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

BACKGROUND: FluoroSim, a novel fluoroscopic simulator, can be used to practice dynamic hip screw (DHS) guidewire insertion in a high-fidelity clinical scenario. Our aim was to demonstrate a training effect in undergraduate medical students who are not familiar with this operation and its simulation. METHODS: Forty-five undergraduate medical students were recruited and randomized to either training (n = 23) or control (n = 22) cohorts. The training cohort had more exposure to FluoroSim (5 attempts each week) over a 2-week period (with a 1-week washout period in between) compared with the control cohort (a single attempt 1 week apart) over a 2-week period. Five real-time objective performance metrics were recorded: (1) tip-apex distance (TAD) (mm), (2) predicted cut-out rate (%), (3) total procedural time (sec), (4) total number of radiographs (n), and (5) total number of guidewire retries (n). RESULTS: At baseline, there was no significant difference in the performance metrics, which confirmed the absence of a selection bias. The intragroup training effect demonstrated a significant improvement in all metrics for the training cohort only. A significant difference between groups was demonstrated as the training cohort significantly outperformed the control cohort in 3 metrics (procedural time [25%], number of radiographs [57%], and number of guidewire retries [100%]; p < 0.001). A learning curve showed an inversely proportional correlation between frequency of attempts and procedural time as well as the number of digital fluoroscopic radiographs that were made, indicating the development of psychomotor skills. There was also an improved baseline of the learning curve after the 1-week washout period, suggesting skill retention. CONCLUSIONS: Skill acquisition with the FluoroSim system was demonstrated with repeat exposure in a safe, radiation-free high-fidelity clinical simulation with actual operating room equipment. The task of DHS guidewire insertion requires cognitive and psychomotor skills that take a variable number of attempts to acquire, as demonstrated on the learning curve. Additional work is required to demonstrate that the skill tested by the FluoroSim is the same skill that is required for intraoperative DHS guidewire insertion. However, use of the FluoroSim provides improvement in skills with extra-clinical training opportunities for orthopaedic trainees. CLINICAL RELEVANCE: FluoroSim has demonstrated validity and training effect. It has the potential to be approved for possible use on patients in the operating room to help surgeons with the operation. Consequently, operating time, accuracy of TAD, and surgical outcomes may all be improved

Design, validation and implementation of a virtual reality high fidelity laparoscopic appendicectomy curriculum

INTRODUCTION: The treatment for acute appendicitis is laparoscopic appendicectomy (LA), usually performed by trainees who face significant challenges to training. Simulation curricula are being increasingly utilised and optimised to accelerate learning and improve skill retention in a safe environment. The aim of this study is to produce and implement a virtual reality (VR) curriculum for laparoscopic appendicectomy (LA) on the high-fidelity LAP Mentor VR simulator. METHODOLOGY: Performance data of randomised experts and novices were compared to assess the construct validity of the LAP Mentor basic skills (BS) and LA modules. Face validity of the simulator and module was assessed by questionnaire. These results informed the construction of a VR LA curriculum on an evidence-based theoretical framework. The curriculum was implemented and evaluated by analysis of participant diaries. RESULTS: Thirty-five novices and 25 experienced surgeons performed either BS, five LA procedural tasks or the LA full procedure. Both modules demonstrated construct validity. The LA module was deemed moderately realistic and useful for developing laparoscopic psychomotor skills. Seven novice trainees completed the new LA curriculum (three others dropped out). Analysis of participants diaries revealed the presence of frustration, the benefits of feedback sessions and the advantages and pitfalls of open access. DISCUSSION: Evaluations of the implementation of similar curricula are rare and participant diaries led to critical insights. The curriculum was difficult and sometimes frustrating, mitigated by rewarding experiences and coaching. The latter facilitated deliberate practice. Scheduling issues were mitigated by open access. Limitations of the curricula include the invariability in the presentation of appendicitis, and the reason for dropouts are not known. CONCLUSION: Several BS and all LA tasks are construct-valid. A new VR LA curriculum was implemented and analysis of participant diaries yielded critical insights into real-world implementation. Future study should investigate its effect on real-world performance and patient outcomes

Education in laparoscopic surgery:All eyes towards in vivo training

Tegenwoordig worden steeds meer buikoperaties d.m.v. laparoscopische (knoopsgat) chirurgie uitgevoerd. Omdat deze manier van chirurgie zo anders is dan conventionele chirurgie staat tegenwoordig de manier van selectie, training en beoordeling van artsen in opleiding tot chirurg ter discussie in de wetenschap. Uit dit proefschrift blijkt dat neuropsychologische testen voor ruimtelijk inzicht en psychomotorische vaardigheden een voorspellende waarde hebben in de laparoscopische chirurgie. Beoordeling van applicaties voor de opleiding chirurgie zouden daarom gebaat zijn bij een neuropsychologische test van deze vaardigheden. De training van chirurgen kan mogelijk worden verbeterd door het gebruik van het Pareto-principe, een principe dat veel gebruikt wordt in de bedrijfseconomie en verondersteld dat 20% van de verschillende oorzaken verantwoordelijk is voor 80% van de gevolgen. Ook op de operatiekamer blijkt namelijk 20% van de laparoscopische vaardigheden verantwoordelijk te zijn voor 80% van de verbale correcties gegeven door supervisoren. Ten behoeve van trainingsefficiëntie lijkt het dus verstandig om traininginstrumenten (VR simulator taken, boeken, cursussen, etc.) te ontwikkelen die juist deze 20% aanpakken. In het huidige trainingsysteem wordt een algemeen beoordelingsformulier gebruikt voor het geven van feedback, de OSATS. Alhoewel dit een duidelijke vooruitgang is t.o.v. de meer subjectieve beoordelingen van vroeger kan het formulier niet gebruikt worden voor procedure specifieke feedback. Uit dit proefschrift blijkt dat het beoordelen van de mate van fysieke en verbale ondersteuning die een arts in opleiding tot chirurg nodig heeft van zijn supervisor een goed beeld geeft van zijn/haar niveau tijdens een laparoscopische operatie en tevens kan worden gebruikt voor het geven van procedure specifieke feedback

Generalizability of Predictive Performance Optimizer Predictions across Learning Task Type

The purpose of my study is to understand the relationship of learning and forgetting rates estimated by a cognitive model at the level of the individual and overall task performance across similar learning tasks. Cognitive computational models are formal representations of theories that enable better understanding and prediction of dynamic human behavior in complex environments (Adner, Polos, Ryall, & Sorenson, 2009). The Predictive Performance Optimizer (PPO) is a cognitive model and training aid based in learning theory that tracks quantitative performance data and also makes predictions for future performance. It does so by estimating learning and decay rates for specific tasks and trainees. In this study, I used three learning tasks to assess individual performance and the model\u27s potential to generalize parameters and retention interval predictions at the level of the individual and across similar-type tasks. The similar-type tasks were memory recall tasks and the different-type task was a spatial learning task. I hypothesized that the raw performance scores, PPO optimized parameter estimates, and PPO predictions for each individual would be similar for two learning tasks within the same type and different for the different type learning task. Fifty-eight participants completed four training sessions, each consisting of the three tasks. I used the PPO to assess performance on task, knowledge acquisition, learning, forgetting, and retention over time. Additionally, I tested PPO generalizability by assessing fit when PPO optimized parameters for one task were applied to another. Results showed similarities in performance, PPO optimization trends, and predicted performance trends across similar task types, and differences for the different type task. As hypothesized, the results for PPO parameter generalizability and overall performance predictions were less distinct. Outcomes of this study suggest potential differences in learning and retention based on task-type designation and potential generalizability of PPO by accounting for these differences. This decreases the requirements for individual performance data on a specific task to determine training optimization scheduling

Use of Video-Enhanced Debriefing in Clinical Nursing Skill Acquisition: Indwelling Urinary Catheterization as an Exemplar

Nursing students struggle to acquire and maintain clinical psychomotor skills. Hiring agencies bear the cost of retraining graduate nurses inept with skills learned early in their nursing curriculum. Improperly performed clinical skills pose a risk to patient safety, resulting in pain and suffering for the patient. This empirical study aimed to determine if video-enhanced debriefing (VED) improved initial skill validation scores, skill feedback, satisfaction with learning, and reduced skill decay among first-semester, pre-licensure BSN students performing female indwelling urinary catheterization (IUC) in a simulated clinical setting compared to no debriefing. Participants received standard instruction, then video-recorded their IUC skill. Participants randomized into the VED group individually participated in an advocacy/inquiry debriefing with the principal investigator while viewing their performance video. Both groups completed a summative IUC skill validation per standard course instruction and submitted their skill performance ratings. All participants completed a survey including their perceived IUC knowledge, amount of skill practice, learning satisfaction with VED, and an evaluation of their skill performance feedback. All participants re-recorded their IUC skill and received performances ratings with the same instruments again ten weeks after the initial skill validation. The analysis revealed that VED did not improve nursing skills, knowledge, practice, or perceptions of the learning experience compared to the video-only group. Nursing students in the VED condition did rate their skill performance feedback higher than those in the video-only group. Students improved performance in both conditions, showing that learning via video is an effective teaching strategy to enhance student\u27s satisfaction with learning, to engage in repetitive practice with feedback, and to improve learning