Final-product Score Research Articles

Structural neuroplasticity in computer programming beginners.

We examined the structural neuroplastic changes associated with the learning of computer programming in university students with no previous programming experience. They participated in a 15-week course (26 lessons) on the "Processing" computer programming language. We have conducted a longitudinal analysis of gray matter volume (GMV) in the magnetic resonance images obtained before and after learning computer programming. Significant neuroplastic changes appeared in the following 8 sites: the left frontal pole; the right frontal pole; the right medial frontal gyrus; the left cuneus; the left lateral cerebellum (posterior lobule and tuber); the medial cerebellum (uvula and tonsil); the right pallidum; and the left pallidum. The amount of change in the GMV of the right frontal pole correlated positively with the final product score. Furthermore, the amount of change in the GMV of the right medial frontal gyrus and the bilateral pallidum correlated positively with the test scores. Thus, the right frontal pole was presumably associated with the function of persistent attempts to accomplish tasks (goal achievement-related function). The right medial frontal gyrus and the bilateral pallidum were presumably related to deduction and reward functions, respectively. Therefore, multiple brain regions appear to be involved in programming learning through different functions.

Automated summative feedback improves performance and retention in simulation training of mastoidectomy: a randomised controlled trial.

This study aimed to investigate the effects of automated metrics-based summative feedback on performance, retention and cognitive load in distributed virtual reality simulation training of mastoidectomy. Twenty-four medical students were randomised in two groups and performed 15 mastoidectomies on a distributed virtual reality simulator as practice. The intervention group received additional summative metrics-based feedback; the control group followed standard instructions. Two to three months after training, participants performed a retention test without learning supports. The intervention group had a better final-product score (mean difference = 1.0 points; p = 0.001) and metrics-based score (mean difference = 12.7; p < 0.001). At retention, the metrics-based score for the intervention group remained superior (mean difference = 6.9 per cent; p = 0.02). Also at the retention, cognitive load was higher in the intervention group (mean difference = 10.0 per cent; p < 0.001). Summative metrics-based feedback improved performance and lead to a safer and faster performance compared with standard instructions and seems a valuable educational tool in the early acquisition of temporal bone skills.

Decentralized Virtual Reality Training of Mastoidectomy Improves Cadaver Dissection Performance: A Prospective, Controlled Cohort Study.

Virtual reality (VR) simulation training can improve temporal bone (TB) cadaver dissection skills and distributed, self-regulated practice is optimal for skills consolidation. Decentralized training (DT) at the trainees' own department or home offers more convenient access compared with centralized VR simulation training where the simulators are localized at one facility. The effect of DT in TB surgical training is unknown. We investigated the effect of decentralized VR simulation training of TB surgery on subsequent cadaver dissection performance. Prospective, controlled cohort study. Otorhinolaryngology (ORL) teaching hospitals and the Danish national TB course. Thirty-eight ORL residents: 20 in the intervention cohort (decentralized training) and 18 in the control cohort (standard training during course). Three months of access to decentralized VR simulation training at the local ORL department or the trainee's home. A freeware VR simulator (the visible ear simulator [VES]) was used, supplemented by a range of learning supports for directed, self-regulated learning. Mastoidectomy final-product scores from the VR simulations and cadaver dissection were rated using a modified Welling Scale by blinded expert raters. Participants in the intervention cohort trained decentrally a median of 3.5 hours and performed significantly better than the control cohort during VR simulation (p < 0.01), which importantly also transferred to a 76% higher performance score during subsequent cadaver training (mean scores: 8.8 versus 5.0 points; p < 0.001). Decentralized VR simulation training of mastoidectomy improves subsequent cadaver dissection performance and can potentially improve implementation of VR simulation surgical training.

The effect of structured self-assessment in virtual reality simulation training of mastoidectomy.

Virtual reality (VR) simulation surgical skills training is well established, but self-directed practice is often associated with a learning curve plateau. In this study, we investigate the effects of structured self-assessment as a means to improve performance in mastoidectomy training. The study was a prospective, educational study. Two cohorts of novices (medical students) were recruited for practice of anatomical mastoidectomy in a training program with five distributed training blocks. Fifteen participants performed structured self-assessment after each procedure (intervention cohort). A reference cohort of another 14 participants served as controls. Performances were assessed by two blinded raters using a modified Welling Scale and simulator-recorded metrics. The self-assessment cohort performed superiorly to the reference cohort (mean difference of final product score 0.87 points, p = 0.001) and substantially reduced the number of repetitions needed. The self-assessment cohort also had more passing performances for the combined metrics-based score reflecting increased efficiency. Finally, the self-assessment cohort made fewer collisions compared with the reference cohort especially with the chorda tympani, the facial nerve, the incus, and the malleus. VR simulation training of surgical skills benefits from having learners perform structured self-assessment following each procedure as this increases performance, accelerates the learning curve thereby reducing time needed for training, and induces a safer performance with fewer collisions with critical structures. Structured self-assessment was in itself not sufficient to counter the learning curve plateau and for continued skills development additional supports for deliberate practice are needed.

Expert sampling of VR simulator metrics for automated assessment of mastoidectomy performance

Often the assessment of mastoidectomy performance requires time-consuming manual rating. Virtual reality (VR) simulators offer potentially useful automated assessment and feedback but should be supported by validity evidence. We aimed to investigate simulator metrics for automated assessment based on the expert performance approach, comparison with an established assessment tool, and the consequences of standard setting. The performances of 11 experienced otosurgeons and 37 otorhinolaryngology residents. Participants performed three mastoidectomies in the Visible Ear Simulator. Nine residents contributed additional data on repeated practice in the simulator. One hundred and twenty-nine different performance metrics were collected by the simulator and final-product files were saved. These final products were analyzed using a modified Welling Scale by two blinded raters. Seventeen metrics could discriminate between resident and experienced surgeons' performances. These metrics mainly expressed various aspects of efficiency: Experts demonstrated more goal-directed behavior and less hesitancy, used less time, and selected large and sharp burrs more often. The combined metrics-based score (MBS) demonstrated significant discriminative ability between experienced surgeons and residents with a mean difference of 16.4% (95% confidence interval [12.6-20.2], P << 0.001). A pass/fail score of 83.6% was established. The MBS correlated poorly with the final-product score but excellently with the final-product score per time. The MBS mainly reflected efficiency components of the mastoidectomy procedure, and although it could have some uses in self-directed training, it fails to measure and encourage safe routines. Supplemental approaches and feedback are therefore required in VR simulation training of mastoidectomy. 2b Laryngoscope, 129:2170-2177, 2019.

Informed decision making: a tool to aid the decision making process of sourcing responsible growing media throughout the UK supply chain

A previous publication (Alexander and Bragg, 2014) presented work in progress in the UK towards defining sustainable growing media. The work represented the response of the UK horticultural industry to a government White paper which had established targets for peat use in UK horticulture (zero peat use in hobby market products by 2020 and zero peat use in professional products by 2030). In addition, the UK horticultural industry is conscious of having to operate in a more sustainable fashion and these factors are increasingly part of the decision making process. Good progress has been made by the working group (representing manufacturers, growers, retailers and NGO's). Discussion has revised the aspiration of the tool to be about responsibility, not sustainability, to avoid overly ambitious expectations associated with the latter. The group has now published guidelines for the assessment criteria, newly revised assessment decision trees have been generated and the group has also commissioned a 'Calculator' which allows end users to assess both individual materials and media mixes. Example growing media products will be presented to illustrate how the information will be presented to the buyer and how much detail is provided at both a product and ingredient level. The scoring system will be used to highlight the effect of how sourcing ingredients from different suppliers or geographical sites can influence the final product score and thus responsibility of a product. A scheme to manage the tool moving forwards (administering it and revising targets) as well as auditing the tool will also be described. For the first time in the UK this tool allows the growing media buyer the opportunity to include factors other than just cost and quality in their decision making process.

A novel perfused porcine simulator for teaching aortic anastomosis increases resident interest in vascular surgery

ObjectiveThis report describes a novel simulator, euthanized pigs on cardiopulmonary bypass, and validates this simulator with a controlled trial in general surgery residents learning aortic anastomosis. We evaluated this novel simulator with the following hypothesis: our porcine perfused simulator is as good as or better than the standard rubber tubing, low-fidelity models used for vascular anastomotic training. MethodsEuthanized pigs were placed on cardiopulmonary bypass, creating a perfused, ex vivo model on which to perform surgical procedures. The participants in the study were postgraduate year 2, 3, and 4 general surgery residents. Residents were randomized to practice aortic anastomosis in the pig laboratory (PL) simulator or in a dry laboratory. The PL residents and control residents performed a first vascular anastomosis on the rubber tube model. Anastomosis creation was filmed. The anastomosis and video were stored for later grading. Next, all residents underwent an ungraded, one-on-one training session with the attending vascular surgeon. After the training session, all residents completed a second videotaped rubber tubing anastomosis. The grading scales used were validated by other authors: Global Assessment Score, Final Product Score, and Checklist Scoring Instrument. Survey data describing this experience were collected using a 13-question prelaboratory and 16-question postlaboratory questionnaires consisting of yes/no, multiple selection, and 5-point Likert-type scale questions. ResultsAll residents had a statistically significant improvement in time to completion and in the Global Assessment Score with tutored practice. The PL residents showed statistically significant improvement in completion time between the first and second videotaped anastomosis; however, there was no statistically significant improvement in the scoring metrics. The control residents showed statistically significant improvement in all three scoring metrics, but no statistically significant difference was found in completion time. The survey data showed a statistically significant shift in considering vascular surgery as a career after the experience in the PL group (P = .05) compared with the control group, who had no change in interest (P = .91). ConclusionsOur prospective, randomized clinical trial shows that the porcine cardiopulmonary bypass model achieves similar results to a previously validated bench top model while improving general surgery resident interest in vascular surgery as a career.

Hands-on Simulation versus Traditional Video-learning in Teaching Microsurgery Technique

Bench model hands-on learning may be more effective than traditional didactic practice in some surgical fields. However, this has not been reported for microsurgery. Our study objective was to demonstrate the efficacy of bench model hands-on learning in acquiring microsuturing skills. The secondary objective was to evaluate the aptitude for microsurgery based on personality assessment. Eighty-six medical students comprising 62 men and 24 women were randomly assigned to either 20 min of hands-on learning with a bench model simulator or 20 min of video-learning using an instructional video. They then practiced microsuturing for 40 min. Each student then made three knots, and the time to complete the task was recorded. The final products were scored by two independent graders in a blind fashion. All participants then took a personality test, and their microsuture test scores and the time to complete the task were compared. The time to complete the task was significantly shorter in the simulator group than in the video-learning group. The final product scores tended to be higher with simulator-learning than with video-learning, but the difference was not significant. Students with high “extraversion” scores on the personality inventory took a shorter time to complete the suturing test. Simulator-learning was more effective for microsurgery training than video instruction, especially in understanding the procedure. There was a weak association between personality traits and microsurgery skill.

The effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial.

BackgroundCognitive overload can inhibit learning, and cognitive load theory-based instructional design principles can be used to optimize learning situations. This study aims to investigate the effect of implementing cognitive load theory-based design principles in virtual reality simulation training of mastoidectomy.MethodsEighteen novice medical students received 1 h of self-directed virtual reality simulation training of the mastoidectomy procedure randomized for standard instructions (control) or cognitive load theory-based instructions with a worked example followed by a problem completion exercise (intervention). Participants then completed two post-training virtual procedures for assessment and comparison. Cognitive load during the post-training procedures was estimated by reaction time testing on an integrated secondary task. Final-product analysis by two blinded expert raters was used to assess the virtual mastoidectomy performances.ResultsParticipants in the intervention group had a significantly increased cognitive load during the post-training procedures compared with the control group (52 vs. 41 %, p = 0.02). This was also reflected in the final-product performance: the intervention group had a significantly lower final-product score than the control group (13.0 vs. 15.4, p < 0.005).ConclusionsInitial instruction using worked examples followed by a problem completion exercise did not reduce the cognitive load or improve the performance of the following procedures in novices. Increased cognitive load when part tasks needed to be integrated in the post-training procedures could be a possible explanation for this. Other instructional designs and methods are needed to lower the cognitive load and improve the performance in virtual reality surgical simulation training of novices.

The effect of self-directed virtual reality simulation on dissection training performance in mastoidectomy.

To establish the effect of self-directed virtual reality (VR) simulation training on cadaveric dissection training performance in mastoidectomy and the transferability of skills acquired in VR simulation training to the cadaveric dissection training setting. Prospective study. Two cohorts of 20 novice otorhinolaryngology residents received either self-directed VR simulation training before cadaveric dissection training or vice versa. Cadaveric and VR simulation performances were assessed using final-product analysis with three blinded expert raters. The group receiving VR simulation training before cadaveric dissection had a mean final-product score of 14.9 (95 % confidence interval [CI] [12.9-16.9]) compared with 9.8 (95% CI [8.4-11.1]) in the group not receiving VR simulation training before cadaveric dissection. This 52% increase in performance was statistically significantly (P < 0.0001). A single dissection mastoidectomy did not increase VR simulation performance (P = 0.22). Two hours of self-directed VR simulation training was effective in increasing cadaveric dissection mastoidectomy performance and suggests that mastoidectomy skills are transferable from VR simulation to the traditional dissection setting. Virtual reality simulation training can therefore be employed to optimize training, and can spare the use of donated material and instructional resources for more advanced training after basic competencies have been acquired in the VR simulation environment. NA. Laryngoscope, 126:1883-1888, 2016.

Mastoidectomy performance assessment of virtual simulation training using final-product analysis.

The future development of integrated automatic assessment in temporal bone virtual surgical simulators calls for validation against currently established assessment tools. This study aimed to explore the relationship between mastoidectomy final-product performance assessment in virtual simulation and traditional dissection training. Prospective trial with blinding. A total of 34 novice residents performed a mastoidectomy on the Visible Ear Simulator and on a cadaveric temporal bone. Two blinded senior otologists assessed the final-product performance using a modified Welling scale. The simulator gathered basic metrics on time, steps, and volumes in relation to the on-screen tutorial and collisions with vital structures. Substantial inter-rater reliability (kappa = 0.77) for virtual simulation and moderate inter-rater reliability (kappa = 0.59) for dissection final-product assessment was found. The simulation and dissection performance scores had significant correlation (P = .014). None of the basic simulator metrics correlated significantly with the final-product score except for number of steps completed in the simulator. A modified version of a validated final-product performance assessment tool can be used to assess mastoidectomy on virtual temporal bones. Performance assessment of virtual mastoidectomy could potentially save the use of cadaveric temporal bones for more advanced training when a basic level of competency in simulation has been achieved. NA.

Development of a cast application simulator and evaluation of objective measures of performance.

Surgical simulation offers a low-risk learning environment with repetitive practice opportunities for orthopaedic residents. It is increasingly prevalent in many training programs, as acquisition of technical skills in the face of educational demands and reduced work hours becomes more challenging. In addition to surgical skills, orthopaedic residents must also learn the technique of cast application. Deficiencies in casting skill are risk factors for re-displacement of fractures and cast-specific complications. Formal educational models to instruct or to evaluate casting technique have not been well described or tested. The purposes of this study were to develop a cast application simulator and to validate a novel method of evaluating casting skill. A module that simulates short arm cast application on a synthetic forearm model was developed. An Objective Structured Assessment of Technical Skill checklist was created with use of Delphi methodology involving nine content experts (five orthopaedic surgeons and four orthopaedic technologists). Nine participants (three medical students, three orthopaedic residents, two orthopaedic fellows, and one orthopaedic technologist) were used to evaluate the reliability and validity of the checklist. Nine de-identified videos of cast application were recorded and were utilized to test the newly developed Objective Structured Assessment of Technical Skill checklist and Modified Global Rating Scale for reliability and validity. Participants were grouped by training level (medical students, orthopaedic residents, and orthopaedic fellows or orthopaedic technologists) and were evaluated twice. Reliability was high as shown by intraclass correlation. The inter-rater reliability was 0.85 for the Objective Structured Assessment of Technical Skill, 0.81 for the Modified Global Rating Scale performance, and 0.78 for the Modified Global Rating Scale final product; the intra-rater reliability was 0.88 for the Objective Structured Assessment of Technical Skill, 0.85 for the Modified Global Rating Scale performance, and 0.81 for the Modified Global Rating Scale final product. The Objective Structured Assessment of Technical Skill checklist scores were 9.28 points for the medical students, 17.46 points for the orthopaedic residents, and 18.85 points for the orthopaedic fellows or orthopaedic technologists (p &lt; 0.05, F = 6.32). The Modified Global Rating Scale performance and final product scores also reflected the level of training. Post hoc analysis showed a significant difference between the medical students and orthopaedic fellows or orthopaedic technologists for the Objective Structured Assessment of Technical Skill checklist and Modified Global Rating Scale. This casting simulation model and evaluation instrument is a reliable assessment of casting skill in applying a short arm cast. However, given the inability to stratify all three groups on the basis of the level of training, further work is needed to establish construct validity.