Expert Video Research Articles

Does Robotic Surgical Simulator Performance Correlate With Surgical Skill?

To assess the relationship between robotic surgical simulation performance and the real-life surgical skill of attending surgeons. We hypothesized that simulation performance would not correlate with real-life robotic surgical skill in attending surgeons. In 2013, Birkmeyer et al. demonstrated an association between laparoscopic surgical performance as determined by expert review of video clips and surgical outcomes. Using that model of expert review, we studied the relationship between robotic simulator performance and real-life surgical skill. Ten attending robotic surgeons performed 4 tasks on the da Vinci Skills Simulator (Camera Targeting 1, Ring Walk 3, Suture Sponge 3, and Energy Dissection 3). Two video clips of a robotic-assisted operation were then recorded for each surgeon. Three expert robotic surgeons reviewed the recordings and rated surgical technique using the Global Evaluative Assessment of Robotic Skills. University of Virginia; Charlottesville, VA; tertiary hospital PARTICIPANTS: All attending surgeons who perform robotic-assisted surgery at our institution were enrolled and completed the study. The surgeons had a median of 7.25 years of robotic surgical experience with a median of 91 cases (ranging: 20-346 cases) in the last 4 years. Median scores for each simulator task were 87.5%, 39.0%, 77.5%, and 81.5%. Using Pearson's correlation, scores for each of the individual tasks correlated poorly with expert review of intraoperative performance. There was also no correlation (r = -0.0304) between overall simulation score (mean: 70.7 ± 9.6%) and expert video ratings (mean: 3.66 ± 0.32 points). There was no correlation between attending surgeons' simulator performance and expert ratings of intraoperative videos based on the Global Evaluative Assessment of Robotic Skills scale. Although novice surgeons may put considerable effort into training on robotic simulators, performance on a simulator may not correlate with attending robotic surgical performance. Development of simulation exercises that guide novice surgeons toward expert performance is needed.

Video demonstration as way of teaching in education

The advancement of technology and its easy access contributed to the everyday use of different technical aids in all aspects of human society as an essential asset for work. In the area of education, especially within physical exercising, for information transfer and familiarizing with the new task at hand, the most common way of introducing a new task is live demonstration. A video demonstration is especially interesting as a mean of transferring information. Model learning cannot be considered as a simple imitation within specific area of motor behavior, hence it is a process in which a subject observes the model behavior and adjusts it to his/her's performance as a result of an interaction (Horn i Williams, 2004). It is an effective method used for learning simple and complex motor tasks, and observational practice if used with physical performance of the task significantly contributes to the learning of observed skills (Wulf, Shea i Lewthwaite, 2010). An expert video demonstration or direct demonstration is the most common way of giving instructions while learning motor tasks (Doussoulin i Rehbein, 2011). The use and practical application of expert video demonstration was confirmed in other areas as well. Research of video demonstration effectiveness in learning different skills as well as comparison with other ways of learning were conducted in medical students, nurses, in learning social skills in children with development difficulties, students with emotional problems in behavior, in children aged 12 to 18. The main goal of this paper was a review of literature considering video demonstration as a means of information feedback for facilitated learning of certain motor tasks in particular field of kinesiology.

“Take-home” box trainers are an effective alternative to virtual reality simulators

BackgroundPractice on virtual reality simulators (VRSs) has been shown to improve surgical performance. However, VRSs are expensive and usually housed in surgical skills centers that may be inaccessible at times convenient for surgical trainees to practice. Conversely, box trainers (BT) are inexpensive and can be used anywhere at anytime. This study assesses “take-home” BTs as an alternative to VRS. MethodsAfter baseline assessments (two simulated laparoscopic cholecystectomies, one on a VRS and one on a BT), 25 surgical trainees were randomized to two groups. Trainees were asked to practice three basic laparoscopic tasks for 6 wk (BT group using a “take-home” box trainer; VR group using VRS in clinical skills centers). After the practice period, all performed two laparoscopic cholecystectomy, one on a VRS and one on a BT; (i.e., posttraining assessment). VRS provided metrics (total time [TT], number of movements instrument tip path length), and expert video assessment of cholecystectomy in a BT (Global Operative Assessment of Laparoscopic Skills [GOALS] score) were recorded. Performance during pretraining and posttraining assessment was compared. ResultsThe BT group showed a significant improvement for all VRS metrics (P = 0.008) and the efficiency category of GOALS score (P = 0.03). Only TT improved in the VRS group, and none of the GOALS categories demonstrated a statistically significant improvement after training. Finally, the improvement in VRS metrics in the BT group was significantly greater than in the VR group (TT P = 0.005, number of movements P = 0.042, path length P = 0.031), although there were no differences in the GOALS scores between the groups. ConclusionsThis study suggests that a basic “take-home” BT is a suitable alternative to VRS.

Individualised Expert Feedback is Not Essential for Improving Basic Clinical Skills Performance in Novice Learners: A Randomized Trial

To determine whether unsupervised video feedback (UVF) is as effective as direct expert feedback (DEF) in improving clinical skills performance for medical students learning basic surgical skills-intravenous cannulation, catheterization, and suturing. Feedback is a vital component of the learning process, yet great variation persists in its quality, quantity, and methods of delivery. The use of video technology to assist in the provision of feedback has been adopted increasingly. A prospective, blinded randomized trial comparing DEF, an expert reviewing students' performances with subsequent improvement suggestions, and UVF, students reviewing their own performance with an expert teaching video, was carried out. Medical students received an initial teaching lecture on intravenous cannulation, catheterization, and suturing and were then recorded performing the task. They subsequently received either DEF or UVF before reperforming the task. Students' recordings were additionally scored by 2 blinded experts using a validated proforma. A total of 71 medical students were recruited. Cannulation scores improved 4.3% with DEF and 9.5% with UVF (p = 0.044), catheterization scores improved 8.7% with DEF and 8.9% with UVF (p = 0.96), and suturing improved 15.6% with DEF and 13.2% with UVF (p = 0.54). Improvement from baseline scores was significant in all cases (p < 0.05). Video-assisted feedback allows a significant improvement in clinical skills for novices. No significant additional benefit was demonstrated from DEF, and a similar improvement can be obtained using a generic expert video and allowing students to review their own performance. This could have significant implications for the design and delivery of such training.

Collision count in rugby union: A comparison of micro-technology and video analysis methods

ABSTRACTThe aim of our study was to determine if there is a role for manipulation of g force thresholds acquired via micro-technology for accurately detecting collisions in rugby union. In total, 36 players were recruited from an elite Guinness Pro12 rugby union team. Player movement profiles and collisions were acquired via individual global positioning system (GPS) micro-technology units. Players were assigned to a sub-category of positions in order to determine positional collision demands. The coding of collisions by micro-technology at g force thresholds between 2 and 5.5 g (0.5 g increments) was compared with collision coding by an expert video analyst using Bland–Altman assessments. The most appropriate g force threshold (smallest mean difference compared with video analyst coding) was lower for all forwards positions (2.5 g) than for all backs positions (3.5 g). The Bland–Altman 95% limits of agreement indicated that there may be a substantial over- or underestimation of collisions coded via GPS micro-technology when using expert video analyst coding as the reference comparator. The manipulation of the g force thresholds applied to data acquired by GPS micro-technology units based on incremental thresholds of 0.5 g does not provide a reliable tool for the accurate coding of collisions in rugby union. Future research should aim to investigate smaller g force threshold increments and determine the events that cause coding of false positives.

Synergy of wearable technologies and proficiency-based progression for effecting improvement in procedural skill training

The move from time-based to competence-based training has been limited by practical (often resource) issues and by the variability of effect offered by different training methodologies. Two independent advances, one...

Knowing Operative Tying: The KnOT Study

BACKGROUND: The purpose of this study was to determine if viewing an expert knot tying training video, in addition to the standard medical student curriculum, will result in more proficient surgical knot tying. METHODS: At the start of the clerkship, 20 students were videotaped tying surgical knots for 2 minutes using a board model. Two blinded gynecologic surgeons evaluated proficiency with a standard checklist (score range 0–16) and anchored scoring scale (range 0–20); higher numbers represent better skill. Students were randomized to either (1) expert video or (2) no video. The “video” group was given unlimited access to a knot tying instructional video. At the completion of the clerkship, students were again videotaped and evaluated. RESULTS: At initial evaluation, overall the group mean checklist score was 8.7±4.9, and the anchored scale score was 9.9±4.6 (range 0–18). These pre-clerkship scores did not differ between groups (P=.11 and 0.12, respectively). Post-clerkship checklist scores significantly improved in both the non-video group (14.2±1.6, P=.02) and video group (13.5±2.9, P=.003); similarly, anchor scores also improved in both groups (17.1±3.0, P=.004 and 16.5±3.4, P=.003, respectively). Knot board practice frequency was not different between groups (P=.23). In the expert video group, increased practice significantly correlated with higher post-rotation scores on both the checklist (r=0.69, P&lt;.05) and anchored scales (r=0.68, P&lt;.05). DISCUSSION: The addition of an instructional video appears to have a positive impact on medical student knot tying proficiency.

Exploring Self-regulation of More or Less Expert College-Age Video Game Players: A Sequential Explanatory Design.

This study examined differences in self-regulation among college-age expert, moderately expert, and non-expert video game players in playing video games for fun. Winne's model of self-regulation (Winne, 2001) guided the study. The main assumption of this study was that expert video game players used more processes of self-regulation than the less-expert players. We surveyed 143 college students about their game playing frequency, habits, and use of self-regulation. Data analysis indicated that while playing recreational video games, expert gamers self-regulated more than moderately expert and non-expert players and moderately expert players used more processes of self-regulation than non-experts. Semi-structured interviews also were conducted with selected participants at each of the expertise levels. Qualitative follow-up analyses revealed five themes: (1) characteristics of expert video gamers, (2) conditions for playing a video game, (3) figuring out a game, (4) how gamers act and, (5) game context. Overall, findings indicated that playing a video game is a highly self-regulated activity and that becoming an expert video game player mobilizes multiple sets of self-regulation related skills and processes. These findings are seen as promising for educators desiring to encourage student self-regulation, because they indicate the possibility of supporting students via recreational video games by recognizing that their play includes processes of self-regulation.

Expert Role Modeling Effect on Novice Nursing Students' Clinical Judgment

BackgroundThe purpose of this study was to determine the effect of the specific prebriefing strategy of expert role modeling on novice nursing students' clinical judgment scores. MethodQuantitative experimental design assessed clinical judgment scores with the Lasater Clinical Judgment Rubric (LCJR). Both the control and treatment groups received standard prebriefing. The treatment group received the intervention of viewing an expert role modeling video. Data analysis included comparison of self-assessed, peer rated, and trained external faculty rated clinical judgment scores obtained with the LCJR for each student performing the role of the primary registered nurse. Theoretical foundation was Bandura's social cognitive theory and Tanner's model of clinical judgment. ResultsStudent self and peer LCJR scores did not demonstrate statistically significant differences between the control and treatment groups. Expert faculty reviewer ratings demonstrated statistically significant (p = .000) differences between the control and treatment groups' LCJR scores. ConclusionsStudy findings supported the concept that incorporating an expert nurse role modeling video before each simulation scenario improved students' scores on the LCJR when rated by expert faculty reviewers.

P046: The “Nightmares-FM” course: an effective simulation-based acute care training method for family medicine residents

Introduction / Innovation Concept: Acute care skills are difficult to teach but can be improved using high-fidelity simulation training. We developed a comprehensive acute care “Nightmares-FM” simulation course (NM) for our Family Medicine residents and compared it to our standard simulation teaching- episodic Acute Care Rounds (ACR). Methods: NM course consisted of an initial 2 day session followed by 3 follow-on sessions interspersed throughout the PGY-1 year. ACR participants got access to 3 sessions interspersed throughout the PGY-1 year, each focusing on a different aspect of acute care. Both groups got access to the NM manual which covered the relevant topics: shock, arrhythmias, shortness of breath, altered level of consciousness and myocardial infarction. The manual is physiology-based and written specifically at the level that an average Family Medicine resident would be expected to perform at during on-call crises or emergency medicine rotations. 12 residents participating in the NM and 12 residents in time-matched ACR filled out questionnaires asking them to rate their level of knowledge of various aspects of acute care. Self-reported changes before and after each session, and at the end of the year, were analyzed using Wilcoxon matched pairs test. End of the year mean scores were compared using a two sided t-test. Finally, we developed a high-complexity acute care Objective Structured Clinical Examination (OSCE): COPD exacerbation with septic shock requiring use of positive pressure ventilation, fluids and vasopressors. The groups participated in the OSCE in February of their PGY-2 year and were graded using a validated scoring sheet marked by two independent expert video reviewers. Curriculum, Tool, or Material: NM initial 2-day session significantly improved the resident’s self-assessment scores on all 20 items of the questionnaire (p&lt;0.05). Time matched ACR improved 11 out of 20 items (p&lt;0.05) level. Follow-up NM sessions improved 5-8 out of 20 items, (p&lt;0.05). Follow-up ACR sessions improved 1-5 out of 20 items, (p&lt;0.05). End of the year means were higher for 13/20 items in the NM group (p&gt;0.05) The NM group scored significantly higher on both the mean scores of OSCE individual categories: Initial assessment, Diagnostic workup, Therapeutic interventions and Communication and teamwork (p&lt;0.05) and the Global Assessment Score (p&lt;0.026). Conclusion: “Nightmares-FM” course is more effective than our standard curriculum at teaching acute care skills to Family Medicine residents.

Validation of the AUA BLUS Tasks

Standardized assessment of laparoscopic skill in urology is lacking. Weinvestigated whether the AUA (American Urological Association) BLUS (Basic Laparoscopic Urologic Skills) skill tasks are valid to address thisneed. This institutional review board approved study included 27 medical students, 42 urology residents, 18 fellows and 37 faculty urologists across 8 sites. Using the EDGE (Electronic Data Generation and Evaluation) device (Simulab, Seattle, Washington) 454 recordings were collected on peg transfer, pattern cutting, suturing and clip applying tasks, which together comprise the expert determined BLUS tasks. We collected synchronized video and tool motion data for each trial. For each task errors, time, path length, economy of motion, peak grasp force and EDGE score were collected. An expert panel of 5 faculty members performed GOALS (Global Objective Assessment of Laparoscopic Skills) evaluations on a representative subset of peg transfer and suturing skill tasks performed by 24 participants (IRR = 0.95). Demographically derived skill levels proved unsuitable to evaluate construct validity. Separation of mean scores by grouped skill levels was strongest for the suturing task. Objective motion metrics and errors supported construct validity vis-à-vis correlation with blinded expert video ratings (motion metrics R(2) = 0.95, p <0.01). Expert scores appeared to reward errors in suturing but not in block transfer. BLUS skill task performance scoring can discriminate among basic laparoscopic technical skill levels. Self-reported demographics are an unreliable source of determining laparoscopic technical skill.

Simulation-based multiprofessional obstetric anaesthesia training conducted in situ versus off-site leads to similar individual and team outcomes: a randomised educational trial

ObjectiveTo investigate the effect of in situ simulation (ISS) versus off-site simulation (OSS) on knowledge, patient safety attitude, stress, motivation, perceptions of simulation, team performance and organisational impact.DesignInvestigator-initiated single-centre randomised...

Video game experience and its influence on visual attention parameters: An investigation using the framework of the Theory of Visual Attention (TVA)

Experts with video game experience, in contrast to non-experienced persons, are superior in multiple domains of visual attention. However, it is an open question which basic aspects of attention underlie this superiority. We approached this question using the framework of Theory of Visual Attention (TVA) with tools that allowed us to assess various parameters that are related to different visual attention aspects (e.g., perception threshold, processing speed, visual short-term memory storage capacity, top-down control, spatial distribution of attention) and that are measurable on the same experimental basis. In Experiment 1, we found advantages of video game experts in perception threshold and visual processing speed; the latter being restricted to the lower positions of the used computer display. The observed advantages were not significantly moderated by general person-related characteristics such as personality traits, sensation seeking, intelligence, social anxiety, or health status. Experiment 2 tested a potential causal link between the expert advantages and video game practice with an intervention protocol. It found no effects of action video gaming on perception threshold, visual short-term memory storage capacity, iconic memory storage, top-down control, and spatial distribution of attention after 15days of training. However, observations of a selected improvement of processing speed at the lower positions of the computer screen after video game training and of retest effects are suggestive for limited possibilities to improve basic aspects of visual attention (TVA) with practice.

Testing the reliability of hands and ears as biometrics: the importance of viewpoint.

Two experiments are presented to explore the limits when matching a sample to a suspect utilising the hand as a novel biometric. The results of Experiment 1 revealed that novice participants were able to match hands at above-chance levels as viewpoint changed. Notably, a moderate change in viewpoint had no notable effect, but a more substantial change in viewpoint affected performance significantly. Importantly, the impact of viewpoint when matching hands was smaller than that when matching ears in a control condition. This was consistent with the suggestion that the flexibility of the hand may have minimised the negative impact of a sub-optimal view. The results of Experiment 2 confirmed that training via a 10-min expert video was sufficient to reduce the impact of viewpoint in the most difficult case but not to remove it entirely. The implications of these results were discussed in terms of the theoretical importance of function when considering the canonical view and in terms of the applied value of the hand as a reliable biometric across viewing conditions.Electronic supplementary materialThe online version of this article (doi:10.1007/s00426-014-0625-x) contains supplementary material, which is available to authorized users.

Increased Prefrontal-Parietal EEG Gamma Band Correlation during Motor Imagery in Expert Video Game Players

Abstract. The aim of this study was to characterize the prefrontal-parietal EEG correlation in experienced video game players (VGPs) in relation to individuals with little or no video game experience (NVGPs) during a motor imagery condition for an action-type video game. The participants in both groups watched a first-person shooter (FPS) gameplay from Halo Reach during five minutes. None of the participants was notified as to the content of the video before watching it. Only the VGPs showed an increased right intrahemispheric prefrontal-parietal correlation (F4-P4) in the gamma band (31-50 Hz) during the observation of the gameplay. These data provide novel information on the participation of the gamma band during motor imagery for an action-type video game. It is probable that this higher degree of coupling between the prefrontal and parietalcortices could represent a characteristic pattern of brain functionality in VGPs as they make motor representations.

Solitary Colonic Peutz-Jeghers Polyp

Peutz-Jeghers (PJ) polyps are often associated with the PJ syndrome (PJS), an autosomal dominant genetic disease characterized by the development of benign hamartomatous polyps in the gastrointestinal tract and hyperpigmented macules on the lips and oral mucosa. However, rarely, solitary PJ polyps (<3) may also occur in patients without PJS. The case of a 62–year-old patient without PJS is presented, with an incidental finding of a solitary Petz-Jeghers polyp in the sigmoid. This article is part of an expert video encyclopedia.

Colonic Involvement in Systemic Mastocytosis

Systemic mastocytosis is a heterogeneous disease of the bone marrow with abnormal proliferation and infiltration of mast cells in the skin and viscera, including the mucosal surfaces of the digestive tract. Gastrointestinal symptoms are frequent and may include abdominal pain, diarrhea, nausea, vomiting, and bloating. A case of macroscopic involvement of the colon is presented herein. It is important to recognize the endoscopic appearance of this disorder and to communicate the suspicion to the pathologist so that special stains may be performed, allowing the information to contribute to the diagnosis. This article is part of an expert video encyclopedia.

Small Bowel Capsule Endoscopy Visualizing Colonic Adenocarcinoma

Small bowel endoscopy is indicated for patients with an unidentified bleeding site in esophago-gastro-duodenoscopy and ileo-colonoscopy and symptoms of intestinal blood loss or unexplained anemia. In approximately two-thirds of these cases, capsule endoscopy (CE) detects a lesion within the small bowel that explains the patient's symptoms. In few cases, though, lesions outside of the small bowel might be revealed by CE. Therefore, attention to all intestines that are visualized by CE might be necessary not to overlook bleeding sites that had not been discovered by prior flexible endoscopy.The authors present the case of a 71-year-old male patient who presented to their outpatient clinic for unexplained anemia. Small bowel CE revealed minor bleeding from an adenocarcinoma in the cecum. This article is part of an expert video encyclopedia.

Appendiceal Mucocele

Appendiceal mucocele (AM) is a descriptive term for dilated appendiceal lumen, occasionally observed in either symptomatic or asymptomatic patients during colonoscopy. Endoscopically, AM looks like submucosal tumor of the cecum, and may mimic lipoma, gastrointestinal stromal tumor, or neuroendocrine tumor. Etiological factors range from inflammatory to neoplastic, and right hemicolectomy is the treatment of choice. The biopsy of lesion during colonoscopy should be avoided to prevent serious complications at surgery; preoperative diagnosis by other imaging studies should be confirmed. Here a patient is presented with symptomatic AM. This article is part of an expert video encyclopedia.

Resection of Large Pedunculated Rectal Polyp with Preinjection and Clips Followed by Roth Net Retrieval

Large pedunculated polyps in the colon and rectum represent a challenge to the endoscopist to resect in a controlled and safe manner. How stalk preinjection with epinephrine (adrenaline) can help avoiding immediate postpolypectomy bleeding has been demonstrated in the given video. Endoscopic clips are applied to the polyp base following polypectomy to reduce the risk of delayed bleeding. Retrieval with a Roth net is also demonstrated. This article is part of an expert video encyclopedia.