Feasibility and fidelity of practising surgical fixation on a virtual ulna bone (original) (raw)
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Cureus, 2023
Background Virtual reality (VR) simulation is a potential solution to the barriers surgical trainees are facing. There needs to be validation for its implementation within current training. We aimed to compare VR simulation to traditional methods in acquiring surgical skills for a TFN-ADVANCED™ Proximal Femoral Nailing System (TFNA; DePuy Synthes, Auckland, New Zealand) femoral nailing system. Methods Thirty-one surgical trainees were randomised to two groups: traditional-training group (control group) and a VR-training group (intervention group) for insertion of a short cephalomedullary TFNA nail. Both groups then inserted the same TFNA system into saw-bone femurs. Surveys evaluated validity of the relevant activities, perception of simulation, confidence, stress and anxiety. The primary outcomes were tip-apex distance (TAD) and user anxiety/confidence levels. Secondary outcomes included number of screw-and nail-guidewire insertion attempts, the time taken to complete and user validity of the VR system. Results There was no statistical difference in TAD between the intervention and control groups (9mm vs 15mm, p=0.0734). The only TAD at risk of cutout was in the control group (25mm). There was no statistical difference in time taken (2547.5ss vs 2395ss, p=0.668), nail guide-wire attempts (two for both groups, p=0.355) and screw guide-wire attempts (one for both groups, p=0.702). The control group versus intervention had higher anxiety levels (50% vs 33%) and had lower confidence (61% vs 84%). Interpretation There was no objective difference in performance on a saw-bone model between groups. However, this VR simulator resulted in more confidence and lower anxiety levels whilst performing a simulated TFNA. Whilst further studies with larger sample sizes and exploration of transfer validity to the operating theatre are required, this study does indicate potential benefits of VR within surgical training.
Construct Validity Testing of a Laparoscopic Surgical Simulator
Journal of the American College of Surgeons, 2006
BACKGROUND: We present initial data on the construct, content, and face validity of the LAPMentor (Simbionix), virtual reality laparoscopic surgical simulator. STUDY DESIGN: Medical students (MS), residents and fellows (R/F), and experienced laparoscopic surgeons (ES), with Ͻ 30 laparoscopic cases per year (ES Ͻ 30) and those with Ͼ 30 laparoscopic cases per year (ES Ͼ 30), were tested on 9 basic skill tasks (SK) including manipulation of 0-degree and 30-degree cameras (SK1, SK2), eye-hand coordination (SK3), clipping (SK4), grasping and clipping (SK5), two-handed maneuvers (SK6), cutting (SK7), fulguration (SK8), and objecttranslocation (SK9).
When Does Fidelity Matter? An Evaluation of Two Medical Simulation Methods
2011
Job or task simulations are used in training when the use of the real task is dangerous or expensive, such as flying aircraft or surgery. This study focused on comparing two types of simulations used in assessments during a Clinical Performance Examination of thirdyear medical students: computer enhanced mannequins and standardized patients. Each type of simulation has advantages, but little empirical work exists to guide the use of different types of simulation for training and evaluating different aspects of performance. This study analyzed performance scores for different competencies as well as the reliability and validity of the different simulation types. The results showed that though neither simulator was generally superior to the other, the mannequin performed surprisingly well on interpersonal tasks such as communication and history taking.
Biomedical Journal of Scientific & Technical Research, 2018
Laparoscopic surgery is the standard approach for most surgical operations because of its benefits for the patients, although it requires a significant learning curve. For this reason, the FDA established the need for certified laparoscopic training programs, supported by validated surgical simulators. Our multidisciplinary team developed a virtual surgical simulator (eLap4D) based on: a low-cost and a realistic haptic feedback. This study presents the validation process of the eLap4D, performed through the construct and face validities. The authors preliminarily analyzed and excluded the possible impact of videogame experience on eLap4D users. The construct validity was used to objectively assess the surgical value of five basic skills by comparing the performances between two groups with different levels of laparoscopy experience. The presence of a learning curve was also evaluated by comparing the results of the first and second attempts. The difference among exercises was investigated in terms of the difficulty and kind of basic gestures, comparing the completion rates of every task in the three difficulty levels each. Face validation was performed using a specific questionnaire investigating the realism and accuracy of the simulator. This last survey was administered only to experienced surgeons. The validation process indicated that eLap4D can measure surgical ability and not just videogame experience. It also positively affects the learning curve and reproduces different basic gestures and levels of difficulty. Face validity confirmed that its structural features and ergonomics are satisfactory. In conclusion, eLap4D seems suitable and useful for learning basic laparoscopy skills.
A Systematic Review on Orthopedic Simulators for Psycho-Motor Skill and Surgical Procedure Training
Journal of Medical Systems, 2018
Precise simulators can replicate complete understanding of the models. In this survey, we focus on orthopedic simulators that are not only in replicating real-world models but also in educating with complete procedure: surgical, for instance. It covers 18 hip replacement, three-knee replacement, three facial surgeries, one spine surgery and six orthopedic psychomotor skills training and assessment-based simulators. We also provide comparative studies and highlight current trends and possible challenges. We observed that orthopedic training methodologies have undergone a paradigm shift. This means that the simulators replace the use of sensitive hospital settings for training and skill acquisition. In brief, we address classified overview on existing orthopedic simulators: physical and Virtual Reality (VR)-based simulators. Key steps to develop computer-assisted, VR-based simulator are explored. Experts' opinion on the use of simulation technologies in the field of orthopedics is discussed.
Assessment of a new kind of surgical simulator. The physical surgical simulator
Acta cirurgica brasileira, 2018
To evaluate whether the use of the physical surgical simulator may benefit the development of laparoscopic skills. Ten medical students were divided into two groups: the first one performed ten weekly training sessions with a physical surgical simulator - ETX A2 LAP and, afterwards, one laparoscopic cholecystectomy in a porcine model, while the second group performed only a laparoscopic cholecystectomy. Both groups were compared regarding bleeding, total surgical time, time to perform each surgical step and qualitative parameters, based on a previously validated tool. There was no difference in any of the evaluated parameters. We did not find any evidence of benefit in the use of the physical simulator for surgical performance in medical students.
BMC Medical Education, 2011
Background: Yearly surveys among the undergraduate students in oral and maxillofacial surgery at Karolinska Institutet have conveyed a wish for increased clinical training, and in particular, in surgical removal of mandibular third molars. Due to lack of resources, this kind of clinical supervision has so far not been possible to implement. One possible solution to this problem might be to introduce simulation into the curriculum. The purpose of this study was to investigate undergraduate students' perception of two different simulation methods for practicing clinical reasoning skills and technical skills in oral and maxillofacial surgery. Methods: Forty-seven students participating in the oral and maxillofacial surgery course at Karolinska Institutet during their final year were included. Three different oral surgery patient cases were created in a Virtual Patient (VP) Simulation system (Web-SP) and used for training clinical reasoning. A mandibular third molar surgery simulator with tactile feedback, providing hands on training in the bone removal and tooth sectioning in third molar surgery, was also tested. A seminar was performed using the combination of these two simulators where students' perception of the two different simulation methods was assessed by means of a questionnaire. Results: The response rate was 91.5% (43/47). The students were positive to the VP cases, although they rated their possible improvement of clinical reasoning skills as moderate. The students' perception of improved technical skills after training in the mandibular third molar surgery simulator was rated high. The majority of the students agreed that both simulation techniques should be included in the curriculum and strongly agreed that it was a good idea to use the two simulators in concert. The importance of feedback from the senior experts during simulator training was emphasised. Conclusions: The two tested simulation methods were well accepted and most students agreed that the future curriculum would benefit from permanent inclusion of these exercises, especially when used in combination. The results also stress the importance of teaching technical skills and clinical reasoning in concert.
Does Perception of Usefulness of Arthroscopic Simulators Differ with Levels of Experience?
Clinical Orthopaedics and Related Research®, 2011
Background Some commercial simulators are available for training basic arthroscopic skills. However, it is unclear if these simulators allow training for their intended purposes and whether the perception of usefulness relates to level of experience. Questions/purposes We addressed the following questions: (1) Do commercial simulators have construct (times to perform tasks) and face validity (realism), and (2) is the perception of usefulness (educational value and userfriendliness) related to level of experience? Methods We evaluated two commercially available virtual reality simulators (Simulators A and B) and recruited 11 and nine novices (no arthroscopies), four and four intermediates (one to 59 arthroscopies), and seven and nine experts ([ 60 arthroscopies) to test the devices. To assess construct validity, we recorded the median time per experience group for each of five repetitions of one identical navigation task. To assess face validity, we used a questionnaire to judge up to three simulator characteristic tasks;
Validation and implementation of surgical simulators: a critical review of present, past, and future
Surgical Endoscopy, 2010
Background In the past 20 years the surgical simulator market has seen substantial growth. Simulators are useful for teaching surgical skills effectively and with minimal harm and discomfort to patients. Before a simulator can be integrated into an educational program, it is recommended that its validity be determined. This study aims to provide a critical review of the literature and the main experiences and efforts relating to the validation of simulators during the last two decades. Methods Subjective and objective validity studies between 1980 and 2008 were identified by searches in Pubmed, Cochrane, and Web of Science. Results Although several papers have described definitions of various subjective types of validity, the literature does not offer any general guidelines concerning methods,