3D Anatomy Models and Impact on Learning: A Review of the Quality of the Literature

AbstractBackgroundThe aims of this study were to identify studies exploring three-dimensional (3D) anatomy models and their impact on learning, and to assess the quality of research in this area.MethodsPubMed, EMBASE, and the Web of Knowledge databases were searched using the following keywords "3D anatomy", "three dimensional anatomy," "3D virtual reality anatomy," "3D VR anatomy," "3D anatomy model, “3D anatomy teaching", and “anatomy learning VR” . Three evaluators independently assessed the quality of research using the Medical Education Research Study Quality Instrument (MERSQI).ResultsOf the 94,616 studies identified initially, 30 studies reported data on the impact of using 3D anatomy models on learning. The majority were of moderate quality with a mean MERSQI score=10.26 (SD 2.14, range 6.0–13.5). The rater intra-class correlation coefficient was 0.79 (95% confidence interval 0.75–0.88). Most studies were from North America (53%), and Europe (33%) and the majority were from medical (73%) and Dental (17%) schools.ConclusionsThere was no solid evidence that the use of 3D models is superior to traditional teaching. However, the studies varied in research quality. More studies are needed to examine the short- and long-term impacts of 3D models on learning using valid and appropriate tools

Enhancing surgical training by audio-visual simulation with hazard cognitive training and reflection tools: a design-based study in laparoscopic cholecystectomy

Abstract Background Surgical training has become more challenging in the UK with the reduction in training time and the reduced training opportunities, making every training opportunity precious. This study aims to address this curriculum challenge by enhancing surgical training and assessment in the surgical training environment. Methodology Using a design-based approach a two-step design was created. Step One involved creating an online, standalone, Cognitive Hazard Training module. It uses videos of real operations to mentally train candidates to recognise, anticipate and avoid hazards during the operation. An online example of this Module was created for laparoscopic cholecystectomy. The second design step was a Reflective Formative Assessment. The trainee and supervisor reviewed the trainee’s video-recording of a supervised-operation which involved reassessing the trainee’s performance to enhance feedback and reflection. Design feasibility was tested in the Northern Deanery training environment and the feasibility study was complemented by a theatre observation study to capture the details of the complex surgical training environment. Results The feasibility of this two-step design was tested with 2 experts, 32 trainees and 15 trainers. Trainee and trainer qualitative feedback was collected, via semi-structured interviews. Users’ feedback along with multiple additional data from the operation-recordings and video-review session were analysed and triangulated to improve the design and establish the feasibility and role of this style of video-review in the current surgical training. Observational data was also collected during live surgery in theatre to identify any factors affecting safety and training. Discussion This study has developed a novel approach to enhance surgical training, which has been tested and has received overwhelming support from both supervisors and their trainees. Cognitive Hazards Training steepened the learning curve and increased adherence to safety. The videoed operations were found to be an excellent teaching tool, which enhanced feedback and reflection. It increased trainees’ confidence and competence by tailoring the training to their individual needs. The success of this work forms the foundation for future development and testing of this new approach to surgical skills training in the UK

IMHOTEP: cross-professional evaluation of a three-dimensional virtual reality system for interactive surgical operation planning, tumor board discussion and immersive training for complex liver surgery in a head-mounted display

Background Virtual reality (VR) with head-mounted displays (HMD) may improve medical training and patient care by improving display and integration of different types of information. The aim of this study was to evaluate among different healthcare professions the potential of an interactive and immersive VR environment for liver surgery that integrates all relevant patient data from different sources needed for planning and training of procedures. Methods 3D-models of the liver, other abdominal organs, vessels, and tumors of a sample patient with multiple hepatic masses were created. 3D-models, clinical patient data, and other imaging data were visualized in a dedicated VR environment with an HMD (IMHOTEP). Users could interact with the data using head movements and a computer mouse. Structures of interest could be selected and viewed individually or grouped. IMHOTEP was evaluated in the context of preoperative planning and training of liver surgery and for the potential of broader surgical application. A standardized questionnaire was voluntarily answered by four groups (students, nurses, resident and attending surgeons). Results In the evaluation by 158 participants (57 medical students, 35 resident surgeons, 13 attending surgeons and 53 nurses), 89.9% found the VR system agreeable to work with. Participants generally agreed that complex cases in particular could be assessed better (94.3%) and faster (84.8%) with VR than with traditional 2D display methods. The highest potential was seen in student training (87.3%), resident training (84.6%), and clinical routine use (80.3%). Least potential was seen in nursing training (54.8%). Conclusions The present study demonstrates that using VR with HMD to integrate all available patient data for the preoperative planning of hepatic resections is a viable concept. VR with HMD promises great potential to improve medical training and operation planning and thereby to achieve improvement in patient care

Oral Paper SP63. Learner Centred Communication Masterclasses

Background HYMS 3rd and 4th Year MB ChB students frequently encountered communication challenges on clinical placements, despite extensive communication skills teaching in the first two (university based) years of the course. PresentationCompulsory Communication Masterclasses were introduced for 3rd and 4th year students to provide an opportunity for them to address Communication and Professionalism challenges they have encountered on clinical placement. The student-centred Masterclasses are led by Primary /Secondary Care clinicians working with experienced Simulated Patients. They provide an opportunity for students to role play Communication/Professionalism challenges and receive feedback from their peers, Simulated Patient and tutor to help identify strategies for dealing with similar challenges in their future career. Evaluation Students are required to complete an online evaluation which includes descriptive and Likert scale feedback. Students give consistently positive feedback on these sessions, and highlight appreciating the opportunity to reflect and learn from clinician tutors about real-life communication/ professionalism challenges. This student evaluation informs Staff Development Masterclasses for tutors, tutored by faculty and run similarly to the Student Communication Masterclasses. These provide an opportunity to address challenges that tutors have encountered when tutoring Masterclasses and ensure that tutors deliver a consistently high quality student-learning experience

Roundtable RT06. Clinical Reasoning skills: Something that can be taught or just a matter of seeing lots of patients?

There is considerable literature regarding the complex nature of clinical reasoning for clinicians. Norman (2005) stated “there is no such thing as clinical reasoning - there is no best way through a problem. The more one studies the clinical expert, the more one marvels at the complex and multidimensional components of knowledge and skill that he brings to bear on the problem, and the amazing adaptability he must possess to achieve the goals of effective care”.For novices to become experts they need extensive deliberate practice to facilitate the availability of conceptual knowledge and add to their storehouse of already solved problems (Norman 2005).The authors are aware that previously students learnt how to reason clinically by clerking lots of patients and constructing lists of likely differential diagnoses. Students were repeatedly interrogated by doctors to justify their differential diagnoses. Changes in working time directives and increased shift working mean that students are less likely to have to justify their thinking on several occasions to the same doctor who then helps them develop their reasoning skills.Today’s students face further challenges, as modern medical curricula generally focus on delivering clinical experience in system-specific rotations leaving students unable to organise information effectively when patients present with complex, multisystem illnesses. A limitation of systems based curricula is that it does not encourage the development of clinical reasoning skills.There is now extensive literature regarding the need to explicitly teach clinical reasoning skills to students in addition to them having lots of practice in clerking patients and then constructing lists of the most likely differential diagnoses.Delegates at this round table discussion will be encouraged to debate whether they believe that students can be explicitly taught clinical reasoning skills or whether it is just a case of ‘seeing lots of patients’

Oral Paper S26 - What are students frightened of?

Background Despite extensive consistent integrated early clinical experience at HYMS, students have often been noted to struggle in making the transition from the largely University-based Phase I (2 years) to immersion in the clinically-based Phase II. Tutors report student difficulties in adopting an appropriate attitude to learning in this environment; some are noted to respond to this by minimising the time spent on the wards with obvious consequences for their experience and education. Presentation A new “Core Clinical Skills and Professional Expectations” course, lasting 2 weeks was introduced in August 2014 for students making this transition. This block aimed to address many areas which students have been noted to struggle with, including professionalism and development of clinical diagnostic reasoning and skills for independent learning. Evaluation Students were asked to identify their own fears and anxieties about moving into the clinical environment. All students completed a brief survey at both the beginning and the end of this two week period which included identification of their own sources of anxiety in approaching immersion in the clinical environment. Results of this survey are presented and discussed with implications for clinical teaching

Workshop 13. Clinical Diagnostic Reasoning: Equipping students with peer instruction skills to work together in developing their diagnostic reasoning

Workshop Format An introductory presentation covering best evidence in current medical education literature regarding development of diagnostic clinical reasoning skills for undergraduate students Small group work focusing on clinical tutor- identified real case scenarios to enable delegates to identify teaching and learning approaches to help undergraduate students to develop diagnostic reasoning skills. This will include consideration of facilitation of peer-peer approaches for development of clinical reasoning skills A closing plenary will include • DVD demonstrating the authors’ approach to facilitation of skills development in this area • Further discussion about the student-led approach • Reflection on incorporating novel approaches in delegates` own curriculum and teaching sessions • Presentation of the authors student “pocket guide” hand-out • Questions/Answers/Sharing best practice. Workshop Submissions Objectives To consider clinical tutor-identified, specific, student cognitive-processing difficulties in clinical diagnostic reasoning in contemporary systems based curricula. o consider specific challenges for students in developing their own clinical reasoning skills, following a transition from university to clinical teaching environments. To aid development of students` ability to consider their own clinical reasoning skills and facilitate development of these skills in their colleagues To share best practice with colleagues To discuss the authors` example of curricular innovation in this area Intended audience Tutors responsible for delivering clinical skills/ clinical reasoning teaching in undergraduate training

Perception and Orientation in Minimally Invasive Surgery

During the last two decades, we have seen a revolution in the way that we perform abdominal surgery with increased reliance on minimally invasive techniques. This paradigm shift has come at a rapid pace, with laparoscopic surgery now representing the gold standard for many surgical procedures and further minimisation of invasiveness being seen with the recent clinical introduction of novel techniques such as single-incision laparoscopic surgery and natural orifice translumenal endoscopic surgery. Despite the obvious benefits conferred on the patient in terms of morbidity, length of hospital stay and post-operative pain, this paradigm shift comes at a significantly higher demand on the surgeon, in terms of both perception and manual dexterity. The issues involved include degradation of sensory input to the operator compared to conventional open surgery owing to a loss of three-dimensional vision through the use of the two-dimensional operative interface, and decreased haptic feedback from the instruments. These changes have led to a much higher cognitive load on the surgeon and a greater risk of operator disorientation leading to potential surgical errors. This thesis represents a detailed investigation of disorientation in minimally invasive surgery. In this thesis, eye tracking methodology is identified as the method of choice for evaluating behavioural patterns during orientation. An analysis framework is proposed to profile orientation behaviour using eye tracking data validated in a laboratory model. This framework is used to characterise and quantify successful orientation strategies at critical stages of laparoscopic cholecystectomy and furthermore use these strategies to prove that focused teaching of this behaviour in novices can significantly increase performance in this task. Orientation strategies are then characterised for common clinical scenarios in natural orifice translumenal endoscopic surgery and the concept of image saliency is introduced to further investigate the importance of specific visual cues associated with effective orientation. Profiling of behavioural patterns is related to performance in orientation and implications on education and construction of smart surgical robots are drawn. Finally, a method for potentially decreasing operator disorientation is investigated in the form of endoscopic horizon stabilization in a simulated operative model for transgastric surgery. The major original contributions of this thesis include: Validation of a profiling methodology/framework to characterise orientation behaviour Identification of high performance orientation strategies in specific clinical scenarios including laparoscopic cholecystectomy and natural orifice translumenal endoscopic surgery Evaluation of the efficacy of teaching orientation strategies Evaluation of automatic endoscopic horizon stabilization in natural orifice translumenal endoscopic surgery The impact of the results presented in this thesis, as well as the potential for further high impact research is discussed in the context of both eye tracking as an evaluation tool in minimally invasive surgery as well as implementation of means to combat operator disorientation in a surgical platform. The work also provides further insight into the practical implementation of computer-assistance and technological innovation in future flexible access surgical platforms

Investigating the User Experience with a 3D Virtual Anatomy Application

Decreasing hours dedicated to teaching anatomy courses and declining use of human cadavers have spurred the need for innovative solutions in teaching anatomy in medical schools. Advancements in virtual reality (VR), 3D visualizations, computer graphics, and medical graphic images have enabled the development of highly interactive 3D virtual applications. Over recent years, variations of interactive systems on computer-mediated environments have been used as supplementary resource for learners. However, despite the growing sophistication of these resources for learning anatomy, studies show that students predominantly prefer traditional methods of learning and hands-on cadaver-based learning over computer-mediated platforms. There is limited research on evaluating user experience in the use of interactive 3D anatomy systems, even though Human-Computer Interaction (HCI) studies show that usability (ease of use) and user engagement are essential to technology adoption and satisfaction. The addressable problem of the research was to investigate how ease of use and flow affected aspects of the students’ engagement experience with the use of a 3D virtual anatomy application. The aim of the study was to evaluate the use of a 3D virtual application in performing dissection learning tasks and to understand aspects of user engagement as assessed by ease of use and flow experience. The flow experience was quantified using the Short Flow State Scale (S FSS-2) and the System Usability Scale (SUS) to measure perceptions about ease of use and user satisfaction. The research questions included: (1) What consequences of flow do students experience? (2) What aspects of the 3D virtual platform are distracting to performing the learning tasks? (3) How do students’ perception of ease of use affect the flow experience based on the SUS and S FSS-2 scores? (4) How do students rate their level of engagement as measured by flow based on their S FSS-2 scores? (5) How does flow help explain student satisfaction and motivation? (6) How do students perceive use of the application to learn anatomy compared with cadaver-based dissection? The study consisted of medical student participants who were asked to complete virtual dissection activities associated with learning objectives in the Structure of the Human Body course to perform using a 3D virtual anatomy application. A subset of participants who completed the learning task and the surveys had a follow-up Cognitive Walkthrough with Think-Aloud Protocol observation activity with an interview segment to gain deeper insights into their user experience with the application. The data from the convergent mixed method analysis indicated that ease of use had some impact on the flow experience and that perceived user satisfaction and motivation were attributed to the interactive 3D visualization design. Seven super-ordinate themes were identified: Ease of Use, Learnability, Interface-Technical, User Satisfaction, Visuospatial, Focus/In the Zone, and CA vs Cadaver. The results have implications for educators (particularly anatomists), educational technologists, and HCI and UX practitioners. Additional research should be conducted using the long version of the Flow State Scale to provide a better understanding of each flow dimension. Further study is recommended with students who have hands-on experience with human cadaver dissection that are also able to compare their experience with the use of a 3D virtual anatomy platform for a direct side-by-side assessment. It would also be helpful to conduct the study as part of the entire duration of the anatomy course and assess how the flow experience impacts student learning performance