Minna Silvennoinen

Virtual Reality Simulator Training of Laparoscopic Cholecystectomies — A Systematic Review

Background and Aims: Simulators are widely used in occupations where practice in authentic environments would involve high human or economic risks. Surgical procedures can be simulated by increasingly complex and expensive techniques. This review gives an update on computer-based virtual reality (VR) simulators in training for laparoscopic cholecystectomies. Materials and Methods: From leading databases (Medline, Cochrane, Embase), randomised or controlled trials and the latest systematic reviews were systematically searched and reviewed. Twelve randomised trials involving simulators were identified and analysed, as well as four controlled studies. Furthermore, seven studies comparing black boxes and simulators were included. Results: The results indicated any kind of simulator training (black box, VR) to be beneficial at novice level. After VR training, novice surgeons seemed to be able to perform their first live cholecystectomies with fewer errors, and in one trial the positive effect remained during the first ten cholecystectomies. No clinical follow-up data were found. Optimal learning requires skills training to be conducted as part of a systematic training program. No data on the cost-benefit of simulators were found, the price of a VR simulator begins at EUR 60 000. Conclusions: Theoretical background to learning and limited research data support the use of simulators in the early phases of surgical training. The cost of buying and using simulators is justified if the risk of injuries and complications to patients can be reduced. Developing surgical skills requires repeated training. In order to achieve optimal learning a validated training program is needed.

Expertise and Skill in Minimally Invasive Surgery

New attitudes to medical ethics and demands for efficiency have brought increased attention to surgical skills and training. It is important to characterize the expertise and skill involved in the multidimensional surgical profession. At a time of change, there is a need to discuss the nature of surgical expertise, and also the prospects for resident training, with special reference to new minimally invasive techniques (MIS). In this paper, we selectively review knowledge on surgical expertise and the specific demands placed on a skilled MIS surgeon. In addition, the review contains a selection of studies from those areas that have been seen as important for the future of training in surgery.

Usability challenges in surgical simulator training

Surgical virtual reality simulators have been taken into use in order to improve surgical skills training. Emergence of simulators increases the need for research and knowledge related to usability of medical simulators. In this study usability of laparoscopic surgical simulator was researched experimentally through combined analysis. Data was gathered with heuristic evaluation, questionnaires, and interviews as well as recorded simulator parameters. Results suggest that the surgical simulator could be more efficient learning and training tool if usability issues such as support and error prevention were reconsidered in more detail. There also seem to be grounds for connecting user support into structured simulator training program.

Video-assisted surgery: suggestions for failure prevention in laparoscopic cholecystectomy

Surgery differs from other medical specialties in its execution. It is often complex and includes considerable individual variations. Observing problems in operating theatres (OT) allows for the identification of system failures, which should be defined for learning purposes to increase patient safety and enhance general safety culture within hospital organizations. This study evaluates a common video-assisted surgical procedure, laparoscopic cholecystectomy (LC) through failure analysis. The profile of the LC procedure and failure sources is presented. Data consisted of video observations and interviews concerning twelve LC operations performed at a day surgery unit. All operations were teaching sessions. Qualitative analysis was undertaken. Through task analysis, specialist interviews and failure identification, a failure profile of LC was produced. Twenty failure types were identified, and failures were, for example, remote attention towards ergonomics, novice’s skill failures, inadequate supervision and unnecessary risk-taking caused by tight operating schedules. The results showed that the importance of working principles should be emphasized. The failure profile of LC revealed three phases featuring multiple failures: dissecting the peritoneal covering; identifying, sealing and cutting the cystic duct and cystic artery; and detaching the gallbladder from the hepatic bed and inspecting the hepatic bed. This study offers information for hospital organizations about the current state of surgical work and surgical skills learning. This information could be exploited in the development of system defences: error prevention mechanisms through investing in the redesign of work tasks and working methods; as well as reinforcing education and training for enhancing patient safety in OT.

Learning Surgical Skills with Simulator Training: Residents' Experiences and Perceptions

Simulator training is becoming a more integral part of surgical psychomotor skills training for video-assisted operating techniques, which need to be practiced repeatedly and systematically. Studies concerning the implementation, realization, and potentiality of simulator training programs for hospital surgeons are needed. Also, trainees’ expectations of training, and the feasibility of combining such training with their hospital work, remain rather unknown. This paper presents important theoretical factors that influence surgical skills learning through computer-based simulator training. The curriculum and the study of learners’ training experiences are presented. Statistical analysis on participants’ questionnaire answers before and after training shows that the residents were confident with their progress and skills development, and felt that working in the operating room was easier after the training period. Residents’ expectations before simulator training, and the skills experience gained afterwards, were consistent with the curriculum objectives. Then again, expectations of individual opportunities to practice were somewhat overestimated. The residents also reported not having reached their anticipated skill level during simulator training, which might indicate that a loose, voluntary training schedule alongside hospital work is insufficient for reaching the requisite skill levels. The implications of this research could be exploited when designing and implementing curricula for surgical residents.

Status of Nordic research on simulation-based learning in healthcare: an integrative review

BackgroundBased on common geography, sociopolitics, epidemiology, and healthcare services, the Nordic countries could benefit from increased collaboration and uniformity in the development of simulation-based learning (SBL). To date, only a limited overview exists on the Nordic research literature on SBL and its progress in healthcare education. Therefore, the aim of this study is to fill that gap and suggest directions for future research.MethodsAn integrative review design was used. A search was conducted for relevant research published during the period spanning from 1966 to June 2016. Thirty-seven studies met the inclusion criteria. All included studies were appraised for quality and were analyzed using thematic analysis.ResultsThe Nordic research literature on SBL in healthcare revealed that Finland has published the greatest number of qualitative studies, and only Sweden and Norway have published randomized control trials. The studies included interprofessional or uniprofessional teams of healthcare professionals and students. An assessment of the research design revealed that most studies used a qualitative or a descriptive design. The five themes that emerged from the thematic analysis comprised technical skills, non-technical skills, user experience, educational aspects, and patient safety.ConclusionThis review has identified the research relating to the progress of SBL in the Nordic countries. Most Nordic research on SBL employs a qualitative or a descriptive design. Shortcomings in simulation research in the Nordic countries include a lack of well-designed randomized control trials or robust evidence that supports simulation as an effective educational method. In addition, there is also a shortage of studies focusing on patient safety, the primary care setting, or a combination of specialized and primary care settings. Suggested directions for future research include strengthening the design and methodology of SBL studies, incorporating a cross-country comparison of studies using simulation in the Nordic countries, and studies combining specialized and primary care settings.

To sit or to stand, that is the question: examining the effects of work posture change on the well-being at work of software professionals

Despite the central role of human resources in determining the success of software companies, relatively little academic research has been conducted on the well-being at work aspect of software professionals. This study aims to address the aforementioned gap by examining the effects of using standing instead of sitting workstations on the well-being at work of software professionals in terms of their physical activity, mental alertness, stress, and musculoskeletal strain. An intervention study consisting of two measurements was conducted for 29 employees of a large Finnish software company by using questionnaires and the Firstbeat Lifestyle Assessment service. The findings of the study suggest that the usage of standing instead of sitting workstations results in only modest promotions of physical activity, does not have an effect on mental alertness, actually tilts the stress-recovery balance towards stress, but decreases musculoskeletal strain in the neck and shoulders, although increasing it in the legs and feet.

Educational Application Design Process Experiences

From the educational point of view, the only relevant basis for the design of an educational application are the learning objectives for the content area. However, in the development process of an educational application, there are also other people than experts of education involved. This paper describes a project which primary aim was to develop an application for the needs to enhance perioperative nursing skills�. Besides the development of the application, the project included research about the process. The research task was to discover how the real � not only the formal � objectives could work as the starting point for the construction of an educational game-like application. This paper presents the study process based on the panel discussions of nursing teachers. In the panels, the teachers elaborated the objectives. The transcribed discussions were analysed in terms of the conceptions of learning and teaching of perioperative nursing. The outcomes, the elaborated objectives, were aimed to be used as a basis in the implementation of an educational game. In addition, the discussions were analysed in terms of the view of learning that they indicated. It is argued that views of learning are necessary to be understood in order to make appropriate choices of educational strategy throughout the development process. Finally this paper presents initial observations of the game evaluation. They are discussed from the point of view of project success; why the learning objectives had such a low impact on the game implementation. Also the next phases and future plans of the project are reflected.

Aims vs. technology: Pedagogical view to the use of educational applications in safety critical contexts

Interactive technology for education has formed into a relatively independent domain of research and development. Interactive technology is often seen as a context independent tool. However, we argue that education in different contexts may have so different and incommensurable aims that no single technology can be announced as good or bad per se in terms of learning. The development of educational application should not be based on the technology to be applied, but by careful analysis of learning aims. When formulated in an appropriate way, learning aims work as a relevant basis in all stages of the design process of an educational application. The formulation of aims is therefore critical to the success of the whole application development project. In the current study, we illustrate the complexity of design of educational applications with one design case. This case study concerns the training of nurses who work in an operating room. As such, the case best enlighten the education in skills needed in safety critical contexts.