Virtual Reality Simulator for Training in Myringotomy with Tube Placement

Myringotomy refers to a surgical incision in the eardrum, and it is often followed by ventilation tube placement to treat middle-ear infections. The procedure is difficult to learn; hence, the objectives of this work were to develop a virtual-reality training simulator, assess its face and content validity, and implement quantitative performance metrics and assess construct validity. A commercial digital gaming engine (Unity3D) was used to implement the simulator with support for 3D visualization of digital ear models and support for major surgical tasks. A haptic arm co-located with the stereo scene was used to manipulate virtual surgical tools and to provide force feedback. A questionnaire was developed with 14 face validity questions focusing on realism and 6 content validity questions focusing on training potential. Twelve participants from the Department of Otolaryngology were recruited for the study. Responses to 12 of the 14 face validity questions were positive. One concern was with contact modeling related to tube insertion into the eardrum, and the second was with movement of the blade and forceps. The former could be resolved by using a higher resolution digital model for the eardrum to improve contact localization. The latter could be resolved by using a higher fidelity haptic device. With regard to content validity, 64% of the responses were positive, 21% were neutral, and 15% were negative. In the final phase of this work, automated performance metrics were programmed and a construct validity study was conducted with 11 participants: 4 senior Otolaryngology consultants and 7 junior Otolaryngology residents. Each participant performed 10 procedures on the simulator and metrics were automatically collected. Senior Otolaryngologists took significantly less time to completion compared to junior residents. Junior residents had 2.8 times more errors as compared to experienced surgeons. The senior surgeons also had significantly longer incision lengths, more accurate incision angles, and lower magnification keeping both the umbo and annulus in view. All metrics were able to discriminate senior Otolaryngologists from junior residents with a significance of p \u3c 0.002. The simulator has sufficient realism, training potential and performance discrimination ability to warrant a more resource intensive skills transference study

Three-Dimensional Visualization Technology in the Medical Curriculum: Exploring Faculty Use in Preclinical, Clinical, and Postgraduate Anatomy Education

Indiana University-Purdue University Indianapolis (IUPUI)Background: The advancement of three-dimensional visualization technology provides exciting new opportunities in medical education, including new methods for teaching complex anatomical relationships and promising tools for the training of postgraduate physicians. Information on how faculty use three-dimensional visualization technology for anatomy education is essential for informed discussions surrounding their effectiveness as a teaching tool and use in the medical curriculum, yet the current literature lacks necessary contextual details on how faculty integrate these technologies into actual medical curricula. Methods: Fifteen medical educators from North American medical schools and teaching hospitals completed semi-structured interviews and discussed how they use three-dimensional visualization technology for teaching in preclinical courses, clinical clerkships, and postgraduate programs. Transcripts were analyzed using the constant comparative method and resulting themes were used to inform the creation of a questionnaire. Results: The resulting themes of analysis were organized according to a curricular framework that describes how faculty use these technologies as an instructional resource and how this use is related to the purposes, content, sequence, instructional processes and evaluation of medical curricula. The results demonstrate how three-dimensional visualization technology is being is implemented in a variety of ways in the curriculum and revealed numerous similarities of use across the levels of medical education. Analyses revealed minimal use of three-dimensional visualization technology for assessment and indicated faculty face significant challenges in designing such assessment. Conclusions: Results suggest continuing assessment of the effectiveness of these technologies as a teaching tool needs to encompass broader aspects of use, such as those described in this study. Additionally, results showing similarities of use across levels suggest that educators and administrators should consider how threedimensional visualization technology can be thoughtfully integrated to address the changing needs of learners as they progress through medical education. Findings also suggest that administrators who want to support the integration of three-dimensional visualization technology into the curriculum need to provide adequate support and training to help faculty overcome time limitations and difficulties designing assessment methods

Translating computational modelling tools for clinical practice in congenital heart disease

Increasingly large numbers of medical centres worldwide are equipped with the means to acquire 3D images of patients by utilising magnetic resonance (MR) or computed tomography (CT) scanners. The interpretation of patient 3D image data has significant implications on clinical decision-making and treatment planning. In their raw form, MR and CT images have become critical in routine practice. However, in congenital heart disease (CHD), lesions are often anatomically and physiologically complex. In many cases, 3D imaging alone can fail to provide conclusive information for the clinical team. In the past 20-30 years, several image-derived modelling applications have shown major advancements. Tools such as computational fluid dynamics (CFD) and virtual reality (VR) have successfully demonstrated valuable uses in the management of CHD. However, due to current software limitations, these applications have remained largely isolated to research settings, and have yet to become part of clinical practice. The overall aim of this project was to explore new routes for making conventional computational modelling software more accessible for CHD clinics. The first objective was to create an automatic and fast pipeline for performing vascular CFD simulations. By leveraging machine learning, a solution was built using synthetically generated aortic anatomies, and was seen to be able to predict 3D aortic pressure and velocity flow fields with comparable accuracy to conventional CFD. The second objective was to design a virtual reality (VR) application tailored for supporting the surgical planning and teaching of CHD. The solution was a Unity-based application which included numerous specialised tools, such as mesh-editing features and online networking for group learning. Overall, the outcomes of this ongoing project showed strong indications that the integration of VR and CFD into clinical settings is possible, and has potential for extending 3D imaging and supporting the diagnosis, management and teaching of CHD

Designing and implementing online assessment in the clinical workplace

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Digital assessment in the clinical workplace : Design, implementation, opportunities, challenges

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Scholarship is not just research : Nurturing scholarship in health professions education

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