The exploration of remote simulation strategies for the acquisition of psychomotor skills in medicine: a pilot randomized controlled trial.

Background: Progress in remote educational strategies was fueled by the advent of the COVID-19 pandemic. This pilot RCT explored the efficacy of a decentralized model of simulation based on principles of observational and peer-to-peer learning for the acquisition of surgical skills. Methods: Sixty medical students from the University of Montreal learned the running subcuticular suture in four different conditions: (1) Control group (2) Self-learning (3) Peer-learning (4) Peer-learning with expert feedback. The control group learned with error-free videos, while the others, through videos illustrating strategic sub-optimal performances to be identified and discussed by students. Performance on a simulator at the end of the learning period, was assessed by an expert using a global rating scale (GRS) and checklist (CL). Results: Students engaging in peer-to-peer learning strategies outperformed students who learned alone. The presence of an expert, and passive vs active observational learning strategies did not impact performance. Conclusion: This study supports the efficacy of a remote learning strategy and demonstrates how collaborative discourse optimizes the students' acquisition of surgical skills. These remote simulation strategies create the potential for implantation in future medical curriculum design.Trial Registration: NCT04425499 2020-05-06.

Hand Sewn Anastomosis Skill Acquisition and In Vivo Transfer Using 3D-Printed Small Bowel Simulator.

INTRODUCTION: General surgery residents need to master the hand-sewn bowel anastomosis (HSBA) technique. However, practice opportunities outside of the operating room are rare, and commercial simulators are often costly. The objective of this study is to assess the efficacy of a new, affordable silicone small bowel simulator, made with a three-dimensional (3D) printed mold, as a training tool to learn this technique. METHODS: This was a single-blinded pilot randomized controlled trial comparing two groups of eight junior surgical residents. All participants completed a pretest using an inexpensive, custom developed 3D-printed simulator. Next, participants randomized to the experimental group practiced the HSBA skill at home (eight sessions), while those randomized to the control group did not receive any hands-on practice opportunities. A posttest was done using the same simulator as for the pretest and practice sessions, and the retention-transfer test was performed on an anesthetized porcine model. Pretests, posttests and retention-transfer tests were filmed and graded by a blinded evaluator using assessments of technical skills, quality of final product, and tests of procedural knowledge. RESULTS: The experimental group significantly improved after practicing with the model (P = 0.01), while an equivalent improvement was not noted in the control group (P = 0.07). Moreover, the experimental group's performance remained stable between the posttest and the retention-transfer test (P = 0.95). CONCLUSIONS: Our 3D-printed simulator is an affordable and efficacious tool to teach residents the HSBA technique. It allows development of surgical skills that are transferable to an in vivo model.

Development, manufacture and initial assessment of validity of a 3-dimensional-printed bowel anastomosis simulation training model.

BACKGROUND: It is critical that junior residents be given opportunities to practise bowel anastomosis before performing the procedure in patients. Three-dimensional (3D) printing is an affordable way to provide realistic, reusable intestinal simulators. The aim of this study was to test the face and content validity of a 3D-printed simulator for bowel anastomosis. METHODS: The bowel anastomosis simulator was designed and assembled with the use of desktop 3D printers and silicone solutions. The production cost ranges from $2.67 to $131, depending on which aspects of the model one prefers to include. We incorporated input from a general surgeon regarding design modifications to improve the realism of the model. Nine experts in general surgery (6 staff surgeons and 3 senior residents) were asked to perform an anastomosis with the model and then complete 2 surveys regarding face and content validity. Items were rated on a 5-point Likert scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"). RESULTS: The overall average score for product quality was 3.58, indicating good face validity. The average score for realism (e.g., flexibility and texture of the model) was 3.77. The simulator was rated as being useful for training, with an overall average score of 3.98. In general, the participants agreed that the simulator would be a valuable addition to current simulation-based medical education (average score 4.11). They commented that the model would be improved by adding extra layers to simulate mucosa. CONCLUSION: Experts found the 3D-printed bowel anastomosis simulator to be an appropriate tool for the education of surgical residents, based on the model's texture, appearance and ability to undergo an anastomosis. This model provides an affordable way for surgical residents to learn bowel anastomosis. Future research will focus on proving educational efficacy, effectiveness and transfer that can be adapted for laparoscopic anastomosis training, hand-sewing and stapling procedures.

"It's Only Brain Surgery": Using 3D Printing and Simulation to Prepare Rural Physicians for the Management of Acute Epidural Hematoma.

Patients presenting to rural emergency departments with increased intracranial pressure (ICP) can be challenging to diagnose, manage, and treat and although the presentation is rare, it is associated with high morbidity and mortality. In areas such as Newfoundland and Labrador, Canada, where the majority of the province is located far from tertiary care, this problem can be compounded by adverse weather impeding transport, necessitating that the problem is handled by rural physicians instead of neurosurgical care. However, many rural medical personnel do not receive any formal training in treating increased ICP. In this technical report, we use a low-tech, low-cost, high fidelity 3D printed skull to outline a simulation of increased ICP to better prepare rural physicians and emergency department teams who may encounter such a scenario in their practice in a rural area.

An Educational Network for Surgical Education Supported by Gamification Elements: Protocol for a Randomized Controlled Trial.

BACKGROUND: Traditionally, medical students have learned surgical skills by observing a resident physician or surgeon who is performing the technique. Due to inconsistent practice opportunities in the clinical setting, a disparity of skill levels among students has been observed. In addition, the poor availability of faculty professors is a limiting factor in teaching and adequately preparing medical students for their clerkship years. With the ongoing COVID-19 pandemic, medical students do not have access to traditional suturing learning opportunities. Didactic courses are available on videoconferencing platforms; however, these courses do not include technical training. OBJECTIVE: Our overarching goal is to evaluate the efficacy and usability of web-based peer-learning for advanced suturing techniques (ie, running subcuticular sutures). We will use the Gamified Educational Network (GEN), a newly developed web-based learning tool. We will assess students' ability to identify and perform the correct technique. We will also assess the students' satisfaction with regard to GEN. METHODS: We will conduct a prospective randomized controlled trial with blinding of expert examiners. First-year medical students in the Faculty of Medicine of Université de Montréal will be randomized into four groups: (1) control, (2) self-learning, (3) peer-learning, and (4) peer-learning with expert feedback. Each arm will have 15 participants who will learn how to perform running subcuticular sutures through videos on GEN. For our primary outcome, the students' ability to identify the correct technique will be evaluated before and after the intervention on GEN. The students will view eight videos and rate the surgical techniques using the Objective Structured Assessment of Technical Skills Global Rating Scale and the Subcuticular Suture Checklist as evaluation criteria. For our secondary outcomes, students will anonymously record themselves performing a running subcuticular suture and will be evaluated using the same scales. Then, a survey will be sent to assess the students' acceptance of the intervention. RESULTS: The study will be conducted in accordance with the Declaration of Helsinki and has been approved by our institutional review board (CERSES 20-068-D). No participants have been recruited yet. CONCLUSIONS: Peer learning through GEN has the potential to overcome significant limitations related to the COVID-19 pandemic and the lack of availability of faculty professors. Further, a decrease of the anxiety related to traditional suturing classes can be expected. We aim to create an innovative and sustainable method of teaching surgical skills to improve the efficiency and quality of surgical training in medical faculties. In the context of the COVID-19 pandemic, the need for such tools is imperative. TRIAL REGISTRATION: ClinicalTrials.gov NCT04425499; https://clinicaltrials.gov/ct2/show/NCT04425499. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/21273.

Patient Handover in Emergency Trauma Situations.

Miscommunication during patient handover can be a major cause of preventable medical errors. Emergency traumas are situations where high stress and cognitive load make communication more difficult. Simulation allows for junior learners to practice emergency scenarios in a low-risk setting. This technical report outlines a simulation involving patient handover in emergency trauma scenarios. The intended group of learners are first-year surgery and emergency medicine residents. The scenarios were developed based on the learning objectives of communication, collaboration, and information transfer. Using a high-fidelity simulation mimicking a tertiary care facility, the skills performed in these scenarios can be applied to everyday practice.

Evaluating the Use of a Generic Three-Dimensionally (3D) Printed Abdominal Aortic Aneurysm Model as an Adjunct Patient Education Tool.

An abdominal aortic aneurysm (AAA) is a serious medical condition that requires invasive surgery or endovascular treatment with stent grafts. This procedure is primarily carried out by vascular surgeons and interventional radiologists. Current methods of educating patients about their procedure have been inadequate, causing unnecessary stress in patients who have this condition and seek treatment. In this study, we evaluate a three-dimensionally (3D) printed AAA model to use as an adjunct patient education tool, thus allowing patients to make a more knowledgeable decision when providing informed consent. The physical attributes and realism of the model are evaluated through the use of a quantitative and qualitative survey completed by physicians at St. Clare's Mercy Hospital in St. John's, Newfoundland. These physicians are referred to as "Experts" in our study and also rate and comment on the necessity of having patient-specific versus generic 3D AAA models for patient education purposes. The aim of this study is to determine whether our 3D printed AAA model is ready to be used as an adjunct patient education tool and to seek suggestions for improvements that can be made in the model. Furthermore, having generic 3D AAA models would significantly decrease healthcare costs as compared to patient-specific models. Thus, we also investigate if generic models would suffice from the perspective of the physicians.

The Use of Silicone Vaginal Repair Models as an Adjunct to Mannequins for Simulation Training in Sexual Assault Clinical Learning for Obstetrics and Gynecology Medical Residents.

Within urgent care scenarios in obstetrics and gynecology, there is little educational development surrounding sexual assault simulation scenarios, which reveals a need for increased rehearsal opportunities within medical education. Simulation-based medical education using mannequins, standardized patients, and anatomical silicone models have been suggested as a means to improve such parameters by providing realistic training for residents in the rehearsal of sexual assault scenarios and the application of forensic evidence kits. However, sexual assault training is often only provided to emergency medicine physicians and clinical staff and is not currently a mandatory component of obstetrics and gynecology residency programs across most national academic institutions. This technical report describes the development, implementation, and user-based evaluation of a simulation exercise within a sexual assault clinical learning scenario that uses a silicone vaginal model produced using a three-dimensional (3D) printed mold. The silicone model was covered in artificial blood and attached to an existing mannequin to simulate an examination following a violent sexual assault, which resulted in vaginal lacerations. The clinical room in which the simulation was held reflected that of an operating room in an emergency department, complete with simulation confederates acting as an attending general surgeon, nurse, and anesthesiologist. The obstetrics and gynecology residents acted as the urgent care providers being called into the operating room. The residents were briefed by the general surgeon upon arrival and scrubbed into the surgery. Next, they examined and repaired vaginal lacerations on the silicone model attached to the simulation mannequin. Finally, the residents followed up the clinical simulation with an opportunity to rehearse patient communication and empathy by consoling a standardized patient who acted as the victim of the sexual assault. The purpose of this technical report is to evaluate the efficacy of a silicone vaginal model created from a 3D printed mold, which included a second-degree laceration, to train obstetrics and gynecology residents in the repair of injuries resulting from sexual assault. An evaluation survey was completed by attending residents and the results were strongly in favor of using such anatomical silicone models to increase realism and for the improvement of procedural competency in repairing vaginal lacerations caused by sexual assault.

Investigating the Perceived Efficacy of a Silicone Suturing Task Trainer Using Input from Novice Medical Trainees.

Suturing is an essential procedural skill that medical students are expected to be competent in before they graduate medical school; however, there is often a lack of suturing instruction and practice in undergraduate medicine curriculums. Silicone suturing task trainers created from 3D printed molds can help address this gap in medical education by improving student's manual skills before they perform procedures on real patients upon graduation. Commercially available suture task trainers on the market today lack validation from medical learners; therefore, this study aimed to evaluate the perceived efficacy of a silicone skin suture task trainer created from a 3D printed mold using input from novice medical trainees. A silicone task trainer created by MUN Med 3D was used to teach suturing during two surgery interest group skill development sessions. At the end of the sessions, 38 medical students completed a product evaluation survey that assessed the perceived educational efficacy of the suturing task trainer. Overall, the feedback received from the participants was positive and supported the use of silicone suturing task trainers in undergraduate medicine curriculums.

Comparing the effectiveness of simulation as adjuncts to standardized lectures, on the identification and reporting of intimidation during surgical clerkship: A mixed method randomized controlled trial.

BACKGROUND: Intimidation constitutes a learning barrier for undergraduates and its reporting rate to authorities remains suboptimal. METHODS: A randomized controlled trial was conducted to evaluate the effectiveness of three interventions designed to increase reporting by undergraduates during their surgical rotation. As adjuncts to a standardized lecture, participants were assigned to a simulated intimidation scenario, a video of intimidation events, or a control group. Surveys were completed before the interventions, and at the end of the rotation. RESULTS: Of the 119 included participants, 17.6% reported that they had been intimidated during their previous rotation as compared to 37.0% after the surgical rotation. There were no statistically significant differences in the reporting of intimidation between the groups. However, 65.5% of all participants declared feeling more at ease to report intimidation, yet the reporting rate remained low. CONCLUSION: Intimidation during clerkship persists as a frequent problem although the best method to increase its reporting remains unclear.

Development of a Three-dimensional Printed Emergent Burr Hole and Craniotomy Simulator.

Patients with a traumatic head injury (THI) require immediate surgical intervention, as rapidly expanding intracranial hematomas can be imminently life-threatening, not permitting transfer time to neurosurgical care in a tertiary care center. In rural and remote areas, where neurosurgeons may not be readily available, surgical intervention by Community General Surgeons (CGS) may be required. Currently, the CGS in Newfoundland and Labrador (NL) do not have access to, or have experience training with, an emergent burr hole/craniotomy (EBHC) simulator. One of the barriers is the availability of inexpensive and reliable simulators to practice these skills. Therefore, a low-cost, three-dimensional (3D) printed EBHC simulator was designed and 3D-printed by MUN Med 3D (St John's, NL). The aim of this technical report is to assess the need for such simulator in rural and remote healthcare centers and report on the iterative development of the EBHC simulator. The 3D-printed EBHC simulator developed by MUN Med 3D was utilized during a general surgery workshop at the 26th Annual Rural and Remote Medicine Conference in St. John's, NL. A total of six 3D-printed EBHC simulators were provided for the hour and a half workshop. At the end of the workshop, 16 participants were asked to provide feedback on the need for this simulator in their rural or remote environment as well as feedback on the physical attributes. The feedback received from the participants was overall positive, informative, and supported the need for the 3D-printed EBHC simulator.

Investigating the Efficacy of Anatomical Silicone Models Developed from a 3D Printed Mold for Perineal Repair Suturing Simulation.

There is a scarcity of affordable, validated, standardized and anatomically correct silicone perineum models for the rehearsal of postpartum laceration repair. The purpose of this technical report is to describe and validate evidence for a silicone, perineal repair model created from a 3D printed mold for medical resident training and clinical skills maintenance. A pre-existing model from an open-source royalty-free website was purchased and converted using Fusion360TM (Autodesk Inc., San Rafael, CA, USA) into a stereolithography (.stl) file and altered to produce a negative mold. Using a spatula, a fine silicone layer was first applied inside the mold, followed by a small piece of flesh-colored mesh netting material within the perineal surface area, fitting the width of the mold. The mesh was pressed into the thin layer of silicone, which was meant to provide anatomical structure to prevent the sutures from tearing through the silicone. The remainder of the silicone mix was then poured into the mold, which required three hours to fully set before being removed from the mold. Twelve silicone models were produced and used during a one-hour workshop at the Rural and Remote Conference by 16 obstetrics and gynecology residents and practicing rural physicians, and four facilitators. At the end of the workshop, the participants were provided with a qualitative survey and asked to rate the perceived realism and educational effectiveness of the silicone perineum model as compared to pre-existing simulation models that they have used previously. The overall workshop participant feedback was positive, noting that the models provided more realistic visualization for the suturing simulation of first- and second-degree perineal injuries. The silicone models were considered to be useful in simulation training when attempting first- and second-degreeperineum suturing techniques within a confined space. The overall feedback was positive, noting that they provided more realistic visualization experience compared to pre-existing simulation models, such as beef tongues and synthetic sponges. The feedback from the participants and facilitators included thoughts about how to add additional mesh to the silicone model so the subcutaneous and vaginal plane sutures would hold, as well as increase the size of the vaginal canal size to more accurately represent a postpartum repair. There were also suggestions to alter the colour of the model to be flesh-toned as opposed to pink, to more accurately simulate human tissue. Silicone perineum models, created from a 3D printed mold, are an economical training tool as compared to commercially available, cost prohibitive models. They also provide anatomically accurate simulation training opportunities for residents to learn and maintain clinical skills in perineal repair, as compared to beef tongues and synthetic sponges, which have previously been used in obstetrics and gynecology simulation-based medical education.

Modelling and Manufacturing of a 3D Printed Trachea for Cricothyroidotomy Simulation.

Cricothyroidotomy is a life-saving medical procedure that allows for tracheal intubation. Most current cricothyroidotomy simulation models are either expensive or not anatomically accurate and provide the learner with an unrealistic simulation experience. The goal of this project is to improve current simulation techniques by utilizing rapid prototyping using 3D printing technology and expert opinions to develop inexpensive and anatomically accurate trachea simulators. In doing so, emergency cricothyroidotomy simulation can be made accessible, accurate, cost-effective and reproducible. Three-dimensional modelling software was used in conjunction with a desktop three-dimensional (3D) printer to design and manufacture an anatomically accurate model of the cartilage within the trachea (thyroid cartilage, cricoid cartilage, and the tracheal rings). The initial design was based on dimensions found in studies of tracheal anatomical configuration. This ensured that the landmarking necessary for emergency cricothyroidotomies was designed appropriately. Several revisions of the original model were made based on informal opinion from medical professionals to establish appropriate anatomical accuracy of the model for use in rural/remote cricothyroidotomy simulation. Using an entry-level desktop 3D printer, a low cost tracheal model was successfully designed that can be printed in less than three hours for only $1.70 Canadian dollars (CAD). Due to its anatomical accuracy, flexibility and durability, this model is great for use in emergency medicine simulation training. Additionally, the model can be assembled in conjunction with a membrane to simulate tracheal ligaments. Skin has been simulated as well to enhance the realism of the model. The result is an accurate simulation that will provide users with an anatomically correct model to practice important skills used in emergency airway surgery, specifically landmarking, incision and intubation. This design is a novel and easy to manufacture and reproduce, high fidelity trachea model that can be used by educators with limited resources.

Development of a Sustainable Simulator and Simulation Program for Laparoscopic Skills Training in Haiti.

Laparoscopic surgery has been shown to have many favorable effects on surgical outcomes and postoperative recovery times. However, the cost of currently available training programs, such as the Fundamentals of Laparoscopic Surgery (FLS), limits their adoption in developing countries. To address this cost constraint, educators at the Justinian University Hospital (JUH) in Northern Haiti used local materials to build their own laparoscopic skills box trainer. This trainer is used to teach all surgical and OB/GYN residents in their laparoscopic skills program. The progressive curriculum consists of seven modules, three of which are for all trainees and four of which are specifically for surgery and OB/GYN (2). The seven modules are arranged in the order of difficulty; they start with basic maneuvers and progress to complex skills. This report describes both the preparation of the seven models and evaluation of the skills that are learned. This approach may facilitate global access to feasible, progressive, and sustainable laparoscopic training.

Improving the Acquisition of Basic Technical Surgical Skills with VR-Based Simulation Coupled with Computer-Based Video Instruction.

Next to practice, feedback is the most important variable in skill acquisition. Feedback can vary in content and the way that it is used for delivery. Health professions education research has extensively examined the different effects provided by the different feedback methodologies. In this paper we compared two different types of knowledge of performance (KP) feedback. The first type was video-based KP feedback while the second type consisted of computer generated KP feedback. Results of this study showed that computer generated performance feedback is more effective than video based performance feedback. The combination of the two feedback methodologies provides trainees with a better understanding.

Simulation as a suitable education approach for medical training in marine and off-shore industries: theoretical underpinning.

Healthcare providers in marine and offshore industries must often perform high-risk procedures outside of their usual scope of practice, frequently using novel, complex telemedical technologies to perform an already unfamiliar task--often while multitasking, and sometimes in extreme environmental conditions. Given all the novelty occurring at once, the probability of medical error increases. This increase can be explained by the Cognitive Load Theory, which states that too much demand on the working memory can tax the ability of the long-term memory. This article will show that one solution to this situation is to use simulation in the medical training of offshore and marine medical practitioners. Contextualised simulation practice creates automatic schemas that reside in the long-term memory, minimising strain on the working memory--and, in a marine medical context, also minimising the risk of medical error.

Measuring cognitive load: performance, mental effort and simulation task complexity.

CONTEXT: Interest in applying cognitive load theory in health care simulation is growing. This line of inquiry requires measures that are sensitive to changes in cognitive load arising from different instructional designs. Recently, mental effort ratings and secondary task performance have shown promise as measures of cognitive load in health care simulation. OBJECTIVES: We investigate the sensitivity of these measures to predicted differences in intrinsic load arising from variations in task complexity and learner expertise during simulation-based surgical skills training. METHODS: We randomly assigned 28 novice medical students to simulation training on a simple or complex surgical knot-tying task. Participants completed 13 practice trials, interspersed with computer-based video instruction. On trials 1, 5, 9 and 13, knot-tying performance was assessed using time and movement efficiency measures, and cognitive load was assessed using subjective rating of mental effort (SRME) and simple reaction time (SRT) on a vibrotactile stimulus-monitoring secondary task. RESULTS: Significant improvements in knot-tying performance (F(1.04,24.95)  = 41.1, p < 0.001 for movements; F(1.04,25.90)  = 49.9, p < 0.001 for time) and reduced cognitive load (F(2.3,58.5)  = 57.7, p < 0.001 for SRME; F(1.8,47.3)  = 10.5, p < 0.001 for SRT) were observed in both groups during training. The simple-task group demonstrated superior knot tying (F(1,24)  = 5.2, p = 0.031 for movements; F(1,24)  = 6.5, p = 0.017 for time) and a faster decline in SRME over the first five trials (F(1,26)  = 6.45, p = 0.017) compared with their peers. Although SRT followed a similar pattern, group differences were not statistically significant. CONCLUSIONS: Both secondary task performance and mental effort ratings are sensitive to changes in intrinsic load among novices engaged in simulation-based learning. These measures can be used to track cognitive load during skills training. Mental effort ratings are also sensitive to small differences in intrinsic load arising from variations in the physical complexity of a simulation task. The complementary nature of these subjective and objective measures suggests their combined use is advantageous in simulation instructional design research.

Self-directed practice schedule enhances learning of suturing skills.

BACKGROUND: Most preoperative surgical training programs experience challenges with the availability of expert surgeons to teach trainees. Some research suggests that trainees may benefit from being allowed to actively shape their learning environments, which could alleviate some of the time and resource pressures in surgical training. The purpose of this study was to investigate the effects of self-directed or prescribed practice schedules (random or blocked) on learning suturing skills. METHODS: Participants watched an instructional video for simple interrupted, vertical mattress and horizontal mattress suturing then completed a pretest to assess baseline skills. Participants were assigned to 1 of 4 practice groups: self-directed practice schedule, prescribed blocked practice schedule, prescribed random practice schedule or matched to the self-directed group (control). Practice of the skill was followed by a delayed (1 h) posttest. Improvement from pretest to posttest was determined based on differences in performance time and expert-based assessments. RESULTS: Analyses revealed a significant effect of group for difference in performance time of the simple interrupted suture. Random practice did not show the expected advantage for skill learning, but there was an advantage of self-directed practice. CONCLUSION: Self-directed practice schedules may be desirable for optimal learning of simple technical skills, even when expert instruction is available. Instructors must also take into account the interaction between task difficulty and conditions of practice to develop ideal training environments.

CONTEXTE: La plupart des programmes de formation préopératoire en chirurgie ont du mal à trouver des experts pour enseigner la chirurgie aux stagiaires. Selon certaines recherches, il pourrait être utile de permettre aux stagiaires de structurer eux-mêmes leurs milieux d'apprentissage, ce qui pourrait se révéler avantageux compte tenu des contraintes de temps et de ressources. Le but de cette étude était de mesurer les effets de différents horaires d'exercices, autodirigés ou prescrits (aléatoires ou fixes), sur l'apprentissage des techniques de sutures. MÉTHODES: Les participants ont regardé une vidéo de formation sur les sutures uniques interrompues de type matelassier verticales et horizontales, avant de subir un prétest pour évaluer leurs compétences de base. Les participants ont ensuite été assignés à 1 de 4 groupes de pratique : horaires d'exercices autodirigés, fixes prescrits, aléatoires prescrits ou assortis au groupe « autodirigé ¼ (témoin). La période d'exer - cices était suivie d'un post-test administré après un délai d'une heure. L'amélioration des résultats entre le prétest et le post-test a été déterminée par les différences de temps d'exécution et l'évaluation d'un expert. RÉSULTATS: Les analyses ont révélé un effet significatif selon le groupe en ce qui a trait aux différences de temps d'exécution pour la suture simple interrompue. Les horaires d'exercices aléatoires ne se sont pas accompagnés de l'avantage attendu pour ce qui est de l'apprentissage de la technique, mais on a noté un avantage associé aux horaires d'exercices autodirigés. CONCLUSION: Les horaires d'exercices autodirigés pourraient être souhaitables pour un apprentissage optimal des habiletés techniques simples, même lorsqu'un enseignement par les experts est disponible. Les instructeurs doivent aussi tenir compte de l'interaction entre la difficulté de la tâche et les conditions dans lesquelles se font les exercices pour améliorer les milieux de formation.

Z-DOC: a serious game for Z-plasty procedure training.

We present Z-DOC, a (prototype) serious game for training plastic surgery residents the steps comprising the Z-plasty surgical procedure. Z-DOC employs touch-based interactions and promotes competition amongst multiple players/users thus promote engagement and motivation. It is hypothesized that by learning the Z-plasty procedure in an interactive, engaging, and fun gaming environment, trainees will have a much better understanding of the procedure than by traditional learning modalities.