Novice Skills Research Articles

Objective performance indicators versus GEARS: an opportunity for more accurate assessment of surgical skill.

Surgical skill evaluation that relies on subjective scoring of surgical videos can be time-consuming and inconsistent across raters. We demonstrate differentiated opportunities for objective evaluation to improve surgeon training and performance. Subjective evaluation was performed using the Global evaluative assessment of robotic skills (GEARS) from both expert and crowd raters; whereas, objective evaluation used objective performance indicators (OPIs) derived from da Vinci surgical systems. Classifiers were trained for each evaluation method to distinguish between surgical expertise levels. This study includes one clinical task from a case series of robotic-assisted sleeve gastrectomy procedures performed by a single surgeon, and two training tasks performed by novice and expert surgeons, i.e., surgeons with no experience in robotic-assisted surgery (RAS) and those with more than 500 RAS procedures. When comparing expert and novice skill levels, OPI-based classifier showed significantly higher accuracy than GEARS-based classifier on the more complex dissection task (OPI 0.93 ± 0.08 vs. GEARS 0.67 ± 0.18; 95% CI, 0.16-0.37; p = 0.02), but no significant difference was shown on the simpler suturing task. For the single-surgeon case series, both classifiers performed well when differentiating between early and late group cases with smaller group sizes and larger intervals between groups (OPI 0.9 ± 0.08; GEARS 0.87 ± 0.12; 95% CI, 0.02-0.04; p = 0.67). When increasing the group size to include more cases, thereby having smaller intervals between groups, OPIs demonstrated significantly higher accuracy (OPI 0.97 ± 0.06; GEARS 0.76 ± 0.07; 95% CI, 0.12-0.28; p = 0.004) in differentiating between the early/late cases. Objective methods for skill evaluation in RAS outperform subjective methods when (1) differentiating expertise in a technically challenging training task, and (2) identifying more granular differences along early versus late phases of a surgeon learning curve within a clinical task. Objective methods offer an opportunity for more accessible and scalable skill evaluation in RAS.

Can University Marks Measure Programming Skills for Novice Programmers? An Exploratory Study

<p>Programming skills are the key ability of programmers. For novice programmers who are new and have little experience in programming, it is important to measure and improve their programming skills. In practice, novice programmers learn programming knowledge and coding ability at university, and course learning is the main way for novice programmers to improve programming skills. However, can university marks be used to measure the programming skills of programming novices? To answer this question, in a controlled experiment, we compare university marks of novice programmers with their performance in programming tasks. The results showed that there were 7 courses with significant correlation among the 13 courses, among which the software engineering course had the most significant correlation.</p> <p> </p>

Development of laparoscopic skills in skills-naïve trainees using self-directed learning with take-home laparoscopic trainer boxes

BackgroundTo determine if take home laparoscopic trainer boxes with only self-directed learning can develop laparoscopic skills in surgically naive learners. Methods74 starting PGY1 OB/Gyn residents and OB/Gyn clerkship medical students volunteered for the study. Learners performed a laparoscopic peg transfer task with only task instructions and no additional training. Initial tasks were recorded and scored. The participants took home a laparoscopic trainer box for 3 weeks to practice without guidance and returned to perform the same task for a second/final score. Initial and final scores were compared for improvement. This improvement was compared to practice and variables such as demographics, surgical interest, comfort with laparoscopy, and past experiences. ResultsMean peg transfer task scores improved from 287 (SD = 136) seconds to 193 (SD = 79) seconds (p < 0.001). Score improvement showed a positive correlation with number of home practice sessions with a linear regression R2 of 0.134 (p = 0.001). More practice resulted in larger increases in comfort levels, and higher comfort levels correlated with better final task scores with a linear regression R2 of 0.152 (p < 0.001). Interest in a surgical specialty had no impact on final scores or improvement. Playing a musical instrument and having two or more dexterity-based hobbies was associated with a better baseline score (p = 0.032 and p = 0.033 respectively), but no difference in the final scores or score improvement. No other past experiences impacted scores. ConclusionsOur study demonstrates that the use of home laparoscopic box trainers can develop laparoscopic skills in surgical novices even without formal guidance or curriculum.

A Comparative Study of Traditional Technique Guide versus Virtual Reality in Orthopedic Trauma Training.

Medical and surgical education is an expansive field fraught with many challenges. Technology such as virtual reality could be a new venue that can offer a solution to improve surgical training. The objective of this prospective, blinded study was to evaluate virtual reality as a training model for orthopedic surgery and surgical training at large. Fourth-year medical students with novice skills volunteered to participate in this observer-blinded 1:1 randomized controlled trial. They had no prior experience in tibia intramedullary nail (IMN) surgery. They were randomized into traditional technique guide education and virtual reality. The participants were timed on their mock surgery, and a blinded observer was utilized to subjectively grade their performance throughout the procedure using the Global Assessment 5-point Rating Scale and Procedure-Specific Checklist. Thirty-eight participants were recruited and randomized into virtual reality (19) and traditional (19) groups. There were trends in all categories favoring the virtual reality group. The VR group had improved time to completion (9.6 minutes vs 12.2 minutes, P = 0.034) and reduced need for corrections within the mock procedure (2.2 vs 2.5; P = 0.05). Virtual reality training was more effective than traditional training in learning and completing the steps of the tibia IMN surgery for novice medical students. Virtual reality training may be a useful method to augment orthopedic education and surgical training.

Does Regular Practice with a "Flexible Bronchoscopy Simulator" Improve Fibreoptic Intubation Skills in Experts and Novices? A Randomized Controlled Study.

The appropriate management of a "difficult airway" remains a challenge for novices and experienced anaesthetists. With the current available airway technologies, e.g., video laryngoscopy, flexible bronchoscopy (fibreoptic intubation (FOI)) for endotracheal intubation is decreasing, likely diminishing caregiver skills. We investigated whether bronchoscopy simulator training improved FOI skills. 72 volunteers, consisting of anaesthetists, anaesthesia residents, and nurses, performed six exercises on a bronchoscopy simulator. At baseline and after 12 months, the six exercises included one serious game (to train agility), two basic airways, and three difficult airways. After a baseline assessment, subjects were randomly allocated to the intervention group (with) or control group without bronchoscopy simulator training every six weeks for 10 min using a preloaded serious game. The primary outcome was the difference in the time to reach the carina after 12 months, as measured objectively by the simulator. The level of stress and FOI confidence after 12 months were secondary outcomes. The control and intervention groups had a similar time to reach the carina in difficult airway cases and the reported stress levels, at baseline and 12 months, showed no difference. In contrast, the intervention group's self-reported confidence in FOI skills improved more. Although participants rated higher in confidence, practicing FOI skills on an airway simulator with an agility game did not increase their performance in simulated challenging airway instances.

Development and assessment of validity and reliability of a checklist to evaluate the Circulating and Scrub Skills of Operating Room Novices (CSSORN checklist).

Assessment of circulating and scrub skills is an important issue in operating room (OR) programs. However, there is a lack of well-designed tools that are specifically developed for this purpose. Hence, this study aimed to develop and determine the validity and reliability of a checklist to measure the circulating and scrub skills of OR novices. This cross-sectional methodological study was conducted among 124 OR technology students who were selected during three consecutive academic years (2019-2020 to 2021-2022). The developed checklist was evaluated with face validity, content validity (quantitative and qualitative), construct validity (known-groups validity), criterion-related validity (concurrent and predictive validities), internal consistency (Kuder-Richardson 20, KR-20), and inter-rater reliability (intra-class correlation coefficient, ICC). Known-groups validity was evaluated by comparing the difference between the checklist scores of first-semester and third-semester students using independent samples t-test. Additionally, concurrent and predictive validities were evaluated by ICC through measuring the correlation between the total score of checklist and grades of a multiple-choice test and two clinical apprenticeship courses, respectively. Data were analyzed in the Statistical Package for Social Sciences software. After reconciling the preliminary checklist in terms of face and content validities, a checklist with 17 sub-scales and 340 items called "Circulating and Scrub Skills of Operating Room Novices (CSSORN)" was developed. Regarding the known-groups validity, the third-semester students had higher scores compared to the first-semester students (p < 0.001 in most sub-scales). Besides, the total score of checklist showed a significant correlation with the criteria of concurrent and predictive validities (ICC = 0.64, ICC = 0.72; P < 0.001). The KR-20 for the entire checklist was 0.90 (range: 0.60-0.93). The ICC for inter-rater reliability was also 0.96 for the entire checklist (range: 0.76-0.99, P < 0.001 in all sub-scales). The CSSORN had appropriate validity and reliability to be used for measuring the circulating and scrub skills of OR novices. To shed light on the findings, further testing of this checklist on larger populations and in different contexts is suggested.

8033 Development of Laparoscopic Skills in Skills-Naïve Trainees Using Self-Directed Learning with Take-Home Laparoscopic Trainer Boxes

<h3>Study Objective</h3> Our study aims to evaluate the utility of take-home laparoscopic trainer boxes with self-directed learning in the development of laparoscopic skills in medical students and surgically naïve gynecology interns. <h3>Design</h3> Prospective cohort study. <h3>Setting</h3> Tertiary care university hospital. <h3>Patients or Participants</h3> 74 medical students and beginning OB/Gyn interns (postgraduate year 1). <h3>Interventions</h3> Participants performed a laparoscopic peg transfer task with only task instructions and no additional training. Tasks were recorded and scored by adding completion time to penalties for dropped pegs. Participants subsequently took home a laparoscopic trainer box for 3 weeks to practice without guidance and returned to perform the peg transfer task for a final score. <h3>Measurements and Main Results</h3> Initial and final peg transfer scores were compared for improvement. Improvement was compared to practice as well as variables such as demographics, surgical interest, comfort with laparoscopy, and past experiences. Mean peg transfer task scores improved from 287 seconds to 193 seconds (p<0.001). Score improvement showed a positive correlation with number of home practice sessions with a linear regression R² of 0.134 (p=0.001). More practice, both in time and number of sessions, resulted in larger increases in comfort levels, and higher comfort levels correlated with better final task scores with a linear regression R² of 0.152 (p<0.001). Medical students interested in surgery had less practice sessions (p=0.496), however, interest in a surgical field had no impact on final scores or improvement. Playing a musical instrument and having two or more hobbies involving manual dexterity was associated with a better baseline score (p=0.032 and p=0.033 respectively), but no difference in the final scores or score improvement. No other past experiences impacted initial or final scores. <h3>Conclusion</h3> Our study demonstrates that the use of home laparoscopic box trainers can develop laparoscopic skills in surgical novices even without formal guidance or curriculum.

Art Therapy Service Provision during the COVID-19 Pandemic in the Gulf Cooperation Council (GCC)

Objective: To report novel developments in standard art therapy practices in the United Arab Emirates (UAE) and Qatar that arose during the COVID-19 pandemic circa 2020-22. Background: Art therapy services are a new phenomenon in the Middle East, with current practitioners having received their training primarily in the UK, US, and Australia. Religious therapies, such as prayers, rituals, talismans (against the evil eye) and Quranic recitation continue to be common approaches to mental illness in the Arabian Gulf. The visual arts have experienced a renaissance in the Gulf Cooperation Council (GCC) region, with billions of U.S. dollars of government funds invested in art education, galleries, exhibitions, and museums (Louvre Abu Dhabi, Museum of Islamic Art, etc.). Qatar has a national strategy to become an art and cultural hub in the Middle East. Methodology: Self-reflective exercises, process art, and specialist discussions among 5 experts in the field currently practicing in the Gulf were conducted in 2020 to document and analyze new methodologies and perspectives implemented during COVID-19 lockdowns, primarily in the area of telehealth and telemedicine. A related study by the authors in 2020, “Best Practices in Art Therapy Telehealth Communication: Perspectives from the Middle East,” provided additional analytical data. Qualitative data was organized into themes using standard Grounded Theory techniques. The practitioners framed their therapeutic work within the model of Relational Cultural Theory (RCT). Results and Discussion: The thematic findings were grouped under the headings: “Stigma,” “Empowerment,” “Confidentiality,” “Therapeutic Relations,” and “Art/Nonverbal Communication.” The pandemic allowed practitioners to expand services geographically outside of the Gulf beyond traditional face-face meetings through the Zoom.com videoconferencing platform. Online sessions provided unexpected benefits in the areas of increased privacy and reduction of social stigma. Since telehealth laws in the Gulf are almost non-existent, practitioners collaborated with international partners to develop best practices and ethical guidelines adapted to the local cultural context. Results of the analysis revealed shifts in previously established boundaries and power dynamics (clients and therapists can turn video and microphone off, see each other’s house, pets and other family members). The presence of family members at home sometimes impacted the privacy of the client, but in some situations allowed opportunities to meet extended family members, providing additional diagnostic clues into family dynamics. A reduced ability to communicate and understand nonverbal cues and body language (eye contact was different, lack of seeing the body) was cited as a drawback to virtual clinical encounters. The expert / novice skill level disparity of the therapist / client was diminished when co-creating digital artwork (ex. use of the Zoom whiteboard). The limitations on art materials that could be obtained during shop closures for some clients increased creativity and innovation in artmaking, but for others it decreased artmaking opportunities. Conclusion: All aspects of art therapy in the Arabian Gulf, and especially online services provision, are under-researched. Areas for further inquiry include: cultural adaptation of western models of care, local perceptions of the origins and treatment of mental health disorders, and awareness and acceptance of expressive arts psychotherapeutic interventions.

Motor imagery during action observation in virtual reality: the impact of watching myself performing at a level I have not yet achieved

ABSTRACT Feedforward modeling, the creation of one’s own behaviour that is potentially achievable in the future, can support motor performance and learning. While this has been shown for sequences of motor actions, it remains to be tested whether feedforward modelling is beneficial for single complex motor actions. Using an immersive, state-of-the-art, low-latency Cave Automatic Virtual Environment (CAVE), we compared motor imagery during action observation (AOMI) of oneself performing at one’s current skill level against AOMI of oneself performing at an achievable future skill level. We performed 3D scans and created a ready-to-animate virtual human of each participant. During acquisition, participants observed an avatar of themselves performing either one of their own previously executed squats (Me-Novice) or observed an avatar of themselves performing a skilled squat (Me-Skilled), whilst simultaneously imagining the feelings and sensations associated with movement execution. Findings revealed an advantage for the Me-Skilled group as compared to the Me-Novice group in motor performance and cognitive representation structure, while self-efficacy improved in both groups. In comparison to watching and imagining oneself performing at the current novice skill level, watching and imagining oneself performing at a more advanced skill level prevented from making errors in motor performance and led to perceptual-cognitive scaffolding as shown by functional changes in underlying representations. Simultaneous imagery whilst observing future states of action may therefore help to establish cognitive prerequisites that enable better motor performance. To this end, virtual reality is a promising tool to create learning environments that exceed an individual’s current performance level.

Evaluating Virtual Patient Interaction Fidelity With Advanced Communication Skills Learners

Previous research in educational medical simulation has drawn attention to the interplay between a simulation’s fidelity and its educational effectiveness. As virtual patients (VPs) are increasingly used in medical simulations for education purposes, a focus on the relationship between virtual patients’ fidelity and educational effectiveness should also be investigated. In this paper, we contribute to this investigation by evaluating the use of a virtual patient selection interface (in which learners interact with a virtual patient via a set of pre-defined choices) with advanced medical communication skills learners. To this end, we integrated virtual patient interviews into a graduate-level course for speech-language therapists over the course of 2 years. In the first cohort, students interacted with three VPs using only a chat interface. In the second cohort, students used both a chat interface and a selection interface to interact with the VPs. Our results suggest that these advanced learners view the selection interfaces as more appropriate for novice learners and that their communication behavior was not significantly affected by using the selection interface. Based on these results, we suggest that selection interfaces may be more appropriate for novice communication skills learners, but for applications in which selection interfaces are to be used with advanced learners, additional design research may be needed to best target these interfaces to advanced learners.

Development and Validation for Extended Reality-Based MIS Simulator Using Cumulative Summation

ABSTRACT Minimally invasive surgery (MIS) is gradually replacing traditional open surgery. Novices need a lot of practice in the surgical simulator to master surgical skills. Therefore, this paper developed an extended reality-based minimally invasive surgery (MIS-XR) simulator, which includes VR, AR and IVR simulators, and introduces the traditional Box simulator to compare these four simulators. Twenty-two subjects were divided into the expert group (6) and novice group (16) and were invited to participate in the experiment. Face, content, and construct validation methods were used to evaluate the tactile sense, visual sense, scene authenticity, and performance of the four simulators. The cumulative summation was used to further analyze the learning curve of 30 times training for the novice group, to verify the effectiveness of the four simulators and determine which simulator can improve the operator’s surgical skills more quickly. The results of the face and content validation show that the Box simulator is the strongest among the four simulators in the tactile sense, IVR simulator is superior to the Box simulator and VR simulator in scene authenticity. The result of construction validation shows that the four simulators are not only useful in improving the surgical skills of novices but also retain the surgical skills after a period of rest. The MIS-XR simulator developed in this paper is effective and can be used as a training device of surgical skills for novices.

Working Towards Competence: A Novel Application of Borderline Regression to a Task-Specific Checklist for Technical Skills in Novices

Demonstrated competence through frequent assessment is an expected goal for progressive development in competency-based medical education curricula. The Objective Structured Assessment of Technical Skill (OSATS) is considered a valid method of formative assessment, but in few instances have standards been set for determining competence. The present study used borderline regression methods to examine standard setting of performance on a complex technical task with novices assessed using an OSATS checklist. This was a single institution prospective single arm experimental design study. Participants were 58 non-medical undergraduate students with no previous surgical experience, who observed a computer-based training module on end-to-side vascular anastomosis. Subsequently, participants were provided two 20-minute training sessions, two weeks apart where they received expert feedback whilst performing the task on a low-fidelity model. After each training session, participants completed the task unaided. Sessions were recorded and assessed using an OSATS checklist retrospectively by experts. Paired t-test analyses indicate that for both the checklist total score (t(52) = 8.05, p < 0.001) and the global rating score (t(53) = 8.15, p < 0.001), individuals performed significantly better in Phase 2. Borderline regression analyses indicated that in Phase 1 (R2 = .60) and Phase 2 (R2 = .75), the OSATS checklist could adequately capture variation in performance in novices. Further, the checklist could reliably classify novices at three of the five global rating performance levels. Pass rates determined by regression equations improved from Phase 1 to Phase 2 on all global rating levels. With the increasing focus on competency-based medical education, it is imperative that training programs have the capacity to accurately assess outcomes and set minimum performance standards. Borderline regression methods can accurately differentiate novice learners of varying performance levels before and after training on a complex technical skill task using an OSATS checklist.

Development of and Validity Evidence for a Canine Ocular Model for Training Novice Veterinary Students to Perform a Fundic Examination.

Indirect fundoscopy is challenging for novice learners, as patients are often intolerant of the procedure, impeding development of proficiency. To address this, we developed a canine ocular simulator that we hypothesized would improve student learning compared to live dogs. Six board-certified veterinary ophthalmologists and 19 second-year veterinary students (novices) performed an indirect fundic examination on the model and live dog. Prior to assessment, novices were introduced to the skill with a standardized teaching protocol and practiced (without feedback) with either the model (n = 10) or live dog (n = 9) for 30 minutes. All participants evaluated realism and usefulness of the model using a Likert-type scale. Performance on the live dog and model was evaluated in all participants using time to completion of task, performance of fundic examination using a checklist and global score, identification of objects in the fundus of the model, and evaluation of time spent looking at the fundus of the model using eye tracking. Novices (trained on simulator or live dogs) were compared in fundic examination performance on the live dog and identification of shapes in the model. In general, experts performed the fundic examination faster (p ≤ .0003) and more proficiently than the novices, although there were no differences in eye tracking behavior between groups (p ≥ .06). No differences were detected between training on simulator versus live dog in development of fundoscopy skills in novices (p ≥ .20). These findings suggest that this canine model may be an effective tool to train students to perform fundoscopy.

Dual-task training to offset technologically induced human error: justification and call for further research

ABSTRACT There is a lack of published research examining ways to mitigate the effects of attention on human error prevalence in the marine setting. Evidence from the aviation industry, a very similar field, shows that attention does impact performance, especially when more than one task is to be completed at the same time. Much like pilots, mariners are constantly completing tasks concurrently, and thus need to be able to disperse their attention over multiple sources of incoming information. Manipulating attention through effective education is proposed to reduce the rates of human error at sea. The relationship between attention, dual-task learning, and human information processing is explored in an attempt to provide a foundation for future researchers to dive deeper into this issue and create a curriculum that focuses on instilling attention allocation skills in novices.

Global Assessment of Urological Endoscopic Skills (GAUES): development and validation of a novel assessment tool to evaluate endourological skills

To develop and evaluate an assessment tool for endourological skills during simulation including cystoscopy, ureteroscopy (URS) and transurethral resection (TUR) procedures. We designed a Global Assessment of Urological Endoscopic Skills (GAUES) tool, comprised of nine endourology task-specific and two global-rating skills items. The tool was developed through two rounds of the Delphi process. The GAUES tool was used to assess acquisition of URS and TUR skills of novices (Year 2 core surgical trainees, CT2) and intermediate level trainees (residents at the start of the UK higher surgical training programme in Urology, Speciality Trainee Year 3, ST3) at the Urology Simulation Boot Camp (USBC) between 2016 and 2018. Validity was evaluated by comparing scores between trainees with different levels of urological experience. Inter-rater reliability was also assessed. We evaluated 130 residents, 52% of trainees were at an intermediate stage of training and 39% were novices. In all, 9% of the anonymous forms were missing demographics. The completion rate of the GAUES tool during the USBC for URS and TUR was 85% and 89%, respectively. Our analysis demonstrated a significant difference in all domains between intermediates and novices at assessment in URS, except for one domain more suited to clinical assessment (P=0.226). There was excellent intraclass correlation (ICC) overall between the two experts' judgements, ICC=0.841 (95% confidence interval 0.767-0.893; P<0.001, n=88). We have developed the novel GAUES tool for cystoscopic, URS and TUR skills. Overall, we demonstrated good face, content and construct validity and excellent reliability, suggesting that the GAUES tool can be useful for endourological skills assessment.

The Effect of Music on Laparoscopic Skills in Novices: A Randomised Controlled Trial

Journal of the American College of Surgeons 231(4):p e201-e202, October 2020. | DOI: 10.1016/j.jamcollsurg.2020.08.537

Distinguishing Intermediate and Novice Surgeons by Eye Movements.

Surgical skill-level assessment is key to collecting the required feedback and adapting the educational programs accordingly. Currently, these assessments for the minimal invasive surgery programs are primarily based on subjective methods, and there is no consensus on skill level classifications. One of the most detailed of these classifications categorize skill levels as beginner, novice, intermediate, sub-expert, and expert. To properly integrate skill assessment into minimal invasive surgical education programs and provide skill-based training alternatives, it is necessary to classify the skill levels in as detailed a way as possible and identify the differences between all skill levels in an objective manner. Yet, despite the existence of very encouraging results in the literature, most of the studies have been conducted to better understand the differences between novice and expert surgical skill levels leaving out the other crucial skill levels between them. Additionally, there are very limited studies by considering the eye-movement behaviors of surgical residents. To this end, the present study attempted to distinguish novice- and intermediate-level surgical residents based on their eye movements. The eye-movement data was recorded from 23 volunteer surgical residents while they were performing four computer-based simulated surgical tasks under different hand conditions. The data was analyzed using logistic regression to estimate the skill levels of both groups. The best results of the estimation revealing a 91.3% recognition rate of predicting novice and intermediate surgical residents on one scenario were selected from four under the dominant hand condition. These results show that the eye-movements can be potentially used to identify surgeons with intermediate and novice skills. However, the results also indicate that the order in which the scenarios are provided, and the design of the scenario, the tasks, and their appropriateness with the skill levels of the participants are all critical factors to be considered in improving the estimation ratio, and hence require thorough assessment for future research.

The effect of verbal feedback, video feedback, and self-assessment on laparoscopic intracorporeal suturing skills in novices: a randomized trial.

Laparoscopic skill acquisition involves a steep learning curve and laparoscopic suturing is an exceptionally challenging task. By improving the way feedback is given, trainees can learn these skills more effectively. This study aims to establish the most effective form of structured feedback on laparoscopic suturing skill acquisition in novices, by comparing the effects of expert verbal feedback, video review with expert feedback (video feedback), and video review with self-assessment. A prospective randomized blinded trial comparing verbal feedback, video feedback, and self-assessment. Novices in laparoscopic surgery were tasked with performing laparoscopic suturing with intracorporeal knot tying. Time was given for practice, and pre- and post-feedback assessments were undertaken. Suturing performance was measured using a task-specific checklist and global ratings. A post-study questionnaire was used to measure participant-perceived confidence, knowledge, and experience levels. Fifty-one participants were randomized and allocated equally into the three groups. Performance in all three groups improved significantly from baseline. Video feedback had the largest improvement margin with checklist and global score improvements of 17.1% (± 9.9%) and 14.7% (± 9.3%), respectively. Performance improvements between groups were statistically significant in the global components (p = 0.004) but not the checklist components (p = 0.186). Global score improvement was significantly better in the video feedback group but was statistically insignificant between the self-assessment and verbal feedback groups. Questionnaire responses demonstrated positive results in confidence, knowledge, and experience levels, across all three study groups, with no differences between the groups (p > 0.05). Structured video feedback facilitates reflection and self-directed learning, which improves the ability to develop proficiency in surgical skills. Combining both self-assessment and video feedback may be beneficial over verbal feedback alone due to the advantages of video review. These techniques should therefore be considered for implementation into surgical education curricula.

Improvement of Pressure Control Skill with Knife Device for Paper-Cutting

In this paper, we propose an interactive system for controlling the pressure while cutting paper with a knife. The purpose is to improve the cutting skill of novices learning the art of paper-cutting. Our system supports skill improvement for novices by measuring and evaluating their cutting pressure in real-time. In this study, we use a knife with a blade attached to a stylus with a pressure sensor, which can measure the pressure, coordinates, and cutting time. We have developed a similar support system using a stylus and a tablet device. This system allows the user to experience the pressure of experts through tracing. Paper-cutting is created by cutting paper with a knife. The practice system in this paper provides practice in an environment more akin to the production of paper cutting. In the first experiment, we observed differences in cutting ability by comparing cutting pressures between novices and experts. As a result, we confirmed that novices cut paper at a higher pressure than experts. We developed a practice system that guides the novices on controlling the pressure by providing information on the cutting pressure values of experts. This system shows the difference in pressure between novices and experts using a synchronous display of color and sound. Using these functions, novices learn to adjust their cutting pressure according to that of experts. Determining the right cutting pressure is a critical skill in the art of paper-cutting, and we aim to improve the same with our system. In the second experiment, we tested the effect of the practice system on the knife device. We compared the changes in cutting pressure with and without our system, the practice methods used in the workshop, and the previously developed stylus-based support system. As a result, we confirmed that practicing with the knife device had a better effect on the novice's skill in controlling cutting pressure than other practice methods.

Use of pelvic model-based simulation for sacrospinous ligament fixation education in novice learners: a single-blinded randomized controlled trial.

We hypothesize that there will be improvement in a novice learners' confidence and skill level with sacrospinous ligament fixation (SSLF) following a pelvic model-based simulation. We performed a single-blinded randomized controlled trial with obstetrics and gynecology residents who were novices at SSLF. The residents were randomly assigned to two groups. The control group received a lecture on the SSLF procedure and anatomy, whereas the intervention group received the same lecture in addition to a pelvic model-based simulation session taught by urogynecologists. The residents' knowledge of SSLF anatomy and confidence level with the procedure were measured via assessments administered before and after the educational interventions. Their technical skills were objectively assessed by one of two fellowship-trained urogynecologists who were blinded to their group allocation. A total of 28 residents were recruited with 14 residents in each group and equal distribution of junior and senior trainees. None of the residents had previously performed the SSLF procedure. There was no difference in anatomical knowledge between the two groups. The intervention group showed a greater increase in their average confidence score compared with the control group: 4.0 ± 1.4 (95% CI 3.1-4.8) versus 2.6 ± 1.6 (95% CI 1.7-3.4) respectively, with p = 0.02. The intervention group also showed better objective scores in specific technical skills, such as instrument handling (p < 0.001), instrument movement/motion (p < 0.001), and speed (p = 0.01). Our results demonstrate that inclusion of a pelvic model simulation significantly improves confidence and certain technical skills of novice trainees in performing SSLF.