Haptic-Enhanced Learning in Preclinical Operative Dentistry

Background: Virtual reality haptic simulators represent a new paradigm in dental education that may potentially impact the rate and efficiency of basic skill acquisition, as well as pedagogically influence the various aspects of students’ preclinical experience. However, the evidence to support their efficiency and inform their implementation is still limited. Objectives: This thesis set out to empirically examine how haptic VR simulator (Simodont®) can enhance the preclinical dental education experience particularly in the context of operative dentistry. We specify 4 distinct research themes to explore, namely: simulator validity (face, content and predictive), human factors in 3D stereoscopic display, motor skill acquisition, and curriculum integration. Methods: Chapter 3 explores the face and content validity of Simodont® haptic dental simulator among a group of postgraduate dental students. Chapter 4 examines the predictive utility of Simodont® in predicting subsequent preclinical and clinical performance. The results indicate the potential utility of the simulator in predicting future clinical dental performance among undergraduate students. Chapter 5 investigates the role of stereopsis in dentistry from two different perspectives via two studies. Chapter 6 explores the effect of qualitatively different types of pedagogical feedback on the training, transfer and retention of basic manual dexterity dental skills. The results indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visualdisplay VR-driven feedback. A pedagogical model for integration of haptic dental simulator into the dental curriculum has been proposed in Chapter 7. Conclusion: The findings from this thesis provide new insights into the utility of the haptic virtual reality simulator in undergraduate preclinical dental education. Haptic simulators have promising potential as a pedagogical tool in undergraduate dentistry that complements the existing simulation methods. Integration of haptic VR simulators into the dental curriculum has to be informed by sound pedagogical principles and mapped into specific learning objectives

Feedback and motor skill acquisition using a haptic dental simulator

Aim: To investigate the effect of qualitatively different types of pedagogical feedback (FB) on the training, transfer and retention of basic manual dexterity dental skills using a virtual reality (VR) haptic dental simulator. Methods: Sixty-three participants (M = 22.7 years; SD = 3.4 years), with no previous dental training, were randomly allocated to one of three groups (n = 21 each). Group 1 received device-only feedback during the training phase, that is the visual display of the simulator (DFB); Group 2 received verbal feedback from a qualified dental instructor (IFB); and Group 3 received a combination of instructor and device feedback (IDFB). Participants completed four tasks during which feedback was given according to group allocation as well as two skills transfer tests. Skill retention was examined immediately after training, at 1 week and at 1 month post-test. Results: Statistically significant differences were found between the groups in overall performance (P < 0.001) and error (P = 0.006). Post hoc comparisons revealed the IDFB group produced substantially better performance and fewer errors in comparison with DFB and IFB training. This difference translated to improved performance in skill retention and generalisation of knowledge to novel tasks. Conclusion: These data indicate that the acquisition and retention of basic dental motor skills in novice trainees is best optimised through a combination of instructor and visual display (VR)-driven feedback. The results have implications for the utility and implementation of VR haptic technology in dental education

Effectiveness and Student Perceptions of Haptic Virtual Reality Simulation Training as an Instructional Tool in Pre-Clinical Paediatric Dentistry: A Pilot Pedagogical Study

Simulation training for invasive dental procedures is a core component of the pre-clinical dental curriculum. Besides conventional mannequin-based simulators, dental schools are now incorporating haptic virtual reality simulation (HVRS) devices to facilitate the transition of students from the simulated dental learning environment to the clinical settings. This study aimed to assess student performance and perceptions of HVRS training as a pedagogical tool in pre-clinical paediatric dentistry. After practicing the primary molar pulpotomy procedure on plastic teeth, participants were randomized into test and control groups. Test group students performed the same procedure on a HVRS device, namely the SIMtoCARE Dente®. Subsequently, both the test and control group students attended another conventional pulpotomy simulation session where the quality of their access outline and pulp chamber deroofing steps were evaluated on plastic teeth. After the control group students also experienced the HVRS, all study participants completed a perception questionnaire on their experience. No significant differences were found between the study and control group students for the quantitative parameters assessed. Although the students regarded HVRS to be a useful adjunct to support their pre-clinical training, an overwhelming majority of the students did not consider HVRS to be a replacement for conventional pre-clinical simulation training

Objective assessment and feedback generation in dental surgical simulation : a framework based on correlating procedure and outcome

Fine motor skill is indispensable for a dentist. As in many other medical fields of study, the traditional surgical master-apprentice model is widely adopted in dental education. Recently, virtual reality (VR) simulators have been employed as supplementary components to the traditional skill-training curriculum, and numerous dental VR systems have been developed academically and commercially. However, the full promise of such systems has yet to be realized due to the lack of sufficient support for formative feedback. Without such a mechanism, evaluation still demands dedicated time of experts in scarce supply. With the aim to fill the gap of formative assessment using VR simulators in skill training in dentistry, this thesis presents a framework to objectively assess the surgical skill and generate formative feedback automatically. VR simulators enable collecting detailed data on relevant metrics throughout a procedure. Our approach to formative feedback is to correlate procedure metrics with the procedure outcome in order to identify the portions of a procedure that need to be improved. Prior to the correlation, the procedure outcome needs to be evaluated. The scoring algorithm designed in this thesis provides an overall score and identifies specific errors and their severity. Building upon this, we developed techniques to identify the portion of the procedure responsible for the errors. Specifically, for the errors in the outcome the responsible portions of the procedure are identified based on correlation of location of the error. For some types of feedback one mode may be more suitable than another. Tutoring formative feedback are provided using the video- and haptic- modalities. The effectiveness of the feedback systems have been evaluated with the dental students with randomized controlled trials and the findings show the feedback mechanisms to be effective and have potentials to use as valuable supplemental training resources

Haptic Enhancement of Sensorimotor Learning for Clinical Training Applications

Modern surgical training requires radical change with the advent of increasingly complex procedures, restricted working hours, and reduced ‘hands-on’ training in the operating theatre. Moreover, an increased focus on patient safety means there is a greater need to objectively measure proficiency in trainee surgeons. Indeed, the existing evidence suggests that surgical sensorimotor skill training is not adequate for modern surgery. This calls for new training methodologies which can increase the acquisition rate of sensorimotor skill. Haptic interventions offer one exciting possible avenue for enhancing surgical skills in a safe environment. Nevertheless, the best approach for implementing novel training methodologies involving haptic intervention within existing clinical training curricula has yet to be determined. This thesis set out to address this issue. In Chapter 2, the development of two novel tools which enable the implementation of bespoke visuohaptic environments within robust experimental protocols is described. Chapters 3 and 4 report the effects of intensive, long-term training on the acquisition of a compliance discrimination skill. The results indicate that active behaviour is intrinsically linked to compliance perception, and that long-term training can help to improve the ability of detecting compliance differences. Chapter 5 explores the effects of error augmentation and parameter space exploration on the learning of a complex novel task. The results indicate that error augmentation can help improve learning rate, and that physical workspace exploration may be a driver for motor learning. This research is a first step towards the design of objective haptic intervention strategies to help support the rapid acquisition of sensorimotor skill. The work has applications in clinical settings such as surgical training, dentistry and physical rehabilitation, as well as other areas such as sport