Article

Can Video Games be Used to Predict or Improve Laparoscopic Skills?

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Abstract

Performance of laparoscopic surgery requires adequate hand-eye coordination. Video games are an effective way to judge one's hand-eye coordination, and practicing these games may improve one's skills. Our goal was to see if there is a correlation between skill in video games and skill in laparoscopy. Also, we hoped to demonstrate that practicing video games can improve one's laparoscopic skills. Eleven medical students (nine male, two female) volunteered to participate. On day 1, each student played three commercially available video games (Top Spin, XSN Sports; Project Gotham Racing 2, Bizarre Creations; and Amped 2, XSN Sports) for 30 minutes on an X-box (Microsoft, Seattle, WA) and was judged both objectively and subjectively. Next, the students performed four laparoscopic tasks (object transfer, tracing a figure-of-eight, suture placement, and knot-tying) in a swine model and were assessed for time to complete the task, number of errors committed, and hand-eye coordination. The students were then randomized to control (group A) or "training" (i.e., video game practicing; group B) arms. Two weeks later, all students repeated the laparoscopic skills laboratory and were reassessed. Spearman correlation coefficients demonstrated a significant relation between many of the parameters, particularly time to complete each task and hand-eye coordination at the different games. There was a weaker association between video game performance and both laparoscopic errors committed and hand-eye coordination. Group B subjects did not improve significantly over those in group A in any measure (P >0.05 for all). Video game aptitude appears to predict the level of laparoscopic skill in the novice surgeon. In this study, practicing video games did not improve one's laparoscopic skill significantly, but a larger study with more practice time could prove games to be helpful.

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... 4 In this respect VG play has been established to correlate positively with fundamental surgical skills. [5][6][7][8] Furthermore, playing VGs have been shown to be an effective mode of improving laparoscopic skills in surgical novices. 9 Given that interventional radiology (IR) and minimally invasive surgery both require a singular combination of dexterity and perception of 3-D environments in 2-D, VGs may also be relevant to the field of IR. ...
... 28 Herein we demonstrate a statistically significant, albeit relatively weak, positive correlation between past VG experience and IR skill that is consistent with analogous studies in the surgical literature. [5][6][7][8] Several cognitive learning theories describing skill acquisition have been promulgated to better understand simulation training in healthcare. 29 Transfer of learning details the effective extent to which past experiences in 1 context affect learning and performance in a new, but similar context. ...
... Perhaps the most striking result of this investigation is the lack of correlation between IR skills and VG skills, which is at odds with prior literature comparing VG to laparoscopic skills. 5,6 In general, it was thought that study power rather than the revelation of contradictory truths accounted for the discrepancy between current and past investigational findings, further discussed in limitations. The observation that VG skill was not directly applicable to IR skill may highlight the importance of acquiring transferable skills through situations highly specific to the task, such as is achievable through medical simulation. ...
Article
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Purpose To elucidate the relationship between video game (VG) play and interventional radiology (IR) technical skills in medical students. Materials and Methods Twenty medical students recruited at our institution’s IR symposium completed a survey to ascertain demographics and prior VG experience, then participated in a 3-part trial of skills assessing IR and VG skill and visuospatial aptitude (VSA). IR skill was evaluated via an endovascular simulation task, VG skill by performance on three separate VGs, and VSA using the Cube Comparison test. Regression analysis was tested the strength of relationship between IR skill and VG experience, VG skill, and VSA, respectively, and participants were stratified by IR skill to top and bottom halves for survey-response comparison. Results There was no correlation between either VG skill or visuospatial aptitude and IR skill (r = −0.22, p = 0.35; and r = 0.14, p = 0.57). Greater number of years playing VGs correlated with superior IR skill (Spearman’s rho=-0.45, p<0.05). Students who selected IR as their specialty of interest had extensive VG experience, playing for > 15 years (n = 4, 80%), at least 10 hours per week at their peak (n = 3, 60%), and reported being either “skilled” or “highly skilled” at VGs (n = 3, 60%). Conclusions In our study, though limited by power, number of years playing VGs correlated positively with IR skills in medical students. Prior VG experience may predict an early advanced capacity to learn IR skills and an interest in the specialty.
... Five randomized controlled trials, assessing the effect of video game use on laparoscopic surgical skills, are included in this review. [7][8][9][10][11] Two studies showed a significant reduction in error after the use of video games. 7,8 Several other vari-ables (time, path length of instruments, smoothness), however, were assessed in these two studies without yielding any significant difference between control and intervention groups. ...
... Two studies showed no difference between control (no video game warm-up) and intervention group (video game warm-up). 9, 10 Plerhoples and coworkers 7 made a considerable effort to eliminate confounders through stratification and randomization. There were, however, 15% more experienced trainees (>41 laparoscopic procedures performed) in the intervention group compared with the control group. ...
... VG players also more rapidly learn the proper perceptual templates as they experience new tasks compared to their non-VG playing counterparts [4]. VGs that use mechanics similar to those used in surgical tasks may impact the acquisition and/or supplementation of the basic visuospatial, motor, and attention skills required for surgical tasks [34]. These findings have spurred interest in studying the relationship between VG play and surgical skills, and use of VGs for various types of surgical skills training. ...
... Studies have found positive relationships between VGE and laparoscopic task performance in dry lab or in VR training settings [2,20,23,30,36,38]. When tested with a MIS VR trainer, VG players make significantly fewer errors, show better hand-eye coordination skills and are more efficient than those who do not play VGs regularly [12,32,34,38]. Some studies demonstrated causal evidence that training on VGs can improve bimanual dexterity and facilitate the development of basic laparoscopic skills [23,36,44]. ...
Article
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Robotic surgery is increasing in prevalence, thanks to its potential benefits for patients (e.g., reduced blood loss) and surgeons (e.g., ergonomics). It is important to know what inherent characteristics of potential surgeons may facilitate robotic surgery training and performance. Findings from previous studies indicate videogames can be inexpensive tools that help improve hand–eye coordination, coordination of 3-D movements with 2-D images, and spatial orientation. In the context of robotic-assisted knee arthroscopy using a MAKO robotic arm, this study explored performance and subjective experiences of novices (N = 104) with a fake bone shaving task at a public event. Participants’ performance was measured based on how much of the bone they successfully shaved. Findings showed that duration of videogame play per week was negatively related to performance with the robotic arm. Male and female participants performed similarly on the bone shaving task, and reported similar difficulty with and enjoyment of the task. However, female participants who played videogames performed better than those who did not play videogames. Participants who were younger than 11 had the worst performance and the most difficulty with the robotic arm. Overall, the findings indicate that the effect of videogame experience on the performance with the robotic arm may differ based on gender and age. This has implications on the length of training for surgeons of different gender using videogames and other emerging technologies.
... In the literature, a frequent topic of interest is the existence of a correlation between experience with computer games and surgical abilities (29)(30)(31)(32)(33)(34)(35)(36)(37)(38). We found in this study a significant positive correlation between experience with computer games and better scores on depth perception (Figure 4). ...
... We found in this study a significant positive correlation between experience with computer games and better scores on depth perception (Figure 4). This is in accordance with the findings of other similar studies (30)(31)(32)(33), whereas yet other studies did not find any statistically significant correlation between computer games experience and better clinical performance (34)(35)(36)(37)(38). A question of interest is whether playing computer games results in better visual-spatial abilities or manual dexterity, or whether those who play computer games have innate abilities that make them interested in activities that let them explore their abilities, such as computer games. ...
Article
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Background and objective: Virtual reality (VR) simulators enrich surgical training and offer training possibilities outside of the operating room (OR). In this study, we created a criterion-based training program on a VR simulator with haptic feedback and tested it by comparing the performances of a simulator group against a control group. Material and methods: Medical students with no experience in laparoscopy were randomly assigned to a simulator group or a control group. In the simulator group, the candidates trained until they reached predefined criteria on the LapSim(®) VR simulator (Surgical Science AB, Göteborg, Sweden) with haptic feedback (Xitact(TM) IHP, Mentice AB, Göteborg, Sweden). All candidates performed a cholecystectomy on a porcine organ model in a box trainer (the clinical setting). The performances were video rated by two surgeons blinded to subject training status. Results: In total, 30 students performed the cholecystectomy and had their videos rated (N = 16 simulator group, N = 14 control group). The control group achieved better video rating scores than the simulator group (p < .05). Conclusions: The criterion-based training program did not transfer skills to the clinical setting. Poor mechanical performance of the simulated haptic feedback is believed to have resulted in a negative training effect.
... Nevertheless, previous studies on laparoscopic skills assessment found that certain attributes, personal qualities and other non-surgical skill factors like playing video games, the regular use of chop sticks, playing a music instrument, dexterity, the type of laparoscopic teaching method and even gender may predict a better performance in the accomplishment of laparoscopic skills [3][4][5][6][7][8][9][10]. ...
... In contrast, previous studies found that non-surgical skills might be beneficial for developing surgical expertise [3][4][5][6][7][8][9][10]: playing video games turned out to correlate with a good handeye-coordination [15]; chopstick usage seems to be associated with laparoscopic ability [16]. In spite of their positive findings, most of these studies were criticised for investigating only one non-surgical skill on simple basic laparoscopic tasks like stretching elastics and carrying balls. ...
Article
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Background: Acquiring laparoscopic skills is a necessity for every young surgeon. Whether it is a talent or a non-surgical skill that determines the surgical performance of an endoscopic operation has been discussed for years. In other disciplines aptitude testing has become the norm. Airlines, for example, have implemented assessments to test the natural aptitude of future pilots to predict their performance later on. In the medical field, especially surgery, there are no similar comparable tests implemented or even available. This study investigates the influence of potential factors that may predict the successful performance of a complex laparoscopic operation, such as the surgeon's age, gender or learning method. Methods: This study focussed 70 surgical trainees. It was designed as a secondary analysis of data derived from a 2 × 2 factorial randomised controlled trial of practical training and/or multimedia training (four groups) in an experimental exercise. Both before and then after the training sessions, the participating trainees performed a laparoscopic cholecystectomy in a pelvitrainer. Surgical performance was then evaluated using a modified objective structured assessment of technical skills (OSATS). Participants were classified as 'Skilled' (high score in the pre-test), 'Good Learner' (increase from pre- to post-test) or 'Others' based on the OSATS results. Based on the results of the recorded performance, the training methods as well as non-surgical skills were eventually evaluated in a univariate and in a multivariate analysis. Results: In the pre-training performance 11 candidates were categorised as 'Skilled' (15.7%), 35 participants as 'Good Learners' (50.0%) and 24 participants were classified as 'Others'. The univariate analysis showed that the age, a residency in visceral surgery, and participation in a multimedia training were significantly associated with this grouping. Multivariate analyses revealed that residency in visceral surgery was the most predictive factor for the 'Skilled' participants (p = 0.059), and multimedia training was most predictive for the 'Good Learner' (p = 0.006). Participants in the group of 'Others' who were neither 'Skilled' nor improved in the training phase were younger (p = 0.011) and did not receive multimedia (p < 0.001) or practical (p = 0.025) training. Conclusion: The type of learning method has been shown to be the most effective factor to improve laparoscopic skills, with multimedia training proving to be more effective than practical training.
... Prior studies have shown a correlation between video game experience and a better ability to learn laparoscopic surgery techniques [1][2][3]. However, there is conflicting research on how this experience translates into surgical ability [4][5][6]. Most research depends on either self-reported video game experience/ability and/or testing with off-the-shelf video games. ...
... Alternatively, it is possible that experts' video game experience made a negligible contribution to their performance compared with the impact of their professional experience. The literature is divided as to whether video game experience positively impacts operating room performance, with some studies finding a positive effect and others finding no impact [30,[33][34][35][36][37][38]. ...
Article
Background: Surgical residents underutilize opportunities for traditional laparoscopic simulation training. Serious gaming may increase residents' motivation to practice laparoscopic skills. However, little is known about the effectiveness of serious gaming for laparoscopic skills training. Objective: The aim of this study was to establish construct validity for the laparoscopic serious game Underground. Methods: All study participants completed 2 levels of Underground. Performance for 2 novel variables (time and error) was compared between novices (n=65, prior experience <10 laparoscopic procedures), intermediates (n=26, prior experience 10-100 laparoscopic procedures), and experts (n=20, prior experience >100 laparoscopic procedures) using analysis of covariance. We corrected for gender and video game experience. Results: Controlling for gender and video game experience, the effects of prior laparoscopic experience on the time variable differed significantly (F2,106=4.77, P=.01). Both experts and intermediates outperformed novices in terms of task completion speed; experts did not outperform intermediates. A similar trend was seen for the rate of gameplay errors. Both gender (F1,106=14.42, P<.001 in favor of men) and prior video game experience (F1,106=5.20, P=.03 in favor of experienced gamers) modulated the time variable. Conclusions: We established construct validity for the laparoscopic serious game Underground. Serious gaming may aid laparoscopic skills development. Previous gaming experience and gender also influenced Underground performance. The in-game performance metrics were not suitable for statistical evaluation. To unlock the full potential of serious gaming for training, a more formal approach to performance metric development is needed.
... According to Rosenberg and colleagues, highly realistic simulation of laparoscopy is the only way to gain laparoscopic aptitude [42]. Our results and the results of other studies discussed here do not support this proposal, and notions such as realism, resemblance, or physical fidelity are currently being discouraged as theoretical tools [43]. ...
Article
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Background: Residents find it hard to commit to structural laparoscopic skills training. Serious gaming has been proposed as a solution on the premise that it is effective and more motivating than traditional simulation. We establish construct validity for the laparoscopic serious game Underground by comparing laparoscopic simulator performance for a control group and an Underground training group. Methods: A four-session laparoscopic basic skills course is part of the medical master students surgical internship at the Radboud University Medical Centre. Four cohorts, representing 107 participants, were assigned to either the Underground group or the control group. The control group trained on the FLS video trainer and the LapSim virtual reality simulator for four sessions. The Underground group played Underground for three sessions followed by a transfer session on the FLS video trainer and the LapSim. To assess the effect of engaging in serious gameplay on performance on two validated laparoscopic simulators, initial performance on the FLS video trainer and the LapSim was compared between the control group (first session) and the Underground group (fourth session). Results: We chose task duration as a proxy for laparoscopic performance. The Underground group outperformed the control group on all three LapSim tasks: Camera navigation F(1) = 12.71, p < .01; Instrument navigation F(1) = 8.04, p < .01; and Coordination F(1) = 6.36, p = .01. There was no significant effect of playing Underground for performance on the FLS video trainer Peg Transfer task, F(1) = 0.28, p = .60. Conclusions: We demonstrated skills transfer between a serious game and validated laparoscopic simulator technology. Serious gaming may become a valuable, cost-effective addition to the skillslab, if transfer to the operating room can be established. Additionally, we discuss sources of transferable skills to help explain our and previous findings.
... To our knowledge, the use of skill games in predicting novices' performance have not been previously studied in literature, unlike the use of video games, which has been considered to be associated with innate technical skill. In a study looking at the relationship between performance on video games and laparoscopic skills, Resenberg et al. 19 found that video game aptitude can predict the level of laparoscopic skills of medical students. As well, Badurdeen et al. 20 demonstrated a strong correlation between performance on Nintendo Wii and a box-design laparoscopic trainer, which lead to the conclusion that surgical candidates with better performance on Wii possess higher baseline ability for laparoscopic skills. ...
Article
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Objective: To identify new tools capable of predicting surgical performance of novices on an augmentation mammoplasty simulator. The pace of technical skills acquisition varies between residents and may necessitate more time than that allotted by residency training before reaching competence. Identifying applicants with superior innate technical abilities might shorten learning curves and the time to reach competence. The objective of this study is to identify new tools that could predict surgical performance of novices on a mammoplasty simulator. Method: We recruited 14 medical students and recorded their performance in 2 skill-games: Mikado and Perplexus Epic, and in 2 video games: Star War Racer (Sony Playstation 3) and Super Monkey Ball 2 (Nintendo Wii). Then, each participant performed an augmentation mammoplasty procedure on a Mammoplasty Part-task Trainer, which allows the simulation of the essential steps of the procedure. Results: The average age of participants was 25.4 years. Correlation studies showed significant association between Perplexus Epic, Star Wars Racer, Super Monkey Ball scores and the modified OSATS score with rs = 0.8491 (p < 0.001), rs = -0.6941 (p = 0.005), and rs = 0.7309 (p < 0.003), but not with the Mikado score rs = -0.0255 (p = 0.9). Linear regressions were strongest for Perplexus Epic and Super Monkey Ball scores with coefficients of determination of 0.59 and 0.55, respectively. A combined score (Perplexus/Super-Monkey-Ball) was computed and showed a significant correlation with the modified OSATS score having an rs = 0.8107 (p < 0.001) and R2 = 0.75, respectively. Conclusions: This study identified a combination of skill games that correlated to better performance of novices on a surgical simulator. With refinement, such tools could serve to help screen plastic surgery applicants and identify those with higher surgical performance predictors.
... The interactive nature of video games presents an ideal environment in which to learn various skills that may be transferred to real-world scenarios (Gentile, 2011). For example, video games have been employed to train pilots (Gopher, Weil, & Bereket, 1994) and surgeons (Rosenberg, Landsittel, & Averch, 2005;Rosser, Lynch, Haskamp, Gentile, & Yalif, 2007). Most relevant to the present research, the United States military uses violent shooting video games to train soldiers (e.g., Bourge & McGonigle, 2006;Grossman, 1995;Shaban, 2013;Stilwell, 2016), and police departments use violent shooting video games to train officers (e.g., Lapowski, 2015). ...
Article
When shooting a gun at a human target, firearms training instructors teach individuals to shoot for the upper torso because it is the largest lethal target on the human body. In contrast, violent first‐person shooter (FPS) video games reward players for headshots. The head is the smallest lethal target, and requires careful aim to hit. In this experiment, participants were randomly assigned to play a violent FPS game with humanoid targets that rewarded headshots, a nonviolent shooting game that punished hits to bull's‐eye targets with faces, or a nonviolent non‐shooting game. After gameplay, participants shot 16 “bullets” from a realistic gun at a life‐sized human‐shaped mannequin. Participants were told to hit the mannequin with as many bullets as possible, but they were not told where to aim. Consistent with operant conditioning theory, participants who played a violent FPS game that rewarded headshots had the most hits to the mannequin's head. Participants whose favorite video games were violent shooting games also had the most hits to the mannequin's head. These findings suggest that FPS games that reward headshots can influence people to aim for the head with a realistic gun after the game is turned off, even though the head is a much smaller target to hit and they are much less likely to hit another body part if they miss. FPS games are often used to train soldiers and police officers, but these findings suggest that such games might train individuals to hit the wrong part of the body.
... In a study of medical students using a surgical simulator, video game experience was associated with improved performance on two of the three manual tasks employed (Chung et al., 2017). Other studies have found correlations between short video game play sessions or self-reported game play and psychomotor tasks suggested to relate to laparoscopic surgery skill (Kennedy, Boyle, Traynor, Walsh, & Hill, 2011;Ou, McGlone, Camm, & Khan, 2013;Rosenberg, Landsittel, & Averch, 2005). However, due to cross sectional designs and limited number of hours of gameplay these studies do not elucidate the nature of motor skill acquisition involved in video games. ...
Article
The effects of playing action video games have been investigated across a wide range of attentional and cognitive abilities. However, few studies have examined the association between motor control and action gaming experience. We report data from two discrete pointing tasks, manipulating the index of difficulty (ID) by movement distance and target size, respectively. Participants' gaming experience ranged from non-players to individuals who played several hours a night. Our results indicated greater experience playing action games, but not video games in general, was associated with shorter movement times (MT), higher velocities, and shallower ID-MT slopes when difficulty was manipulated across increasingly further distances and smaller target sizes. Additionally casual players, those who only play action games a couple times a week, were able to achieve a similar level of performance as more experienced players.
... as Microsoft Xbox, Sony PlayStation, and the Nintendo Wii, all improve performance of laparoscopic techniques. 14,17 , 18 Recently a group of human surgeons from Holland developed a specific video game for the Nintendo Wii intended for laparoscopic training purposes. They have published several studies that suggest the effectiveness of the video game as a laparoscopic skill training tool. ...
Article
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The objective of this study was to investigate the effect of playing video games on the performance of basic laparoscopic skills. The study was an experimental pre-test-post-test comparison group design. Fifty-two students (31 from the Western University of Health Sciences College of Veterinary Medicine and 21 from the Colorado State University College of Veterinary Medicine) completing their first or second year of the veterinary curriculum were randomized into two intervention groups. The intervention consisted of playing the video game Marble Mania on a Nintendo Wii. group L (long) played 18 hours over 6 weeks and group S (short) played 3 hours during the last week of the 6-week intervention period. Before and after the intervention, basic laparoscopic skills for both groups were assessed using a modified McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) instrument. Participants performed two laparoscopic tasks. Results showed that the performance of students improved in both group S and L (p < .05) on both laparoscopic tasks. Both groups showed statistically significant improvement in their post-intervention scores (group L, N = 25, z = -3.711, p < .001, r = 0.742; group S, N = 27, z = -3.016, p < .003, r = 0.580). There was no significant difference in the degree of improvement between group S and group L. The results suggest that playing Marble Mania on a Wii for any time duration could be an effective method for veterinary medicine students to improve basic laparoscopic skills, and indicate the needs for additional studies.
... Surgical education in laparoscopy before surgical procedure on humans could be provided in different models such as: cadaver, animals, physical trainers, and virtual trainer devices [1,2]. However, researchers in surgical education have been demonstrated the advantages of videogame in training [3][4][5][6][7][8][9][10][11]. Assessment results of entertainment games have been an interest for sur-gical education by Bokhari, et al. at the Minnesota University. ...
... Se ha sugerido que los videojuegos tienen efectos positivos que pueden conducir a la adquisición de habilidades complejas en diversos campos, incluyendo medicina, ya que podrían favorecer la familiarización con interfaces de pantalla (5). Es así como en diversos estudios, por medio de diferentes técnicas, se ha señalado que existe una relación entre el desempeño de una persona como jugador de videojuegos y como cirujano de cmi (5)(6)(7)(8)(9). Se presume que dicha relación se debe a que el uso de consolas de videojuego requiere la manipulación de objetos por medio de pantallas 2D, coordinación mano-ojo y el desarrollo de la habilidad de la muñeca y la mano. ...
Article
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Introducción: debido a las crecientes limitaciones éticas y de recursos en el entrenamiento de aprendices en cirugía mínimamente invasiva (cmi, e. g. laparoscopia) en pacientes, se pretende evaluar el efecto de la práctica continua con un videojuego en particular en el desarrollo de las habilidades fundamentales a la hora de ejecutar una de estas cirugías. Materiales y métodos: se seleccionaron tres actividades esenciales (corte, sutura y coordinación mano-ojo) por realizar en simuladores laparoscópicos, con el fin de establecer si la práctica con el videojuego es efectiva en el desarrollo de las habilidades necesarias en cmi. Se evaluaron en total ocho variables de desempeño en las tres actividades seleccionadas. Con base en esto, se evaluaron catorce aprendices médicos sin experiencia en laparoscopia, divididos en dos grupos (control e intervención), antes y después de un programa de entrenamiento estandarizado con el videojuego Marblemanía® y una duración de un mes. Resultados: se evidenció que la práctica continua con el videojuego Marblemanía® mejoró todas las variables de desempeño. Estos resultados positivos fueron significativamente diferentes a favor del grupo que tuvo acceso al programa de entrenamiento con el videojuego en 3 de las 8 variables de desempeño medidas en las tres actividades seleccionadas: errores en la actividad de sutura (p = 0,003), y el tiempo de ejecución y errores en la actividadcoordinación mano-ojo (p = 0,025 y 0,001, respectivamente).
... Through repeated, voluntary interaction with the content, games lead to experiential learning [19]. Although the effectiveness of serious games to enhance 'technical' surgical skills has been shown in previous studies [20][21][22], this is the first study in which a serious game is systematically assessed for its capacity in training the ability to anticipate non-routine adverse events in the surgical theater. ...
Article
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Background: Equipment-related malfunctions directly relate to one-fourth of the adverse events in the surgical theater. A serious game trains residents to recognize and respond to equipment problems in minimally invasive surgery (MIS). These include disturbed vision, gas transport, electrocautery, and pathophysiological disturbances. This randomized controlled trial explores whether game-based training improves surgical residents' response to equipment-related problems during surgery. Methods: Thirty-one surgical residents with no previous experience in MIS took part in a standardized basic laparoscopy training course. Fifteen residents were randomly assigned to the game-enhanced curriculum (intervention) and sixteen were assigned to the regular curriculum (control). Participants performed a MIS task in a live anesthetized pig model, during which three standardized equipment malfunction scenarios occurred. Observers recorded the problems recognized and solved, time, and participants' technical performance. Results: Twenty-four participants completed the post-test (n = 12 per group). The intervention group solved more problems than the control group (59 vs. 33%, p = 0.029). The intervention group also recognized a larger proportion of problems, although this parameter was non-significant (67 vs. 42%, p = 0.14). Random effects modeling showed a significant improved game performance per participant over time. Conclusions: Surgical residents, who play for only 1 h on a custom-made serious game, respond significantly better to equipment-related problems during surgery than residents trained by a standard training curriculum. These results imply that entertaining serious games can indeed be considered for use in official training for surgeons and other medical specialists.
... B. Ärzte, Krankenpfleger) zur Anwendung (Graafland et al. 2012 (Graafland et al. 2012). Während sich vereinzelt Verbesserungen in der Tiefenwahrnehmung (Hogle et al. 2008) und Psychomotorik bei Medizinstudierenden ohne Operationserfahrungen durch das Spielen von Serious Games zeigen (Kennedy et al. 2011), deuten Forschungsarbeiten vor allem auf Vorteile für Personen hin, welche generell erfahrener im Umgang mit Videospielen sind (Graafland et al. 2012;Hogle et al. 2008;Kennedy et al. 2011;Lynch et al. 2010;Rosenberg et al. 2005). ...
Chapter
Der Einsatz von Serious Games in der Gesundheitskommunikation stößt sowohl bei Praktikerinnen und Praktikern als auch Forscherinnen und Forschern in jüngster Zeit vermehrt auf Interesse. Mittlerweile gibt es zahlreiche Spiele, die entwickelt oder eingesetzt werden, um gesundheitsbezogenes Wissen, Einstellungen und Verhalten zu beeinflussen, und mindestens ebenso viele Studien, die sich mit der Wirksamkeit dieser Angebote befassen. Anhand von drei zentralen Einsatzbereichen von Serious Games in der Gesundheitskommunikation (Prävention, Begleitung von Heilungsprozessen, Aus- und Weiterbildung von medizinischem Fachpersonal) werden die Potenziale der Spiele sowie der (bisherige) Forschungsstand diskutiert.
... Now days the digital games are taking an upper hand in medical education. The games are named as 'serious games' and meant to train planned surgeons (82,83). The students of geriatric clerkship at Florida State University College of Medicine take part in 'Elder ...
Thesis
The present study is an attempt to use Problem Solving Exercise (PSE) as an innovative method of teaching radiology imaging sciences to undergraduates. The PSEs were developed, in such a way that it promotes the thinking and reasoning skills among the undergraduate medical students. This kind of learning activity will promote active learning among undergraduate medical students. The current methods of teaching radiology and imaging sciences at the undergraduate level are passive. The PSE as a teaching-learning method has not been much explored in Indian context.This study investigates the impact of PSE on the learning and retention of Radiological concepts among the MBBS students. Hence, the problem has been stated as follows: "Evaluation of Innovative Teaching of Radiology and Imaging Sciences among Undergraduate Medical Students".
... B. Ärzte, Krankenpfleger) zur Anwendung (Graafland et al. 2012 (Graafland et al. 2012). Während sich vereinzelt Verbesserungen in der Tiefenwahrnehmung (Hogle et al. 2008) und Psychomotorik bei Medizinstudierenden ohne Operationserfahrungen durch das Spielen von Serious Games zeigen (Kennedy et al. 2011), deuten Forschungsarbeiten vor allem auf Vorteile für Personen hin, welche generell erfahrener im Umgang mit Videospielen sind (Graafland et al. 2012;Hogle et al. 2008;Kennedy et al. 2011;Lynch et al. 2010;Rosenberg et al. 2005). ...
... 10,11 Still, there is no real consensus about which part of the simulation is enhanced by the video gaming experience. [12][13][14][15][16] J o u r n a l P r e -p r o o f Visuospatial skills, gender differences and simulation performance Visuospatial abilities have been found to improve performance in endoscopic simulation. 17 Visuospatial ability also seems to impact performance in more advanced simulation tasks, which has been shown in two studies with specialists in endoscopy and gynecology. ...
Article
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Background Learning via simulators is under constant development and it is important to further optimize simulator training curricula. This study investigates the impact of Personal Computer (PC)-gaming experience, visuospatial skills, and repetitive training on laparoscopic simulator performance and specifically on the constituent parameters of the simulator score. Methods 47 medical students completed three consecutive Minimally Invasive Surgical Trainer – Virtual Reality (MIST-VR) simulator trials. Previously, they performed a visuospatial test and completed a questionnaire regarding baseline characteristics and PC-gaming experience. Linear regression was used to analyze the relationship between simulator performance and type of PC-gaming experience and visuospatial ability. Results During the first two MIST-VR simulation tasks there was an association between pc-gaming experience and the coordination parameters of the score (e.g. Econ Diath task 1: p = 0.0047; Econ Diath task 2: p = 0.0102; Econ Diath task 3: p = 0.0836). The type of game category played seemed to have an impact on the coordination parameters (e.g. Econ Diath task 1–3 for Sport games vs. No sport games: p = 0.01; p = 0.0013; p = 0.01, respectively). In the first MIST-task, visuospatial ability correlated with MIST-simulator performance but was abolished with repetitive training (Overall MIST-score task 1–3: p = 0.0122; p = 0.0991; p = 0.3506, respectively). Gender specific differences were noted initially but were abolished with training. Conclusions Sport games versus No sport games demonstrated a significantly better MIST-performance. Furthermore, repetitive laparoscopic simulator training may compensate for a previous lack of PC-gaming experience, low visuospatial ability, and gender differences.
... Medical interns at the Leiden University Medical Center (Leiden, the Netherlands) were recruited for voluntary participation in this initial validation study. Participant demographics and baseline characteristics (Supplemental File 1, 2) were obtained by a pre-course survey [9]. All participants first completed a pre-test the ForceSense box trainer, to establish a baseline level of technical skills for laparoscopy, such as hand-eye coordination, depth perception, and bimanual dexterity. ...
Article
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Background As global use of surgical robotic systems is steadily increasing, surgical simulation can be an excellent way for robotic surgeons to acquire and retain their skills in a safe environment. To address the need for training in less wealthy parts of the world, an affordable surgical robot simulator (PoLaRS) was designed. Methods The aim of this pilot study is to compare learning curve data of the PoLaRS prototype with those of Intuitive Surgical’s da Vinci Skills Simulator (dVSS) and to establish face- and construct validity. Medical students were divided into two groups; the test group (n = 18) performing tasks on PoLaRS and dVSS, and the control group (n = 20) only performing tasks on the dVSS. The performance parameters were Time, Path length, and the number of collisions. Afterwards, the test group participants filled in a questionnaire regarding both systems. Results A total of 528 trials executed by 38 participants were measured and included for analyses. The test group significantly improved in Time, Path Length and Collisions during the PoLaRS test phase (P ≤ 0.028). No differences was found between the test group and the control group in the dVSS performances during the post-test phase. Learning curves showed similar shapes between both systems, and between both groups. Participants recognized the potential benefits of simulation training on the PoLaRS system. Conclusions Robotic surgical skills improved during training with PoLaRS. This shows the potential of PoLaRS to become an affordable alternative to current surgical robot simulators. Validation with similar tasks and different expert levels is needed before implementing the training system into robotic training curricula.
... Rosenberg et al. 16 tested 11 medical students by having them play 3 commercially available games. After that, all students performed four laparoscopic tasks on a porcine model. ...
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Introduction: Video games have a positive impact on the skills required for laparoscopic surgery. Several studies have assessed the impact of video games on laparoscopic skills. Aim: This study aims to systematically review the existing evidence. Materials and methods: A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The retrieved articles were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. Results: Twenty-six studies were included in this systematic review. These included prospective (n=9), retrospective (n=5) and interventional (n=12). Other review papers were cited in the discussion section. Studies with positive outcomes significantly outweighed the negative ones (21 vs. 5, respectively). Conclusions: Although there is some evidence that video game experience could give some advantage in laparoscopy no firm conclusions could be drawn yet. The reasons for that lay in the various aims, approaches and results of different study reports. Gaming could be used as a daily warm-up or as a tool to speed-up mastering new skills. A standardized protocol is needed for answering the different questions regarding the impact of video game exposure to laparoscopic skills development and progression.
... Apprenticeship models in surgical training have rapidly evolved from traditional approaches based on an educational philosophy following the principle of "see one, do one, teach one" to more sophisticated surgical simulators aimed at increasing the number of simulations following the "see one, simulate many deliberately, do one" philosophy (Kerr and O'Leary, 1999;Scott et al., 2008), thus allowing a dramatic increase in the skills of medical professionals and the safety of patients (Viglialoro et al., 2021). There are some strategies for surgical training based on serious video games (Rosenberg et al., 2005;Goris et al., 2014), animal models (Daly et al., 2014;DeMasi et al., 2016), and cadavers (Jacobson et al., 2009;Zuckerman et al., 2009;Rocha e Silva et al., 2016). However, due to the economic and ethical issues involved in some of these solutions, surgical training has rapidly shifted toward the use of simulation-based systems (Forgione and Guraya, 2017). ...
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Introduction: Medical training is a long and demanding process, in which the first stages are usually based on two-dimensional, static, and unrealistic content. Conversely, advances in preoperative imaging have made it an essential part of any successful surgical procedure. However, access to this information often requires the support of an assistant and may compromise sterility in the surgical process. Herein, we present two solutions based on mixed reality that aim to improve both training and planning in minimally invasive surgery.Materials and Methods: Applications were developed for the use of the Microsoft HoloLens device. The urology training application provided access to a variety of anatomical and surgical training contents. Expert urological surgeons completed a questionnaire to evaluate its use. The surgical planning solution was used during laparoscopic renal tumorectomy in an experimental model and video-assisted right upper lobectomy in an adult patient. Surgeons reported their experience using this preoperative planning tool for surgery.Results: The solution developed for medical training was considered a useful tool for training in urological anatomy, facilitating the translation of this knowledge to clinical practice. Regarding the solution developed for surgical planning, it allowed surgeons to access the patient’s clinical information in real-time, such as preoperative imaging studies, three-dimensional surgical planning models, or medical history, facilitating the surgical approach. The surgeon’s view through the mixed reality device was shared with the rest of the surgical team.Conclusions: The mixed reality-based solution for medical training facilitates the transfer of knowledge into clinical practice. The preoperative planning tool for surgery provides real-time access to essential patient information without losing the sterility of the surgical field. However, further studies are needed to comprehensively validate its clinical application.
... Another variable that allow us to determine the laparoscopic surgery skills is the development of intraoperative complications. Studies have demonstrated that surgeons, who play video games, make less surgical mistakes in virtual reality applications [23]. On the other hand, contrary to the literature, no significant difference was found between the two groups in terms of intraoperative complications in this study. ...
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In this study, it was aimed to reveal whether playing video games had a positive effect on laparoscopic surgical skills. A retrospective analysis was performed on the data of the patients, who underwent laparoscopic cholecystectomy between 01.08.2016 and 01.02.2021. Patients were divided into two groups as patients, who underwent laparoscopic cholecystectomy performed by surgeons who did not play video games (Group I), and patients, who underwent laparoscopic cholecystectomy performed by surgeons who played video games (Group II). The groups were compared in terms of demographic data, ASA scores, duration of surgery, length of stay in the hospital and intraoperative complications. In the study, 449 patients were included in Group I, and 595 patients were included in Group II, after the exclusion criteria were applied. It was observed that there was no significant difference between the two groups in terms of demographic data, ASA scores and intraoperative complications. The mean duration of surgeries performed by surgeons who did not play video games (Group I) was 49.39 ± 18.05 minutes, and the mean duration of surgeries performed by surgeons who played video games (Group II) were found to be 46.74 ± 17.50 minutes, with statistically significance (p= 0.01). Playing video game regularly has a positive effect in terms of ability and speed of laparoscopy. Besides, it is considered to be encouraging in terms of advanced laparoscopic surgical interventions. [Med-Science 2021; 10(3.000): 959-62]
... Los conocimientos previos en sutura de heridas han demostrado ser un predictor muy poco fidedigno de la adquisición de habilidades quirúrgicas en estudiantes de Medicina 22 . Otros factores como la práctica de videojuegos, haber realizado sutura de heridas en pabellón quirúrgico, el año académico del tutor o, incluso, el sexo del estudiante, tampoco han mostrado asociación estadística suficiente con los puntajes finales de un ejercicio de sutura en diferentes modelos de simulación 11,[22][23][24][25] . ...
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Objetivo: Comparar la adquisición de habilidades quirúrgicas básicas en estudiantes de medicina según el tipo de instrucción teórico-práctica recibida previo a un taller estandarizado de sutura de heridas. Materiales y Método: Estudio cuasiexperimental antes-después para estudiantes de cuarto año durante el 2018. Se realizó taller de sutura de heridas aplicado en modelo biológico (pata de cerdo), previo consentimiento informado y aprobación Comité Ético Científico. Mediante instrumento “The Objective Structured Assessment Of Technical Skills” (OSATS) se evaluó técnica de sutura antes y después del entrenamiento. Se dividió a los participantes según conocimientos previos al taller: Grupo A: recibió instrucción teórico-práctica en pacientes in vivo. Grupo B: recibió instrucción teórico-práctica en modelos de simulación. Grupo C: sin conocimientos previos en suturas. Se evaluó percepción de estudiantes mediante encuesta validada. Se comparó puntaje OSATS antes-después del taller y encuesta de percepción según grupo, utilizando SPSS24® y ANOVA. Se consideró significativo p < 0,05. Resultados: Se evaluaron 124 estudiantes. Grupo A: 17 (13,7%); Grupo B: 38 (30,7%); Grupo C: 69 (55,6%) respectivamente. Existió diferencia en puntaje OSATS de ingreso al taller Grupo A: 19,4 ± 4,9; Grupo B: 13,7 ± 6,3; Grupo C: 11,1 ± 4,5 (p < 0,05). Puntaje OSATS finalizada la intervención Grupo A: 28,8 ± 1,5; Grupo B: 28,0 ± 1,9; Grupo C: 27,9 ± 2,2 (p = 0,48), sin diferencia significativa. La intervención fue bien percibida, sin diferencias significativas entre grupos. Discusión: El resultado de evaluación OSATS finalizado el taller es independiente de experiencias, instrucción teórico-práctica o conocimientos previos a la intervención. Conclusión: Los programas de entrenamiento con evaluación estandarizada pueden equiparar los resultados entre estudiantes con diferentes conocimientos previos.
... Eleven students without surgical or previous VGs experience were divided into two groups among which five students trained for 6.2 h on VGs during the 2 weeks between the sessions. In this study, the X-Box VGs failed to enhance laparoscopic performance skills as the two groups did not show any statistical significance [19]. ...
Article
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Several studies have evaluated the impact of video games (VGs) on psychomotor skills in laparoscopic surgery. Our review of literature revealed that prior VGs experience ameliorates the initial skill level of novice trainees and accelerates their learning curve by facilitating a better perception of 3D images, ambidexterity, and tone reflexes. The published studies are unfortunately limited by the small number of participants, the heterogeneity of the sample, the endpoints, and the evaluation tools of the studies. Randomized control studies with strict inclusion criteria and valid evaluation tool are required before including this concept in surgical educational programs.
... 4 A moderate to strong correlation has been suggested between the skills used in gaming and those used while performing surgery. [11][12][13][14] Only 8.5% of the participants in this study reported to currently playing video games. However, a recent review by Glassman et al. 15 claims that the evidence demonstrating the positive effects of previous gaming on surgical simulation performance is very limited. ...
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Objective: Serious games are new in the field of laparoscopic surgical training. We evaluate the residents׳ opinion of a new laparoscopic simulator for the Nintendo Wii-U platform. Design: Prospective questionnaire study. Participants received a standardized introduction and completed level 3 and 4 of the game "Underground." They filled out a questionnaire concerning demographics and their opinion on realism, usefulness, suitability, haptic feedback, and home training-use of the game. Setting: Two tertiary teaching hospitals. Participants: Obstetrics and gynaecology residents postgraduate year 1 to 6 (n = 59) from several European countries. Results: Subjects (n = 59) were divided into 2 groups based on laparoscopic experience: Group A (n = 38) and Group B (n = 21). The realism of different aspects of the game received mean scores around 3 on a 5-point Likert scale. The hand-eye coordination was regarded most useful for training with a mean of 3.92 (standard deviation 0.93) and the game was considered most suitable for residents in the first part of their postgraduate training with a mean of 3.73 (standard deviation 0.97). Both groups differed especially concerning their opinion of the usefulness of the game as a training tool. Conclusions: Most residents liked the new serious game for the Nintendo Wii-U. The usefulness and suitability as a laparoscopic training tool were rated at an acceptable to high level. However, the game does require improvements such as inclusion of a good scoring system before it can be integrated in resident training curricula.
... This study is the first to find a positive association between VGE and RSS performance. While many prior studies have shown a strong association between VGE and MIS skills, most have established a link in the context of LS [17][18][19]. However, a similar trend has not been demonstrated in the context of robotic surgery. ...
Article
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Laparoscopic surgery and robotic surgery, two forms of minimally invasive surgery (MIS), have recently experienced a large increase in utilization. Prior studies have shown that video game experience (VGE) may be associated with improved laparoscopic surgery skills; however, similar data supporting a link between VGE and proficiency on a robotic skills simulator (RSS) are lacking. The objective of our study is to determine whether volume or timing of VGE had any impact on RSS performance. Pre-clinical medical students completed a comprehensive questionnaire detailing previous VGE across several time periods. Seventy-five subjects were ultimately evaluated in 11 training exercises on the daVinci Si Skills Simulator. RSS skill was measured by overall score, time to completion, economy of motion, average instrument collision, and improvement in Ring Walk 3 score. Using the nonparametric tests and linear regression, these metrics were analyzed for systematic differences between non-users, light, and heavy video game users based on their volume of use in each of the following four time periods: past 3 months, past year, past 3 years, and high school. Univariate analyses revealed significant differences between heavy and non-users in all five performance metrics. These trends disappeared as the period of VGE went further back. Our study showed a positive association between video game experience and robotic skills simulator performance that is stronger for more recent periods of video game use. The findings may have important implications for the evolution of robotic surgery training.
... The global simulation market was estimated at a value of $790.1 million in 2012, with expected growth to reach $1930.5 million by 2017 [7]. With technology developed from the videogame industry, designed to enhance hand-eye co-ordination and the ability to perform 3D skills using a 2D screen, has led to simulations mostly designed to advance skills in laparoscopic surgery [8]. Virtual reality training involves the use of a computer screen for graphic display of the organs to be operated upon. ...
Article
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Simulation training, where a scenario or setting is replicated, is now firmly associated with surgical training. Involving both technical and non-technical competencies, it provides a valuable tool in training new skills to both new and current surgeons. As patient safety becomes more of a focus, alongside advances in technology and surgical techniques, there is a continued concern regarding operative exposure for futures surgeons. This void in which simulated training fits, a claim supported by an expanding literature base. The recent integration of simulation into training curricula aims to promote consistency in access to simulation facilities across deaneries and invite the experience of dedicated instructors to optimise educational use.
Chapter
Introduction Everyday experience makes it seem that hearing or auditory processing requires little if any effort under normal circumstances. In actuality, extensive research indicates that understanding information presented though the auditory channel (referred to as auditory cognition) can place significant demands on attentional resources, particularly in challenging listening environments or when multitasking is required (Baldwin, 2012). A focus of this chapter is key concepts in auditory perception that minimize the attentional demands of auditory cognition in order to maximize our ability to use this sensory channel effectively and safely in communications and auditory displays. We begin with some of the advantages and disadvantages of the auditory modality and then a brief discussion on when to use the auditory modality, followed by a section on auditory vigilance. We then discuss the psychoacoustics of auditory displays followed by a review of auditory warning recommendations and parameters. We conclude with examples of auditory displays and warnings in applied settings. Advantages and Disadvantages of the Auditory Modality The auditory modality has several unique characteristics that result in specific advantages and disadvantages when used to present information in displays. We begin by discussing some of the many advantages and then we point out some key disadvantages.
Article
Introduction Video games are mainly considered to be of entertainment value in our society. Laparoscopic surgery and video games are activities similarly requiring eye-hand and visual-spatial skills. Previous studies have not conclusively shown a positive correlation between video game experience and improved ability to accomplish visual-spatial tasks in laparoscopic surgery. This study was an attempt to investigate this relationship. Aim The aim of the study was to investigate whether previous video gaming experience affects the baseline performance on a laparoscopic simulator trainer. Methods Newly qualified medical officers with minimal experience in laparoscopic surgery were invited to participate in the study and assigned to the following groups: gamers (n = 20) and non-gamers (n = 20). Analysis included participants' demographic data and baseline video gaming experience. Laparoscopic skills were assessed using a laparoscopic simulator trainer. Results There were no significant demographic differences between the two groups. Each participant performed three laparoscopic tasks and mean scores between the two groups were compared. The gamer group had statistically significant better results in maintaining the laparoscopic camera horizon ± 15° (p value = 0.009), in the complex ball manipulation accuracy rates (p value = 0.024) and completed the complex laparoscopic simulator task in a significantly shorter time period (p value = 0.001). Although prior video gaming experience correlated with better results, there were no significant differences for camera accuracy rates (p value = 0.074) and in a two-handed laparoscopic exercise task accuracy rates (p value = 0.092). Conclusion The results show that previous video-gaming experience improved the baseline performance in laparoscopic simulator skills.
Conference Paper
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ÖZET Bu çalışmanın amacı, hareket kontrollü bir aktif oyunun hedef algısı ve el göz koordinasyonu üzerine etkisini dart örneğiyle araştırmaktır. Araştırmaya daha önce dart oynamamış 30 (15 kız ve 15 erkek) gönüllü dokuzuncu sınıf öğrencisi katılmıştır. Katılımcılar; ilk önce normal darta ve dairesel darta altı atış yaptırıldı sonrasında sekiz hafta, haftada üç gün ve her çalışmada 15 dakika olmak üzere Microsoft Xbox 360 Kinect ile dart oynatıldı. Sekiz hafta sonunda ise tekrar normal darta ve dairesel darta altı atış yaptırılarak ilk test ve son test puanları değerlendirildi. Verilerin normal dağılım gösterip göstermediğine Shapiro-Wilk testi ile bakıldı ve verilerin normal dağılım gösterdiği tespit edildi. Ortalama ve standart sapma değerleri hesaplanıp verilerin analizi için Paired t testi kullanıldı. Çalışmada kız ve erkek öğrencilerin ilk test - son test puanları arasında istatistiksel bir anlamlılık tespit edildi, benzer şekilde bu anlamlılık tüm öğrenciler değerlendirildiğinde de gözlendi (p<0.01). Kız ve erkek katılımcıların normal dart ve dairesel dart atışları kendi aralarında değerlendirildiğinde ilk test puanları arasında anlamlı bir fark tespit edildi (p<0.05), fakat son test puanlarında ve normal dartın ilk test - son test puanlarında herhangi bir farklılık ortaya çıkmadı (p>0.05). Sonuç olarak Kinect ile sekiz haftalık çalışma, katılımcıların hedefe atış puanlarında olumlu yönde bir artış sağladı. Hareket kontrollü aktif oyun konsolunun çocuklarda el-göz koordinasyonu ve hedef algısını geliştirdiği tespit edildi. Özellikle spora yeni başlayan çocuklarda temel tekniklerin öğretiminde hareket kontrollü oyunların tekniğin algılanması ve öğrenilmesinde etkili olduğu düşünülmektedir. Anahtar kelimeler: Microsoft Xbox 360 Kinect, Dart, Hedef Algısı, El-Göz Koordinasyonu
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Visual search is the process of finding specific target items within an environment using particular visual features or prior knowledge. Searches can be as easy as finding your friend with purple hair in a lecture hall or as complicated as finding a purposefully concealed weapon among thousands of harmless bags at an airport checkpoint. Visual searches take place in everyday, innocuous contexts such as finding your car in a parking lot, and in critical contexts, such as finding enemy combatants in an urban battlefield. We conduct searches all the time, and most searches are relatively commonplace. However, in some cases, visual searches can be critically important. For example, airport security screeners must identify harmful items in baggage, and radiologists must identify abnormalities in medical radiographs. Despite the ubiquitous nature of search and the fact that it is sometimes life-or-death critical, human visual search is far from ideal - errors are often made, and searches are typically conducted for either too little or too much time. Thus, some fundamental research questions are the following: How can we maximize search efficiency? What is the best way to increase both search speed and accuracy? Much academic research has focused on increasing search performance, but does such research adequately translate to situations outside the laboratory environment? These open questions are the foundation of research in applied visual search - the application of what has been learned about search accuracy and efficiency from lab-based experimentation to search conditions in the workplace for career searchers, with the goal of increasing performance.
Chapter
Introduction Researchers have studied sustained attention systematically for more than a half-century (Dember and Warm, 1979). Experiments with adults have identified crucial influences on an individual’s ability to remain vigilant - influences such as task parameters (Warm and Jerison, 1984), environmental conditions (Hancock, 1984), and individual differences (Shaw et al., 2010). By contrast, interest in sustained attention in children has only a short history, and its focus has been directed primarily to disorders of attention in clinical populations. As a consequence, studies of children have remained largely distinct from adult vigilance research and have borrowed only rarely from the extensive foundation in experimental work established by Warm and his colleagues (Parasuraman, Warm, and Dember, 1987; Warm, Dember, and Hancock, 1996; Warm and Dember, 1998). However, research on sustained attention, once centered on adult populations, now investigates infants and children, and clinical research directed to the diagnosis of disorders now seeks comparative knowledge on typically developing children. Lines of research that once ran parallel are revealing valuable points of intersection. This chapter explores those theoretical and methodological contacts. We first explore general theories of the development of childhood attention and the methods used to assess sustained attention in infants and children. Theories of Sustained Attention Few theories address the development of sustained attention in infancy and childhood. While no theories to date address change across all age ranges, several theories have been influential in guiding research on early attentional abilities. The following section addresses several of these theories, beginning with infancy and then moving on to childhood.
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Introduction The ability to perceive and act upon collision events has widespread practical value. People avoid collisions when they walk around obstacles, drive amid moving traffic, avoid being tackled in football, and avoid damage to blood vessels while performing surgery. People create collisions when they pick up objects, hit or catch baseballs, and control a plane’s contact with the runway to land smoothly. It is important to understand how collision events are perceived. Collision perception has been studied in various applied contexts such as driving (e.g., Caird and Hancock, 2002), sports (Gray, 2002; Gray and Sieffert, 2005), and aviation (Kruk and Regan, 1996). Studies of perceived collision focused on the perception of when a collision would occur or time-to-contact (TTC), and the perception of whether a collision would occur, or collision detection. This chapter collects results of both types of studies. It is concluded that collision perception is based on multiple information sources and that the information observers use depends on the context. It is essential to determine the conditions under which different information sources are used. Toward this aim, a conceptual framework is proposed. This chapter is organized into four sections. First, different types of collision events that people perceive are elucidated. The term “collision” includes contacting, intercepting, or reaching a target.
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This paper presents a set of interfaces to estimate the impact of playing computer games over a short period of time on players skills and abilities such as memory, reaction time and hand eye coordination. A review over other studies that have been conducted on the field with compares methodology and results is reported. The a set of 3 different systems is presented with the design of experimental protocols in order to validate such systems. Four subjects are selected at random, with all different ages and past computer game experience. These 4 subjects are all tested with the 3 proposed systems (i) before playing the computer games and (ii) after that. Results of suggest that playing computer games over a short period of time can slightly improve the reaction time and the short-term memory, as well as the hand eye coordination.
Conference Paper
By using simulations in virtual reality (VR), people have the chance to train without supervision in a safe and controlled environment. VR simulation training allows users to gain new skills and apply them to real-life situations. However, the learning curve of this technology from a novice level could influence the expected learning results of a training session. A training approach based on the combination of VR and gamification could speed up this overall learning process and not just for a novice. In this paper we evaluate how gamification in a VR training session can improve the efficiency of the training and the accuracy of the task execution in a real-world practical test. In the training scenario of this study, 50 randomly assigned participants were divided into two groups. The groups were assigned to a gamified and a non-gamified version of the same VR training and were then guided through a step-by-step tutorial outlining how to solve an assembly task. Performance differences were evaluated based on time taken and specific errors made during the training session. The results of this study show, in general, that beneficial effects can be attributed to the use of gamification in the conducted VR training simulation, particularly for the VR novice participants.
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Technological advancements in video equipment and biocompatible materials have enabled improvements in complex surgery through small incisions. The mastery of these laparoscopic surgical techniques is now a requirement for surgeons, however, the necessary skills are not intuitive and require hundreds of practice hours. The current state of surgical education includes animate models, inanimate physical models, and computer-based simulations, the latter of which are limited by cost, accessibility, and a lack of engagement. We propose a novel low-cost training interface that mimics the laparoscopic surgical environment using customized instruments whose movement and control are used as inputs for video games. The system is significantly less expensive than commercial systems and allows users freedom to select and play any game, enabling a take-home system with potential for higher levels of engagement, as well as familiarity and expertise with ambidextrous laparoscopic hand motion. A preliminary study compared performance on FLS (Fundamentals of Laparoscopic Surgery) testing before and after training. For a precision cutting task, groups that trained on a standard simulator or on the new system with either a noninverted or inverted hand-instrument mapping showed statistically significant improvements, warranting further investigation of training with this new system.
Chapter
Game playing is made possible by players’ engagement in configurative practices that work in conjunction with interpretive practices, referring to how a viewer’s semiotic work on the text (when reading and interpreting it) is taken directly from the semiotic resources that are put to use and made available by the text itself. That is, games are dynamic entities that remain ‘in potentia’ until actualised by the player. In doing so, the player is involved in recursive actions that produce polysemic performances and readings. The literacy demands of games support the argument that it is a ‘mistake’ to consider that [they] offer only one type of experience and foster one type of engagement (Newman, 2002). Yet, when applied to the processes of media regulation and classifying game content (which guides the general publics’ understanding of games), the competencies required to engage successfully with interactive texts fail to receive accurate representation or acknowledgment. This chapter addresses how the rise of new forms of literacy, has created a discrepancy between the literacy employed by digital natives when playing games and the way digital immigrants classify games by attributing greater meaning to the ‘screen’ as the major carrier of information. The central thesis of this chapter is to present an argument for classification processes to account for the contributions to knowledge from theory and research examining game based learning.
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Reports evaluating simulation-based sigmoidoscopy training among nurses are scarce. The aim of this prospective nonrandomized study was to assess the performance of nurses in simulated sigmoidoscopy training and the potential impact on their performance of endoscopy unit experience, general professional experience, and skills in manual activities requiring coordinated maneuvers. Forty-four subjects were included: 12 nurses with (Group A) and 14 nurses without endoscopy unit experience (Group B) as well as 18 senior nursing students (Group C). All received simulator training in sigmoidoscopy. Participants were evaluated with respect to predetermined validated metrics. Skills in manual activities requiring coordinated maneuvers were analyzed to draw possible correlations with their performance. The total population required a median number of 5 attempts to achieve all predetermined goals. Groups A and C outperformed Group B regarding the number of attempts needed to achieve the predetermined percentage of visualized mucosa (p = .017, p = .027, respectively). Furthermore, Group A outperformed Group B regarding the predetermined duration of procedure (p = .046). A tendency was observed for fewer attempts needed to achieve the overall successful endoscopy in both Groups A and C compared with Group B. Increased score on playing stringed instruments was associated with decreased total time of procedure (rs =-.34, p = .03) and with decreased number of total attempts for successful endoscopy (rs =-.31, p = .046). This study suggests that training nurses and nursing students in simulated sigmoidoscopy is feasible by means of a proper training program. Experience in endoscopy unit and skills in manual activities have a positive impact on the training process.
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Objective To systematically assess literature examining the impact of being a gamer or participating in video-game–based training on surgical skills acquisition amongst medical students. Background Video games and surgical procedures share similar skills such as visuospatial abilities and hand-eye coordination; therefore, video games can be a valuable tool for surgical training amongst medical students. However, comprehensive, up-to-date systematic reviews are necessary to confirm. Methods A systematic literature search of PubMed, MEDLINE, and EMBASE was performed in April 2020 with no limits set on the date of publication. Observational and randomized controlled studies were included. Quality and bias were assessed using the Newcastle-Ottawa Scale for nonrandomized studies and the Grading of Recommendations Assessment, Development and Evaluation system for randomized studies. Results A total of 575 participants from 16 studies were included. The most common surgical skills tested were laparoscopy (n = 283, from 8 studies) and robotic surgery (n = 199, from 5 studies). A history of gaming and video-game–based training were associated with improved metrics in robotic surgery and laparoscopy, respectively. Neither was beneficial in arthroscopy or bronchoscopy. Studies using the Wii U and Underground reported significant improvement in overall laparoscopic performance. Conclusion Video games demonstrate potential as adjunctive training in surgical skill education, with a history of gaming and video-game–based training being beneficial in robotic surgery and laparoscopy, respectively. Methodological heterogeneity amongst included studies limit the ability to make conclusive decisions; thus, future studies with long-term follow-up, larger sample sizes, outcomes stratified by video-game characteristics, and up-to-date technology are necessary.
Thesis
Could we flow knowledge faster and better? Why is this a problem in the first place? How can we tackle it technologically? What could be a prototype solution? This work unifies these questions in the outline of a single, refutable paradigm of noodynamics - the study of knowledge flows - and nooconomics, the economy of knowledge. This paradigm will answer the question “Why”. Neuroergonomics (“brain ergonomics”), and biomimicry, will be summoned in answer to the question “How”. Their contribution will follow from the simplest knowledge flow equation that is proposed in this work. Two original optimisation problems are also posed in software neuroergonomics and biomimetics: the Mindscape and Serendipity Problem. A case of theoretical neuroergonomics, or neuroergonomics ex ante is proposed with the study of Hyperwriting, a written grapheme-loceme association, or a glyphic method for externalising spatial memory. Its application to the design of user interface will finally found neuroergonomic design, or neuromimicry, with the example of a collegial interface to augment multiscale knowledge flows: Chréage. The anatomy of this prototype mindscape will be the conclusion of this work, and its answer to the question “What”?
Article
Background This study aims to investigate if a smartphone laparoscopy simulator, SimuSurg, is effective in improving laparoscopic skills in surgically inexperienced medical students. Methods This is a single-blinded randomized controlled trial featuring 30 preclinical medical students without prior laparoscopic simulation experience. The students were randomly allocated to a control or intervention group (n = 15 each) and 28 students completed the study (n = 14 each). All participants performed three validated exercises in a laparoscopic box trainer and repeated them after 1 week. The intervention group spent the intervening time completing all levels in SimuSurg, whereas the control group refrained from any laparoscopic activity. A prestudy questionnaire was used to collect data on age, sex, handedness, and experience with gaming. Results The total score improved significantly between the two testing sessions for the intervention group (n = 14, median change [MC] = 182.00, P = 0.009) but not for the control group (n = 14, MC = 161.50, P = 0.08). Scores for the nondominant hand improved significantly in the intervention group (MC = 66.50, P = 0.008) but not in the control group (MC = 9.00, P = 0.98). There was no improvement in dominant hand scores for either the intervention (MC = 62.00, P = 0.08) or control (MC = 26.00, P = 0.32) groups. Interest in surgery (β = −234.30, P = 0.02) was positively correlated with the baseline total scores; however, age, sex, and experience with video games were not. Conclusions The results suggest that smartphone applications improve laparoscopic skills in medical students, especially for the nondominant hand. These simulators may be a cost-effective and accessible adjunct for laparoscopic training among surgically inexperienced students and clinicians.
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Background: Oral and maxillofacial surgery demands high precision navigation to achieve optimal surgical outcomes. Augmented reality has been a promising solution for intuitive and accurate guidance, whereas existing systems have room for improvement. Methods: We propose a high-quality and accurate in-situ AR navigation system. Enhanced image quality is achieved by deploying eye tracking in lenticular-based autostereoscopic display. Viewpoint tracking and optical tracking are integrated to assure accurate in-situ images. Results: The proposed system can provide in-situ AR images in real-time, with a viewing angle of 59.5° × 49.1°, 3D image resolution of 0.35 mm × 0.21 mm, and image accuracy of 0.99 ± 0.70 mm. A maxillary drilling experiment obtains average position error of 1.12 ± 0.30 mm and localization time of 8.7 ± 3.9 s, significantly better than conventional 2D navigation system. Conclusions: The proposed system can display high-quality AR images and therefore reduce positioning error and operating time. This article is protected by copyright. All rights reserved.
Thesis
(Internet) Gaming Disorder ((I)GD) is one of the most problematic psychiatric disorders to be recently proposed. It is noted as a condition of further study in the DSM-5 as ‘Internet Gaming Disorder’ and is likely to be included in future editions of the DSM pending further research. Both Gaming Disorder and Internet Gaming Disorder have been added to the ICD-11. In this multidisciplinary conceptual analysis, I have combined a philosophical approach with current research in psychiatry, psychology and neuroscience, game studies, and economic theory in the area. Presented is a Picoeconomic and Neuroeconomic (PE/NE) model of addiction centred on Disordered and Addictive Gambling. I then begin application of the model to the evidence presented for the (I)GD. I argue that it is possible that some individuals do experience a clinical addiction when they engage in specific activities within games. However, the broader conception of all (video)gaming as socially undesirable and addictive is incorrect and potentially damaging. By pathologising game play, the psychosciences could be engaging in subjective social judgement of a leisure activity enjoyed by many millions of people of all walks of life, that forms an important part of the personal and social identity of many. Combined with negative media attention on (I)GD, this is contributing to the potentially problematic framing of such behaviour as disordered. This has direct implications for the conceptual understanding of (I)GD in psychiatry; for clinical treatment of those presenting with problematic gaming behaviour; and more broadly for game player’s self-conception – both as individuals and as a group. (I)GD does not currently fit the PE/NE model because it tends to consider games as a singular category or set of categories. Gamers are grouped according to their negative psychological symptoms, rather than based on their gameplay. It is unclear at this point if grouping gamers in the current way makes conceptual sense, as they may not be engaging in the same behavioural regularities. Additionally, if (I)GD is a discrete disorder, it should not be better understood as a coping mechanism associated with underlying psychosocial or contextual issues. That a minority of gamers experience negative outcomes from excessive gaming is not in dispute. In fact, such negative outcomes are crucial for understanding any individual gamer behaviour as potentially disordered. However, it is not yet clear that these problems should be attributed to a new disorder. Because of the diversity of both games and gamers, application of the PE/NE model to gaming would require specification of the structural mechanisms of games, and how gamers interact with them. I argue both that (I)GD is a good candidate for conceptual sound application of the PE/NE model of addiction, and that we should be cautious about reifying it as a legitimate, discrete disorder.
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Complex skills, such as ureteroscopy and stone extraction, are increasingly taught to novice urology trainees using bench models in surgical skills laboratories. We determined whether hands-on training improved the performance of novices more than those taught only by a didactic session and whether there was a difference in the performance of subjects taught on a low versus a high fidelity model. We randomized 40 final year medical students to a didactic session or 1 of 2 hands-on training groups involving low or high fidelity bench model practice. Training sessions were supervised by experienced endourologists. Testing involved removal of a mid ureteral stone using a semirigid ureteroscope and a basket. Blinded examiners tested subjects before and after training. Performance was measured by a global rating scale, checklist, pass rating and time needed to complete the task. There was a significant effect of hands-on training on endourological performance (p <0.01). With respect to bench model fidelity the low fidelity group did significantly better than the didactic group (p <0.05). However, no significant difference was found between the high and low fidelity groups (p >0.05). The low fidelity model cost Canadian $20 to produce, while the high fidelity model cost Canadian $3,700 to purchase. Hands-on training using bench models can be successful for teaching novices complex endourological skills. A low fidelity bench model is a more cost-effective means of teaching ureteroscopic skills to novices than a high fidelity model.
Article
Evaluation of eye-hand coordination skills in relation to experiential human factors may lead to improved instruction for videoendoscopic surgical skills acquisition. Twenty-nine subjects (medical students or residents in surgical specialties) volunteered to perform three exercises of increasing complexity in an "inanimate" trainer system that simulated the eye-hand coordination tasks inherent in a laboratory videoendoscopic surgical environment. Fourteen subjects participated in a biweekly practice program of 4 weeks duration using an inanimate trainer. Fifteen subjects had no practice on the laparoscopic trainer during the 4 weeks. Both groups were tested after demonstration on three exercises at the beginning and end of a 4 week period and all performed the procedures in solitude. Both groups of subjects increased performance levels (time and accuracy) over the four weeks, but improvement was significantly greater for the practicing subjects. After eight sessions, convergence of performance levels was observed, but plateauing of performance levels was not evident, even with the simple paradigms evaluated. To investigate what factors contribute to learning, subjects were assessed with respect to their surgical experiences, personality, and self-evaluated motor skills. Subjects with prior endoscopic surgical experience, interest in mechanical activities (as measured by the Strong Interest Inventory), or regular engagement in video game play tended to be more skillful initially, but demonstrated less improvement in performance levels after practice than subjects who had lower levels of experience, interest, or video game play. Manual dexterity (as measured by the Purdue Pegboard Manual Dexterity Test) was positively related to the degree of observed improvement. We conclude that "inanimate" videoendoscopic paradigms offer relatively inexpensive and useful training exercises for acquiring basic eye-hand coordination skills. Relevance for animate laboratory skills requirements are probable but can only be inferred. Subjects with manual dexterity skills used in video games may perform better initially in the inanimate videoendoscopic situation but this advantage is shortlived.
Article
The concept of virtual reality (VR) involves the computer generation of environments with which a user can interact directly. Virtual reality is now being used for medical applications, especially in the area of surgical simulation. As technology advances, VR simulation will play an important training role for both residents and urologists already in practice. This paper examines the history of VR, current developments, and its future implications for the field of urology.
Article
As laparoscopy has become more commonplace in urology, increased emphasis has been placed on laparoscopic education. We assessed the impact of laparoscopic skills training on the operative performance of urological surgeons inexperienced with laparoscopy. Urology residents were prospectively randomized to undergo laparoscopic skills training (6) or no training (6). Baseline assessment of operative performance (scale 0 to 35) during porcine laparoscopic nephrectomy was completed by all subjects. Cumulative time to complete laparoscopic tasks using an inanimate trainer was also recorded. The skills training group then practiced inanimate trainer tasks for 30 minutes daily for 10 days. The 2 groups then repeated the timed inanimate trainer tasks and underwent repeat assessment of the ability to perform porcine laparoscopic nephrectomy. At baseline no statistical difference was noted in laparoscopic experience, inanimate trainer time or overall operative assessment in the 2 groups. In the skills training group mean cumulative time to complete inanimate trainer tasks decreased from 341 to 176 seconds (p = 0.003), while in the control group it decreased from 365 to 301 (p = 0.15). Operative assessment improved from initial to repeat porcine laparoscopic nephrectomy regardless of the trained versus control randomization grouping (22.0 to 27.8, p = 0.0008 and 20.8 to 26.5, p = 0.00007, respectively). In vivo experience enables urological surgeons inexperienced with laparoscopy to improve significantly in all aspects of complex laparoscopic procedures. In this pilot study the magnitude of improvement was independent of additional training in laparoscopic skills. Educational curriculum should include in vivo practice in addition to skills training.
Article
Surgical simulation has emerged in the last decade as a potential tool for aiding acquisition of technical skills, including anesthesia protocols, trauma management, cardiac catheterization and laparoscopy. We evaluate and validate the use of a computer based ureteroscopy simulator (URO Mentor, Simbionix Ltd., Lod, Israel) in the acquisition of basic ureteroscopic skills. We assessed 20 novice trainees for the ability to perform basic ureteroscopic tasks on a computer based ureteroscopy simulator. Participants were randomized to receive individualized mentored instruction or no additional training, and subsequently underwent post-testing. Pre-training and post-training improvement in performance was assessed by objective simulator based measurements. Subjective overall performance was rated using a validated endourological global rating scale by an observer blinded to subject training status. Demographics and pre-test scores were similar between groups. Post-testing revealed a significant effect of training on objective and subjective measurements. Spearman rank correlation demonstrated a significant association between objective simulator based measurements and the endourological global rating scale. Use of a computer based ureteroscopy simulator resulted in rapid acquisition of ureteroscopic skills in trainees with no prior surgical training. Results of this study demonstrate the use of a virtual reality ureteroscopy simulator in endourological training. Correlation of simulator based measurements with a previously validated endourological global rating scale provides initial validation of the ureteroscopy simulator for the assessment of ureteroscopic skills.
Article
As video-game playing has become a ubiquitous activity in today's society, it is worth considering its potential consequences on perceptual and motor skills. It is well known that exposing an organism to an altered visual environment often results in modification of the visual system of the organism. The field of perceptual learning provides many examples of training-induced increases in performance. But perceptual learning, when it occurs, tends to be specific to the trained task; that is, generalization to new tasks is rarely found. Here we show, by contrast, that action-video-game playing is capable of altering a range of visual skills. Four experiments establish changes in different aspects of visual attention in habitual video-game players as compared with non-video-game players. In a fifth experiment, non-players trained on an action video game show marked improvement from their pre-training abilities, thereby establishing the role of playing in this effect.
Article
Background: Interest in laparoscopic surgery has prompted development of educational programs designed to teach and assess laparoscopic skills. Although these programs are beneficial, because of the inherent demands imposed by laparoscopy some aspects of operative performance might not improve with practice. This suggests that innate ability could predict level of operative skill. Assessment of operative and technical potential to date has relied largely on subjective rather than objective criteria. In this study, the relationships between objective measures of human basic performance resources (BPRs) and laparoscopic performance were evaluated using Nonlinear Causal Resource Analysis (NCRA), a novel predictive and explanatory modeling approach based on General Systems Performance Theory. Study design: Twenty urology residents were voluntary enrolled. Thirteen validated BPRs were measured and analyzed relative to operative laparoscopic performance (assessed by two experts) of two porcine laparoscopic nephrectomies (LN). The laparoscopic procedure, representing a High Level Task (HLT), was evaluated using a modified Global Rating of Operative Performance Scale. NCRA models were devised to predict performance of the HLT laparoscopic nephrectomies based on BPRs and to determine the limiting performance resource. Results: NCRA models predicted excellent agreement with actual operative performance, suggesting that measures of innate ability (or BPRs) predicted performance of laparoscopic nephrectomy. In 65%, the prediction by NCRA was near identical to the expert rating on the HLT. In 25% of cases, NCRA overpredicted performance; in 10%, NCRA underpredicted performance of the HLT compared to the subjective ratings. Neuromotor channel capacity was the most common performance-limiting resource. Conclusions: Preliminary findings suggest objective prediction of laparoscopic performance with limiting resource diagnostics for an individual surgeon is possible and practical using appropriate new measurement and modeling methods. Selection of surgical candidates, training, and educational curriculum could be positively affected.
Article
To evaluate the impact of a formal laparoscopic training program on patient outcomes in an obstetrics and gynecology residency. Retrospective cohort study (Canadian Task Force classification II-1). University-affiliated public hospital. Comparison of nonlaparoscopy-trained group (A) with a formally trained group (B). Three hundred sixty-eight women (group A) and 154 women (group B) undergoing operative laparoscopy. Beginning October 1, 1999, residents, regardless of postgraduate year status, participated in six 4-hour sessions/year in a committed laparoscopic training program consisting of didactics, bench exercises (designed to mimic laparoscopic gynecologic technical skills), instrumentation instruction, animate tissue model surgery, and supervised gynecologic operating experience. Two certified gynecology laparoscopists facilitated each training session, and gynecologists with various laparoscopic skill levels supervised patient surgeries. Operating room time, blood loss, hospital stay, and conversion to laparotomy were less for group B than for group A, but the groups did not differ in complication rates. Adhesions and bleeding were the main reasons for conversion to laparotomy. Formal laparoscopic training of gynecologic residents improved patient outcomes.
Article
This study examined the impact of virtual reality (VR) surgical simulation on improvement of psychomotor skills relevant to the performance of laparoscopic cholecystectomy. Sixteen surgical trainees performed a laparoscopic cholecystectomy on patients in the operating room (OR). The participants were then randomized to receive VR training (ten repetitions of all six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR)) or no training. Subsequently, all subjects performed a further laparoscopic cholecystectomy in the OR. Both operative procedures were recorded on videotape, and assessed by two independent and blinded observers using predefined objective criteria. Time to complete the procedure, error score and economy of movement score were assessed during the laparoscopic procedure in the OR. No differences in baseline variables were found between the two groups. Surgeons who received VR training performed laparoscopic cholecystectomy significantly faster than the control group (P=0.021). Furthermore, those who had VR training showed significantly greater improvement in error (P=0.003) and economy of movement (P=0.003) scores. Surgeons who received VR simulator training showed significantly greater improvement in performance in the OR than those in the control group. VR surgical simulation is therefore a valid tool for training of laparoscopic psychomotor skills and could be incorporated into surgical training programmes.
Article
Increasing constraints on the time and resources needed to train surgeons have led to a new emphasis on finding innovative ways to teach surgical skills outside the operating room. Virtual reality training has been proposed as a method to both instruct surgical students and evaluate the psychomotor components of minimally invasive surgery ex vivo. The performance of 100 laparoscopic novices was compared to that of 12 experienced (>50 minimally invasive procedures) and 12 inexperienced (<10 minimally invasive procedures) laparoscopic surgeons. The values of the experienced surgeons' performance were used as benchmark comparators (or criterion measures). Each subject completed six tasks on the Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) three times. The outcome measures were time to complete the task, number of errors, economy of instrument movement, and economy of diathermy. After three trials, the mean performance of the medical students approached that of the experienced surgeons. However, 7-27% of the scores of the students fell more than two SD below the mean scores of the experienced surgeons (the criterion level). The MIST-VR system is capable of evaluating the psychomotor skills necessary in laparoscopic surgery and discriminating between experts and novices. Furthermore, although some novices improved their skills quickly, a subset had difficulty acquiring the psychomotor skills. The MIST-VR may be useful in identifying that subset of novices.
Article
A preliminary study to evaluate the feasibility of a protocol for comparing the learning curves for open and laparoscopic surgical procedures. Thirteen pre-clinical medical students with no previous surgical training were given intensive coaching in open and laparoscopic surgical techniques for 12 weeks. At the end of this period, their open and laparoscopic skills were assessed by three independent examiners. Individual and aggregate ability scores in various aspects of open and laparoscopic surgery and the time taken to perform the procedures were compared using Student's t-test. There was no statistically significant difference in the overall scores by the two different techniques ( p=0.057 ). However, differences between the two techniques were significant in certain criteria including tissue dissection (p=0.024), tidiness of gall bladder (p=0.034 ) and liver ( p=0.016 ) specimens and the time taken for the two techniques ( p < or = 0.001 ). This study suggests that when inexperienced subjects are given equal training in laparoscopy and open surgery, the overall skills acquired were similar by both methods when assessed after 6 weeks. However, on detailed analysis of the different components of surgery, the laparoscopic skills were deficient in finer dissection, identification of correct planes and two-dimensional perception when compared to open surgery and required more operative time. Our study group perceived that laparoscopy was more difficult to learn than open surgery even after the training. The study group also felt that the training in basic surgical skills during their undergraduate careers would make them more interested in studying surgery and choosing it as a career.
The impact of intense laparoscopic skills training on the operative performance of urol-ogy residents
  • O Traxter
  • Mt Gettman
  • Napper
  • Ca
Traxter O, Gettman MT, Napper CA, et al. The impact of intense laparoscopic skills training on the operative performance of urol-ogy residents. J Urol 2001;166:1658.