Educational simulator for mastoidectomy considering mechanical properties using 3D printing and its usability evaluation.

Complex temporal bone anatomy complicates operations; thus, surgeons must engage in practice to mitigate risks, improving patient safety and outcomes. However, existing training methods often involve prohibitive costs and ethical problems. Therefore, we developed an educational mastoidectomy simulator, considering mechanical properties using 3D printing. The mastoidectomy simulator was modeled on computed tomography images of a patient undergoing a mastoidectomy. Infill was modeled for each anatomical part to provide a realistic drilling sensation. Bone and other anatomies appear in assorted colors to enhance the simulator's educational utility. The mechanical properties of the simulator were evaluated by measuring the screw insertion torque for infill specimens and cadaveric temporal bones and investigating its usability with a five-point Likert-scale questionnaire completed by five otolaryngologists. The maximum insertion torque values of the sigmoid sinus, tegmen, and semicircular canal were 1.08 ± 0.62, 0.44 ± 0.42, and 1.54 ± 0.43 N mm, displaying similar-strength infill specimens of 40%, 30%, and 50%. Otolaryngologists evaluated the quality and usability at 4.25 ± 0.81 and 4.53 ± 0.62. The mastoidectomy simulator could provide realistic bone drilling feedback for educational mastoidectomy training while reinforcing skills and comprehension of anatomical structures.

Laparoscopy training of novices with complex curved instruments using 2D- and 3D-visualization.

PURPOSE: Beside many advantages, disadvantages such as reduced degrees of freedom and poorer depth perception are still apparent in laparoscopic surgery. 3D visualization and the development of complex instruments are intended to counteract the disadvantages. We want to find out whether the use of complex instruments and 3D visualization has an influence on the performance of novices. METHODS: 48 medical students with no experience in laparoscopic surgery or simulator-based laparoscopy training were included. They were randomized in four groups according to a stratification assessment. During a structured training period they completed the FLS-Tasks "PEG Transfer", "Pattern Cut" and "Intracorporeal Suture" and a transfer task based on these three. Two groups used conventional laparoscopic instruments with 3D or 2D visualization, two groups used complex curved instruments. The groups were compared in terms of their performance. RESULTS: In 2D laparoscopy there was a better performance with straight instruments vs. curved instruments in PEG Transfer and Intracorporeal Suture. In the transfer task, fewer errors were made with straight instruments. In 2D vs. 3D laparoscopy when using complex curved instruments there was an advantage in Intracorporeal Suture and PEG Transfer for 3D visualization. Regarding the transfer exercise, a better performance was observed and fewer errors were made in 3D group. CONCLUSION: We could show that learning laparoscopic techniques with complex curved instruments is more difficult with standard 2D visualization and can be overcome using 3D optics. The use of curved instruments under 3D vision seems to be advantageous when working on more difficult tasks.

Operating under the influence: the effect of alcohol on operative performance using a virtual robotic training platform-an experimental comparative cohort study.

An elevated percentage of medical personnel reports using alcohol to relieve stress. Levels of alcohol addiction are almost double that of the general population. Robotic surgery is becoming more widespread. The purpose of this study is to evaluate the effects of alcohol ingestion on performance of a standardized curriculum using a robotic training platform. Surgeons and surgical trainees were recruited. Candidates performed 4 standardized exercises (Vitruvian Operation (VO), Stacking Challenge (SC), Ring Tower (RT), Suture Sponge (SS)) at 0.0 blood alcohol concentration (BAC), followed by testing in the elimination phase at a target BAC of 0.8‰. Learning effects were minimised through prior training. A total of 20 participants were recruited. Scores for RT and SS exercises were significantly worse under the influence of alcohol [instruments out of view (SS (z = 2.012; p = 0.044), RT (z score 1.940, p = 0.049)), drops (SS (z = 3.250; p = 0.001)), instrument collisions (SS (z = 2.460; p = 0.014)), missed targets (SS (z = 2.907; p = 0.004)]. None of the scores improved with alcohol consumption, and there were measurable deleterious effects on the compound indicators risk affinity and tissue handling. Despite the potential mitigating features of robotic surgery including tremor filtration, motion scaling, and improved three-dimensional visualization, alcohol consumption was associated with a significant increase in risk affinity and rough tissue handling, along with a deterioration of performance in select virtual robotic tasks. In the interest of patient safety, alcohol should not be consumed prior to performing robotic surgery and sufficiently long intervals between alcohol ingestion and surgical performance are mandatory.

Interactive learning environment as a source of critical thinking skills for college students.

BACKGROUND: The cognitive skills underlying critical thinking include analysis, interpretation, evaluation, explanation, inference, and self-regulation. The study aims to consider the possibility and effectiveness of introducing the mobile game Lumosity: Brain Training into the learning process of first-year Philology students studying at Qiqihar University. METHODS: The sample included 30 volunteers: 15 girls and 15 boys, whose average age was 18.4 years. Before the experiment start, the respondents took a pre-test based on the Critical Thinking Skills Success methodology, which was developed by the American scientist Starkey. It was stated that intensive one-month training with the use of the Lumosity premium application in the classroom would improve critical thinking skills. RESULTS: The pre-test results showed that some respondents had had quite good critical thinking skills before the experiment as the average score was 22.13 out of 30 points. The effectiveness was evaluated using the Student's t-test for paired samples. It is established that there are significant differences between standard and empirical values (p = 0.012). CONCLUSIONS: The research can be of interest to those who study the issue of integrating an interactive learning environment into university and student programs, as well as those who consider critical thinking as a field of scientific knowledge and seek to develop critical thinking skills. The novelty of the study is the fact that students were allowed to use the app only during classes, but the research hypothesis was confirmed. This indicates that an interactive learning environment can be considered as a tool for developing students' critical thinking skills in the context of limited screen time.

Virtual reality cricothyrotomy - a case-control study on gamification in emergency education.

BACKGROUND: Cricothyrotomy is an invasive and rare emergency intervention to secure the airway in a "cannot intubate, cannot ventilate" situation. This leads to lack of routine. Cricothyrotomy is performed only hesitantly. Therefore, we aim to improve teaching by including a virtual reality (VR) cricothyrotomy as a learning tool. METHODS: We programmed the VR cricothyrotomy in the C# programming language on the open-source Unity platform. We could include 149 students that we randomly assigned to either a study group (VR cricothyrotomy) or control group (educational video). We asked the study group to subjectively rate the VR cricothyrotomy. To evaluate our intervention (VR cricothyrotomy) we took the time participants needed to perform a cricothyrotomy on a plastic model of a trachea and evaluated the correct procedural steps. RESULTS: The majority of students that performed the VR simulation agreed that they improved in speed (81%) and procedural steps (92%). All participants completed the cricothyrotomy in 47s ± 16s and reached a total score of 8.7 ± 0.7 of 9 possible points. We saw no significant difference in time needed to perform a cricothyrotomy between study and control group (p > 0.05). However, the total score of correct procedural steps was significantly higher in the study group than in the control group (p < 0.05). CONCLUSIONS: Virtual reality is an innovative learning tool to improve teaching of emergency procedures. The VR cricothyrotomy subjectively and objectively improved correct procedural steps. Digitized education fills an educational gap between pure haptic experience and theoretical knowledge. This is of great value when focusing on extension of factual knowledge. TRIAL REGISTRATION: DRKS00031736, registered on the 20th April 2023.

A systematic review of surgical simulation in gender affirmation surgery.

The burgeoning field of gender affirmation surgery (GAS) has become increasingly complex, challenging plastic surgeons to meet high standards for their patients. During the COVID-19 pandemic, the emphasis on remote learning ushered in the increased use of surgical simulation training, offering residents the opportunity to trial challenging procedures before treating patients. This systematic review seeks to summarize current simulation training models used in GAS. A systematic review was conducted according to PRISMA-P guidelines using the following databases: PubMed, Medline, Scopus, Embase, Web of Science, and Cochrane. Inclusion criteria were English-language peer-reviewed articles on surgical simulation techniques or training related to the field of gender surgery. Skills and techniques taught and assessed, model type, equipment, and cost were abstracted from articles. Our search criteria identified 1650 articles, 10 of which met the inclusion criteria for data extraction. Simulation models included those that involved cadavers (n = 2), synthetic benchtop (n = 5), augmented/virtual reality (n = 2), and 3D-printed interfaces (n = 1). The most common procedure involved breast or pectoral reconstruction and/or augmentation (n = 5), followed by vaginal reconstruction (n = 3). One simulation model involved facial GAS. All models focused on surgical technique and anatomy, three on suture skills or knot-tying, and one on surgical decision-making. The evolving field of GAS requires that plastic surgery trainees be knowledgeable on surgical techniques surrounding this scope of practice. Surgical simulation not only teaches residents how to master techniques but also helps address the sensitive nature of GAS.

Merits of simulation-based education: A systematic review and meta-analysis.

BACKGROUND: The drive to improve surgical proficiency through advanced simulation-based training has gained momentum. This meta-analysis systematically evaluated evidence regarding the impact of plastic surgery-related simulation on the performance of residents. METHODS: A systematic search of PubMed, Web of Science, and Cochrane Library and review of articles was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis protocol. An inverse-variance random-effects model was used to combine study estimates to account for between-study variability. Objective structured assessment of technical skills (OSATS) scores and subjective confidence scores were used to assess the impact of the simulation with positive changes from the baseline indicating better outcomes. RESULTS: Eighteen studies pooling 367 trainees who participated in various simulations were included. Completion of simulation training was associated with significant improvement in subjective confidence scores with a mean increase of 1.44 units (95% CI: 0.93 to 1.94, P < 0.001), and in OSATS scores, with a mean increase of 1.24 units (95% CI: 0.87 to 1.62, P < 0.001), both on a 1-5 scale. Participants reported high satisfaction scores (mean = 4.76 units, 95% CI = 4.61 to 4.91, P = 0.006), also on a 1-5 scale. CONCLUSIONS: Participation in surgical simulation markedly improved objective and subjective scoring metrics for surgical trainees. Several simulation devices are available for honing surgical skills, with the potential for advancements. The evidence demonstrates the effectiveness of simulations; thus, incorporating simulation into training curricula should be a priority in the field of plastic surgery.

Resiliencia en estudiantes universitarios de ciencias de la salud chilenos en el contexto de la telesimulación / Resilience in Chilean university health science students in the context of telesimulation

Introducción: El presente trabajo tuvo como propósito conocer el nivel de resiliencia en contexto pandémico en una muestra de estudiantes de pregrado de ciencias de la salud y cómo ésta se comporta en escenarios de telesimulación. Sujetos y métodos: El estudio tuvo un enfoque cuantitativo, con diseño observacional y temporalidad transversal. Se incluyó a 192 estudiantes pertenecientes a cinco carreras de las ciencias de la salud, cuyas edades oscilaron entre los 20 y los 49 años. Para medir la variable de interés se utilizó el cuestionario de resiliencia adaptado a 44 ítems con respuestas en escalamiento de tipo Likert. Resultados: Los resultados muestran niveles altos de resiliencia en carreras con programas de estudio que incluyen la telesimulación y las diferencias entre cada una de estas carreras. Conclusiones: Se sugiere la ampliación de la línea de investigación en otros contextos situacionales e intervención de metodologías de enseñanza-aprendizaje, con el fin de potenciar los procesos de adaptación de los estudiantes de salud y evaluar competencias esperadas del perfil de egreso, directamente relacionadas con su desempeño en su quehacer profesional.(AU)

Introduction: The purpose of this work was to know the level of resilience in a pandemic context in a sample of undergraduate students of health sciences, and how it behaves in tele-simulation scenarios. The study had a quantitative approach, with observational design, cross-sectional temporality and prospective.Subjects and methods: We included 192 students belonging to 5 careers in health sciences, whose ages ranged between 20 and 49 years. To measure the variable of interest, the resilience questionnaire adapted to 44 items with Likert-type scaling responses was used. Results: The results show high levels of resilience in careers with study programs that include tele-simulation and the differences between each of these careers. Conclusions: It is suggested to expand the line of research in other situational contexts and intervention of teachinglearning methodologies, to enhance the adaptation processes of health students and evaluate expected competencies of the graduation profile, directly related to their performance in their professional work.(AU)

Simulating mitral repair: lessons learned.

PURPOSE OF REVIEW: With the growing complexity of cardiac surgical cases, increased focus on patient safety, and minimally invasive techniques, simulation-based training has experienced a renaissance. This review highlights important elements of simulation-based training, focusing specifically on available simulators for mitral valve repair and the uses for simulation. RECENT FINDINGS: Referring to simulators as being high or low fidelity is oversimplified. Fidelity is a multifactorial concept, and for surgical task trainers, structural and functional fidelity should be discussed. For mitral valve repair, there are a spectrum of simulators, including tissue-based models, bench-top models, and hybrid models. All these simulator modalities serve a role in training if they align with predetermined objectives. There have been advancements in mitral valve repair simulation, notably patient-specific 3D printed silicone replicas of disease. SUMMARY: There is evidence to support that simulation improves performance in the simulated environment, but future investigation should look to determine whether simulation improves performance in the clinical setting and ultimately patient outcomes.

Improving Pediatric Trauma Education by Teaching Non-technical Skills: A Randomized Controlled Trial.

BACKGROUND: Pediatric trauma is a significant cause of child mortality, and the absence of non-technical skills (NTS) among health providers is linked with errors in patients' care. In this study, we evaluate the effectiveness of a structured debriefing protocol in enhancing NTS during pediatric trauma simulation. METHODS: A total of 45 medical students were successfully recruited from two medical schools, one in Brazil and one in Canada. Medical students were assigned to a control (N = 20) or intervention group (N = 25) in a randomized control trial. Following simulated scenarios, participants in the intervention group underwent NTS debriefing, while the control received standard debriefing based on the Advanced Trauma Life Support (ATLS) protocol. Students' confidence, NTS level, and performance were measured through self-assessment surveys, the Non-Technical Skills for Surgeons (NOTSS) score, and adherence to the trauma protocol, respectively. Baseline characteristics and outcomes were compared using t-tests, Mann-Whitney, Wilcoxon signed-rank Kruskal-Wallis, ANOVA, and a repeated-measures ANCOVA. A significance level was set at p < 0.05. RESULTS: The workshop increased students' confidence in leading trauma resuscitation regardless of their assignment to condition. While controlling for covariates, students in the intervention group significantly improved their overall NOTSS compared to those in the control and in all categories: situational awareness, decision-making, communication and teamwork, and leadership. The intervention teams also demonstrated a significant increase in completing trauma protocol steps. CONCLUSION: Implementing structured debriefing focusing on NTS enhanced these skills and improved adherence to protocol among medical students managing pediatric trauma-simulated scenarios. These findings support integrating NTS training in pediatric trauma education. LEVEL OF EVIDENCE: I.

3D-printed model for gingival flap surgery simulation: Development and pilot test.

INTRODUCTION: To assess the feasibility of a realistic model for learning oral flaps using 3D printing technology. MATERIALS AND METHODS: A mould was designed to reproduce the mandibular gingival mucosa, and a mandibular model was created using a three-dimensional printer for training undergraduate students to perform gingival flaps. After a short interview about its use, the participants were asked to use the simulator and provide feedback using a 5-point Likert questionnaire. RESULTS: The 3D-printed oral surgery flap training model was practical and inexpensive. The model was very realistic, educational and useful for hands-on training. CONCLUSIONS: 3D printing technology offers new possibilities for training in dental treatments that are currently difficult to replicate. The use of this simulator for oral flap surgery was well-received and considered promising by the participants.

Evaluation of a novel home-based laparoscopic and core surgical skills programme (Monash Online Surgical Training).

INTRODUCTION: Limitations to surgical education access were exacerbated during the COVID-19 Pandemic. In response, we created a national home-based comprehensive surgical skills course: Monash Online Surgical Training (MOST). Our aim was to evaluate the educational impact of this approach. METHODS: A remote, 6-week course was designed with learning objectives aligned to the national surgical training. Participants received a personal laparoscopic bench trainer, instrument tracking software, live webinars, access to an online theoretical learning platform, and individualised feedback by system-generated or expert surgeons' assessments. Mixed method analysis of instrument tracking metrics, pre- and post-course questionnaires (11 core surgical domains) and participant comments was utilised. Data were analysed using the Mann-Whitney U test, and a p-value of < 0.05 was considered statistically significant. RESULTS: A total of 54 participants with varied levels of experience (1 to > 6 years post-graduate level) completed MOST. All 11 learning-outcome domains demonstrated statistically significant improvement including core laparoscopic skills (1.4/5 vs 2.8/5, p < 0.0001) and handling laparoscopic instruments (1.5/5 vs 2.8/5, p < 0.0001). A total of 3460 tasks were completed reflecting 158.2 h (9492 min) of practice, 394 were submitted for formal feedback. Participants rated the course (mean 8.5/10, SD 1.6), live webinars (mean 8.9/10, SD 1.6) and instrument tracking software (mean 8.6, SD 1.7) highly. Qualitative analysis revealed a paradigm shift including the benefits of a safe learning environment and self-paced, self-directed learning. CONCLUSION: The MOST course demonstrates the successful implementation of a fully remote laparoscopic simulation course which participants found to be an effective tool to acquire core surgical skills.

Conception and prospective multicentric validation of a Robotic Surgery Training Curriculum (RoSTraC) for surgical residents: from simulation via laboratory training to integration into the operation room.

There is a lack of training curricula and educational concepts for robotic-assisted surgery (RAS). It remains unclear how surgical residents can be trained in this new technology and how robotics can be integrated into surgical residency training. The conception of a training curriculum for RAS addressing surgical residents resulted in a three-step training curriculum including multimodal learning contents: basics and simulation training of RAS (step 1), laboratory training on the institutional robotic system (step 2) and structured on-patient training in the operating room (step 3). For all three steps, learning content and video tutorials are provided via cloud-based access to allow self-contained training of the trainees. A prospective multicentric validation study was conducted including seven surgical residents. Transferability of acquired skills to a RAS procedure were analyzed using the GEARS score. All participants successfully completed RoSTraC within 1 year. Transferability of acquired RAS skills could be demonstrated using a RAS gastroenterostomy on a synthetic biological organ model. GEARS scores concerning this procedure improved significantly after completion of RoSTraC (17.1 (±5.8) vs. 23.1 (±4.9), p < 0.001). In step 3 of RoSTraC, all participants performed a median of 12 (range 5-21) RAS procedures on the console in the operation room. RoSTraC provides a highly standardized and comprehensive training curriculum for RAS for surgical residents. We could demonstrate that participating surgical residents acquired fundamental and advanced RAS skills. Finally, we could confirm that all surgical residents were successfully and safely embedded into the local RAS team.

Training in Skull Base Endonasal Endoscopic Surgery: Development and Validation of a Novel Low-Cost Simulation with Animal Cadaveric Model.

BACKGROUND: Endoscopic skull base surgery is constantly evolving and its scope has expanded. The acquisition of surgical skills involves a long learning curve with significant risks for the patient. Therefore, training in the laboratory has become essential to achieve appropriate proficiency and reduce the morbidity and mortality associated with these procedures. The objective of our work is to develop and validate a cost-effective and easily replicable simulator for endonasal endoscopy training using a swine cadaveric model. METHODS: We used fresh Pietrain swine heads. Training exercises of increasing complexity were performed. A Specific Technical Skills and Knowledge Scale was created considering the objectives to be assessed in each task. After the simulation, the trainees were required to answer a satisfaction survey. RESULTS: Ten participants were recruited (5 neurosurgery residents and 5 neurosurgeons). The simulator assessment showed statistically significant differences between groups. Performance was better among the group with endoscopic surgery experience. Face validity was assessed through a postsimulation questionnaire showing an overall mean score of 28.7 out of 30, indicating a highly positive overall assessment of the simulator. Furthermore, 100% of the trainees believe that including endoscopy training in their education would be beneficial. CONCLUSIONS: The endonasal endoscopy training simulator using a swine cadaveric model is a useful and accessible tool for enhancing surgical skills in this field. It provides an opportunity for training outside the operating room, reducing the potential risks associated with patient practice, and improving the training of residents.

Clinical Outcomes of Standardized Central Venous Catheterization Simulation Training: A Comparative Analysis.

OBJECTIVE: A standardized ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) using online- and simulation-based training was first designed and then large-scale deployed at a teaching hospital institution to improve CVC surgical education. To understand the impact that the standardized training might have on patient complications, this study focuses on identifying the impact of the integration of an iteratively designed US-IJCVC training on clinical complications at a teaching hospital. DESIGN AND PARTICIPANTS: A comparative study was conducted using TriNetX, a global health research network. Using Current Procedural Terminology (CPT) codes and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified the total number of patients with a CVC and mechanical, infectious, and thrombosis complications with and without billable ultrasound between July 1 to June 30 in 2016, 2017, and 2022. SETTING: A teaching hospital institution in Pennsylvania. RESULTS: Results showed a correlation between years and complications indicating, (1) mechanical complications billable ultrasound, (2) infectious complications billable ultrasound, and (3) thrombosis complications billable ultrasound were significantly lower with the large-scale deployment. Results also showed that (4) mechanical, infectious, and thrombosis complications with and without billable ultrasound are within the range that prior work has reported. CONCLUSION: These results indicate that there has been a decrease in mechanical, infectious, and thrombosis complications, which correlates with the US-IJCVC training large-scale deployment.

[In situ simulation training of medical-surgical teams in the management of severe trauma patients]. / La formation par simulation in situ des équipes médico-chirurgicales à la prise en charge des traumatisés sévères.

In the management of severe trauma, the aim is to assess the patient's clinical stability as quickly as possible, enabling referral to imaging (whole-body CT scan, embolization if necessary) or the operating room, or even the decision to perform in situ surgery (resuscitation thoracotomy). To cope with these critical situations, team training is essential, with the aim of ensuring the reproducibility of the difficulties encountered. High-fidelity in situ simulation is the ideal tool for meeting this training challenge.

Prehospital Pediatric Emergency Training Using Augmented Reality Simulation: A Prospective, Mixed Methods Study.

OBJECTIVE: Pediatric emergencies are high-stakes yet low-volume clinical encounters for emergency medical services (EMS) clinicians, necessitating innovative approaches to training. We sought to explore the acceptability, usability, and ergonomics of a novel augmented reality (AR) software for EMS crisis management training. METHODS: This was a prospective, mixed-methods study employing qualitative and quantitative analyses. We enrolled emergency medical technicians (EMTs) and paramedics at a municipal fire service in Northern California. We ran the Chariot Augmented Reality Medical simulation software (Stanford Chariot Program, Stanford University, Stanford, CA) on the ML1 headset (Magic Leap, Inc., Plantation, FL), which enabled participants to view an AR image of a patient overlaid with real-world training objects. Participants completed a simulation of a pediatric hypoglycemia-induced seizure and cardiac arrest. Participants subsequently engaged in structured focus group interviews assessing acceptability, which we coded and thematically analyzed. We evaluated the usability of the AR system and ergonomics of the ML1 headset using previously validated scales, and we analyzed findings with descriptive statistics. RESULTS: Twenty-two EMS clinicians participated. We categorized focus group interview statements into seven domains after an iterative thematic analysis: general appraisal, realism, learning efficacy, mixed reality feasibility, technology acceptance, software optimization, and alternate use cases. Participants valued the realism and the mixed reality functionality of the training simulation. They reported that AR could be effective for practicing pediatric clinical algorithms and task prioritization, building verbal communication skills, and promoting stress indoctrination. However, participants also noted challenges with integrating AR images with real-world objects, the learning curve required to adapt to the technology, and areas for software improvement. Participants favorably evaluated the ease of use of the technology and comfortability of wearing the hardware; however, most participants reported that they would need technical support. CONCLUSION: Participants positively evaluated the acceptability, usability, and ergonomics of an AR simulator for pediatric emergency management training, and participants identified current technological limitations and areas for improvement. AR simulation may serve as an effective training adjunct for prehospital clinicians.

Effectiveness of immersive virtual reality in orthognathic surgical education: A randomized controlled trial.

PURPOSE: To evaluate the efficacy of an iVR surgical training system for orthognathic surgery training in medical students. METHODS: This study comprised 20 fifth year medical students who were randomly assigned to the VR or traditional group for orthognathic surgical education. All participants were initially provided a lecture on orthognathic surgery. The VR group then received 10 educational sessions using the self-developed iVR training system, whereas the traditional group received 10 sessions using technical manuals and annotated operation videos. These sessions were 40-min long in both the groups. Before the evaluation, the traditional group completed one session using the training and assessment modes to become familiar with the iVR training system. The score in the assessment mode, time to complete the procedure, number of instrument selection errors, number of prompts given by the system, number of positional and angular errors, and number of timeouts during each step were recorded to evaluate the learning effect. RESULTS: The VR group achieved higher scores than the traditional group (94.67 vs. 87.65). Compared with the control group, the VR group completed the procedure more quickly, with fewer instrument selection and angular errors. No difference in the number of prompts given by the system was observed between the two groups. CONCLUSIONS: The iVR surgical training system showed a better learning effect than the traditional learning method for orthognathic surgery. The iVR surgical training system may have utility as a supplement and potential substitute for the traditional surgical training method.

Comparison of the Effectiveness of Single-Loop and Double-Loop Debriefing Techniques.

BACKGROUND: The goal of this study is to compare the quality between single-loop and double-loop debriefing techniques from the perspectives of new nurses, preceptors, and senior nurses. Single-loop debriefing techniques were used in traditional nursing education. In recent years, double-loop debriefing techniques have been used in nursing education. METHOD: This study adopted a prospective observational design, and the sample included three groups, new nurses, preceptors, and senior nurses, each with 53 participants. The Debriefing Assessment for Simulation in Healthcare (DASH) instrument was used to measure the quality of different debriefing techniques. RESULTS: The DASH scores for double-loop debriefing techniques were significantly higher than the scores for single-loop debriefing techniques among the three groups. The scores for new nurses were higher than those for the senior nurses and preceptors. CONCLUSION: The results indicated that double-loop debriefing techniques are more effective than single-loop debriefing techniques. Double-loop debriefing techniques can improve teaching satisfaction. [J Contin Educ Nurs. 2024;55(3):137-143.].

A Systematic Review of Immersive Virtual Reality for Nontechnical Skills Training in Surgery.

OBJECTIVE: Immersive virtual reality (IVR) can be utilized to provide low cost and easily accessible simulation on all aspects of surgical education. In addition to technical skills training in surgery, IVR simulation has been utilized for nontechnical skills training in domains such as clinical decision-making and pre-operative planning. This systematic review examines the current literature on the effectiveness of IVR for nontechnical skill acquisition in surgical education. DESIGN: A literature search was performed using MEDLINE, EMBASE, and Web of Science for primary studies published between January 1, 1995 and February 9, 2022. Four reviewers screened titles, abstracts, full texts, extracted data, and analyzed included studies to answer 5 key questions: How is IVR being utilized in nontechnical skills surgical education? What is the methodological quality of studies? What technologies are being utilized? What metrics are reported? What are the findings of these studies? RESULTS: The literature search yielded 2340 citations, with 12 articles included for qualitative synthesis. Of included articles, 33% focused on clinical decision-making and 67% on anatomy/pre-operative planning. Motion sickness was a recorded metric in 25% of studies, with an aggregate incidence of 13% (11/87). An application score was reported in 33% and time to completion in 16.7%. A commercially developed application was utilized in 25%, while 75% employed a noncommercial application. The Oculus Rift was used in 41.7% of studies, HTC Vive in 25%, Samsung Gear in 16.7% of studies, Google Daydream in 8%, and 1 study did not report. The mean Medical Education Research Quality Instrument (MERSQI) score was 10.3 ± 2.3 (out of 18). In all studies researching clinical decision-making, participants preferred IVR to conventional teaching methods and in a nonrandomized control study it was found to be more effective. Averaged across all studies, mean scores were 4.33 for enjoyment, 4.16 for utility, 4.11 for usability, and 3.73 for immersion on a 5-point Likert scale. CONCLUSIONS: The IVR nontechnical skills applications for surgical education are designed for clinical decision-making or anatomy/pre-operative planning. These applications are primarily noncommercially produced and rely upon a diverse array of HMDs for content delivery, suggesting that development is primarily coming from within academia and still without clarity on optimal utilization of the technology. Excitingly, users find these applications to be immersive, enjoyable, usable, and of utility in learning. Although a few studies suggest that IVR is additive or superior to conventional teaching or imaging methods, the data is mixed and derived from studies with weak design. Motion sickness with IVR remains a complication of IVR use needing further study to determine the cause and means of mitigation.