Comparative evaluation of video-based on-line course versus serious game for training medical students in cardiopulmonary resuscitation: A randomised trial.

PURPOSE: To estimate the effect size of a serious game for cardiopulmonary resuscitation (CPR) training in comparison with a video-based on-line course in terms of learning outcomes among medical students before simulation-based CPR using a manikin. METHODS: Participants were 45 first-year medical students randomly assigned to CPR self-training using either a video-based Apple Keynote presentation (n = 22) or a serious game developed in a 3D learning environment (n = 23) for up to 20 min. Each participant was evaluated on a written, multiple-choice test (theoretical test) and then on a scenario of cardiac arrest (practical test) before and after exposure to the self-learning methods. The primary endpoint was change in theoretical and practical baseline scores during simulated CPR. This study was conducted in 2017. RESULTS: Both groups improved scores after exposure. The video group had superior performance in both the theoretical test (7.56±0.21 vs 6.51±0.21 for the game group; p = 0.001) and the practical test (9.67±0.21 vs 8.40±0.21 for the game group; p < 0.001). However, students showed a preference for using games, as suggested by the longer time they remained interested in the method (18.57±0.66 min for the game group vs 7.41±0.43 for the video group; p < 0.001). CONCLUSIONS: The self-training modality using a serious game, after a short period of exposure, resulted in inferior students' performance in both theoretical and practical CPR tests compared to the video-based self-training modality. However, students showed a clear preference for using games rather than videos as a form of self-training.

Modificação na técnica de Webster para reconstrução total de lábio inferior, com uso da pele da região nasogeniana para aumentar o volume do vermelhão / Modification in Webster technique for lower lip reconstruction, using bilateral nasolabial flaps to improve reconstruction of vermilion

INTRODUÇÃO: A técnica de Bernard modificada por Webster é considerada por diversos autores a primeira escolha para reconstrução total de lábio inferior. Ela preserva as linhas e pontos de referência estética da face, e proporciona boa sensibilidade no lábio reconstruído, permitindo alcançar resultados estéticos e funcionais satisfatórios. Apesar de concordar com os princípios da técnica de Webster, uma modificação é proposta visando aperfeiçoar a reconstrução do vermelhão, usando retalhos nasogenianos bilaterais associados aos retalhos de avançamento originais. MÉTODOS: São apresentados cinco casos operados pelo autor no período de 2003 a 2008, e os resultados são discutidos. RESULTADOS: Demonstrou-se que a dissecção necessária para avançar os retalhos da bochecha na técnica de Bernard-Webster não inviabiliza os retalhos nasogenianos, e estes podem ser rotados adequadamente para acrescentar pele e volume ao vermelhão reconstruído. CONCLUSÃO: A modificação proposta não impõe risco aumentado ou prejuízo sobre a técnica original, e mantém ou aumenta a sua capacidade reconstrutiva.

INTRODUCTION: Many authors consider the Bernard technique modified by Webster the first choice for total lower lip reconstruction. This technique preserves skin folds and anatomical landmarks on the face, and interferes minimally with the tactile sensibility of the reconstructed lip, resulting in satisfying cosmetic and functional outcomes. Despite agreeing with the principles of the Webster technique, a modification is proposed to improve reconstruction of vermilion, by using bilateral nasolabial flaps associated with the original advancement flaps. METHODS: We report five surgical cases carried out between 2003 and 2008, and discussion of results. RESULTS: Dissection need to advance flaps in Bernard-Webster technique does not make nasolabial flaps unviable, and they can be rotated properly to add volume and skin to the reconstructed vermilion. CONCLUSION: Proposed modification of Bernard-Webster technique does not increase risk or damage compared with classic technique, and it maintains the same reconstructive capabilities or even enhances it.

Computer-assisted teaching of skin flap surgery: validation of a mobile platform software for medical students.

The purpose of this study was to develop and validate a multimedia software application for mobile platforms to assist in the teaching and learning process of design and construction of a skin flap. Traditional training in surgery is based on learning by doing. Initially, the use of cadavers and animal models appeared to be a valid alternative for training. However, many conflicts with these training models prompted progression to synthetic and virtual reality models. Fifty volunteer fifth- and sixth-year medical students completed a pretest and were randomly allocated into two groups of 25 students each. The control group was exposed for 5 minutes to a standard text-based print article, while the test group used multimedia software describing how to fashion a rhomboid flap. Each group then performed a cutaneous flap on a training bench model while being evaluated by three blinded BSPS (Brazilian Society of Plastic Surgery) board-certified surgeons using the OSATS (Objective Structured Assessment of Technical Skill) protocol and answered a post-test. The text-based group was then tested again using the software. The computer-assisted learning (CAL) group had superior performance as confirmed by checklist scores (p<0.002), overall global assessment (p = 0.017) and post-test results (p<0.001). All participants ranked the multimedia method as the best study tool. CAL learners exhibited better subjective and objective performance when fashioning rhomboid flaps as compared to those taught with standard print material. These findings indicate that students preferred to learn using the multimedia method.