Supporting Third Year Medical Students' Skill Acquisition and Self-Efficacy with Coping Models and Process Feedback during Laparoscopic Knot Tying Simulation.
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ABSTRACT:
SUBMITTER: Dempsey MS
PROVIDER: S-EPMC5515122 | biostudies-other | 2017
REPOSITORIES: biostudies-other
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Project description:Virtual reality (VR) simulator has emerged as a laparoscopic surgical skill training tool that needs validation using brain-behavior analysis. Therefore, brain network and skilled behavior relationship were evaluated using functional near-infrared spectroscopy (fNIRS) from seven experienced right-handed surgeons and six right-handed medical students during the performance of Fundamentals of Laparoscopic Surgery (FLS) pattern of cutting tasks in a physical and a VR simulator. Multiple regression and path analysis (MRPA) found that the FLS performance score was statistically significantly related to the interregional directed functional connectivity from the right prefrontal cortex to the supplementary motor area with F (2, 114) = 9, p < 0.001, and R2 = 0.136. Additionally, a two-way multivariate analysis of variance (MANOVA) found a statistically significant effect of the simulator technology on the interregional directed functional connectivity from the right prefrontal cortex to the left primary motor cortex (F (1, 15) = 6.002, p = 0.027; partial η2 = 0.286) that can be related to differential right-lateralized executive control of attention. Then, MRPA found that the coefficient of variation (CoV) of the FLS performance score was statistically significantly associated with the CoV of the interregionally directed functional connectivity from the right primary motor cortex to the left primary motor cortex and the left primary motor cortex to the left prefrontal cortex with F (2, 22) = 3.912, p = 0.035, and R2 = 0.262. This highlighted the importance of the efference copy information from the motor cortices to the prefrontal cortex for postulated left-lateralized perceptual decision-making to reduce behavioral variability.
| S-EPMC9411170 | biostudies-literature
Project description:The acquisition of basic surgical skills is a key component of medical education and trainees in laparoscopic surgery typically begin developing their skills using simulation box trainers. However, despite the advantages of simulation surgical training, access can be difficult for many trainees. One technique that has shown promise to enhance the deliberate practice of motor skills is transcranial electric stimulation (tES). The purpose of this study was to assess the impact of transcranial direct current stimulation (tDCS) on training induced improvements and retention of traditional time and kinematic based laparoscopic surgical skill metrics. Forty-nine medical students were randomly allocated to a neurostimulation or sham group and completed 5 training sessions of a bead transfer and threading laparoscopic task. Participants in both the sham and stimulation groups significantly improved their time and kinematic performance on both tasks following training. Although we did find that participants who received M1 tDCS saw greater performance benefits in response to training on a bead transfer task compared to those receiving sham stimulation no effect of neurostimulation was found for the threading task. This finding raises new questions regarding the effect that motor task complexity has on the efficacy of neurostimulation to augment training induced improvement and contributes to a growing body of research investigating the effects of neurostimulation on the sensory-motor performance of laparoscopic surgical skill.
| S-EPMC10447451 | biostudies-literature
Project description:BackgroundChanges in medical education may limit opportunities for trainees to gain proficiency in surgical skills. Transcranial direct-current stimulation (tDCS) can augment motor skill learning and may enhance surgical procedural skill acquisition. The aim of this study was to determine the effects of tDCS on simulation-based laparoscopic surgical skill acquisition.MethodsIn this double-blind, sham-controlled randomized trial, participants were randomized to receive 20 min of anodal tDCS or sham stimulation over the dominant primary motor cortex, concurrent with Fundamentals of Laparoscopic Surgery simulation-based training. Primary outcomes of laparoscopic pattern-cutting and peg transfer tasks were scored at baseline, during repeated performance over 1 h, and again at 6 weeks. Intent-to-treat analysis examined the effects of treatment group on skill acquisition and retention.ResultsOf 40 participants, those receiving tDCS achieved higher mean(s.d.) final pattern-cutting scores than participants in the sham group (207·6(30·0) versus 186·0(32·7) respectively; P = 0·022). Scores were unchanged at 6 weeks. Effects on peg transfer scores were not significantly different (210·2(23·5) in the tDCS group versus 201·7(18·1) in the sham group; P = 0·111); the proportion achieving predetermined proficiency levels was higher for tDCS than for sham stimulation. Procedures were well tolerated with no serious adverse events and no decreases in motor measures.ConclusionThe addition of tDCS to laparoscopic surgical training may enhance skill acquisition. Trials of additional skills and translation to non-simulated performance are required to determine the potential value in medical education and impact on patient outcomes. Registration number: NCT02756052 (https://clinicaltrials.gov/).
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Project description:The ability to perceive differences in depth is important in many daily life situations. It is also of relevance in laparoscopic surgical procedures that require the extrapolation of three-dimensional visual information from two-dimensional planar images. Besides visual-motor coordination, laparoscopic skills and binocular depth perception are demanding visual tasks for which learning is important. This study explored potential relations between binocular depth perception and individual variations in performance gains during laparoscopic skill acquisition in medical students naïve of such procedures. Individual differences in perceptual learning of binocular depth discrimination when performing a random dot stereogram (RDS) task were measured as variations in the slope changes of the logistic disparity psychometric curves from the first to the last blocks of the experiment. The results showed that not only did the individuals differ in their depth discrimination; the extent with which this performance changed across blocks also differed substantially between individuals. Of note, individual differences in perceptual learning of depth discrimination are associated with performance gains from laparoscopic skill training, both with respect to movement speed and an efficiency score that considered both speed and precision. These results indicate that learning-related benefits for enhancing demanding visual processes are, in part, shared between these two tasks. Future studies that include a broader selection of task-varying monocular and binocular cues as well as visual-motor coordination are needed to further investigate potential mechanistic relations between depth perceptual learning and laparoscopic skill acquisition. A deeper understanding of these mechanisms would be important for applied research that aims at designing behavioral interventions for enhancing technology-assisted laparoscopic skills.
| S-EPMC8524002 | biostudies-literature
Project description:Introduction:Despite the increasing prevalence of minimally invasive surgery (MIS), medical students receive little training in MIS techniques like laparoscopy. Cost is perhaps the biggest obstacle, as expensive laparoscopic skill simulators (box trainers) are needed to mimic the laparoscopic environment. Low-cost, homemade box trainers have been built and described in the literature but are generally relegated to self-directed practice for surgical residents. These do-it-yourself (DIY) box trainers are uniquely capable of addressing cost as a major barrier to laparoscopic skills training for medical students but have not previously been used specifically for this purpose. Methods:Students from the Oakland University William Beaumont School of Medicine (n = 17) participated in a laparoscopic skills training course using DIY box trainers. Four basic laparoscopic tasks were taught using live demonstrations followed by directed practice. Learners were instructed to record their first and last attempts in order to enable self-assessment of their progress. Results:All learners were able to successfully complete each of the four laparoscopic tasks by the end of their respective sessions. Feedback from the learners in the form of a postsession survey indicated that the course provided an enjoyable and high-quality experience. Discussion:This resource is effective at providing medical students with a low-cost opportunity to experience laparoscopy and develop basic laparoscopic skills.
| S-EPMC6415328 | biostudies-literature
Project description:The plasticity of the human nervous system allows us to acquire an open-ended repository of sensorimotor skills in adulthood, such as the mastery of tools, musical instruments or sports. How novel sensorimotor skills are learned from scratch is yet largely unknown. In particular, the so-called inverse mapping from goal states to motor states is underdetermined because a goal can often be achieved by many different movements (motor redundancy). How humans learn to resolve motor redundancy and by which principles they explore high-dimensional motor spaces has hardly been investigated. To study this question, we trained human participants in an unfamiliar and redundant visually-guided manual control task. We qualitatively compare the experimental results with simulation results from a population of artificial agents that learned the same task by Goal Babbling, which is an inverse-model learning approach for robotics. In Goal Babbling, goal-related feedback guides motor exploration and thereby enables robots to learn an inverse model directly from scratch, without having to learn a forward model first. In the human experiment, we tested whether different initial conditions (starting positions of the hand) influence the acquisition of motor synergies, which we identified by Principal Component Analysis in the motor space. The results show that the human participants' solutions are spatially biased towards the different starting positions in motor space and are marked by a gradual co-learning of synergies and task success, similar to the dynamics of motor learning by Goal Babbling. However, there are also differences between human learning and the Goal Babbling simulations, as humans tend to predominantly use Degrees of Freedom that do not have a large effect on the hand position, whereas in Goal Babbling, Degrees of Freedom with a large effect on hand position are used predominantly. We conclude that humans use goal-related feedback to constrain motor exploration and resolve motor redundancy when learning a new sensorimotor mapping, but in a manner that differs from the current implementation of Goal Babbling due to different constraints on motor exploration.
| S-EPMC6420027 | biostudies-literature
Project description:The aim of this study is to demonstrate the potential of sensory substitution/augmentation (SS/A) techniques for driver assistance systems in a simulated driving environment. Using a group-comparison design, we examined lane-keeping skill acquisition in a driving simulator that can provide information regarding vehicle lateral position by changing the binaural balance of auditory white noise delivered to the driver. Consequently, lane-keeping accuracy was significantly degraded when the lower visual scene (proximal part of the road) was occluded, suggesting it conveyed critical visual information necessary for lane keeping. After 40?minutes of training with auditory cueing of vehicle lateral position, lane-keeping accuracy returned to the baseline (normal driving) level. This indicates that auditory cueing can compensate for the loss of visual information. Taken together, our data suggest that auditory cueing of vehicle lateral position is sufficient for lane-keeping skill acquisition and that SS/A techniques can potentially be used for the development of driver assistance systems, particularly for situations where immediate time-sensitive actions are required in response to rapidly changing sensory information. Although this study is the first to apply SS/A techniques to driver assistance, further studies are however required to establish the generalizability of the findings to real-world settings.
| S-EPMC6884475 | biostudies-literature
Project description:ObjectivesTo investigate how visuospatial abilities develop and influence intraoperative laparoscopic performance during surgical residency training programmes.BackgroundLaparoscopic surgery is a challenging technique to acquire and master. Visuospatial ability is an important attribute but most prior research have predominantly explored the influence of visuospatial abilities in lab-based settings and/or among inexperienced surgeons. Little is known about the impact of visuospatial profiles on actual laparoscopic performance and its role in shaping competency.MethodA longitudinal observational cohort study using a pair-matched design over 27 months. At baseline, visuospatial profiles of 43 laparoscopic surgeons of all expertise levels and 19 control subjects were compared. The development of visuospatial abilities and their association with intraoperative performance of 18 residency surgeons were monitored during the course of their laparoscopic training.ResultsLaparoscopic surgeons significantly outperformed the control group on the measure of spatial visualisation (U = 273.0, p = 0.03, η2 = 0.3). Spatial visualisation was found to be a significant predictor of laparoscopic expertise (R2 = 0.70, F (1.60) = 6.788, p = 0.01) and improved with laparoscopic training (B = 4.01, SE = 1.83, p = 0.02, 95% CI [0.40, 7.63]). From month 6 to 18, a strong positive correlation between spatial visualisation and intraoperative depth perception (r = 0.67, p < 0.01), bimanual dexterity (r = 0.60, p < 0.01), autonomy (r = 0.78, p < 0.01) and the total score (r = 0.70, p < 0.01) were observed but a strong relationship remained only with autonomy (r = 0.89, p < 0.01) and total score (r = 0.80, p < 0.01) at 18 months.ConclusionIn this longitudinal cohort study, visuospatial abilities associate with laparoscopic skills and improve with training. Spatial visualisation may be characteristic of laparoscopic expertise as it has clear association with competency development during laparoscopy residency training programme.
| S-EPMC9154204 | biostudies-literature
Project description:BackgroundThree-dimensional (3D) visual displays have been suggested to aid laparoscopic skills training by providing the depth cues not present in traditional two-dimensional (2D) displays. However, few studies have robustly investigated the impact of viewing mode (2D vs. 3D) on learning outcomes.PurposeTo examine how viewing mode (2D vs. 3D) impacts the acquisition and transferability of basic laparoscopic skills by comparing performance between transfer and control groups on a complete proficiency-based training program.MethodA counterbalanced between-subjects design was employed. Each participant was randomly allocated to one of four groups, comprising two transfer groups (trained in one viewing mode and tested in the alternate mode: the 2D → 3D and 3D → 2D groups) and two control groups (trained and tested in one viewing mode: the 2D → 2D and 3D → 3D groups). Participants completed proficiency-based training in six laparoscopic training tasks. Testing included two further repetitions of all tasks under test conditions. Objective performance measures included the total number of repetitions to reach proficiency, and total performance scores (i.e. time + error penalties across all repetitions) in training and testing.ResultsThe groups trained in 3D demonstrated superior training performance (i.e. less time + errors) and took fewer repetitions to reach proficiency than the groups trained in 2D. The groups tested in 3D also demonstrated superior test performance compared to those tested in 2D. However, training mode did not yield significant test differences between the groups tested in 2D (i.e. 2D → 2D vs. 3D → 2D), or between the groups tested in 3D (i.e. 3D → 3D vs. 2D → 3D).ConclusionNovices demonstrate superior performance in laparoscopic skills training using a 3D viewing mode compared to 2D. However, this does not necessarily translate to superior performance in subsequent testing or enhanced learning overall. Rather, test performance appears to be dictated by the viewing mode used during testing, not that of prior training.
| S-EPMC8263422 | biostudies-literature
Project description:Feedback is an essential factor that may affect students' motor skill learning during physical education (PE) classes. This review aimed to (1) systematically examine the evidence for the effectiveness of feedback on students' skill learning during PE classes and (2) summarize the evidence for the effects of feedback elements (i.e., format and content). A systematic search was conducted on seven electronic databases to identify studies that explored the effects of feedback on student learning during PE classes. Twenty-three studies were selected, and the study quality was evaluated using the Physiotherapy Evidence Database scale. The levels of evidence were determined with the best evidence synthesis. Strong evidence indicates the effectiveness of feedback intervention on students' skill learning compared with those who received no feedback. Limited evidence was found for the effect of visual feedback compared with verbal feedback. There were mixed results for the effectiveness of information feedback compared with praise or corrective feedback. The current evidence suggests that feedback is useful for skill learning during PE classes. Emergent questions still need to be addressed, such as those regarding the efficiency of using different formats and contents for feedback delivery to enhance motor skill learning during PE classes.
| S-EPMC8296044 | biostudies-literature