Visuo-spatial ability in colonoscopy simulator training

Visuo-spatial ability is associated with a quality of performance in a variety of surgical and medical skills. However, visuo-spatial ability is typically assessed using Visualization tests only, which led to an incomplete understanding of the involvement of visuo-spatial ability in these skills. To remedy this situation, the current study investigated the role of a broad range of visuo-spatial factors in colonoscopy simulator training. Fifteen medical trainees (no clinical experience in colonoscopy) participated in two psycho-metric test sessions to assess four visuo-spatial ability factors. Next, participants trained flexible endoscope manipulation, and navigation to the cecum on the GI Mentor II simulator, for four sessions within 1 week. Visualization, and to a lesser degree Spatial relations were the only visuo-spatial ability factors to correlate with colonoscopy simulator performance. Visualization additionally covaried with learning rate for time on task on both simulator tasks. High Visualization ability indicated faster exercise completion. Similar to other endoscopic procedures, performance in colonoscopy is positively associated with Visualization, a visuo-spatial ability factor characterized by the ability to mentally manipulate complex visuo-spatial stimuli. The complexity of the visuo-spatial mental transformations required to successfully perform colonoscopy is likely responsible for the challenging nature of this technique, and should inform training- and assessment design. Long term training studies, as well as studies investigating the nature of visuo-spatial complexity in this domain are needed to better understand the role of visuo-spatial ability in colonoscopy, and other endoscopic techniques

Visuospatial ability factors and performance variables in laparoscopic simulator training

Visuospatial ability has been shown to be important to several aspects of laparoscopic performance, including simulator training. Only a limited subset of visuospatial ability factors however has been investigated in such studies. Tests for different visuospatial ability factors differ in stimulus complexity, in their emphasis on identifying visual stimuli in a cluttered context, and in the demands they make on speed of processing. To help clarify the involvement of visuospatial ability factors in laparoscopic performance the current study investigated the role of four such factors in laparoscopic simulator performance. Twenty four students participated in a two-month course, consisting of eight weekly, half-hour laparoscopic simulator training sessions. Before the start of this course four visuospatial ability factors were measured. Learning curves were based on the simulator performance variables of (task) Duration, Motion efficiency, and Damage. The visuospatial ability factor Visualization impacted Damage and Motion efficiency. The factor Spatial relations impacted Damage. Visuospatial ability factors measuring the ability to mentally manipulate complex to moderately complex stimuli are more important than other visuospatial ability factors during basic laparoscopic simulator training. A finding relevant to theories of skill development is that the impact of Visualization on learning curves for Damage and Motion efficiency was most evident during early- and late (but not middle) training, which may be an indicator of a switch between different phases of skills learning. Learning curves and repeated measures analyses indicated damage control should be emphasized in laparoscopic skills trainin

Stereopsis in Medical Virtual-Learning-Environments

In surgical training a lot of effort is directed at developing virtual learning environments (VLE's). These environments usually include one or more of the following features: haptic feedback, the sending of a slightly different computer-generated image to both eyes (affording an user's experience of stereoptical depth), and a transparant interface that allows ‘natural’ interaction.\ud \ud Now that many of these VLE's are approaching a state of maturity, time has come to start evaluating these environments, as basic questions regarding the effectiveness of the features mentioned above remain unanswered.\ud \ud The purpose of this article is to present an experiment aimed at evaluating the effects of stereopsis during a learning phase on visuo-spatial reasoning in two subsequent tasks that are related to the medical practice of diagnosi

Stereopsis in Medical Virtual-Learning-Environments

In surgical training a lot of effort is directed at developing virtual learning environments (VLE's). These environments usually include one or more of the following features: haptic feedback, the sending of a slightly different computer-generated image to both eyes (affording an user's experience of stereoptical depth), and a transparant interface that allows ‘natural’ interaction. Now that many of these VLE's are approaching a state of maturity, time has come to start evaluating these environments, as basic questions regarding the effectiveness of the features mentioned above remain unanswered. The purpose of this article is to present an experiment aimed at evaluating the effects of stereopsis during a learning phase on visuo-spatial reasoning in two subsequent tasks that are related to the medical practice of diagnosi

Competency assessment tool for laparoscopic suturing: Development and reliability evaluation

Background: Laparoscopic suturing can be technically challenging and requires extensive training to achieve competency. To date no specific and objective assessment method for laparoscopic suturing and knot tying is available that can guide training and monitor performance in these complex surgical skills. In this study we aimed to develop a laparoscopic suturing competency assessment tool (LS-CAT) and assess its inter-observer reliability. Methods: We developed a bespoke CAT tool for laparoscopic suturing through a structured, mixed methodology approach, overseen by a steering committee with experience in developing surgical assessment tools. A wide Delphi consultation with over twelve experts in laparoscopic surgery guided the development stages of the tool. Following, subjects with different levels of laparoscopic expertise were included to evaluate this tool, using a simulated laparoscopic suturing task which involved placing of two surgical knots. A research assistant video recorded and anonymised each performance. Two blinded expert surgeons assessed the anonymised videos using the developed LS-CAT. The LS-CAT scores of the two experts were compared to assess the inter-observer reliability. Lastly, we compared the subjects’ LS-CAT performance scores at the beginning and end of their learning curve. Results: This study evaluated a novel LS-CAT performance tool, comprising of four tasks. Thirty-six complete videos were analysed and evaluated with the LS-CAT, of which the scores demonstrated excellent inter-observer reliability. Cohen’s Kappa analysis revealed good to excellent levels of agreement for almost all tasks of both instrument handling and tissue handling (0.87; 0.77; 0.75; 0.86; 0.85, all with p &lt; 0.001). Subjects performed significantly better at the end of their learning curve compared to their first attempt for all LS-CAT items (all with p &lt; 0.001). Conclusions: We developed the LS-CAT, which is a laparoscopic suturing grading matrix, with excellent inter-rater reliability and to discriminate between experience levels. This LS-CAT has a potential for wider use to objectively assess laparoscopic suturing skills.</p