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Supporting Third Year Medical Students' Skill Acquisition and Self-Efficacy with Coping Models and Process Feedback during Laparoscopic Knot Tying Simulation.

ABSTRACT: Background: During the third year general surgery clerkship, medical students are required to develop laparoscopic knot-tying skills. Knot-tying skills studies often rely on objective variables (e.g., time, materials used, number of iterations) that lend themselves to correlational analysis of pre- and post-intervention skill level. This study differs by examining how instructional interventions-role modeling and feedback-affect medical students' skill acquisition and self-efficacy during a laparoscopic surgical simulation training session. Methods: Seventy-eight surgical clerkship students were assigned randomly to one cell of a 2X2 factorial design. Participants observed one of two types of role modeling (expert vs. coping) and received either process-oriented or outcome-oriented feedback during a 30-min laparoscopic training session. Participants also completed several surveys that assessed their interest in surgery and their self-efficacy for laparoscopic knot tying. Results: Coping model groups tended to perform better on the knot tying task, though this was less the case in the presence of outcome feedback. Expert model groups slightly outperformed the coping model group on the peg transfer task, but in the presence of outcome feedback they reported the lowest satisfaction with their performance and the lowest self-efficacy for the knot tying task. The coping model combined with process feedback had a positive influence on students' efficiency in learning the task, on their satisfaction with their performance, and on their self-efficacy for laparoscopic knot typing. Conclusions: Results are discussed relative to self-regulated learning theory.

SUBMITTER: Dempsey MS

PROVIDER: S-EPMC5515122 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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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.

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.

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Project description:BackgroundMinimally invasive surgeons must acquire complex technical skills while minimizing patient risk, a challenge that is magnified in pediatric surgery. Trainees need realistic practice with frequent detailed feedback, but human grading is tedious and subjective. We aim to validate a novel motion-tracking system and algorithms that automatically evaluate trainee performance of a pediatric laparoscopic suturing task.MethodsSubjects (n = 32) ranging from medical students to fellows performed two trials of intracorporeal suturing in a custom pediatric laparoscopic box trainer after watching a video of ideal performance. The motions of the tools and endoscope were recorded over time using a magnetic sensing system, and both tool grip angles were recorded using handle-mounted flex sensors. An expert rated the 63 trial videos on five domains from the Objective Structured Assessment of Technical Skill (OSATS), yielding summed scores from 5 to 20. Motion data from each trial were processed to calculate 280 features. We used regularized least squares regression to identify the most predictive features from different subsets of the motion data and then built six regression tree models that predict summed OSATS score. Model accuracy was evaluated via leave-one-subject-out cross-validation.ResultsThe model that used all sensor data streams performed best, achieving 71% accuracy at predicting summed scores within 2 points, 89% accuracy within 4, and a correlation of 0.85 with human ratings. 59% of the rounded average OSATS score predictions were perfect, and 100% were within 1 point. This model employed 87 features, including none based on completion time, 77 from tool tip motion, 3 from tool tip visibility, and 7 from grip angle.ConclusionsOur novel hardware and software automatically rated previously unseen trials with summed OSATS scores that closely match human expert ratings. Such a system facilitates more feedback-intensive surgical training and may yield insights into the fundamental components of surgical skill.

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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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