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Background:
Mastery of laparoscopic skills is essential in surgical practice and requires considerable time and effort to achieve. The Virtual Basic Laparoscopic Skill Trainer (VBLaST-PC(©)) is a virtual simulator that was developed as a computerized version of the pattern cutting (PC) task in the Fundamentals of Laparoscopic Surgery (FLS) system....
Context in source publication
Context 1
... on the intermediate proficiency criteria score of 52, two students achieved the 5% acceptable failure rate (see Fig. 6) on the VBLaST simulator (MS 37 achieved at the 58 th trial and MS 30 at the 143 rd trial). The performance of MS 4 was between the two decision limits. All students showed transition points (MS 37 at the 12 th trial, MS4 at the 18 th trial, MS 14 at the 32 trial, Ms 26 & MS 22 at the 49 th trial and MS 14 at the 79 th ...
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Training improves skills in minimally invasive surgery. This study aimed to investigate the learning curves of complex motion parameters for both hands during a standardized training course using a novel measurement tool. An additional focus was placed on the parameters representing surgical safety and precision. Fifty-six laparoscopic novices part...
Citations
... Five studies are based on laparoscopic performance, all highlighting the non-superior or inferior outcome of VR simulation training compared to dry lab or box trainer simulation training. 10,14,15,32,33 Training with VR simulation training is also inferior to dry lab simulation regarding arthroscopic procedures 34 and robotic surgery. 35 Raison et al 35 demonstrated a significantly greater improvement in transferable skills after dry lab simulation training when compared to VR simulation training (Global Evaluative Assessment of Robotic Skills score þ5.6 after dry lab training, vs þ2.5 after VR simulation training; P ¼ .034). ...
... In addition, VR simulation training was consistently shown to be inferior to dry lab simulation training in the acquisition of transferable laparoscopic skills. 10,14,15,32,33 User feedback also showed that more time and effort were required to become familiarized with VR platforms. 36 In comparison, dry lab simulators such as box trainers are user-friendly, easily accessible, and relatively inexpensive. ...
... The included studies were from Europe [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]; Asia [44][45][46][47][48][49][50][51][52][53][54][55]; Oceania [56,57]; and North America [58][59][60][61][62][63][64][65][66][67][68][69][70][71][72]. ...
... One study reported that a shareable weblink was used but offered no specific information [32]. Regarding the remaining four studies, four different virtual learning environments were used: Basic Burns Management e-learning tool [66], Education in Dermatology [41], the VBLaST-PC system for fundamentals of laparoscopic surgery [70], and the CASUS-a case-based multimedia learning and authoring system for undergraduate, postgraduate and continuing education [28]. Thus, the studies showed substantial variation in the learning environment, making it difficult to draw conclusions of any kind. ...
... The abovementioned teaching methods included many tools, e.g., different types of virtual simulator models, digital scenarios, digital patients, and environments that could have been web-based or not. Four studies [28,34,46,70] used virtual reality (VR)/Augmented Reality (AR), 22 studies [24, 31, 36-39, 42, 43, 49-54, 57, 58, 60, 63, 64, 67, 69, 72] used virtual simulator (VS), four studies [30,55,56,61] used video, and four studies [32,33,41,62] used web-based technological tools. Some studies also utilized more than one tool. ...
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.
... As the workload of radiologists have increased significantly in the last decades, mainly due to the increasing number of time consuming cross-sectional images [19], alternative solutions such as with the involvement of alternative workforce in image annotation might be reasonable. Medical students have demonstrated variable learning rates in other medical contexts like surgery skills or ultrasound [20][21][22][23][24][25]. To our best knowledge, with the involvement of students in studying or annotating radiographic examinations no study has been performed so far. ...
... The literature features only a few related studies on the learning rates of students in medical topics [21][22][23]. In the context of radiology, we found a few studies on ultrasound tasks [20,24] and emergency neuroimaging [25]. ...
The use of artificial intelligence (AI) in image analysis is an intensively debated topic in the radiology community these days. AI computer vision algorithms typically rely on large-scale image databases, annotated by specialists. Developing and maintaining them is time-consuming, thus, the involvement of non-experts into the workflow of annotation should be considered. We assessed the learning rate of inexperienced evaluators regarding correct labeling of pediatric wrist fractures on digital radiographs. Students with and without a medical background labeled wrist fractures with bounding boxes in 7,000 radiographs over ten days. Pediatric radiologists regularly discussed their mistakes. We found F1 scores—as a measure for detection rate—to increase substantially under specialist feedback (mean 0.61±0.19 at day 1 to 0.97±0.02 at day 10, p<0.001), but not the Intersection over Union as a parameter for labeling precision (mean 0.27±0.29 at day 1 to 0.53±0.25 at day 10, p<0.001). The times needed to correct the students decreased significantly (mean 22.7±6.3 seconds per image at day 1 to 8.9±1.2 seconds at day 10, p<0.001) and were substantially lower as annotated by the radiologists alone. In conclusion our data showed, that the involvement of undergraduated students into annotation of pediatric wrist radiographs enables a substantial time saving for specialists, therefore, it should be considered.
... Written consent was obtained from each subject before starting the study. All subjects were instructed verbally with a standard set of instructions on how to complete the FLS pattern cutting task on the FLS-certified physical and the VR simulator 124 . For the completion of the FLS pattern cutting task, the right-handed subjects were asked to grasp the gauze using the left grasper (for traction) and cut along (and within) the circular stamp with the right laparoscopic scissors (for cutting). ...
Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain–behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R ² = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex ( F (1, 15) = 6.002, p = 0.027; partial η ² = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R ² = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.
... It has been widely used for the analysis of the learning curve in many medical procedures. 17 18 22-31 The experts' ratings on the transfer tests were tested for inter-rater reliability by calculating the Cronbach's alpha and then analyzed using a non-parametric Mann-Whitney U test for significance between the groups. ...
Objective
The virtual airway skills trainer (VAST) is a virtual reality simulator for training in cricothyroidotomy (CCT). The goal of the study is to test the effectiveness of training and transfer of skills of the VAST-CCT.
Methods
Two groups, control (no training) and simulation (2 weeks of proficiency-based training), participated in this study. Subjects in the control condition did not receive any training on the task whereas those in the simulation received a proficiency-based training on the task during a period of 2 weeks. Two weeks post-training, both groups performed CCT on the TraumaMan to demonstrate the transfer of skills.
Results
A total of (n=20) subjects participated in the study. The simulation group performed better than the control group at both the post-test (p<0.001) and retention test (p<0.001) on the simulator. The cumulative sum analysis showed that all subjects in the simulation group reached proficiency with acceptable failure rate within the 2 weeks of training. On the transfer test, the simulation group performed better on skin cut (p<0.001), intubation (p<0.001) and total score (p<0.001) than the control group.
Conclusions
The VAST-CCT is effective in training and skills transfer for the CCT procedure.
Level of evidence
Not applicable. Simulator validation study.
... Written consent was obtained from each subject before starting the study. All the subjects were instructed verbally with a standard set of instructions on how to complete the FLS pattern cutting task on the FLS-certified physical and the VR simulator 101 . For the completion of the FLS pattern cutting task, the right-handed subjects were asked to grasp the gauze using the left grasper (for traction) and cut along (and within) the circular stamp with the right laparoscopic scissors (for cutting). ...
Despite substantial progress towards establishing virtual reality (VR) simulators as a replacement for physical ones for skill training, its effect on the brain network during skill acquisition has not been well addressed. In this study, we employed portable optical neuroimaging technology and Granger causality approach to uncover the impact of the two medical simulation technologies on the directed functional brain network of the subjects with two different skill levels. The mobile brain-behavior relantionship was evaluated using functional near-infrared spectroscopy (fNIRS) while right-handed subjects performed well-established fundamentals of laparoscopic surgery (FLS) pattern cutting task. A multiple regression path analysis found that the cognitive-action information flow from the right prefrontal cortex to the supplementary motor area statistically significantly predicted the FLS task performance. Here, the skill level (expert vs novice) affected the cognitive-action information flow from the right prefrontal cortex and the efference copy information flow from the left primary motor cortex via supplementary motor area as hub to the cognitiveperception at the left prefrontal cortex, i.e., the action-preception link. The simulation technology (physical vs VR simulator) affected solely the cognitive-action information flow from the right prefrontal cortex to the left primary motor cortex; however, the interaction between the medical simulation technology) and the skill level affected the efference information flow from the left primary motor cortex to the right prefrontal cortex and from the supplementary motor area to the left prefrontal cortex. These discriminative findings are crucial since our VR simulator had face and construct validity. Therefore, our study highlighted the importance of efference information flow within the framework of the perception-action cycle when comparing medical simulation technology for visuomotor skill acquisition.
... Written consent was obtained from each subject before starting the study. All of the subjects were instructed verbally with a standard set of instructions on how to complete the FLS pattern cutting task on the FLS-certi ed physical and the VR simulator 125 . For the completion of the FLS pattern cutting task, the right-handed subjects were asked to grasp the gauze using the left grasper (for traction) and cut along (and within) the circular stamp with the right laparoscopic scissors (for cutting). ...
The comparison of the effects of physical and virtual reality (VR) simulators on the brain network during skill acquisition has not been well addressed. In this study, the brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) data from seven experienced right-handed surgeons and six right-handed medical students during the performance of a well-established Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks. Multiple regression path analysis found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F(2, 114) = 9, p < 0.001, and R ² = 0.136. The coefficient of variation (CoV) of the FLS performance score was statistically significantly related to the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F(2, 22) = 3.912, p = 0.035, and R ² = 0.262. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F(1,15) = 6.002, p = 0.027; partial η2 = 0.286). This involvement of the right prefrontal cortex is potentially related to the uncertainty that underpins FLS task performance based on skill level and medical simulator technology.
... Indeed, posterior SMA and right dorsal premotor area have been shown to be related to the bimanual coordination of finger movements [11] and medial prefrontal cortex is involved in long-term memory and decision making [12] expected to be different in experts versus novices. However, a lack of correspondence of brain functional connectivity to the surgical motor skills in VBLaST cohort needed further investigation since VBLaST has demonstrated face and construct validity [13,14] including skill transfer [15]. Here, learning bimanual coordination of finger movements by novices for PC task performance (speed and accuracy) is postulated to involve learning to modulate interhemispheric inhibition of the primary motor cortices so we included fNIRS of bilateral primary motor cortices in the current study. ...
... Conversely, fNIRS provided a portable low-cost solution without interfering with the certified FLS task environment. This is also relevant for neuroimaging guided transcranial electrical stimulation (tES) [22] where we have shown the feasibility of online monitoring of the brain activation during surgical training that can be facilitated with tES [23][24][25][13], [14]. Such portable neuroimaging guided tES approach, based on the brain-behavior correspondence, will allow subject-specific learning-stage specific application using multi-channel tES [26]. ...
Functional brain connectivity using functional near-infrared spectroscopy (fNIRS) during a pattern cutting (PC) task was investigated in physical and virtual simulators.
14 right-handed novice medical students were recruited and divided into separate cohorts for physical (N=8) and virtual (N=6) PC training. Functional brain connectivity measured were based on wavelet coherence (WCOH) from task-related oxygenated hemoglobin (HBO2) changes from baseline at left and right prefrontal cortex (LPFC, RPFC), left and right primary motor cortex (LPMC, RPMC), and supplementary motor area (SMA). HBO2 changes within the neurovascular frequency band (0.01-0.07Hz) from long-separation channels were used to compute average inter-regional WCOH metrics during the PC task. The coefficient of variation (CoV) of WCOH metrics and PC performance metrics were compared. WCOH metrics from short-separation fNIRS time-series were separately compared.
Partial eta squared effect size (Bonferroni correction) between the physical versus virtual simulator cohorts was found to be highest for LPMC-RPMC connectivity. Also, the percent change in magnitude-squared WCOH metric was statistically (p<0.05) different for LPMC-RPMC connectivity between the physical and the virtual simulator cohorts. Percent change in WCOH metrics from extracerebral sources was not different at the 5% significance level. Also, higher CoV for both LPMC-RPMC magnitude-squared WCOH metric and PC performance metrics were found in physical than a virtual simulator.
We conclude that interhemispheric connectivity of the primary motor cortex is the distinguishing functional brain connectivity feature between the physical versus the virtual simulator cohorts. Brain-behavior relationship based on CoV between the LPMC-RPMC magnitude-squared WCOH metric and the FLS PC performance metric provided novel insights into the neuroergonomics of the physical and virtual simulators that is crucial for validating Virtual Reality technology.
... Previous studies show that a minimum of 6 participants per group is required for assessing training [24,41]. Therefore, a total of 26 participants (16 males, 10 females) were retained for the study (N = 26), and were divided into three groups: the control group (N = 9) and two training groups (N = 9 and N = 8, respectively for training with the virtual hand and the tools only representation). ...
... In CUSUM analysis, positive or negative increments are added to a cumulative score according to the failure or success of the successive trial (36). The pass/fail threshold was set at the average score they received on the first five trials (FLS score of 33), a method derived from (37). This value is lower than 44 in the non-competent group in (38) and 39 in the novice group in (39). ...
Acquisition of fine motor skills is a time-consuming process as it requires frequent repetitions. Transcranial electrical stimulation is a promising means of enhancing simple motor skill development via neuromodulatory mechanisms. Here, we report that non-invasive neurostimulation facilitates the learning of complex fine bimanual motor skills associated with a surgical task. During the training of 17 medical students on the Fundamentals of Laparoscopic Surgery (FLS) pattern cutting task over a period of 12 days, we observed that transcranial direct current stimulation (tDCS) decreased the error level and the variability in performance, compared to the Sham group. By concurrently monitoring the cortical activations of the subjects via functional near-infrared spectroscopy (fNIRS), our study showed that the cortical activation significantly stimulated by tDCS. The lowered performance error and the increased brain activation were retained after one-month post-training. This work supports the use of tDCS to enhance performance accuracy in fine bimanual motor tasks.