic surgeons in operating more accurately and safely. More comparative studies are necessary, including studies focusing on clinical outcomes and cost-effectiveness.
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Affiliation(s)
- Peng Sun
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Yao Zhao
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Jie Men
- Department of Bone and Joint Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yan tai, China
| | - Zhe-Ru Ma
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Hao-Zhuo Jiang
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Cheng-Yan Liu
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
| | - Wei Feng
- Department of Bone and Joint Surgery, Orthopaedic Center, The First Hospital of Jilin University, Chang chun, China
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Zhang J, Lu V, Khanduja V. The impact of extended reality on surgery: a scoping review. INTERNATIONAL ORTHOPAEDICS 2023; 47:611-621. [PMID: 36645474 PMCID: PMC9841146 DOI: 10.1007/s00264-022-05663-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/03/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Extended reality (XR) is defined as a spectrum of technologies that range from purely virtual environments to enhanced real-world environments. In the past two decades, XR-assisted surgery has seen an increase in its use and also in research and development. This scoping review aims to map out the historical trends in these technologies and their future prospects, with an emphasis on the reported outcomes and ethical considerations on the use of these technologies. METHODS A systematic search of PubMed, Scopus, and Embase for literature related to XR-assisted surgery and telesurgery was performed using Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines. Primary studies, peer-reviewed articles that described procedures performed by surgeons on human subjects and cadavers, as well as studies describing general surgical education, were included. Non-surgical procedures, bedside procedures, veterinary procedures, procedures performed by medical students, and review articles were excluded. Studies were classified into the following categories: impact on surgery (pre-operative planning and intra-operative navigation/guidance), impact on the patient (pain and anxiety), and impact on the surgeon (surgical training and surgeon confidence). RESULTS One hundred and sixty-eight studies were included for analysis. Thirty-one studies investigated the use of XR for pre-operative planning concluded that virtual reality (VR) enhanced the surgeon's spatial awareness of important anatomical landmarks. This leads to shorter operating sessions and decreases surgical insult. Forty-nine studies explored the use of XR for intra-operative planning. They noted that augmented reality (AR) headsets highlight key landmarks, as well as important structures to avoid, which lowers the chance of accidental surgical trauma. Eleven studies investigated patients' pain and noted that VR is able to generate a meditative state. This is beneficial for patients, as it reduces the need for analgesics. Ten studies commented on patient anxiety, suggesting that VR is unsuccessful at altering patients' physiological parameters such as mean arterial blood pressure or cortisol levels. Sixty studies investigated surgical training whilst seven studies suggested that the use of XR-assisted technology increased surgeon confidence. CONCLUSION The growth of XR-assisted surgery is driven by advances in hardware and software. Whilst augmented virtuality and mixed reality are underexplored, the use of VR is growing especially in the fields of surgical training and pre-operative planning. Real-time intra-operative guidance is key for surgical precision, which is being supplemented with AR technology. XR-assisted surgery is likely to undertake a greater role in the near future, given the effect of COVID-19 limiting physical presence and the increasing complexity of surgical procedures.
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Affiliation(s)
- James Zhang
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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Casey JC, Daniels AH. CORR Synthesis: How Have Film Review and Motion Analysis Been Used to Enhance Orthopaedic Surgical Performance? Clin Orthop Relat Res 2023; 481:564-579. [PMID: 36719752 PMCID: PMC9928675 DOI: 10.1097/corr.0000000000002506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/02/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Jack C. Casey
- Division of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alan H. Daniels
- Division of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Su S, Wang R, Zhou R, Chen Z, Zhou F. The effectiveness of virtual reality, augmented reality, and mixed reality training in total hip arthroplasty: a systematic review and meta-analysis. J Orthop Surg Res 2023; 18:121. [PMID: 36803782 PMCID: PMC9940416 DOI: 10.1186/s13018-023-03604-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/10/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Extended reality (XR), including virtual reality (VR), augmented reality (AR), and mixed reality (MR), has been used in the training of total hip arthroplasty (THA). This study aims to examine the effectiveness of XR training in THA. METHODS In this systematic review and meta-analysis, we searched PubMed (MEDLINE), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and clinicaltrials.gov from inception to September 2022 for eligible studies. The Review Manager 5.4 software was applied to compare accuracy of inclination and anteversion, and surgical duration between XR training and conventional methods. RESULTS We identified 213 articles, of which 4 randomized clinical trials and 1 prospective controlled study including 106 participants met inclusion criteria. The pooled data indicated the XR training had better accuracy of inclination and shorter surgical duration than conventional methods (MD = -2.07, 95% CI [- 4.02 to -0.11], P = 0.04; SMD = -1.30, 95% CI [- 2.01 to -0.60], P = 0.0003), but the accuracy of anteversion was similar in the two groups. CONCLUSIONS This systematic review and meta-analysis found XR training had better accuracy of inclination and shorter surgical duration than conventional methods in THA, but the accuracy of anteversion was similar. Based on the pooled results, we suggested that XR training can better improve trainees' surgical skills than conventional methods in THA.
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Affiliation(s)
- Shilong Su
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Ruideng Wang
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Rubing Zhou
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Zhengyang Chen
- grid.411642.40000 0004 0605 3760Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191 China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191, China.
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Zagury-Orly I, Solinski MA, Nguyen LH, Young M, Drozdowski V, Bain PA, Gantwerker EA. What is the Current State of Extended Reality Use in Otolaryngology Training? A Scoping Review. Laryngoscope 2023; 133:227-234. [PMID: 35548939 DOI: 10.1002/lary.30174] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To map current literature on the educational use of extended reality (XR) in Otolaryngology-Head and Neck Surgery (OHNS) to inform teaching and research. STUDY DESIGN Scoping Review. METHODS A scoping review was conducted, identifying literature through MEDLINE, Ovid Embase, and Web of Science databases. Findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review checklist. Studies were included if they involved OHNS trainees or medical students who used XR for an educational purpose in OHNS. XR was defined as: fully-immersive virtual reality (VR) using head-mounted displays (HMDs), non-immersive and semi-immersive VR, augmented reality (AR), or mixed reality (MR). Data on device use were extracted, and educational outcomes were analyzed according to Kirkpatrick's evaluation framework. RESULTS Of the 1,434 unique abstracts identified, 40 articles were included. All articles reported on VR; none discussed AR or MR. Twenty-nine articles were categorized as semi-immersive, none used occlusive HMDs therefore, none met modern definitions of immersive VR. Most studies (29 of 40) targeted temporal bone surgery. Using the Kirkpatrick four-level evaluation model, all studies were limited to level-1 (learner reaction) or level-2 (knowledge or skill performance). CONCLUSIONS Current educational applications of XR in OHNS are limited to VR, do not fully immerse participants and do not assess higher-level learning outcomes. The educational OHNS community would benefit from a shared definition for VR technology, assessment of skills transfer (level-3 and higher), and deliberate testing of AR, MR, and procedures beyond temporal bone surgery. Laryngoscope, 133:227-234, 2023.
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Affiliation(s)
- Ivry Zagury-Orly
- Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Mark A Solinski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Lily Hp Nguyen
- Department of Otolaryngology-Head and Neck Surgery, McGill University, Montreal, Quebec, Canada.,Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Meredith Young
- Institute of Health Sciences Education, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.,Department of Medicine, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Veronica Drozdowski
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, USA
| | - Paul A Bain
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric A Gantwerker
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
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Curran VR, Xu X, Aydin MY, Meruvia-Pastor O. Use of Extended Reality in Medical Education: An Integrative Review. MEDICAL SCIENCE EDUCATOR 2023; 33:275-286. [PMID: 36569366 PMCID: PMC9761044 DOI: 10.1007/s40670-022-01698-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
UNLABELLED Extended reality (XR) has emerged as an innovative simulation-based learning modality. An integrative review was undertaken to explore the nature of evidence, usage, and effectiveness of XR modalities in medical education. One hundred and thirty-three (N = 133) studies and articles were reviewed. XR technologies are commonly reported in surgical and anatomical education, and the evidence suggests XR may be as effective as traditional medical education teaching methods and, potentially, a more cost-effective means of curriculum delivery. Further research to compare different variations of XR technologies and best applications in medical education and training are required to advance the field. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40670-022-01698-4.
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Affiliation(s)
- Vernon R. Curran
- Office of Professional and Educational Development, Faculty of Medicine, Health Sciences Centre, Memorial University of Newfoundland, Room H2982, St. John’s, NL A1B 3V6 Canada
| | - Xiaolin Xu
- Faculty of Health Sciences, Queen’s University, Kingston, ON Canada
| | - Mustafa Yalin Aydin
- Department of Computer Sciences, Memorial University of Newfoundland, St. John’s, NL Canada
| | - Oscar Meruvia-Pastor
- Department of Computer Sciences, Memorial University of Newfoundland, St. John’s, NL Canada
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Abstract
SUMMARY STATEMENT Simulation-based training using virtual reality head-mounted displays (VR-HMD) is increasingly being used within the field of medical education. This article systematically reviews and appraises the quality of the literature on the use of VR-HMDs in medical education. A search in the databases PubMed/MEDLINE, Embase, ERIC, Scopus, Web of Science, Cochrane Library, and PsychINFO was carried out. Studies were screened according to predefined exclusion criteria, and quality was assessed using the Medical Education Research Study Quality Instrument. In total, 41 articles were included and thematically divided into 5 groups: anatomy, procedural skills, surgical procedures, communication skills, and clinical decision making. Participants highly appreciated using VR-HMD and rated it better than most other training methods. Virtual reality head-mounted display outperformed traditional methods of learning surgical procedures. Although VR-HMD showed promising results when learning anatomy, it was not considered better than other available study materials. No conclusive findings could be synthesized regarding the remaining 3 groups.
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Howgate D, Oliver M, Stebbins J, Roberts PG, Kendrick B, Rees J, Taylor S. Validating the accuracy of a novel virtual reality platform for determining implant orientation in simulated primary total hip replacement. Digit Health 2022; 8:20552076221141215. [PMCID: PMC9742742 DOI: 10.1177/20552076221141215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction Accurate acetabular cup and femoral stem component orientation are critical for optimising patient outcomes, reducing complications and increasing component longevity following total hip replacement (THR). This study aimed to determine the accuracy of a novel virtual reality (VR) platform in assessing component orientation in a simulated THR model. Methods The VR platform (HTC Vive Pro® system hardware) was compared against the validated Vicon® optical motion capture (MoCap) system. An acetabular cup and femoral stem were manually implanted across a range of orientations into pelvic and femur sawbones, respectively. Simultaneous readings of the acetabular cup operative anteversion (OA) and inclination (OI) and femoral stem alignment (FSA) and neck anteversion (FNA) were obtained from the VR and MoCap systems. Statistical analysis was performed using Pearson product-moment correlation coefficient (PPMCC) (Pearson’s r) and linear regression (R2). Results A total of 55 readings were obtained for the acetabular cup and 68 for the femoral stem model. The mean average differences in OA, OI, FSA and FNA between the systems were 3.44°, −0.01°, 0.01° and −0.04°, respectively. Strong positive correlations were demonstrated between both systems in OA, OI, FSA and FNA, with Pearson’s r = 0.92, 0.94, 0.99 and 0.99, and adjusted R2 = 0.82, 0.9, 0.98 and 0.98, respectively. Conclusion The novel VR platform is highly accurate and reliable in determining both acetabular cup and femoral stem component orientations in simulated THR models. This adaptable and cost-effective digital tracking platform may be modified for use in a range of simulated surgical training and educational purposes, particularly in orthopaedic surgery.
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Affiliation(s)
- Daniel Howgate
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK,Dinwoodie Charitable Company and Royal College of Surgeons of England Research Fellow, London, UK,Daniel Howgate, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), The Botnar Research Centre, University of Oxford, Old Road, Headington, Oxford, OX3 7LD, UK.
| | - Michael Oliver
- The MRC Weatherall Institute of Molecular Medicine, Oxford, UK
| | - Julie Stebbins
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK
| | - Patrick Garfjeld Roberts
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK
| | - Ben Kendrick
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK
| | - Jonathan Rees
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, The Botnar Research Centre, University of Oxford, Oxford, UK,NIHR Oxford Biomedical Research Centre, The Joint Research Office, Oxford, UK,Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, Oxfordshire, UK, London, UK
| | - Stephen Taylor
- The MRC Weatherall Institute of Molecular Medicine, Oxford, UK
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Vázquez Gómez M, Galipienso Eri M, Hernández Martínez A. [Translated article] Has 2020 been a lost year in orthopaedic surgery and trauma training? Residents’ perceptions. Rev Esp Cir Ortop Traumatol (Engl Ed) 2022; 66:T397-T402. [PMID: 35843551 PMCID: PMC9281451 DOI: 10.1016/j.recot.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/13/2021] [Indexed: 11/28/2022] Open
Abstract
Objective The COVID-19 pandemic has affected specialised healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopaedic surgery residency training has so far not been assessed. Material and methods An online survey of 17 questions was sent via web link to orthopaedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analysed. Results A total of 307 orthopaedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad. Conclusions The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximising learning opportunities.
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Berthold DP, Muench LN, Rupp MC, Siebenlist S, Cote MP, Mazzocca AD, Quindlen K. Head-Mounted Display Virtual Reality Is Effective in Orthopaedic Training: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1843-e1849. [PMID: 36312724 PMCID: PMC9596866 DOI: 10.1016/j.asmr.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/19/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose To conduct a systematic review to determine the efficacy of head-mounted display (HMD) virtual reality (VR) in orthopaedic surgical training. Methods A thorough search was conducted on PubMed for articles published between January 2000 and August 2020. Studies were included if they (1) concerned orthopaedic surgery, (2) dealt with an HMD VR device, (3) the technology was being used for training purposes, and (4) was a randomized control trial (RCT). Results Eight articles met the inclusion criteria. Analysis of the 8 RCTs reveals 6 of the 8 demonstrating HMD VR to be a superior training method to traditional-based training modules. However, in the remaining 2 articles, authors found no significant difference between the VR group and controls, but showed at least equivalent ability to train novice surgeons. Conclusions RCTs show promising evidence that HMD VR is an efficacious tool in surgical training for orthopaedic procedures, with most randomized clinical trials showing improvement in novice students/surgeons compared with controls. Clinical Relevance As VR technology advances, so must the research directed at determining the efficacy of such technologies at educating our novice surgeons. RCTs are already demonstrating the role HMD VR can play in the education of novice orthopaedic surgeons.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
- Address correspondence to Daniel P. Berthold, M.D., Department of Orthopaedic Sports Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.
| | - Lukas N. Muench
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Marco-Christopher Rupp
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Sebastian Siebenlist
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Mark P. Cote
- Department of Orthopaedic Surgery, University of Connecticut, Storrs, Connecticut, U.S.A
| | - Augustus D. Mazzocca
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
| | - Kevin Quindlen
- Department of Orthopaedic Surgery, University of Connecticut, Storrs, Connecticut, U.S.A
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Hall AJ, Walmsley P. Technology-enhanced learning in orthopaedics: Virtual reality and multi-modality educational workshops may be effective in the training of surgeons and operating department staff. Surgeon 2022:S1479-666X(22)00077-4. [PMID: 35624020 DOI: 10.1016/j.surge.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/06/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022]
Abstract
AIM The aims were to assess the utility of: 1) virtual reality-mediated simulation, and 2) a multi-modality 'Bootcamp' in the delivery of total knee arthroplasty (TKA) teaching to orthopaedic surgical trainees. BACKGROUND Surgical training opportunities are diminished as a result of the COVID-19 pandemic which may result in delays to training completion and gaps in the permanent workforce. Modern and technology-enhanced learning methods have been identified as having the potential to support high-quality and sustainable education. METHODS This mixed-methods study assessed the educational benefit of two activities designed to teach TKA to junior (ST1-3) orthopaedic trainees. A multi-modality training Bootcamp was delivered that included: virtual reality (VR) and saw-bone simulation; tutorials, and case-based symposia. The VR component was delivered to different participants (surgical trainees, scrub nurses, and consultants) on a further two separate occasions. Qualitative and quantitative data were collected pertaining to utility and performance. RESULTS Trainees reported that the Bootcamp improved comprehension of arthroplasty principles including component alignment, knee balancing, and intraoperative strategies. Case-based discussions helped develop diagnostic and decision-making skills. The VR activity improved understanding of the surgical process map, increased ability to anticipate steps, and consider the procedure strategically. All staff groups found the VR activity beneficial and would recommend it as a useful addition to a surgical department. CONCLUSION VR-mediated simulation could augment the education of surgical trainees and scrub team staff by improving comprehension of the surgical process map. Integrated multi-modality 'Bootcamp-style' training activities constructed around trainees' needs may provide a sustainable solution to bridge the experience gap related to reduced exposure to elective orthopaedic practice.
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Affiliation(s)
- Andrew J Hall
- Chief Resident & Research Fellow, Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK; MBChB Module Organiser, Department of Orthopaedics & Trauma, University of Edinburgh, UK; Clinical Teaching Fellow, Medical Education Directorate, NHS Lothian, UK.
| | - Phil Walmsley
- Consultant Orthopaedic Surgeon, Department of Trauma & Orthopaedics, NHS Fife, UK; Honorary Senior Lecturer, University of St Andrews Medical School, UK; Associate Postgraduate Dean (Quality), NHS Education for Scotland, UK.
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40
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Wang J, Wei L, Li H, Zhang H, Gu R, Zhang Y, Li Q, Sun T, Wang Y. Effectiveness of a Game-Based Phone Application in Educating Health Care Workers on the Proper Use of Personal Protective Equipment. J Contin Educ Nurs 2022; 53:212-220. [PMID: 35510925 DOI: 10.3928/00220124-20220414-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective This study explored the feasibility and effects of a game-based phone application for training health care workers to use personal protective equipment. Method A single-blind randomized controlled trial was conducted. All participants in the experimental group (n = 123) and the control group (n = 125) received 75 minutes of training and were provided with a video and a paper copy of the procedures. Participants in the experimental group used an additional game-based phone application to simulate the procedures. Results Participants in the experimental group practiced a median of 15 times (range, 14-19 times). The learning curve indicated that they needed at least 12 repetitions to master the skill. Score improvements (Z = -2.257, p = .024) in the experimental group were significantly superior to those in the control group, as were the incidences of procedural errors of hand hygiene (χ2 = 4.085, p = .043) and protective clothing (χ2 = 5.394, p = .02). Conclusion The game-based phone application simulation guided participants to practice enough times to master the skill, enhance their skill performance, and reduce the incidence of procedural errors. [J Contin Educ Nurs. 2022;53(5):212-220.].
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Digital Game-Based Support for Learning the Phlebotomy Procedure in the Biomedical Laboratory Scientist Education. COMPUTERS 2022. [DOI: 10.3390/computers11050059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Practice-based training in education is important, expensive, and resource-demanding. Digital games can provide complementary training opportunities for practicing procedural skills and increase the value of the limited laboratory training time in biomedical laboratory science (BLS) education. This paper presents how a serious game can be integrated in a BLS course and supplement traditional learning and teaching with accessible learning material for phlebotomy. To gather information on challenges relevant to integrating Digital Game-Based Learning (DGBL), a case was carried out using mixed methods. Through a semester-long study, following a longitudinal, interventional cohort study, data and information were obtained from teachers and students about the learning impact of the current application. The game motivated students to train more, and teachers were positive towards using it in education. The results provide increased insights into how DGBL can be integrated into education and give rise to a discussion of the current challenges of DGBL for practice-based learning.
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Evaluation of a Slipped Capital Femoral Epiphysis Virtual Reality Surgical Simulation for the Orthopaedic Trainee. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202204000-00020. [PMID: 35467580 PMCID: PMC9042586 DOI: 10.5435/jaaosglobal-d-22-00028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to compare outcomes between orthopaedic trainees using various preoperative training platforms (physical simulation [PS], virtual reality [VR], and reading/videos) in a slipped capital femoral epiphysis model.
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43
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Paquay M, Goffoy J, Chevalier S, Servotte JC, Ghuysen A. Relationships Between Internal Factors, Social Factors and the Sense of Presence in Virtual Reality-Based Simulations. Clin Simul Nurs 2022. [DOI: 10.1016/j.ecns.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alpaugh K, Ast MP, Haas SB. Immersive technologies for total knee arthroplasty surgical education. Arch Orthop Trauma Surg 2021; 141:2331-2335. [PMID: 34652513 DOI: 10.1007/s00402-021-04174-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 09/06/2021] [Indexed: 12/30/2022]
Abstract
The need to adapt surgical curricula to meet the demands of an increasingly restrictive training environment is rising. Modern constraints of surgical trainees including work-hour restrictions and concerns surrounding patient safety have created an opportunity to supplement traditional teaching methods with developing immersive technologies including virtual and augmented reality. Virtual reality (VR) and augmented reality (AR) have been preliminarily investigated as it relates to total joint arthroplasty. The purpose of this article is to discuss VR and AR as it applies to modern total knee replacement (TKR) surgical education.
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Affiliation(s)
- Kyle Alpaugh
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E. 70th Street, New York, NY, 10021, USA.
- Division of Hip and Knee Replacement, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
| | - Michael P Ast
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E. 70th Street, New York, NY, 10021, USA
| | - Steven B Haas
- Hospital for Special Surgery, Adult Reconstruction and Joint Replacement, 535 E. 70th Street, New York, NY, 10021, USA
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Nassar AK, Al-Manaseer F, Knowlton LM, Tuma F. Virtual reality (VR) as a simulation modality for technical skills acquisition. Ann Med Surg (Lond) 2021; 71:102945. [PMID: 34840738 PMCID: PMC8606692 DOI: 10.1016/j.amsu.2021.102945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 12/25/2022] Open
Abstract
Efforts continue to facilitate surgical skills training and provide accessible and safe training opportunities. Educational technology has played an essential role in minimizing the challenges facing traditional surgical training and providing feasible training opportunities. Simulation and virtual reality (VR) offer an important innovative training approach to enhance and supplement both technical and non-technical skills acquisition and overcome the many training challenges facing surgical training programs. To maximize the effectiveness of simulation modalities, an in-depth understanding of the cognitive learning theory is necessary. Knowing the stages and mental processes of skills acquisition when integrated with simulation applications can help trainees achieve maximal learning outcomes. This article aims to review important literature related to VR effectiveness and discuss the leading theories of technical skills acquisition related to VR simulation technologies. VR simulation offers an innovative training approach to supplement both technical and non-technical skills acquisition. VR simulation with haptic feedback is a promising modality for safe, repetitive, and learner-oriented operative training. VR simulation facilitates deliberate practice with built-in auto feedback to address limited staff resources. To maximize the effectiveness of simulation, an in-depth understanding of the cognitive learning theory is necessary.
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Affiliation(s)
| | | | | | - Faiz Tuma
- Central Michigan University College of Medicine, Saginaw, USA
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Le A, Krishna A, Lambers AP, Hardidge A, Balakumar J. Rationale and feasibility assessment of an institution-based virtual reality hub in orthopaedic surgical training: an Australian pilot study. ANZ J Surg 2021; 91:2767-2772. [PMID: 34791746 DOI: 10.1111/ans.17331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 10/05/2021] [Accepted: 10/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Virtual reality (VR) has been established as a valuable tool outside of medicine but there has been limited uptake in orthopaedics despite being a specialty heavily dependent on psychomotor skills. The purpose of this study was to assess the feasibility of setting up an on-site virtual reality surgical training hub for an orthopaedic surgery unit. A secondary objective was to document encountered hurdles to assist other institutions with a similar process. METHODS The study explored the logistical and organizational considerations in the process of creating a virtual reality training area. This included: review of location, set up management, funding arrangements, set up time, research opportunities and training time. Set up and completion times were recorded during a separate trial of 24 participants ranging from medical students to senior consultant orthopaedic surgeons. RESULTS A VR training area was successfully established over a period of 3 months. A dedicated area for training where the equipment remains permanently was designated to facilitate ease of use. Average set up took 7.5 min to turn the computer on and 25 min for the participants to start the module. Issues identified during set up were recorded. CONCLUSIONS The study demonstrated that it is possible to set up a dedicated area for virtual reality surgical training within a hospital unit. A dedicated lockable area is the most feasible method of establishing such a space and reduces the requirement to recalibrate and transfer equipment around the hospital.
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Affiliation(s)
- Allan Le
- Orthopaedic Surgery, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
| | - Anuj Krishna
- Orthopaedic Surgery, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
| | - Anton Philip Lambers
- Orthopaedic Surgery, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
| | - Andrew Hardidge
- Orthopaedic Surgery, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
| | - Jitendra Balakumar
- Orthopaedic Surgery, Austin and Repatriation Medical Centre, Melbourne, Victoria, Australia
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Hasan LK, Haratian A, Kim M, Bolia IK, Weber AE, Petrigliano FA. Virtual Reality in Orthopedic Surgery Training. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1295-1301. [PMID: 34785971 PMCID: PMC8590940 DOI: 10.2147/amep.s321885] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/25/2021] [Indexed: 06/09/2023]
Abstract
One emerging technology with the potential to improve and further transform the field of orthopaedic surgery is virtual reality (VR). VR has been explored and used in many different specialties with clinical applications, such as psychiatric therapy, pain management, rehabilitation, and traumatic brain injury. Recent studies have suggested that the use of VR during the training of orthopaedic surgery residents produces similar or improved surgical performance by residents. This is an area where VR can provide a tremendous benefit to the field of orthopaedic surgery, as it offers a safe and accessible complement to orthopaedic surgical training outside of the operating room (OR) and without involving patients directly. This review will elucidate the current state of virtual reality use in the training of orthopaedic surgeons and highlight key benefits and challenges in its application as a training resource.
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Affiliation(s)
- Laith K Hasan
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Aryan Haratian
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Michael Kim
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
| | - Frank A Petrigliano
- USC Epstein Family Center for Sports Medicine at Keck Medicine of USC, Los Angeles, CA, USA
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Novel Application of Immersive Virtual Reality Simulation Training: A Case Report. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202111000-00009. [PMID: 34807871 PMCID: PMC8604004 DOI: 10.5435/jaaosglobal-d-21-00114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/08/2021] [Indexed: 12/03/2022]
Abstract
Case: A percutaneous pinning of a slipped capital femoral epiphysis is described after the use of immersive virtual reality (iVR) training. This case report documents the first reported example of an immediate translation of surgical skill from iVR to the operating room. Conclusion: There is increasing evidence for the use of iVR in orthopaedic education. Several randomized controlled trials demonstrate improved trainee performance relative to control when measured in analogous operating room assessments. This is the first case report demonstrating direct patient care after the use of iVR. The implications of cost-effectiveness through skill transfer and patient safety are highlighted.
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Mitigating Surgical Skill Decay in Orthopaedics Using Virtual Simulation Learning. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202110000-00010. [PMID: 34637404 DOI: 10.5435/jaaosglobal-d-21-00193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND The COVID-19 pandemic has interrupted orthopaedic training structures for both surgeons and trainees. The concept of skill decay must be considered during inactivity of elective practice. The purpose of this study was to provide an evidence-based curriculum in association with immersive virtual reality (iVR) to prevent skill decay during periods of training cessation and beyond. METHODS A review of pertinent literature for orthopaedic surgical skill decay was performed. Early experience by faculty instructors and residency and fellowship program directors was gathered from multiple institutions with experience in virtual training methods including iVR. A proposed curriculum for cognitive and manual skill acquisition during COVID-19 was produced from qualitative narrative group opinion. RESULTS Skill decay can occur on the order of days to months and is dependent on the initial skill level. A novel curriculum for structured continuing medical education during and after periods of surgical disruption including e-learning, virtual meetings, and iVR simulators was produced from expert opinion and based on competency-based curriculum standards. CONCLUSION Skill decay mitigation strategies should use best available evidence technologies and course structures that satisfy advanced learning concepts. The virtual curriculum including iVR simulators may provide cost-effective solutions to training.
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3D virtual pre-operative planning may reduce the incidence of dorsal screw penetration in volar plating of intra-articular distal radius fractures. Eur J Trauma Emerg Surg 2021; 48:3911-3921. [PMID: 34623473 PMCID: PMC9532324 DOI: 10.1007/s00068-021-01800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 09/26/2021] [Indexed: 11/24/2022]
Abstract
Purpose To evaluate the effect of three-dimensional virtual pre-operative planning (3DVP) on the incidence of dorsal screw penetration after volar plating of distal radius fractures. Methods A cross-sectional diagnostic imaging study was performed. Twenty out of 50 patients were randomly selected from our index prospective cohort (IPC): a prior study evaluating dorsal tangential views (DTVs) in reducing dorsal screw penetration in internal fixation of intra-articular distal radius fractures using post-operative CT scans to quantify screw protrusion. Pre-operative CTs from this cohort were now used for 3DVP by three experienced orthopaedic trauma surgeons (supplementary video). 3DVP was compared with the corresponding post-operative CT for assessing screw lengths and incidence of dorsal penetration. The Wilcoxon Signed Ranks test was used to compare screw lengths and the Fishers’ exact for incidence of penetration. Results Three surgeons performed 3DVP for 20 distal radius fractures and virtually applied 60 volar plates and 273 screws. Median screw length was shorter in the 3DVP when compared to IPC: 18 mm (range, 12–22) versus 20 mm (range, 14–26) (p < 0.001). The number of penetrating screws was 5% (13/273 screws) in the 3DVP group compared to 11% (10/91 screws) in the IPC (p = 0.047). Corresponding to a reduction in incidence of at least one dorsally penetrating screw in 40% of patients in the IPC group, to 18% in the 3DVP group (p = 0.069). Conclusion Three-Dimensional Virtual Pre-Operative Planning (3DVP) may reduce the incidence of dorsally penetrating screws in patients treated with volar plating for intra-articular distal radius fractures. Level of evidence II, diagnostic imaging study. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01800-2.
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