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BACKGROUND: This review aims to evaluate the effectiveness of extended reality-based training in surgical education. METHODS: This systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 33 studies were included in the qualitative analysis. Nine studies evaluated the effectiveness of virtual reality-based training against no substitutional training. Seven studies looked at training for laparoscopic surgery, and the results were contradicting. Two studies focused on orthopedics training, and the outcomes were positive. Fourteen studies compared the outcomes of virtual reality-based training to conventional didactic teaching, all demonstrating superior outcomes for virtual reality-based training. Nine studies compared the outcomes of virtual reality simulation training to dry lab simulation training. The inferior outcomes of virtual reality simulation training were demonstrated by 5 studies for laparoscopic surgery, 1 study for arthroscopic procedures, 1 study for robotic surgery, and 1 study for dental procedures. One study found potential benefits of virtual reality simulation training on orthopedics surgeries. One study found virtual reality simulation training to be superior to cadaveric training, and 3 studies found augmented reality and virtual reality-based training to be comparable to supervised operative opportunities. CONCLUSION: Extended reality-based training is a potentially useful modality to serve as an adjunct to the current physical surgical training.
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Introduction: A novel chatbot mobile app for training of undergraduate medical students' clinical history taking skills was developed in 2021. Students were able to take clinical history from the virtual patient for bedside teaching. A case-control study was conducted to evaluate the effectiveness of learning with chatbot mobile app, versus conventional bedside teachings with real patients. Methods: 132 final year medical students were randomized into two groups - Conventional bedside teaching with clinical history taken from a real patient, and Bedside teaching with clinical history taken from the Chatbot. Independent blinded assessment of students' history taking skills was conducted. Students' performance were assessed by standardized marking scheme. Results: Median age was 23 years old (Range 21-30 years old). There were 62 female and 70 male students.64 students were randomized into conventional group while 68 students were randomized into the chatbot group. Baseline demographic data were comparable between the two groups.Blinded assessment of students' performance in clinical history taking were comparable between the conventional group and chatbot group (p > 0.05). Conclusion: With the promising results we have demonstrated in this study, we believe training of history taking skills by chatbot will be a feasible alternative to conventional bedside teaching.
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RATIONALE: Tumor lysis syndrome is a potentially lethal condition caused by rapid cell death, releasing a high level of toxic cytokines. It is common in patients with hematological malignancy but rare in solid tumors. PATIENT CONCERNS: A 64-year-old patient presented to our unit with a 17.3-cm hepatocellular carcinoma and marginal liver reserve. The first-stage operation of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) was performed. DIAGNOSIS: The patient was found to be anuric with grossly deranged electrolytes after the first-stage operation. Tumor lysis syndrome was diagnosed. INTERVENTIONS: The patient was transferred to the intensive care unit for aggressive fluid administration and continuous venovenous hemofiltration for the management of tumor lysis syndrome. OUTCOMES: The patient recovered and then underwent the second-stage operation of ALPPS with extended right hepatectomy 8 days after the initial operation without any long-term sequelae. LESSONS: ALPPS is a relatively new technique in liver surgery, entailing an increased risk of tumor lysis syndrome due to an in situ tumor after the first-stage operation. Clinicians should have a high index of suspicion regarding this potentially lethal complication with prompt management.
