Learning Through Surgeon's Eyes: Design, Development, and Evaluation of an Immersive Virtual Reality Training Tool for Oral and Maxillofacial Surgery

Background: Reduced training hours, over-crowded operating rooms, and lack of focus on non-technical skills are severely affecting surgical training. In specialities such as Oral and Maxillofacial Surgery, there is an increasing need for innovation in training. On the other hand, despite the application of technological advancements including virtual reality (VR) and augmented reality (AR), twenty-eight to forty percent of novice trainees are not confident in performing major surgery. The current research aims to address these challenges by finding a suitable way to develop an evidence-based immersive virtual reality (iVR) experience. Further, the research investigates the impact of this solution on the learning and confidence of trainees. This research introduces VR Surgery, an iVR experience, to address the gaps in the knowledge. VR Surgery is the first multi-sensory, holistic surgical training experience demonstrating Le Fort I osteotomy, a type of maxillofacial surgery, using Oculus Rift and Leap Motion devices. This research demonstrates the design, development and evaluation of VR Surgery and provides a way for future studies on the use of immersive technologies for surgical education. Methods: A design science research approach was followed to identify the problem, build the solution in collaboration with expert surgeons and evaluate it. Using a combination of multimedia, VR Surgery enables trainee surgeons to experience a realistic operating room environment, and interact with the patient’s anatomy while watching the surgery in a close-up stereoscopic 3D view. Consultant oral and maxillofacial surgeons in the UK evaluated VR Surgery for Face and Content validity. Surgeons commented on the content, usability and applicability of VR Surgery to surgical training. Further, to investigate the impact of VR Surgery on the perceived self-confidence of trainees, a single-blinded, parallel, randomised controlled trial (RCT) was performed. Surgical trainees (95) from seven dental schools took part in one of the first experiments to test the role of iVR on self-confidence. Experimental group participants learnt about the Le Fort I procedure using VR Surgery on an Oculus Rift. The control group used similar content in a standard PowerPoint presentation. The primary outcome measures were the self-assessment scores of trainees’ confidence as measured on a Likert scale and objective assessment based on the knowledge. Outcomes: The expert surgeons agreed with the validity of VR Surgery. The participants of the RCT were randomly divided into the experimental (51) and control (44) groups. Trainees had a mean age of 27∙14, and they were 45∙3% female students and 50∙5% male students. A repeated measures multivariate ANOVA was applied to the data to assess the overall impact of receiving the VR surgery intervention over conventional means on the confidence of trainees. Experimental group participants showed higher perceived self-confidence levels compared to those in the control group (p=0∙034, =0∙05). Novices in the first year of their training showed the highest improvement in their confidence, compared to those in the second and third year. Interpretation: Surgical trainees improve their knowledge and self-confidence levels after using an iVR training experience. The study proves that virtual reality applications such as VR Surgery have a substantial potential to bridge the differences in the quality of global surgical training. This research provides a framework for future researchers who use mixed reality for healthcare

'Man is a dining animal': the archaeology of the English at table, c.1750-1900

This study investigates the role of gender and, within that, class in changing English dining styles in the eighteenth and nineteenth centuries. The period c.1750-1900 has been chosen to cover a major period for dining change, as it is during this time that service à la Russe superseded service à la Française as the dominant formal dining style. This change has been much discussed by food historians and sociologists, but the materiality of change has not hitherto been placed within an archaeologically-informed framework. Equally, while the artefacts of dining are among the most frequently recorded finds in domestic contexts in the historical period, archaeologists have rarely considered them in the context of long-term dining development. Drawing on data from country houses, collections, and published material on middle class and elite settings, this thesis investigates the hypothesis that dining change was driven by women, specifically middle class wives; and that dining-related ephemera must therefore be understood in its relationship with women. It also proposes a narrative of stylistic change using historical archaeological paradigms, introducing the concept of a third, clearly identifiable stage between à la Française and à la Russe. After introducing the data sets and giving a background to dining in the historical period, the first part of the study uses table plans and etiquette, together with depictions of dishes, food moulds and experimental archaeology in the form of historic cookery, to demonstrate the way in which the process of change was driven by middle class women. It argues that à la Russe suited gender and class-specific needs and that, far from being emulative, as has hitherto been assumed, the adaption of à la Russe broke with aristocratic habits. It proposes that a transitional stage in dining style should be recognised, and interprets food design and serving style in the light of this intermediate phase. The setting of dining is explored next, with data on dining décor, plates and physical location interpreted to support the conclusions of the previous section. Following this, the impact of change on food preparation will be used to demonstrate that à la Russe was the result of changes in underlying mentalities which also affected household structure and organisation. The ways women used the materiality of food, including cookbooks, to negotiate status will be demonstrated. A final section will broaden the discussion of gender, class and food. Tea has been chosen as a case study for the further testing of the conclusions drawn from the study of dinner for two reasons: firstly it was, from its introduction, immediately associated with women; and, secondly, tea-related artefacts are among the commonest of archaeological finds, but are rarely understood as engendered and active objects in a domestic context

Bowdoin Orient v.126, no.1-23 (1997-1998)

https://digitalcommons.bowdoin.edu/bowdoinorient-1990s/1010/thumbnail.jp

Bowdoin Orient v.64, no.1-26 (1934-1935)

https://digitalcommons.bowdoin.edu/bowdoinorient-1930s/1006/thumbnail.jp

Bowdoin Orient v.84, no.1-25 (1954-1955)

https://digitalcommons.bowdoin.edu/bowdoinorient-1950s/1005/thumbnail.jp

Bowdoin Orient v.92, no.1-22 (1962-1963)

https://digitalcommons.bowdoin.edu/bowdoinorient-1960s/1003/thumbnail.jp

Furman vs Clemson (9/15/2007)

Furman vs Clemson (9/15/2007)https://tigerprints.clemson.edu/fball_prgms/1309/thumbnail.jp