Assessment of learning in simulator-based arthroscopy training with the diagnostic arthroscopy skill score (DASS) and neurophysiological measures.

PURPOSE: Virtual arthroscopic training has become increasingly popular. However, there is a lack of efficiency-based tracking of the trainee, which may be critical for determining the specifics of training programs and adapting them for the needs of each trainee. This study aims to evaluate and compare the measures obtained with a non-invasive neurophysiological method with The Diagnostic Arthroscopy Skill Score (DASS), a commonly used assessment tool for evaluating arthroscopic skills. METHODS: The study collected simulator performance scores, consisting of "Triangulation Right Hand", "Triangulation Left Hand", "Catch the Stars" and "Three Rings" and DASS scores from 22 participants (11 novices, 11 experts). These scores were obtained while participants underwent a structured program of exercises for the fundamentals of arthroscopic surgery training (FAST) and knee module using a simulator-based arthroscopy device. During the evaluation, data on oxy-hemoglobin and deoxy-hemoglobin levels in the prefrontal cortex were collected using the Functional Near-Infrared Spectroscopy (fNIRS) imaging system. Performance scores, DASS scores, and fNIRS data were subsequently analyzed to determine any correlation between performance and cortex activity. RESULTS: The simulator performance scores and the DASSPart2 scores were significantly higher in the expert group compared to the novice group (200.1 ± 28.5 vs 172.5 ± 48.9, p = 0.04 and 9.4 ± 5.6 vs. 5.4 ± 5.6 p = 0.02). In the expert group, fNIRS data showed a significantly lower prefrontal cortex activation during fundamental tasks in the FAST module, indicating significantly more efficient mental resource use. CONCLUSION: The analysis of cognitive workload changes during simulation-based arthroscopy training revealed a significant correlation between the trainees' DASS scores and fNIRS data. This correlation suggests the potential use of fNIRS data and DASS scores as additional metrics to create adaptive training protocols for each participant. By incorporating these metrics, the training process can be optimized, leading to more efficient arthroscopic training and better preparedness for clinical operations. LEVEL OF EVIDENCE: III.

Studying Brain Activation during Skill Acquisition via Robot-Assisted Surgery Training.

Robot-assisted surgery systems are a recent breakthrough in minimally invasive surgeries, offering numerous benefits to both patients and surgeons including, but not limited to, greater visualization of the operation site, greater precision during operation and shorter hospitalization times. Training on robot-assisted surgery (RAS) systems begins with the use of high-fidelity simulators. Hence, the increasing demand of employing RAS systems has led to a rise in using RAS simulators to train medical doctors. The aim of this study was to investigate the brain activity changes elicited during the skill acquisition of resident surgeons by measuring hemodynamic changes from the prefrontal cortex area via a neuroimaging sensor, namely, functional near-infrared spectroscopy (fNIRS). Twenty-four participants, who are resident medical doctors affiliated with different surgery departments, underwent an RAS simulator training during this study and completed the sponge suturing tasks at three different difficulty levels in two consecutive sessions/blocks. The results reveal that cortical oxygenation changes in the prefrontal cortex were significantly lower during the second training session (Block 2) compared to the initial training session (Block 1) (p < 0.05).

Performance Monitoring via Functional Near Infrared Spectroscopy for Virtual Reality Based Basic Life Support Training.

The use of serious game tools in training of medical professions is steadily growing. However, there is a lack of reliable performance assessment methods to evaluate learner's outcome. The aim of this study is to determine whether functional near infrared spectroscopy (fNIRS) can be used as an additional tool for assessing the learning outcome of virtual reality (VR) based learning modules. The hypothesis is that together with an improvement in learning outcome there would be a decrease in the participants' cerebral oxygenation levels measured from the prefrontal cortex (PFC) region and an increase of participants' serious gaming results. To test this hypothesis, the subjects were recruited and divided into four groups with different combinations of prior virtual reality experience and prior Basic Life Support (BLS) knowledge levels. A VR based serious gaming module for teaching BLS and 16-Channel fNIRS system were used to collect data from the participants. Results of the participants' scores acquired from the serious gaming module were compared with fNIRS measures on the initial and final training sessions. Kruskal Wallis test was run to determine any significant statistical difference between the groups and Mann-Whitney U test was utilized to obtain pairwise comparisons. BLS training scores of the participants acquired from VR based serious game's the learning management system and fNIRS measurements revealed decrease in use of resources from the PFC, but increase in behavioral performance. Importantly, brain-based measures can provide an additional quantitative metric for trainee's expertise development and can assist the medical simulation instructors.