2022
Andreas Frithioff1 Martin Frendø, Lars Konge
Assessing competence in cochlear implant surgery using the newly developed Cochlear Implant Surgery Assessment Tool Journal Article
In: European Archives of Oto-Rhino-Laryngology , iss. 279, pp. 127–136, 2022.
@article{nokey,
title = {Assessing competence in cochlear implant surgery using the newly developed Cochlear Implant Surgery Assessment Tool},
author = {Martin Frendø, Andreas Frithioff1, Lars Konge, Søren Foghsgaard, Peter Trier Mikkelsen, Mads Sølvsten Sørensen, Per Cayé‑Thomasen, Steven Arild Wuyts Andersen},
url = {https://www.researchgate.net/publication/349453745_Assessing_competence_in_cochlear_implant_surgery_using_the_newly_developed_Cochlear_Implant_Surgery_Assessment_Tool},
doi = {10.1007/s00405-021-06632-9},
year = {2022},
date = {2022-01-01},
journal = {European Archives of Oto-Rhino-Laryngology },
issue = {279},
pages = {127–136},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
2021
Martin Frendø Andreas Frithioff, Peter Trier Mikkelsen
In: Cochlear Implants International, iss. 23, pp. 1-7, 2021.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Cochlear implantation: Exploring the effects of 3D stereovision in a digital microscope for virtual reality simulation training – A randomized controlled trial},
author = {Andreas Frithioff, Martin Frendø, Peter Trier Mikkelsen, Mads Sølvsten Sørensen, Steven Arild Wuyts Andersen},
doi = {10.1080/14670100.2021.1997026},
year = {2021},
date = {2021-12-01},
journal = {Cochlear Implants International},
issue = {23},
pages = {1-7},
abstract = {Objective In cochlear implantation (CI), excellent surgical technique is critical for hearing outcomes. Recent advances in temporal bone Virtual Reality (VR) training allow for specific training of CI and through introduction of new digital microscopes with ultra-high-fidelity (UHF) graphics. This study aims to investigate whether UHF increases performance in VR simulation training of CI electrode insertion compared with conventional, screen-based VR (cVR). Methods Twenty-four medical students completed a randomized, controlled trial of an educational intervention. They performed a total of eight CI electrode insertions each in blocks of four using either UHF-VR or cVR, in randomized order. CI electrode insertion performances were rated by two blinded expert raters using a structured assessment tool supported by validity evidence. Results Performance scores in cVR were higher than in the UHF-VR simulation although this was not significant (19.8 points, 95% CI [19.3–20.3] vs. 18.8 points, 95% CI [18.2–19.4]; P = 0.09). The decisive factor for performance was participants’ ability to achieve stereovision (mean difference = 1.1 points, 95% CI [0.15–2.08], P = 0.02). Discussion No additional benefit was found from UHF-VR over cVR training of CI electrode insertion for novices. Consequently, standard cVR simulation should be used for novices’ basic skills acquisition in CI surgery. Future studies should instead explore the effects of other improvements in CI surgery training and if the lacking benefit of UHF-VR also applies for more experienced learners. Conclusion The increased graphical perception and the superior lifelikeness of UHF-VR does not improve early skills acquisition of CI insertion for novices.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objective In cochlear implantation (CI), excellent surgical technique is critical for hearing outcomes. Recent advances in temporal bone Virtual Reality (VR) training allow for specific training of CI and through introduction of new digital microscopes with ultra-high-fidelity (UHF) graphics. This study aims to investigate whether UHF increases performance in VR simulation training of CI electrode insertion compared with conventional, screen-based VR (cVR). Methods Twenty-four medical students completed a randomized, controlled trial of an educational intervention. They performed a total of eight CI electrode insertions each in blocks of four using either UHF-VR or cVR, in randomized order. CI electrode insertion performances were rated by two blinded expert raters using a structured assessment tool supported by validity evidence. Results Performance scores in cVR were higher than in the UHF-VR simulation although this was not significant (19.8 points, 95% CI [19.3–20.3] vs. 18.8 points, 95% CI [18.2–19.4]; P = 0.09). The decisive factor for performance was participants’ ability to achieve stereovision (mean difference = 1.1 points, 95% CI [0.15–2.08], P = 0.02). Discussion No additional benefit was found from UHF-VR over cVR training of CI electrode insertion for novices. Consequently, standard cVR simulation should be used for novices’ basic skills acquisition in CI surgery. Future studies should instead explore the effects of other improvements in CI surgery training and if the lacking benefit of UHF-VR also applies for more experienced learners. Conclusion The increased graphical perception and the superior lifelikeness of UHF-VR does not improve early skills acquisition of CI insertion for novices.
Martin Frendø Andreas Frithioff, Martin Frendø
Automated summative feedback improves performance and retention in simulation training of mastoidectomy: a randomised controlled trial Journal Article
In: The Journal of Laryngology & Otology , vol. 136, iss. 1, pp. 29 - 36, 2021.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Automated summative feedback improves performance and retention in simulation training of mastoidectomy: a randomised controlled trial},
author = {Andreas Frithioff, Martin Frendø, Martin Frendø, J Hastrup von Buchwald, Peter Trier Mikkelsen, Mads Sølvsten Sørensen, Steven Arild Wuyts Andersen},
doi = {10.1017/S0022215121003352},
year = {2021},
date = {2021-10-01},
urldate = {2021-10-01},
journal = {The Journal of Laryngology & Otology },
volume = {136},
issue = {1},
pages = {29 - 36},
abstract = {Objective
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.
Method
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.
Results
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).
Conclusion
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.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objective
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.
Method
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.
Results
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).
Conclusion
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.
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.
Method
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.
Results
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).
Conclusion
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.
Daniel Manuel Sieber, Andersen
OpenEar Image Data Enables Case Variation in High Fidelity Virtual Reality Ear Surgery Journal Article
In: Otology & Neurotology, vol. 42, iss. 8, pp. 1245-1252, 2021.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {OpenEar Image Data Enables Case Variation in High Fidelity Virtual Reality Ear Surgery},
author = {Sieber, Daniel Manuel, Andersen, Steven Arild Wuyts, Sørensen, Mads Sølvsten, Mikkelsen, Peter Trier},
doi = {10.1097/MAO.0000000000003175},
year = {2021},
date = {2021-09-01},
urldate = {2021-09-01},
journal = {Otology & Neurotology},
volume = {42},
issue = {8},
pages = {1245-1252},
abstract = {Background:
Virtual reality (VR) simulation is an established option for temporal bone surgical training. Most VR simulators are based on computed tomography imaging, whereas the Visible Ear Simulator (VES) is based on high-fidelity cryosections of a single temporal bone specimen. Recently published OpenEar datasets combine cone-beam computed tomography (CBCT) and micro-slicing to achieve similar model quality. This study explores integration of OpenEar datasets into VES to enable case variation in simulation with implications for patient-specific modeling based on CBCT.
Methods:
The OpenEar dataset consists of segmented, coregistered, multimodal imaging sets of human temporal bones. We derived drillable bone segments from the dataset as well as triangulated surface models of critical structures such as facial nerve or dura. Realistic visualization was achieved using coloring from micro-slicing, custom tinting, and texture maps. Resulting models were validated by clinical experts.
Results:
Six of the eight OpenEar datasets could be integrated in VES complete with instructional guides for various temporal bone surgical procedures. Resulting models were of high quality because of postprocessing steps taken to increase realism including colorization and imaging artifact removal. Bone artifacts were common in CBCT, resulting in dehiscences that most often could not be found in the ground truth micro-slicing data.
Conclusion:
New anatomy models are included in VES version 3.5 freeware and provide case variation for training which could help trainees to learn more quickly and transferably under variable practice conditions. The use of CBCT for VR simulation models without postprocessing results in bone artifacts, which should be considered when using clinical imaging for patient-specific simulation, surgical rehearsal, and planning.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background:
Virtual reality (VR) simulation is an established option for temporal bone surgical training. Most VR simulators are based on computed tomography imaging, whereas the Visible Ear Simulator (VES) is based on high-fidelity cryosections of a single temporal bone specimen. Recently published OpenEar datasets combine cone-beam computed tomography (CBCT) and micro-slicing to achieve similar model quality. This study explores integration of OpenEar datasets into VES to enable case variation in simulation with implications for patient-specific modeling based on CBCT.
Methods:
The OpenEar dataset consists of segmented, coregistered, multimodal imaging sets of human temporal bones. We derived drillable bone segments from the dataset as well as triangulated surface models of critical structures such as facial nerve or dura. Realistic visualization was achieved using coloring from micro-slicing, custom tinting, and texture maps. Resulting models were validated by clinical experts.
Results:
Six of the eight OpenEar datasets could be integrated in VES complete with instructional guides for various temporal bone surgical procedures. Resulting models were of high quality because of postprocessing steps taken to increase realism including colorization and imaging artifact removal. Bone artifacts were common in CBCT, resulting in dehiscences that most often could not be found in the ground truth micro-slicing data.
Conclusion:
New anatomy models are included in VES version 3.5 freeware and provide case variation for training which could help trainees to learn more quickly and transferably under variable practice conditions. The use of CBCT for VR simulation models without postprocessing results in bone artifacts, which should be considered when using clinical imaging for patient-specific simulation, surgical rehearsal, and planning.
Virtual reality (VR) simulation is an established option for temporal bone surgical training. Most VR simulators are based on computed tomography imaging, whereas the Visible Ear Simulator (VES) is based on high-fidelity cryosections of a single temporal bone specimen. Recently published OpenEar datasets combine cone-beam computed tomography (CBCT) and micro-slicing to achieve similar model quality. This study explores integration of OpenEar datasets into VES to enable case variation in simulation with implications for patient-specific modeling based on CBCT.
Methods:
The OpenEar dataset consists of segmented, coregistered, multimodal imaging sets of human temporal bones. We derived drillable bone segments from the dataset as well as triangulated surface models of critical structures such as facial nerve or dura. Realistic visualization was achieved using coloring from micro-slicing, custom tinting, and texture maps. Resulting models were validated by clinical experts.
Results:
Six of the eight OpenEar datasets could be integrated in VES complete with instructional guides for various temporal bone surgical procedures. Resulting models were of high quality because of postprocessing steps taken to increase realism including colorization and imaging artifact removal. Bone artifacts were common in CBCT, resulting in dehiscences that most often could not be found in the ground truth micro-slicing data.
Conclusion:
New anatomy models are included in VES version 3.5 freeware and provide case variation for training which could help trainees to learn more quickly and transferably under variable practice conditions. The use of CBCT for VR simulation models without postprocessing results in bone artifacts, which should be considered when using clinical imaging for patient-specific simulation, surgical rehearsal, and planning.
2020
Steven Arild Wuyts MD Andersen, PhD; Mikkelsen
The Effect of Simulator-Integrated Tutoring for Guidance in Virtual Reality Simulation Training Journal Article
In: Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, vol. 15, iss. 3, pp. 47-153, 2020.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {The Effect of Simulator-Integrated Tutoring for Guidance in Virtual Reality Simulation Training},
author = {Andersen, Steven Arild Wuyts MD, PhD; Mikkelsen, Peter Trier MSc; Sørensen, Mads Sølvsten MD, DMSc},
doi = {10.1097/SIH.0000000000000414},
year = {2020},
date = {2020-06-01},
journal = {Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare},
volume = {15},
issue = {3},
pages = {47-153},
abstract = {Introduction
Simulation-integrated tutoring in virtual reality (VR) simulation training by green lighting is a common learning support in simulation-based temporal bone surgical training. However, tutoring overreliance can negatively affect learning. We therefore wanted to investigate the effects of simulator-integrated tutoring on performance and learning.
Methods
A prospective, educational cohort study of a learning intervention (simulator-integrated tutoring) during repeated and distributed VR simulation training for directed, self-regulated learning of the mastoidectomy procedure. Two cohorts of novices (medical students) were recruited: 16 participants were trained using the intervention program (intermittent simulator-integrated tutoring) and 14 participants constituted a nontutored reference cohort. Outcomes were final-product performance assessed by 2 blinded raters and simulator-recorded metrics.
Results
Simulator-integrated tutoring had a large and positive effect on the final-product performance while turned on (mean difference = 3.8 points, P < 0.0001). However, this did not translate to a better final-product performance in subsequent nontutored procedures. The tutored cohort had a better metrics-based score, reflecting higher efficiency of drilling (mean difference = 3.6%, P = 0.001). For the individual metrics, simulator-integrated tutoring had mixed effects both during procedures and on the tutored cohort in general (learning effect).
Conclusions
Simulator-integrated tutoring by green lighting did not induce a better final-product performance but increased efficiency. The mixed effects on learning could be caused by tutoring overreliance, resulting from a lack of cognitive engagement when the tutor function is on. Further learning strategies such as feedback should be explored to support novice learning and cognitive engagement.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Introduction
Simulation-integrated tutoring in virtual reality (VR) simulation training by green lighting is a common learning support in simulation-based temporal bone surgical training. However, tutoring overreliance can negatively affect learning. We therefore wanted to investigate the effects of simulator-integrated tutoring on performance and learning.
Methods
A prospective, educational cohort study of a learning intervention (simulator-integrated tutoring) during repeated and distributed VR simulation training for directed, self-regulated learning of the mastoidectomy procedure. Two cohorts of novices (medical students) were recruited: 16 participants were trained using the intervention program (intermittent simulator-integrated tutoring) and 14 participants constituted a nontutored reference cohort. Outcomes were final-product performance assessed by 2 blinded raters and simulator-recorded metrics.
Results
Simulator-integrated tutoring had a large and positive effect on the final-product performance while turned on (mean difference = 3.8 points, P < 0.0001). However, this did not translate to a better final-product performance in subsequent nontutored procedures. The tutored cohort had a better metrics-based score, reflecting higher efficiency of drilling (mean difference = 3.6%, P = 0.001). For the individual metrics, simulator-integrated tutoring had mixed effects both during procedures and on the tutored cohort in general (learning effect).
Conclusions
Simulator-integrated tutoring by green lighting did not induce a better final-product performance but increased efficiency. The mixed effects on learning could be caused by tutoring overreliance, resulting from a lack of cognitive engagement when the tutor function is on. Further learning strategies such as feedback should be explored to support novice learning and cognitive engagement.
Simulation-integrated tutoring in virtual reality (VR) simulation training by green lighting is a common learning support in simulation-based temporal bone surgical training. However, tutoring overreliance can negatively affect learning. We therefore wanted to investigate the effects of simulator-integrated tutoring on performance and learning.
Methods
A prospective, educational cohort study of a learning intervention (simulator-integrated tutoring) during repeated and distributed VR simulation training for directed, self-regulated learning of the mastoidectomy procedure. Two cohorts of novices (medical students) were recruited: 16 participants were trained using the intervention program (intermittent simulator-integrated tutoring) and 14 participants constituted a nontutored reference cohort. Outcomes were final-product performance assessed by 2 blinded raters and simulator-recorded metrics.
Results
Simulator-integrated tutoring had a large and positive effect on the final-product performance while turned on (mean difference = 3.8 points, P < 0.0001). However, this did not translate to a better final-product performance in subsequent nontutored procedures. The tutored cohort had a better metrics-based score, reflecting higher efficiency of drilling (mean difference = 3.6%, P = 0.001). For the individual metrics, simulator-integrated tutoring had mixed effects both during procedures and on the tutored cohort in general (learning effect).
Conclusions
Simulator-integrated tutoring by green lighting did not induce a better final-product performance but increased efficiency. The mixed effects on learning could be caused by tutoring overreliance, resulting from a lack of cognitive engagement when the tutor function is on. Further learning strategies such as feedback should be explored to support novice learning and cognitive engagement.
Martin Frendø Andreas Frithioff, Peter Trier Mikkelsen
Ultra-high-fidelity virtual reality mastoidectomy simulation training: a randomized, controlled trial Journal Article
In: European Archives of Oto-Rhino-Laryngology, vol. 277, pp. 1335–1341, 2020.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Ultra-high-fidelity virtual reality mastoidectomy simulation training: a randomized, controlled trial},
author = {Andreas Frithioff, Martin Frendø, Peter Trier Mikkelsen, Mads Sølvsten Sørensen & Steven Arild Wuyts Andersen },
doi = {10.1007/s00405-020-05858-3},
year = {2020},
date = {2020-02-17},
journal = {European Archives of Oto-Rhino-Laryngology},
volume = {277},
pages = {1335–1341},
abstract = {Purpose
Ultra-high-fidelity (UHF) graphics in virtual reality (VR) simulation might improve surgical skill acquisition in temporal bone training. This study aims to compare UHF VR simulation training with conventional, screen-based VR simulation training (cVR) with respect to performance and cognitive load (CL).
Methods
In a randomized trial with a cross-over design, 24 students completed a total of four mastoidectomies in a VR temporal bone surgical simulator: two performances under UHF conditions using a digital microscope and two performances under conventional conditions using screen-based VR simulation. Performances were assessed by two blinded raters using an established assessment tool. In addition, CL was estimated as the relative change in secondary-task reaction time during simulation when compared with individual baseline measurements. Data were analyzed using linear mixed model analysis for repeated measurements.
Results
The mean final-product performance score was significantly lower in UHF VR simulation compared to cVR simulation [mean difference 1.0 points out of 17 points, 95% CI (0.2–1.7), p = 0.02]. The most important factor for performance during UHF simulation was the ability to achieve stereovision (mean difference = 3.4 points, p < 0.001). Under the UHF VR condition, CL was significantly higher than during cVR (28% vs. 18%, respectively, p < 0.001).
Conclusion
UHF graphics in VR simulation training reduced performance and induced a higher CL in novices than conventional, screen-based VR simulation training. Consequently, UHF VR simulation training should be preceded by cVR training and might be better suited for the training of intermediates or experienced surgeons.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Purpose
Ultra-high-fidelity (UHF) graphics in virtual reality (VR) simulation might improve surgical skill acquisition in temporal bone training. This study aims to compare UHF VR simulation training with conventional, screen-based VR simulation training (cVR) with respect to performance and cognitive load (CL).
Methods
In a randomized trial with a cross-over design, 24 students completed a total of four mastoidectomies in a VR temporal bone surgical simulator: two performances under UHF conditions using a digital microscope and two performances under conventional conditions using screen-based VR simulation. Performances were assessed by two blinded raters using an established assessment tool. In addition, CL was estimated as the relative change in secondary-task reaction time during simulation when compared with individual baseline measurements. Data were analyzed using linear mixed model analysis for repeated measurements.
Results
The mean final-product performance score was significantly lower in UHF VR simulation compared to cVR simulation [mean difference 1.0 points out of 17 points, 95% CI (0.2–1.7), p = 0.02]. The most important factor for performance during UHF simulation was the ability to achieve stereovision (mean difference = 3.4 points, p < 0.001). Under the UHF VR condition, CL was significantly higher than during cVR (28% vs. 18%, respectively, p < 0.001).
Conclusion
UHF graphics in VR simulation training reduced performance and induced a higher CL in novices than conventional, screen-based VR simulation training. Consequently, UHF VR simulation training should be preceded by cVR training and might be better suited for the training of intermediates or experienced surgeons.
Ultra-high-fidelity (UHF) graphics in virtual reality (VR) simulation might improve surgical skill acquisition in temporal bone training. This study aims to compare UHF VR simulation training with conventional, screen-based VR simulation training (cVR) with respect to performance and cognitive load (CL).
Methods
In a randomized trial with a cross-over design, 24 students completed a total of four mastoidectomies in a VR temporal bone surgical simulator: two performances under UHF conditions using a digital microscope and two performances under conventional conditions using screen-based VR simulation. Performances were assessed by two blinded raters using an established assessment tool. In addition, CL was estimated as the relative change in secondary-task reaction time during simulation when compared with individual baseline measurements. Data were analyzed using linear mixed model analysis for repeated measurements.
Results
The mean final-product performance score was significantly lower in UHF VR simulation compared to cVR simulation [mean difference 1.0 points out of 17 points, 95% CI (0.2–1.7), p = 0.02]. The most important factor for performance during UHF simulation was the ability to achieve stereovision (mean difference = 3.4 points, p < 0.001). Under the UHF VR condition, CL was significantly higher than during cVR (28% vs. 18%, respectively, p < 0.001).
Conclusion
UHF graphics in VR simulation training reduced performance and induced a higher CL in novices than conventional, screen-based VR simulation training. Consequently, UHF VR simulation training should be preceded by cVR training and might be better suited for the training of intermediates or experienced surgeons.
2019
Mads Guldager Steven Arild Wuyts Andersen, Peter Trier Mikkelsen & Mads Sølvsten Sørensen
The effect of structured self-assessment in virtual reality simulation training of mastoidectomy Journal Article
In: European Archives of Oto-Rhino-Laryngology, vol. 276, pp. 3345–3352, 2019.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {The effect of structured self-assessment in virtual reality simulation training of mastoidectomy},
author = {Steven Arild Wuyts Andersen, Mads Guldager, Peter Trier Mikkelsen & Mads Sølvsten Sørensen },
doi = {10.1007/s00405-019-05648-6},
year = {2019},
date = {2019-09-01},
journal = {European Archives of Oto-Rhino-Laryngology},
volume = {276},
pages = {3345–3352},
abstract = {Purpose
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.
Methods
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.
Results
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.
Conclusions
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.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
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.
Methods
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.
Results
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.
Conclusions
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.
PhD Steven Arild Wuyts Andersen MD, Peter Trier Mikkelsen MSc
Expert sampling of VR simulator metrics for automated assessment of mastoidectomy performance Journal Article
In: The Laryngoscope, vol. 129, pp. 2170–2177, 2019.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Expert sampling of VR simulator metrics for automated assessment of mastoidectomy performance},
author = {Steven Arild Wuyts Andersen MD, PhD,Peter Trier Mikkelsen MSc,Mads Sølvsten Sørensen MD, DMSc},
doi = {10.1002/lary.27798},
year = {2019},
date = {2019-01-09},
journal = {The Laryngoscope},
volume = {129},
pages = {2170–2177},
abstract = {Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Level of Evidence
2b},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objective
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.
Methods
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.
Results
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.
Conclusion
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.
Level of Evidence
2b
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.
Methods
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.
Results
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.
Conclusion
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.
Level of Evidence
2b
2016
effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial, The
In: Advances in Simulation, vol. 1, no. 20, 2016.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {The effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial},
author = {The effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial},
editor = {Steven Arild Wuyts Andersen, Peter Trier Mikkelsen, Lars Konge, Per Cayé-Thomasen & Mads Sølvsten Sørensen },
doi = {10.1186/s41077-016-0022-1},
year = {2016},
date = {2016-06-06},
urldate = {2016-06-06},
journal = {Advances in Simulation},
volume = {1},
number = {20},
abstract = {Background
Cognitive 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.
Methods
Eighteen 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.
Results
Participants 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).
Conclusions
Initial 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.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Cognitive 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.
Methods
Eighteen 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.
Results
Participants 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).
Conclusions
Initial 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.
Cognitive 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.
Methods
Eighteen 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.
Results
Participants 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).
Conclusions
Initial 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.
Lars Konge MD Steven A. W. Andersen MD, PhD
Mapping the plateau of novices in virtual reality simulation training of mastoidectomy Journal Article
In: The Laryngoscope, vol. 127, 2016.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Mapping the plateau of novices in virtual reality simulation training of mastoidectomy},
author = {Steven A. W. Andersen MD,Lars Konge MD, PhD,Peter Trier Mikkelsen MSc,Per Cayé-Thomasen MD, DMSc,Mads Sølvsten Sørensen MD, DMSc},
doi = {10.1002/lary.26000},
year = {2016},
date = {2016-04-14},
journal = {The Laryngoscope},
volume = {127},
abstract = {Objectives/Hypothesis
To explore why novices' performance plateau in directed, self-regulated virtual reality (VR) simulation training and how performance can be improved.
Study Design
Prospective study.
Methods
Data on the performances of 40 novices who had completed repeated, directed, self-regulated VR simulation training of mastoidectomy were included. Data were analyzed to identify key areas of difficulty as well as the procedures terminated without using all the time allowed.
Results
Novices had difficulty in avoiding drilling holes in the outer anatomical boundaries of the mastoidectomy and frequently made injuries to vital structures such as the lateral semicircular canal, the ossicles, and the facial nerve. The simulator-integrated tutor function improved performance on many of these items, but overreliance on tutoring was observed. Novices also demonstrated poor self-assessment skills and often did not make use of the allowed time, lacking knowledge on when to stop or how to excel.
Conclusion
Directed, self-regulated VR simulation training of mastoidectomy needs a strong instructional design with specific process goals to support deliberate practice because cognitive effort is needed for novices to improve beyond an initial plateau.
Level of Evidence
N/A. Laryngoscope, 127:907–914, 2017},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objectives/Hypothesis
To explore why novices' performance plateau in directed, self-regulated virtual reality (VR) simulation training and how performance can be improved.
Study Design
Prospective study.
Methods
Data on the performances of 40 novices who had completed repeated, directed, self-regulated VR simulation training of mastoidectomy were included. Data were analyzed to identify key areas of difficulty as well as the procedures terminated without using all the time allowed.
Results
Novices had difficulty in avoiding drilling holes in the outer anatomical boundaries of the mastoidectomy and frequently made injuries to vital structures such as the lateral semicircular canal, the ossicles, and the facial nerve. The simulator-integrated tutor function improved performance on many of these items, but overreliance on tutoring was observed. Novices also demonstrated poor self-assessment skills and often did not make use of the allowed time, lacking knowledge on when to stop or how to excel.
Conclusion
Directed, self-regulated VR simulation training of mastoidectomy needs a strong instructional design with specific process goals to support deliberate practice because cognitive effort is needed for novices to improve beyond an initial plateau.
Level of Evidence
N/A. Laryngoscope, 127:907–914, 2017
To explore why novices' performance plateau in directed, self-regulated virtual reality (VR) simulation training and how performance can be improved.
Study Design
Prospective study.
Methods
Data on the performances of 40 novices who had completed repeated, directed, self-regulated VR simulation training of mastoidectomy were included. Data were analyzed to identify key areas of difficulty as well as the procedures terminated without using all the time allowed.
Results
Novices had difficulty in avoiding drilling holes in the outer anatomical boundaries of the mastoidectomy and frequently made injuries to vital structures such as the lateral semicircular canal, the ossicles, and the facial nerve. The simulator-integrated tutor function improved performance on many of these items, but overreliance on tutoring was observed. Novices also demonstrated poor self-assessment skills and often did not make use of the allowed time, lacking knowledge on when to stop or how to excel.
Conclusion
Directed, self-regulated VR simulation training of mastoidectomy needs a strong instructional design with specific process goals to support deliberate practice because cognitive effort is needed for novices to improve beyond an initial plateau.
Level of Evidence
N/A. Laryngoscope, 127:907–914, 2017
Peter Trier Mikkelsen Thomas Kjeldsen, Jesper Mosegaard
Making Digital Elevation ModelsAccessible, Comprehensible, and Engaging through Real-Time Visualization Journal Article
In: Geo Forum, vol. 14, no. 25, 2016.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Making Digital Elevation ModelsAccessible, Comprehensible, and Engaging through Real-Time Visualization},
author = {Thomas Kjeldsen, Peter Trier Mikkelsen, Jesper Mosegaard},
url = {https://journals.aau.dk/index.php/gfp/issue/view/124},
doi = {10.5278/ojs.perspektiv.v14i25.1231},
year = {2016},
date = {2016-01-21},
journal = {Geo Forum},
volume = {14},
number = {25},
abstract = {In this paper we present our initial experiments with the new high quality digital elevation model, “Danmarks Højdemodel-2015” (DHM) exposed as an interactive 3D visualization on web and in virtual reality. We argue that such data has great opportunities to spawn new business and new insight for the individual citizen if it is accessible, comprehensible and engaging.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this paper we present our initial experiments with the new high quality digital elevation model, “Danmarks Højdemodel-2015” (DHM) exposed as an interactive 3D visualization on web and in virtual reality. We argue that such data has great opportunities to spawn new business and new insight for the individual citizen if it is accessible, comprehensible and engaging.
2015
Peter TrierMikkelsen MSc Steven Arild WuytsAndersen MD, LarsKonge MD
Cognitive Load in Mastoidectomy Skills Training: Virtual Reality Simulation and Traditional Dissection Compared Journal Article
In: Journal of Surgical Education, vol. 73, 2015.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Cognitive Load in Mastoidectomy Skills Training: Virtual Reality Simulation and Traditional Dissection Compared},
author = {Steven Arild WuytsAndersen MD, Peter TrierMikkelsen MSc, LarsKonge MD, PhD, PerCayé-Thomasen MD, DMSc, Mads SølvstenSørensen MD, DMSc},
url = {https://www.sciencedirect.com/science/article/abs/pii/S1931720415002329?via%3Dihub},
doi = { 10.1016/j.jsurg.2015.09.010},
year = {2015},
date = {2015-10-01},
journal = {Journal of Surgical Education},
volume = {73},
abstract = {Objective
The cognitive load (CL) theoretical framework suggests that working memory is limited, which has implications for learning and skills acquisition. Complex learning situations such as surgical skills training can potentially induce a cognitive overload, inhibiting learning. This study aims to compare CL in traditional cadaveric dissection training and virtual reality (VR) simulation training of mastoidectomy.
Design
A prospective, crossover study. Participants performed cadaveric dissection before VR simulation of the procedure or vice versa. CL was estimated by secondary-task reaction time testing at baseline and during the procedure in both training modalities.
Setting
The national Danish temporal bone course.
Participants
A total of 40 novice otorhinolaryngology residents.
Results
Reaction time was increased by 20% in VR simulation training and 55% in cadaveric dissection training of mastoidectomy compared with baseline measurements. Traditional dissection training increased CL significantly more than VR simulation training (p < 0.001).
Conclusions
VR simulation training imposed a lower CL than traditional cadaveric dissection training of mastoidectomy. Learning complex surgical skills can be a challenge for the novice and mastoidectomy skills training could potentially be optimized by employing VR simulation training first because of the lower CL. Traditional dissection training could then be used to supplement skills training after basic competencies have been acquired in the VR simulation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objective
The cognitive load (CL) theoretical framework suggests that working memory is limited, which has implications for learning and skills acquisition. Complex learning situations such as surgical skills training can potentially induce a cognitive overload, inhibiting learning. This study aims to compare CL in traditional cadaveric dissection training and virtual reality (VR) simulation training of mastoidectomy.
Design
A prospective, crossover study. Participants performed cadaveric dissection before VR simulation of the procedure or vice versa. CL was estimated by secondary-task reaction time testing at baseline and during the procedure in both training modalities.
Setting
The national Danish temporal bone course.
Participants
A total of 40 novice otorhinolaryngology residents.
Results
Reaction time was increased by 20% in VR simulation training and 55% in cadaveric dissection training of mastoidectomy compared with baseline measurements. Traditional dissection training increased CL significantly more than VR simulation training (p < 0.001).
Conclusions
VR simulation training imposed a lower CL than traditional cadaveric dissection training of mastoidectomy. Learning complex surgical skills can be a challenge for the novice and mastoidectomy skills training could potentially be optimized by employing VR simulation training first because of the lower CL. Traditional dissection training could then be used to supplement skills training after basic competencies have been acquired in the VR simulation.
The cognitive load (CL) theoretical framework suggests that working memory is limited, which has implications for learning and skills acquisition. Complex learning situations such as surgical skills training can potentially induce a cognitive overload, inhibiting learning. This study aims to compare CL in traditional cadaveric dissection training and virtual reality (VR) simulation training of mastoidectomy.
Design
A prospective, crossover study. Participants performed cadaveric dissection before VR simulation of the procedure or vice versa. CL was estimated by secondary-task reaction time testing at baseline and during the procedure in both training modalities.
Setting
The national Danish temporal bone course.
Participants
A total of 40 novice otorhinolaryngology residents.
Results
Reaction time was increased by 20% in VR simulation training and 55% in cadaveric dissection training of mastoidectomy compared with baseline measurements. Traditional dissection training increased CL significantly more than VR simulation training (p < 0.001).
Conclusions
VR simulation training imposed a lower CL than traditional cadaveric dissection training of mastoidectomy. Learning complex surgical skills can be a challenge for the novice and mastoidectomy skills training could potentially be optimized by employing VR simulation training first because of the lower CL. Traditional dissection training could then be used to supplement skills training after basic competencies have been acquired in the VR simulation.
Lars Konge Sebastian R. Rasmussen, Peter T. Mikkelsen
Notes From the Field: Secondary Task Precision for Cognitive Load Estimation During Virtual Reality Surgical Simulation Training Journal Article
In: Evaluation & the Health Professions, vol. 39, 2015.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Notes From the Field: Secondary Task Precision for Cognitive Load Estimation During Virtual Reality Surgical Simulation Training},
author = {Sebastian R. Rasmussen, Lars Konge, Peter T. Mikkelsen, Mads S. Sørensen, Steven A. W. Andersen, Steven A. W. Andersen},
doi = {10.1177/0163278715597962},
year = {2015},
date = {2015-08-02},
journal = {Evaluation & the Health Professions},
volume = {39},
abstract = {Cognitive load (CL) theory suggests that working memory can be overloaded in complex learning tasks such as surgical technical skills training, which can impair learning. Valid and feasible methods for estimating the CL in specific learning contexts are necessary before the efficacy of CL-lowering instructional interventions can be established. This study aims to explore secondary task precision for the estimation of CL in virtual reality (VR) surgical simulation and also investigate the effects of CL-modifying factors such as simulator-integrated tutoring and repeated practice. Twenty-four participants were randomized for visual assistance by a simulator-integrated tutor function during the first 5 of 12 repeated mastoidectomy procedures on a VR temporal bone simulator. Secondary task precision was found to be significantly lower during simulation compared with nonsimulation baseline, p < .001. Contrary to expectations, simulator-integrated tutoring and repeated practice did not have an impact on secondary task precision. This finding suggests that even though considerable changes in CL are reflected in secondary task precision, it lacks sensitivity. In contrast, secondary task reaction time could be more sensitive, but requires substantial postprocessing of data. Therefore, future studies on the effect of CL modifying interventions should weigh the pros and cons of the various secondary task measurements.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Cognitive load (CL) theory suggests that working memory can be overloaded in complex learning tasks such as surgical technical skills training, which can impair learning. Valid and feasible methods for estimating the CL in specific learning contexts are necessary before the efficacy of CL-lowering instructional interventions can be established. This study aims to explore secondary task precision for the estimation of CL in virtual reality (VR) surgical simulation and also investigate the effects of CL-modifying factors such as simulator-integrated tutoring and repeated practice. Twenty-four participants were randomized for visual assistance by a simulator-integrated tutor function during the first 5 of 12 repeated mastoidectomy procedures on a VR temporal bone simulator. Secondary task precision was found to be significantly lower during simulation compared with nonsimulation baseline, p < .001. Contrary to expectations, simulator-integrated tutoring and repeated practice did not have an impact on secondary task precision. This finding suggests that even though considerable changes in CL are reflected in secondary task precision, it lacks sensitivity. In contrast, secondary task reaction time could be more sensitive, but requires substantial postprocessing of data. Therefore, future studies on the effect of CL modifying interventions should weigh the pros and cons of the various secondary task measurements.
Peter Trier Mikkelsen MSc Steven Arild Wuyts Andersen MD, Lars Konge MD
Cognitive load in distributed and massed practice in virtual reality mastoidectomy simulation Journal Article
In: The Laryngoscope, vol. 126, 2015.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Cognitive load in distributed and massed practice in virtual reality mastoidectomy simulation},
author = {Steven Arild Wuyts Andersen MD,Peter Trier Mikkelsen MSc,Lars Konge MD, PhD,Per Cayé-Thomasen MD, DMSc,Mads Sølvsten Sørensen MD, DMSc},
doi = {10.1002/lary.25449},
year = {2015},
date = {2015-07-07},
journal = {The Laryngoscope},
volume = {126},
abstract = {Objectives/Hypothesis
Cognitive load theory states that working memory is limited. This has implications for learning and suggests that reducing cognitive load (CL) could promote learning and skills acquisition. This study aims to explore the effect of repeated practice and simulator-integrated tutoring on CL in virtual reality (VR) mastoidectomy simulation.
Study Design
Prospective trial.
Methods
Forty novice medical students performed 12 repeated virtual mastoidectomy procedures in the Visible Ear Simulator: 21 completed distributed practice with practice blocks spaced in time and 19 participants completed massed practice (all practices performed in 1 day). Participants were randomized for tutoring with the simulator-integrated tutor function. Cognitive load was estimated by measuring reaction time in a secondary task. Data were analyzed using linear mixed models for repeated measurements.
Results
The mean reaction time increased by 37% during the procedure compared with baseline, demonstrating that the procedure placed substantial cognitive demands. Repeated practice significantly lowered CL in the distributed practice group but not in massed practice group. In addition, CL was found to be further increased by 10.3% in the later and more complex stages of the procedure. The simulator-integrated tutor function did not have an impact on CL.
Conclusion
Distributed practice decreased CL in repeated VR mastoidectomy training more consistently than was seen in massed practice. This suggests a possible effect of skills and memory consolidation occurring over time. To optimize technical skills learning, training should be organized as time-distributed practice rather than as a massed block of practice, which is common in skills-training courses.
Level of Evidence
N/A. Laryngoscope, 126:E74–E79, 2016},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objectives/Hypothesis
Cognitive load theory states that working memory is limited. This has implications for learning and suggests that reducing cognitive load (CL) could promote learning and skills acquisition. This study aims to explore the effect of repeated practice and simulator-integrated tutoring on CL in virtual reality (VR) mastoidectomy simulation.
Study Design
Prospective trial.
Methods
Forty novice medical students performed 12 repeated virtual mastoidectomy procedures in the Visible Ear Simulator: 21 completed distributed practice with practice blocks spaced in time and 19 participants completed massed practice (all practices performed in 1 day). Participants were randomized for tutoring with the simulator-integrated tutor function. Cognitive load was estimated by measuring reaction time in a secondary task. Data were analyzed using linear mixed models for repeated measurements.
Results
The mean reaction time increased by 37% during the procedure compared with baseline, demonstrating that the procedure placed substantial cognitive demands. Repeated practice significantly lowered CL in the distributed practice group but not in massed practice group. In addition, CL was found to be further increased by 10.3% in the later and more complex stages of the procedure. The simulator-integrated tutor function did not have an impact on CL.
Conclusion
Distributed practice decreased CL in repeated VR mastoidectomy training more consistently than was seen in massed practice. This suggests a possible effect of skills and memory consolidation occurring over time. To optimize technical skills learning, training should be organized as time-distributed practice rather than as a massed block of practice, which is common in skills-training courses.
Level of Evidence
N/A. Laryngoscope, 126:E74–E79, 2016
Cognitive load theory states that working memory is limited. This has implications for learning and suggests that reducing cognitive load (CL) could promote learning and skills acquisition. This study aims to explore the effect of repeated practice and simulator-integrated tutoring on CL in virtual reality (VR) mastoidectomy simulation.
Study Design
Prospective trial.
Methods
Forty novice medical students performed 12 repeated virtual mastoidectomy procedures in the Visible Ear Simulator: 21 completed distributed practice with practice blocks spaced in time and 19 participants completed massed practice (all practices performed in 1 day). Participants were randomized for tutoring with the simulator-integrated tutor function. Cognitive load was estimated by measuring reaction time in a secondary task. Data were analyzed using linear mixed models for repeated measurements.
Results
The mean reaction time increased by 37% during the procedure compared with baseline, demonstrating that the procedure placed substantial cognitive demands. Repeated practice significantly lowered CL in the distributed practice group but not in massed practice group. In addition, CL was found to be further increased by 10.3% in the later and more complex stages of the procedure. The simulator-integrated tutor function did not have an impact on CL.
Conclusion
Distributed practice decreased CL in repeated VR mastoidectomy training more consistently than was seen in massed practice. This suggests a possible effect of skills and memory consolidation occurring over time. To optimize technical skills learning, training should be organized as time-distributed practice rather than as a massed block of practice, which is common in skills-training courses.
Level of Evidence
N/A. Laryngoscope, 126:E74–E79, 2016
2014
Peter Trier Mikkelsen Steven Arild Wuyts Andersen, Karsten Østergaard Noe
Good experiences with interactive temporal bone surgical simulator Journal Article
In: Ugeskrift for Laeger, iss. 176, 2014.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {Good experiences with interactive temporal bone surgical simulator},
author = {Steven Arild Wuyts Andersen, Peter Trier Mikkelsen, Karsten Østergaard Noe, Mads Sølvsten Sørensen},
url = {https://pubmed.ncbi.nlm.nih.gov/25096010/},
year = {2014},
date = {2014-03-01},
journal = {Ugeskrift for Laeger},
issue = {176},
abstract = {The Visible Ear Simulator (VES) is a freeware temporal bone surgical simulator utilizing a high-fidelity haptic and graphical voxel model compiled from segmented digital images of fresh frozen sections. A haptic device provides the 3-dimensional handling and drilling with force-feedback in real time. In a multilingual user interface the integrated tutor function provides stepwise instructions during drilling through an intuitive, volumetric approach. A censor function draws on metrics derived from the simulator to provide instant and summary feedback for the user. The VES can be downloaded from http://ves.cg.alexandra.dk.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The Visible Ear Simulator (VES) is a freeware temporal bone surgical simulator utilizing a high-fidelity haptic and graphical voxel model compiled from segmented digital images of fresh frozen sections. A haptic device provides the 3-dimensional handling and drilling with force-feedback in real time. In a multilingual user interface the integrated tutor function provides stepwise instructions during drilling through an intuitive, volumetric approach. A censor function draws on metrics derived from the simulator to provide instant and summary feedback for the user. The VES can be downloaded from http://ves.cg.alexandra.dk.
2012
Peter Trier Mikkelsen Kim Halskov, Karsten Østergaard Noe
Byens Digitale Liv – Digital Urban Living Book
Forlaget Ajour, 2012, ISBN: 978-87-92816-06-1.
BibTeX | Tags:
@book{nokey,
title = {Byens Digitale Liv – Digital Urban Living},
author = {Kim Halskov, Peter Trier Mikkelsen, Karsten Østergaard Noe, Jens Rimestad, Jesper Mosegaard},
editor = {Martin brynskov, Kim Halskov, Lars Kabel},
isbn = {978-87-92816-06-1},
year = {2012},
date = {2012-02-01},
publisher = {Forlaget Ajour},
keywords = {},
pubstate = {published},
tppubtype = {book}
}
2011
Brian Bunch Christensen Jesper Børlum, Thomas Kim Kjeldsen
SSLPV: subsurface light propagation volumes Conference
HPG '11: Proceedings of the ACM SIGGRAPH Symposium on High Performance Graphic, 2011.
Abstract | Links | BibTeX | Tags:
@conference{nokey,
title = {SSLPV: subsurface light propagation volumes},
author = {Jesper Børlum, Brian Bunch Christensen, Thomas Kim Kjeldsen, Peter Trier Mikkelsen, Karsten Østergaard Noe, Jens Rimestad, Jesper Mosegaard
},
doi = {10.1145/2018323.2018325},
year = {2011},
date = {2011-08-01},
booktitle = {HPG '11: Proceedings of the ACM SIGGRAPH Symposium on High Performance Graphic},
abstract = {This paper presents the Subsurface Light Propagation Volume (SSLPV) method for real-time approximation of subsurface scattering effects in dynamic scenes with changing mesh topology and lighting. SSLPV extends the Light Propagation Volume (LPV) technique for indirect illumination in video games. We introduce a new consistent method for injecting flux from point light sources into an LPV grid, a new rendering method which consistently converts light intensity stored in an LPV grid into incident radiance, as well as a model for light scattering and absorption inside heterogeneous materials. Our scheme does not require any precomputation and handles arbitrarily deforming meshes. We show that SSLPV provides visually pleasing results in real-time at the expense of a few milliseconds of added rendering time.},
keywords = {},
pubstate = {published},
tppubtype = {conference}
}
This paper presents the Subsurface Light Propagation Volume (SSLPV) method for real-time approximation of subsurface scattering effects in dynamic scenes with changing mesh topology and lighting. SSLPV extends the Light Propagation Volume (LPV) technique for indirect illumination in video games. We introduce a new consistent method for injecting flux from point light sources into an LPV grid, a new rendering method which consistently converts light intensity stored in an LPV grid into incident radiance, as well as a model for light scattering and absorption inside heterogeneous materials. Our scheme does not require any precomputation and handles arbitrarily deforming meshes. We show that SSLPV provides visually pleasing results in real-time at the expense of a few milliseconds of added rendering time.
2009
Jesper Mosegaard Mads Solvsten Sorensen, Peter Trier
The Visible Ear Simulator A Public PC Application for GPU-Accelerated Haptic 3D Simulation of Ear Surgery Based on the Visible Ear Data Journal Article
In: Otology & Neurotology, iss. 30, pp. 484-487, 2009.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {The Visible Ear Simulator A Public PC Application for GPU-Accelerated Haptic 3D Simulation of Ear Surgery Based on the Visible Ear Data},
author = {Mads Solvsten Sorensen, Jesper Mosegaard, Peter Trier},
doi = {10.1097/MAO.0b013e3181a5299b},
year = {2009},
date = {2009-07-01},
journal = {Otology & Neurotology},
issue = {30},
pages = {484-487},
abstract = {Background: Existing virtual simulators for middle ear surgery are based on 3-dimensional (3D) models from computed tomographic or magnetic resonance imaging data in which image quality is limited by the lack of detail (maximum, approximately 50 voxels/mm3), natural color, and texture of the source material.Virtual training often requires the purchase of a program, a customized computer, and expensive peripherals dedicated exclusively to this purpose.
Materials and methods: The Visible Ear freeware library of digital images from a fresh-frozen human temporal bone was segmented, and real-time volume rendered as a 3D model of high-fidelity, true color, and great anatomic detail and realism of the surgically relevant structures. A haptic drilling model was developed for surgical interaction with the 3D model.
Results: Realistic visualization in high-fidelity (approximately 125 voxels/mm3) and true color, 2D, or optional anaglyph stereoscopic 3D was achieved on a standard Core 2 Duo personal computer with a GeForce 8,800 GTX graphics card, and surgical interaction was provided through a relatively inexpensive (approximately $2,500) Phantom Omni haptic 3D pointing device.
Conclusion: This prototype is published for download (approximately 120 MB) as freeware at http://www.alexandra.dk/ves/index.htm.With increasing personal computer performance, future versions may include enhanced resolution (up to 8,000 voxels/mm3) and realistic interaction with deformable soft tissue components such as skin, tympanic membrane, dura, and cholesteatomas-features some of which are not possible with computed tomographic-/magnetic resonance imaging-based systems.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Existing virtual simulators for middle ear surgery are based on 3-dimensional (3D) models from computed tomographic or magnetic resonance imaging data in which image quality is limited by the lack of detail (maximum, approximately 50 voxels/mm3), natural color, and texture of the source material.Virtual training often requires the purchase of a program, a customized computer, and expensive peripherals dedicated exclusively to this purpose.
Materials and methods: The Visible Ear freeware library of digital images from a fresh-frozen human temporal bone was segmented, and real-time volume rendered as a 3D model of high-fidelity, true color, and great anatomic detail and realism of the surgically relevant structures. A haptic drilling model was developed for surgical interaction with the 3D model.
Results: Realistic visualization in high-fidelity (approximately 125 voxels/mm3) and true color, 2D, or optional anaglyph stereoscopic 3D was achieved on a standard Core 2 Duo personal computer with a GeForce 8,800 GTX graphics card, and surgical interaction was provided through a relatively inexpensive (approximately $2,500) Phantom Omni haptic 3D pointing device.
Conclusion: This prototype is published for download (approximately 120 MB) as freeware at http://www.alexandra.dk/ves/index.htm.With increasing personal computer performance, future versions may include enhanced resolution (up to 8,000 voxels/mm3) and realistic interaction with deformable soft tissue components such as skin, tympanic membrane, dura, and cholesteatomas-features some of which are not possible with computed tomographic-/magnetic resonance imaging-based systems.
Materials and methods: The Visible Ear freeware library of digital images from a fresh-frozen human temporal bone was segmented, and real-time volume rendered as a 3D model of high-fidelity, true color, and great anatomic detail and realism of the surgically relevant structures. A haptic drilling model was developed for surgical interaction with the 3D model.
Results: Realistic visualization in high-fidelity (approximately 125 voxels/mm3) and true color, 2D, or optional anaglyph stereoscopic 3D was achieved on a standard Core 2 Duo personal computer with a GeForce 8,800 GTX graphics card, and surgical interaction was provided through a relatively inexpensive (approximately $2,500) Phantom Omni haptic 3D pointing device.
Conclusion: This prototype is published for download (approximately 120 MB) as freeware at http://www.alexandra.dk/ves/index.htm.With increasing personal computer performance, future versions may include enhanced resolution (up to 8,000 voxels/mm3) and realistic interaction with deformable soft tissue components such as skin, tympanic membrane, dura, and cholesteatomas-features some of which are not possible with computed tomographic-/magnetic resonance imaging-based systems.
2008
Karsten Østergaard Noe Peter Trier Mikkelsen, Mads Sølvsten Sørensen
The visible ear surgery simulator Journal Article
In: Studies in Health Technology and Informatics, iss. 132, pp. 523-5, 2008.
Abstract | Links | BibTeX | Tags:
@article{nokey,
title = {The visible ear surgery simulator},
author = {Peter Trier Mikkelsen, Karsten Østergaard Noe, Mads Sølvsten Sørensen, Jesper Mosegaard},
url = {https://pubmed.ncbi.nlm.nih.gov/18391361/},
year = {2008},
date = {2008-02-01},
journal = {Studies in Health Technology and Informatics},
issue = {132},
pages = {523-5},
abstract = {This paper presents a real-time computer simulation of surgical procedures in the ear, in which a surgeon drills into the temporal bone to gain access to the middle or inner ear. The purpose of this simulator is to support development of anatomical insight and training of drilling skills for both medical students and experienced otologists. The key contributions in this application are the visualization and interaction models in the context of ear surgical simulation. The visualization is based on an existing data set, "The Visible Ear", containing a unique volume depicting the inner ear in natural colours. The applied visualization is based on GPU ray casting, allowing high quality and flexible volume rendering using modern graphics card. In connection with the visualization model, different methods for optimizing the GPU ray casting procedure are presented, along with a method for combining polygon based graphics with volume rendering. In addition, different light models are presented that contribute to a realistic rendering of the different parts of the inner ear. To achieve a physically plausible drilling experience, a Phantom Omni force feedback device is utilized. The applied interaction model facilitates a realistic user experience of the response forces from the drilling tool.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This paper presents a real-time computer simulation of surgical procedures in the ear, in which a surgeon drills into the temporal bone to gain access to the middle or inner ear. The purpose of this simulator is to support development of anatomical insight and training of drilling skills for both medical students and experienced otologists. The key contributions in this application are the visualization and interaction models in the context of ear surgical simulation. The visualization is based on an existing data set, "The Visible Ear", containing a unique volume depicting the inner ear in natural colours. The applied visualization is based on GPU ray casting, allowing high quality and flexible volume rendering using modern graphics card. In connection with the visualization model, different methods for optimizing the GPU ray casting procedure are presented, along with a method for combining polygon based graphics with volume rendering. In addition, different light models are presented that contribute to a realistic rendering of the different parts of the inner ear. To achieve a physically plausible drilling experience, a Phantom Omni force feedback device is utilized. The applied interaction model facilitates a realistic user experience of the response forces from the drilling tool.