Training and Transfer Effect of FluoroSim, an Augmented Reality Fluoroscopic Simulator for Dynamic Hip Screw Guidewire Insertion: A Single-Blinded Randomized Controlled Trial

The Role of Augmented Reality in Surgical Training: A Systematic Review

This review aims to provide an update on the role of augmented reality (AR) in surgical training and investigate whether the use of AR improves performance measures compared to traditional approaches in surgical trainees.

PUBMED, EMBASE, Google Scholar, Cochrane Library, British Library and Science Direct were searched following PRIMSA guidelines. All English language original studies pertaining to AR in surgical training were eligible for inclusion. Qualitative analysis was performed and results were categorised according to simulator models, subsequently being evaluated using Messick's framework for validity and McGaghie's translational outcomes for simulation-based learning.

Of the 1132 results retrieved, 45 were included in the study. 29 platforms were identified, with the highest 'level of effectiveness' recorded as 3. In terms of validity parameters, 10 AR models received a strong 'content validity' score of 2.15 models had a 'response processes' score ≥ 1. 'Internal structure' and 'consequences' were largely not discussed. 'Relations to other variables' was the best assessed criterion, with 9 platforms achieving a high score of 2. Overall, the Microsoft HoloLens received the highest level of recommendation for both validity and level of effectiveness.

Augmented reality in surgical education is feasible and effective as an adjunct to traditional training. The Microsoft HoloLens has shown the most promising results across all parameters and produced improved performance measures in surgical trainees. In terms of the other simulator models, further research is required with stronger study designs, in order to validate the use of AR in surgical training.

Exploring the activities and outcomes of digital teaching and learning of practical skills in higher education for the social and health care professions: a scoping review

Higher education for health care professionals faces numerous challenges. It is important to develop and apply methods supporting education, especially the practical skills. This scoping review aimed to explore the activities and learning outcomes of digital technology in practical skills teaching and learning in higher education for the social and health professions. Scoping review recommendations and the PRISMA-ScR checklist were applied. Randomized controlled trials published between 2016 and 2021 involving students in higher education who were taking courses in the social sciences and health care and reported interventions with digital technology activities and practices in practical teaching and learning were included. The CINAHL Plus, PubMed, Scopus, ERIC, and Sociological Abstracts/Social Services Abstracts databases were searched. Teaching methods were blended, e-learning or other online-based, and digital simulation-based activities. Teaching and learning environments, methods, resources, and activity characteristics varied, making a summary difficult. Interventions were developed in a face-to-face format prior to digitalization. The outcomes were measured at the knowledge level, not at the performance level. One-third of the studies showed a significant improvement in practical skills in the intervention group in comparison to the control conditions. The use of digital technology in the learning and teaching process have potential to develop of students' skills, knowledge, motivation, and attitudes. The pedagogy of technology use is decisive. The development of new digital methods for teaching and learning practical skills requires the engagement of students and teachers, in addition the researchers.

Head-Mounted Display Virtual Reality Is Effective in Orthopaedic Training: A Systematic Review

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.

Outcomes, Measurement Instruments, and Their Validity Evidence in Randomized Controlled Trials on Virtual, Augmented, and Mixed Reality in Undergraduate Medical Education: Systematic Mapping Review

BACKGROUND

Extended reality, which encompasses virtual reality (VR), augmented reality (AR), and mixed reality (MR), is increasingly used in medical education. Studies assessing the effectiveness of these new educational modalities should measure relevant outcomes using outcome measurement tools with validity evidence.

OBJECTIVE

Our aim is to determine the choice of outcomes, measurement instruments, and the use of measurement instruments with validity evidence in randomized controlled trials (RCTs) on the effectiveness of VR, AR, and MR in medical student education.

METHODS

We conducted a systematic mapping review. We searched 7 major bibliographic databases from January 1990 to April 2020, and 2 reviewers screened the citations and extracted data independently from the included studies. We report our findings in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

Of the 126 retrieved RCTs, 115 (91.3%) were on VR and 11 (8.7%) were on AR. No RCT on MR in medical student education was found. Of the 115 studies on VR, 64 (55.6%) were on VR simulators, 30 (26.1%) on screen-based VR, 9 (7.8%) on VR patient simulations, and 12 (10.4%) on VR serious games. Most studies reported only a single outcome and immediate postintervention assessment data. Skills outcome was the most common outcome reported in studies on VR simulators (97%), VR patient simulations (100%), and AR (73%). Knowledge was the most common outcome reported in studies on screen-based VR (80%) and VR serious games (58%). Less common outcomes included participants' attitudes, satisfaction, cognitive or mental load, learning efficacy, engagement or self-efficacy beliefs, emotional state, competency developed, and patient outcomes. At least one form of validity evidence was found in approximately half of the studies on VR simulators (55%), VR patient simulations (56%), VR serious games (58%), and AR (55%) and in a quarter of the studies on screen-based VR (27%). Most studies used assessment methods that were implemented in a nondigital format, such as paper-based written exercises or in-person assessments where examiners observed performance (72%).

CONCLUSIONS

RCTs on VR and AR in medical education report a restricted range of outcomes, mostly skills and knowledge. The studies largely report immediate postintervention outcome data and use assessment methods that are in a nondigital format. Future RCTs should include a broader set of outcomes, report on the validity evidence of the measurement instruments used, and explore the use of assessments that are implemented digitally.

A review of participant recruitment transparency for sound validation of hip surgery simulators: a novel umbrella approach

Malposition of implants is associated with complications, higher wear and increased revision rates in total hip replacement (THR) along with surgeon inexperience. Training THR residents to reach expert proficiency is affected by the high cost and resource limitations of traditional training techniques. Research in extended reality (XR) technologies can overcome such barriers. These offer a platform for learning, objective skill-monitoring and, potentially, for automated certification. Prior to their incorporation into curricula however, thorough validation must be undertaken. As validity is heavily dependent on the participants recruited, there is a need to review, scrutinise and define recruitment criteria in the absence of pre-defined standards, for sound simulator validation. A systematic review on PubMed and IEEE databases was conducted. Training simulator validation research in fracture, arthroscopy and arthroplasty relating to the hip was included. 46 validation studies were reviewed. It was observed that there was no uniformity in reporting or recruitment criteria, rendering cross-comparison challenging. This work developed Umbrella categories to help prioritise recruitment, and has formulated a detailed template of fields and guidelines for reporting criteria so that, in future, research may come to a consensus as to recruitment criteria for a hip "expert" or "novice".

Differences in the Exposure of the Lumbar Nerve Root Between Experts and Novices: Results From a Realistic Simulation Pilot Study With Force Sensors

STUDY DESIGN

Nonrandomized prospective trial.

OBJECTIVE

Several studies could demonstrate "learning curves" in almost every single surgical procedure for unexperienced surgeons. This is in sharp contrast to the rising quality requirements in public health care to provide surgical training at patients "expense." The aim of this study was to visualize, measure, and set a baseline of the pressure load on the spinal nerve root during a simulated microdiscectomy on a standardized and validated model (RealSpine) under the influence of the level of surgical experience and individual skills.

METHODS

Five highly experienced spine surgeons and 5 trainees without considerable surgical experience were selected to perform a standardized microsurgical discectomy on a validated RealSpine simulator. Force-torque sensors were integrated in this simulator to measure the load on the nerve root. The forces were recorded every 125 ms.

RESULTS

We could identify cumulative for the total intervention as well as for defined single surgical steps of this procedure and as well in between the single subjects a significant higher tension and contusion forces on the nerve for the trainee group (Δp contusion 83-765 Nċs and Δp tension 159-1131 Nċs for the trainees. Δp contusion 16-171 Nċs and Δp tension 27-146 Nċs for the experts).

CONCLUSION

We could measure a difference between unexperienced and experienced surgeons regarding the manipulations of the nerve root during a standardized simulated microdiscectomy. This possibility could be the starting point for a new and innovative surgical education to improve outcome without negative side effects of "learning curves."

Current Perspectives on Augmented Reality in Medical Education: Applications, Affordances and Limitations

This systematic review has been developed against a background of rapid developments in augmented reality (AR) technology and its application in medical education. The objectives are to provide a critical synthesis of current trends in the field and to highlight areas for further research. The data sources used for the study were the PubMed, Web of Science and Discover databases. Sources included in the study comprised peer reviewed journal articles published between 2015 and 2020. Inclusion criteria included empirical research findings related to learning outcomes and the populations for the selected studies were medical students. Studies were appraised in terms of to what extent the use of AR contributed to learning gains in knowledge and/or skill. Twenty-one studies were included in the analysis, and the dates of these suggested an increasing trend of publications in this area. The uses of AR in each selected study were analyzed through a lens of affordance, to identify which specific affordances of AR appear to be most effective in this domain. Results of the study indicated that AR seems to be more effective in supporting skill development rather than knowledge gain when compared to other techniques. Some key affordances of AR in medical education are identified as developing practical skills in a spatial context, device portability across locations and situated learning in context. It is suggested that a focus on relevant affordances when designing AR systems for medical education may lead to better learning outcomes. It is noted that the majority of AR systems reported in the selected studies are concentrated in the areas of anatomy and surgery, but that are also other areas of practice being explored, and these may provide opportunities for new types of AR learning systems to be developed for medical education.