Development of a structured virtual reality curriculum for laparoscopic appendicectomy.

BACKGROUND: Laparoscopic appendicectomy (LA) is a common surgical emergency procedure mainly performed by trainees. The aim was to develop a step-wise structured virtual reality (VR) curriculum for LA to allow junior surgeons to hone their skills in a safe and controlled environment. METHODS: A prospective randomized study was designed using a high-fidelity VR simulator. Thirty-five novices and 25 experts participated in the assessment and their performances were compared to assess construct validity. Learning curve analysis was performed. RESULTS: Five of the psychomotor tasks and all appendicectomy tasks showed construct validity. Learning was demonstrated in the majority of construct-valid tasks. A novel goal-directed VR curriculum for LA was constructed. CONCLUSIONS: A step-wise structured VR curriculum for LA is proposed with a framework which includes computer generated metrics and supports deliberate practice, spacing intervals, human instruction/feedback and assessment. Future study should test the feasibility of its implementation and transferability of acquired skill.

High value and low-cost virtual reality healthcare professional education: proceedings of a roundtable workshop.

This article was migrated. The article was marked as recommended. Introduction The following represents proceedings of an online roundtable workshop on high value and low-cost virtual reality healthcare professional education. The purpose of the workshop was to seek the views of professionals from different sectors and different countries on moving toward high value and low-cost virtual reality education. The workshop was comprised of eight delegates with an interest in this subject. The delegates were from Europe, the Middle East, and Australia. They represented different sectors - including clinical medicine, educational economics, health professional education, simulation, technology, evidence-based methodologies, and industry. Themes The following themes emerged from the workshop: the challenge of thinking about the cost of virtual reality from the points of view of the payer and the user; the core need to define the context of use of virtual reality; the absolute need to define the purpose of a virtual reality programme; the recognition of the growing opportunity of multiplayer virtual reality; the need to exploit the unique properties of virtual reality; the importance of realising that there are already various forms of virtual reality available and these can achieve different outcomes at different costs; the need to integrate virtual reality into the rest of the curriculum; and the various forms of cost analysis that might be suitable for evaluating the cost and outcomes of virtual reality. Conclusions In the long-term, a growing body of evidence that is based on original research and systematic reviews will help us decide what is high value and low-cost virtual reality in healthcare professional education. However, a strategic approach is needed to ensure that the original research concentrates on the right topics that will yield the most value to education decision-makers and to other related stakeholders. We feel that non-hierarchical interdisciplinary roundtable discussions are an effective means of planning strategy.

Development and implementation of a virtual reality laparoscopic colorectal training curriculum.

BACKGROUND: Contemporary surgical training can be compromised by fewer practical opportunities. Simulation can fill this gap to optimize skills' development and progress monitoring. A structured virtual reality (VR) laparoscopic sigmoid colectomy curriculum is constructed and its validity and outcomes assessed. METHODS: Parameters and thresholds were defined by analysing the performance of six expert surgeons completing the relevant module on the LAP Mentor simulator. Fourteen surgical trainees followed the curriculum, performance being recorded and analysed. Evidence of validity was assessed. RESULTS: Time to complete procedure, number of movements of right and left instrument, and total path length of right and left instrument movements demonstrated evidence of validity and clear learning curves, with a median of 14 attempts needed to complete the curriculum. CONCLUSIONS: A structured curriculum is proposed for training in laparoscopic sigmoid colectomy in a VR environment based on objective metrics in addition to expert consensus. Validity has been demonstrated for some key metrics.

Role of virtual reality simulation in endoscopy training.

Recent advancements in virtual reality graphics and models have allowed virtual reality simulators to be incorporated into a variety of endoscopic training programmes. Use of virtual reality simulators in training programmes is thought to improve skill acquisition amongst trainees which is reflected in improved patient comfort and safety. Several studies have already been carried out to ascertain the impact that usage of virtual reality simulators may have upon trainee learning curves and how this may translate to patient comfort. This article reviews the available literature in this area of medical education which is particularly relevant to all parties involved in endoscopy training and curriculum development. Assessment of the available evidence for an optimal exposure time with virtual reality simulators and the long-term benefits of their use are also discussed.

The use of simulation in the acquisition of laparoscopic suturing skills.

OBJECTIVE: Laparoscopic suturing is recognised as one of the most difficult laparoscopic skills to master. With the use of simulation increasing in the training of future surgeons, a comprehensive literature review was carried out to evaluate the current evidence for the role of simulators in facilitating the acquisition of this particular skill. METHOD: A PubMed search was performed using terms 'laparoscopy', 'suturing', and 'simulation'. The resulting literature was then analysed for relevance and summarised. RESULTS: A total of 68 relevant articles were found and evaluated; despite the relatively small sample size in most studies, simulation has been proven to provide an effective method for the tuition of surgical trainees in laparoscopic suturing. Furthermore, the skills acquired through simulator training appear to be successfully transferable to the operating room environment. Simulators have also shown potential as valuable tools in the assessment of proficiency in trainees, with their evaluation of individuals correlating well with expert observer ratings in complex laparoscopic tasks such as suturing. Questions regarding the type of simulator to be used, the nature of the training curriculum, and how such a curriculum can practically be integrated into current surgical training programmes remain to be answered. CONCLUSIONS: Simulation is an integral tool in the training of future laparoscopic surgeons, and further research is required to answer the question of how to maximise benefit from these invaluable training implements.

Establishing a curriculum for the acquisition of laparoscopic psychomotor skills in the virtual reality environment.

BACKGROUND: The unique psychomotor skills required in laparoscopy result in reduced patient safety during the early part of the learning curve. Evidence suggests that these may be safely acquired in the virtual reality (VR) environment. Several VR simulators are available, each preloaded with several psychomotor skills tasks that provide users with computer-generated performance metrics. This review aimed to evaluate the usefulness of specific psychomotor skills tasks and metrics, and how trainers might build an effective training curriculum. METHODS: We performed a comprehensive literature search. RESULTS: The vast majority of VR psychomotor skills tasks show construct validity for one or more metrics. These are commonly for time and motion parameters. Regarding training schedules, distributed practice is preferred over massed practice. However, a degree of supervision may be needed to counter the limitations of VR training. CONCLUSIONS: In the future, standardized proficiency scores should facilitate local institutions in establishing VR laparoscopic psychomotor skills curricula.

The emerging role of screen based simulators in the training and assessment of colonoscopists.

Incorporation of screen based simulators into medical training has recently gained momentum, as advances in technology have coincided with a government led drive to increase the use of medical simulation training to improve patient safety with progressive reductions in working hours available for junior doctors to train. High fidelity screen based simulators hold great appeal for endoscopy training. Potentially, their incorporation into endoscopy training curricula could enhance speed of acquisition of skills and improve patient comfort and safety during the initial phase of learning. They could also be used to demonstrate competence as part of the future relicensing and revalidation of trained endoscopists. Two screen based simulators are widely available for lower gastrointestinal endoscopy training, with a third recently produced in prototype. The utility of these simulators in lower gastrointestinal endoscopy training has been investigated, and construct and expert validity has been shown. Novices demonstrate a learning curve with simulator training that appears to represent real learning of colonoscopy skills. This learning transfers well to the real patient environment, with improvements in performance and patient discomfort scores in subsequent initial live colonoscopy. The significant limitations of currently available screen based simulators include cost implications, and restrictions on a role in certification and revalidation. Many questions remain to be answered by future research, including how best to incorporate screen based simulators into a colonoscopy training programme, their role in training in therapeutic endoscopy and the impact of simulator training on patient safety.

Rupture of tubal pregnancy in the Vilnius population.

OBJECTIVES: To evaluate the determinants of tubal rupture in women who suffered from ectopic pregnancy in relation to their demographic profile and medical history. STUDY DESIGN: This retrospective observational clinical study was conducted in five general hospitals in Vilnius, Lithuania. The population was composed of 879 women with surgically proven ectopic pregnancy. Tubal rupture was diagnosed at the time of surgery. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for tubal rupture. RESULTS: The occurrence of tubal rupture was 29.5% (259/879). It was encountered significantly more often in women with age of > or =35 years (odds ratio 1.9 [1.3-2.8]). Patients whose EP was located in the isthmus were at higher risk of having tubal rupture (odds ratio 3.2 [2.2-4.5]) while known risk factors for EP were not associated with an elevated risk. CONCLUSIONS: Our data suggest that age of > or =35 years and implantation in the straightest segment of the tube could be associated with increased rate of tubal rupture. Of particular interest is the overall tubal rupture prevalence (29.5%) observed since these women were managed in an environment where transvaginal ultrasound equipment and quantitative assessment of beta-human chorionic gonadotrophin were not routinely available.

The accident and emergency department virtual consulting room.

The goal was to describe the development of the Virtual Consulting Room (VcR), a unique intranet-based guidance application providing direct access to local specialist knowledge, and to evaluate its usability and whether it has the potential to educate staff while working in the Accident and Emergency (A&E) department. Duty staff of the A&E Department, The Royal Free Hospital, London, participated in a prospective observational study. Two hundred and twenty consecutive patients were identified from the triage section of their casualty card as having a presenting complaint that featured in the VcR. These casualty cards were highlighted with a red sticker alert and a short questionnaire attached. Members of staff were invited to consult with the VcR after assessing each patient by clicking on an icon located on the department's computer desktops. No prior training was provided. The questionnaire was completed in 103 of 220 (46.8%) patients. The VcR was used in the management of 38 of 220 (17.3%) patients. In 21 of 38 (55.3%), users reported the VcR supported clinical decision making, in 20 of 38 (52.6%) the VcR improved knowledge and in 11 of 38 (28.9%) the VcR helped directly influence the decision to discharge the patient. In 2 of 38 (5.3%) users changed their decision to refer and in 1 of 38 (2.6%) investigations were altered. This evaluation indicates that A&E clinicians accessing the VcR found it easy to use and educational in the workplace.