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Failure affects subjective estimates of cognitive load through a negative carry-over effect in virtual reality simulation of hip fracture surgery.

ABSTRACT: Background:Cognitive overload can impair learning, and different factors might affect cognitive load during simulation-based training. In this study, we investigate the role of failure in repeated practice of virtual reality (VR) simulation of hip fracture surgery on cognitive load (CL) estimated by secondary-task reaction time test and two questionnaires. Methods:The VR simulation training program consisted of three competency levels of increasing complexity starting with the placement of a Kirschner wire in a fractured hip of one patient, adding clinical variability at the intermediate level, and performing the entire dynamic hip screw procedure in 24 different patients at the highest level. Thirteen consecutive passed simulations were required to advance to the next level. Performance was measured as passing/failing a procedure and the number of failed procedures within the latest three and five simulations. CL was measured objectively using reaction time testing during simulation and subjectively using the NASA-TLX and PAAS questionnaires. The study was carried out at a simulation center from November 2016 to March 2019. Forty-two first-year orthopedic surgery residents from the Central Denmark Region and the North Denmark Region participated in the training program. Results:A failing performance in the simulated procedure was associated with a higher CL than passing a procedure. The subjective CL estimates were affected by the number of failures during last three and five procedures with a higher number of failures being associated with a higher CL. In contrast, relative reaction time estimates of CL were not affected by previous failures. Conclusions:Questionnaires for estimation of CL seem to be affected by participant frustration after failure-a meta-cognitive "carry-over" effect. This could be a general limitation of the subjective questionnaire approach to estimate CL. Reducing CL through instructional design and handling of participant frustration might improve the learning outcome of simulation training programs.

SUBMITTER: Rolfing JD

PROVIDER: S-EPMC6868822 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Failure affects subjective estimates of cognitive load through a negative carry-over effect in virtual reality simulation of hip fracture surgery.

Rölfing Jan Duedal JD Nørskov Jeppe Kempf JK Paltved Charlotte C Konge Lars L Andersen Steven Arild Wuyts SAW

Advances in simulation (London, England) 20191121

<h4>Background</h4>Cognitive overload can impair learning, and different factors might affect cognitive load during simulation-based training. In this study, we investigate the role of failure in repeated practice of virtual reality (VR) simulation of hip fracture surgery on cognitive load (CL) estimated by secondary-task reaction time test and two questionnaires.<h4>Methods</h4>The VR simulation training program consisted of three competency levels of increasing complexity starting with the pla ...[more]

PMID: 31832243

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Project description:PURPOSE:To test the face validity of the hip diagnostics module of a virtual reality hip arthroscopy simulator. METHODS:A total of 25 orthopaedic surgeons, 7 faculty members and 18 orthopaedic residents, performed diagnostic supine hip arthroscopies of a healthy virtual reality hip joint using a 70° arthroscope. Twelve specific targets were visualised within the central compartment; six via the anterior portal, three via the anterolateral portal and three via the posterolateral portal. This task was immediately followed by a questionnaire regarding the realism and training capability of the system. This consisted of seven questions addressing the verisimilitude of the simulator and five questions addressing the training environment of the simulator. Each question consisted of a statement stem and 10-point Likert scale. Following similar work in surgical simulators, a rating of 7 or above was considered an acceptable level of realism. RESULTS:The diagnostic hip arthroscopy module was found to have an acceptable level of realism in all domains apart from the tactile feedback received from the soft tissue. 23 out of 25 participants (92%) felt the simulator provided a non-threatening learning environment and 22 participants (88%) stated they enjoyed using the simulator. It was most frequently agreed that the level of trainees who would benefit most from the simulator were registrars and fellows (22 participants; 88%). Additionally, 21 of the participants (84%) agreed that this would be a beneficial training modality for foundation and core trainees, and 20 participants (80%) agreed that his would be beneficial for consultants. CONCLUSIONS:This VR hip arthroscopy simulator was demonstrated to have a sufficient level of realism, thus establishing its face validity. These results suggest this simulator has sufficient realism for use in the acquisition of basic arthroscopic skills and supports its use in orthopaedics surgical training. LEVEL OF EVIDENCE:I.

Dataset Information

Failure affects subjective estimates of cognitive load through a negative carry-over effect in virtual reality simulation of hip fracture surgery.

Publications

Failure affects subjective estimates of cognitive load through a negative carry-over effect in virtual reality simulation of hip fracture surgery.

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