Toward interprofessional team training for surgeons and anesthesiologists using virtual reality

Chheang, Vuthea; Fischer, Virve Tuulia; Buggenhagen, Holger; Huber, Tobias; Huettl, Florentine; Kneist, W.; Preim, Bernhard; Saalfeld, Patrick; Hansen, Christian

doi:10.1007/s11548-020-02276-y

Cited by 31 publications

(25 citation statements)

References 29 publications

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“…Some argued that high up-front expenses created barriers to implementation and maintenance, including purchasing simulators and headsets as well as software licenses, technology maintenance, staff training, and programming requirements [ 26 , 76 , 91 - 95 ]. Integrating VR or AR with manikins was reported to significantly increase costs further [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

“…Developmental and logistical considerations further create barriers because implementing and maintaining VR and AR programs requires imagination, resources, and planning [ 94 ]. From conception, the design and development of training resources can be a lengthy and complicated process, requiring specific programming and animation expertise [ 17 , 26 , 34 , 91 ]. Design needs to be multidisciplinary (to convey accurate content), attractive, and user centered [ 91 ].…”

Section: Resultsmentioning

confidence: 99%

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How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

Gasteiger¹,

Veer²,

Wilson³

et al. 2022

JMIR Serious Games

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Background Using traditional simulators (eg, cadavers, animals, or actors) to upskill health workers is becoming less common because of ethical issues, commitment to patient safety, and cost and resource restrictions. Virtual reality (VR) and augmented reality (AR) may help to overcome these barriers. However, their effectiveness is often contested and poorly understood and warrants further investigation. Objective The aim of this review is to develop, test, and refine an evidence-informed program theory on how, for whom, and to what extent training using AR or VR works for upskilling health care workers and to understand what facilitates or constrains their implementation and maintenance. Methods We conducted a realist synthesis using the following 3-step process: theory elicitation, theory testing, and theory refinement. We first searched 7 databases and 11 practitioner journals for literature on AR or VR used to train health care staff. In total, 80 papers were identified, and information regarding context-mechanism-outcome (CMO) was extracted. We conducted a narrative synthesis to form an initial program theory comprising of CMO configurations. To refine and test this theory, we identified empirical studies through a second search of the same databases used in the first search. We used the Mixed Methods Appraisal Tool to assess the quality of the studies and to determine our confidence in each CMO configuration. Results Of the 41 CMO configurations identified, we had moderate to high confidence in 9 (22%) based on 46 empirical studies reporting on VR, AR, or mixed simulation training programs. These stated that realistic (high-fidelity) simulations trigger perceptions of realism, easier visualization of patient anatomy, and an interactive experience, which result in increased learner satisfaction and more effective learning. Immersive VR or AR engages learners in deep immersion and improves learning and skill performance. When transferable skills and knowledge are taught using VR or AR, skills are enhanced and practiced in a safe environment, leading to knowledge and skill transfer to clinical practice. Finally, for novices, VR or AR enables repeated practice, resulting in technical proficiency, skill acquisition, and improved performance. The most common barriers to implementation were up-front costs, negative attitudes and experiences (ie, cybersickness), developmental and logistical considerations, and the complexity of creating a curriculum. Facilitating factors included decreasing costs through commercialization, increasing the cost-effectiveness of training, a cultural shift toward acceptance, access to training, and leadership and collaboration. Conclusions Technical and nontechnical skills training programs using AR or VR for health care staff may trigger perceptions of realism and deep immersion and enable easier visualization, interactivity, enhanced skills, and repeated practice in a safe environment. This may improve skills and increase learning, knowledge, and learner satisfaction. The future testing of these mechanisms using hypothesis-driven approaches is required. Research is also required to explore implementation considerations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

Gasteiger¹,

Veer²,

Wilson³

et al. 2022

JMIR Serious Games

View full text Add to dashboard Cite

show abstract

“…In this context and maybe more in an emergency scenario, a team of well-trained people is the key factor for a successful robotic program [ 110 ] and should represent the standard also in emergency MIS. Some strategies to ameliorate team work were described, and the emerging solutions to improve technical skills and communication rely on simulation [ 111 – 114 ].…”

Section: Resultsmentioning

confidence: 99%

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

et al. 2023

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Background Minimally invasive surgery (MIS), including laparoscopic and robotic approaches, is widely adopted in elective digestive surgery, but selectively used for surgical emergencies. The present position paper summarizes the available evidence concerning the learning curve to achieve proficiency in emergency MIS and provides five expert opinion statements, which may form the basis for developing standardized curricula and training programs in emergency MIS. Methods This position paper was conducted according to the World Society of Emergency Surgery methodology. A steering committee and an international expert panel were involved in the critical appraisal of the literature and the development of the consensus statements. Results Thirteen studies regarding the learning curve in emergency MIS were selected. All but one study considered laparoscopic appendectomy. Only one study reported on emergency robotic surgery. In most of the studies, proficiency was achieved after an average of 30 procedures (range: 20–107) depending on the initial surgeon’s experience. High heterogeneity was noted in the way the learning curve was assessed. The experts claim that further studies investigating learning curve processes in emergency MIS are needed. The emergency surgeon curriculum should include a progressive and adequate training based on simulation, supervised clinical practice (proctoring), and surgical fellowships. The results should be evaluated by adopting a credentialing system to ensure quality standards. Surgical proficiency should be maintained with a minimum caseload and constantly evaluated. Moreover, the training process should involve the entire surgical team to facilitate the surgeon’s proficiency. Conclusions Limited evidence exists concerning the learning process in laparoscopic and robotic emergency surgery. The proposed statements should be seen as a preliminary guide for the surgical community while stressing the need for further research.

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“…A multiplayer design within the XR environment is thought to be able to offer a chance to rotate through different team roles, supporting an active and immersive learning experience with the potential to equip the learners with the crucial teamwork skills required for medical care [ 25 ]. Chheang et al [ 27 ] established anesthesia simulation software and laparoscopic simulation software that were combined within a multiuser VR environment; the interaction of multiplayers could be fulfilled in the virtual world. It was revealed that the multiuser-based software could improve problem-based communication during surgery.…”

Section: Discussionmentioning

confidence: 99%

A Novel Scenario-Based, Mixed-Reality Platform for Training Nontechnical Skills of Battlefield First Aid: Prospective Interventional Study

Zhong

Jia

et al. 2022

JMIR Serious Games

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Background Although battlefield first aid (BFA) training shares many common features with civilian training, such as the need to address technical skills and nontechnical skills (NTSs), it is more highly scenario-dependent. Studies into extended reality show clear benefits in medical training; however, the training effects of extended reality on NTSs, including teamwork and decision-making in BFA, have not been fully proven. Objective The current study aimed to create and test a scenario-based, mixed-reality platform suitable for training NTSs in BFA. Methods First, using next-generation modeling technology and an animation synchronization system, a 10-person offensive battle drill was established. Decision-making training software addressing basic principles of tactical combat casualty care was constructed and integrated into the scenarios with Unreal Engine 4 (Epic Games). Large-space teamwork and virtual interaction systems that made sense in the proposed platform were developed. Unreal Engine 4 and software engineering technology were used to combine modules to establish a mixed-reality BFA training platform. A total of 20 Grade 4 medical students were recruited to accept BFA training with the platform. Pretraining and posttraining tests were carried out in 2 forms to evaluate the training effectiveness: one was knowledge acquisition regarding the NTS and the other was a real-world, scenario-based test. In addition, the students were asked to rate their agreement with a series of survey items on a 5-point Likert scale. Results A battlefield geographic environment, tactical scenarios, scenario-based decision software, large-space teamwork, and virtual interaction system modules were successfully developed and combined to establish the mixed-reality training platform for BFA. The posttraining score of the students’ knowledge acquisition was significantly higher than that of pretraining (t=−12.114; P≤.001). Furthermore, the NTS score and the total score that the students obtained in the real-world test were significantly higher than those before training (t=−17.756 and t=−21.354, respectively; P≤.001). However, there was no significant difference between the scores of technical skills that the students obtained before and after training. A posttraining survey revealed that the students found the platform helpful in improving NTSs for BFA, and they were confident in applying BFA skills after training. However, most trainees thought that the platform was not helpful for improving the technical skills of BFA, and 45% (9/20) of the trainees were not satisfied with the simulation effect. Conclusions A scenario-based, mixed-reality platform was constructed in this study. In this platform, interaction of the movement of multiple players in a large space and the interaction of decision-making by the trainees between the real world and the virtual world were accomplished. The platform could improve the NTSs of BFA. Future works, including improvement of the simulation effects and development of a training platform that could effectively improve both the technical skills and NTSs of BFA, will be carried out.

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Toward interprofessional team training for surgeons and anesthesiologists using virtual reality

Cited by 31 publications

References 29 publications

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

How, for Whom, and in Which Contexts or Conditions Augmented and Virtual Reality Training Works in Upskilling Health Care Workers: Realist Synthesis

Training curriculum in minimally invasive emergency digestive surgery: 2022 WSES position paper

A Novel Scenario-Based, Mixed-Reality Platform for Training Nontechnical Skills of Battlefield First Aid: Prospective Interventional Study

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