Instructor feedback versus no instructor feedback on performance in a laparoscopic virtual reality simulator: a randomized educational trial

BMC Medical Education

Jette Led Soerensen²  Bent Ottesen²  Teodor Grantcharov¹  Christian Gluud⁴  Charlotte Ringsted³  Christian Rifbjerg Larsen⁵  Per Winkel⁴  Mathilde Maagaard²  Flemming Bjerrum⁵  Jeanett Oestergaard² 

[1] Department of Surgery, St. Michael's Hospital, University Hospital of Toronto, 30 Bond St., ON M5B 1W8 Toronto, Ontario, Canada;Department of Obstetrics and Gynecology, Juliane Marie Centre, Centre for Women, Children and Reproduction, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark;Centre of Clinical Education, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, Copenhagen 2100, Denmark;Copenhagen Trial Unit, University of Copenhagen, Dept, 33.44, Blegdamsvej 3b, Copenhagen 2200, Denmark;Department of Obstetrics and Gynecology, Hillerød Hospital, Dyrehavevej 29, Hillerød 3400, Denmark

关键词: Feedback;    Salpingectomy;    Training;    Laparoscopy;    Virtual reality simulation;   

Others  :  1153817
DOI  :  10.1186/1472-6920-12-7

 received in 2012-01-24, accepted in 2012-02-28,  发布年份 2012

【 摘 要 】

Background

Several studies have found a positive effect on the learning curve as well as the improvement of basic psychomotor skills in the operating room after virtual reality training. Despite this, the majority of surgical and gynecological departments encounter hurdles when implementing this form of training. This is mainly due to lack of knowledge concerning the time and human resources needed to train novice surgeons to an adequate level. The purpose of this trial is to investigate the impact of instructor feedback regarding time, repetitions and self-perception when training complex operational tasks on a virtual reality simulator.

Methods/Design

The study population consists of medical students on their 4^th to 6^th year without prior laparoscopic experience. The study is conducted in a skills laboratory at a centralized university hospital. Based on a sample size estimation 98 participants will be randomized to an intervention group or a control group. Both groups have to achieve a predefined proficiency level when conducting a laparoscopic salpingectomy using a surgical virtual reality simulator. The intervention group receives standardized instructor feedback of 10 to 12 min a maximum of three times. The control group receives no instructor feedback. Both groups receive the automated feedback generated by the virtual reality simulator. The study follows the CONSORT Statement for randomized trials. Main outcome measures are time and repetitions to reach the predefined proficiency level on the simulator. We include focus on potential sex differences, computer gaming experience and self-perception.

Discussion

The findings will contribute to a better understanding of optimal training methods in surgical education.

【 授权许可】

   
2012 Oestergaard et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A: Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg 2007, 246:771-779.
• [2]Ahlberg G, Enochsson L, Gallagher AG, Hedman L, Hogman C, McClusky DA III, et al.: Proficiency-based virtual reality training significantly reduces the error rate for residents during their first 10 laparoscopic cholecystectomies. Am J Surg 2007, 193:797-804.
• [3]Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J, Funch-Jensen P: Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg 2004, 91:146-150.
• [4]Larsen CR, Soerensen JL, Grantcharov TP, Dalsgaard T, Schouenborg L, Ottosen C, et al.: Effect of virtual reality training on laparoscopic surgery: randomised controlled trial. BMJ 2009, 338:b1802.
• [5]Burden C, Oestergaard J, Larsen CR: Integration of laparoscopic virtual-reality simulation into gynaecology training. BJOG 2011, 118(Suppl 3):5-10.
• [6]Schout BM, Hendrikx AJ, Scheele F, Bemelmans BL, Scherpbier AJ: Validation and implementation of surgical simulators: a critical review of present, past, and future. Surg Endosc 2010, 24:536-546.
• [7]Stefanidis D, Heniford BT: The formula for a successful laparoscopic skills curriculum. Arch Surg 2009, 144:77-82.
• [8]Aggarwal R, Grantcharov T, Moorthy K, Hance J, Darzi A: A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill. Am J Surg 2006, 191:128-133.
• [9]Brunner WC, Korndorffer JR Jr, Sierra R, Massarweh NN, Dunne JB, Yau CL, et al.: Laparoscopic virtual reality training: are 30 repetitions enough? J Surg Res 2004, 122:150-156.
• [10]Gallagher AG, Ritter EM, Champion H, Higgins G, Fried MP, Moses G, et al.: Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training. Ann Surg 2005, 241:364-372.
• [11]Snyder CW, Vandromme MJ, Tyra SL, Hawn MT: Proficiency-based laparoscopic and endoscopic training with virtual reality simulators: a comparison of proctored and independent approaches. J Surg Educ 2009, 66:201-207.
• [12]Wulf G, Raupach M, Pfeiffer F: Self-controlled observational practice enhances learning. Res Q Exerc Sport 2005, 76:107-111.
• [13]Wulf G, Shea C, Lewthwaite R: Motor skill learning and performance: a review of influential factors. Med Educ 2010, 44:75-84.
• [14]Brydges R, Carnahan H, Safir O, Dubrowski A: How effective is self-guided learning of clinical technical skills? It's all about process. Med Educ 2009, 43:507-515.
• [15]Larsen CR, Grantcharov T, Aggarwal R, Tully A, Sorensen JL, Dalsgaard T, et al.: Objective assessment of gynecologic laparoscopic skills using the LapSimGyn virtual reality simulator. Surg Endosc 2006, 20:1460-1466.
• [16]Holm S: A simple sequentially rejective multiple test procedure. Scand J Statist 1979, 6:65-70.
• [17]Halvorsen FH, Fosse E, Mjaland O: Unsupervised virtual reality training may not increase laparoscopic suturing skills. Surg Laparosc Endosc Percutan Tech 2011, 21:458-461.
• [18]Cass GK, Crofts JF, Draycott TJ: The use of simulation to teach clinical skills in obstetrics. Semin Perinatol 2011, 35:68-73.
• [19]Zigmont JJ, Kappus LJ, Sudikoff SN: Theoretical foundations of learning through simulation. Semin Perinatol 2011, 35:47-51.
• [20]Bong CL, Lightdale JR, Fredette ME, Weinstock P: Effects of simulation versus traditional tutorial-based training on physiologic stress levels among clinicians: a pilot study. Simul Healthc 2010, 5:272-278.
• [21]Harvey A, Nathens AB, Bandiera G, Leblanc VR: Threat and challenge: cognitive appraisal and stress responses in simulated trauma resuscitations. Med Educ 2010, 44:587-594.
• [22]McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ: A critical review of simulation-based medical education research: 2003-2009. Med Educ 2010, 44:50-63.
• [23]Chiviacowsky S, Wulf G: Self-controlled feedback is effective if it is based on the learner's performance. Res Q Exerc Sport 2005, 76:42-48.
• [24]Elneel FH, Carter F, Tang B, Cuschieri A: Extent of innate dexterity and ambidexterity across handedness and gender: implications for training in laparoscopic surgery. Surg Endosc 2008, 22:31-37.
• [25]Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J: Impact of hand dominance, gender, and experience with computer games on performance in virtual reality laparoscopy. Surg Endosc 2003, 17:1082-1085.
• [26]Thorson CM, Kelly JP, Forse RA, Turaga KK: Can we continue to ignore gender differences in performance on simulation trainers? J Laparoendosc Adv Surg Tech A 2011, 21:329-333.