Introduction: Pediatric laparoscopic surgery (PLS) is an important procedure; however, complications can reach up to 28%. Despite this, pediatric simulation-based training (SBT) has received little scientific attention. To advance pediatric SBT, we aimed to evaluate initial face, content, and construct validity of a new Augmented Reality (AR) simulator for PLS since it has been shown to reduce medical errors. Methods: Four experts and eleven novice residents from Hershey Medical Center were assigned to one of four conditions and performed a peg transfer on: (a) box trainer (BT) with no feedback (NF), then pediatric trainer (PT) with NF, (b) BT with NF, then PT with feedback (F), (c) BT with F, then PT with NF, (d) BT with F, then PT with F. Face/content validity was assessed using a 5-point Likert scale (1 = not realistic/useful, 5 = very realistic/useful). Construct validity was measured using time and errors (pegs dropped). Results: Face validity illustrated that the AR simulator was perceived realistic on all statements (3.6 ± 0.9), including realism in training basic pediatric skills like depth perception (4.0 ± 0.8). Content validity illustrated the simulator’s usefulness on all statements (3.9 ± 0.8), including as a training/testing tool (4.1 ± 0.7). Construct validity illustrated statistically significant differences in expertise for time (p = 0.002) and number of errors (p = 0.012). Conclusions: The AR simulator demonstrated initial face, content, and construct validity for the peg transfer task. As such, it may be used to improve training in PLS with further development and validation across other laparoscopic tasks.

Laparoscopic surgery is an important procedure that is performed over 15 million times annually. However, complications can reach up to 39%. Simulation-based training has been shown to be effective in laparoscopic surgery. Specifically, Augmented Reality (AR) simulators have been shown to improve performance. Leveraging the effectiveness of AR in medical training, this two-phase study aims to explore the potential utility of AR for laparoscopic training. Results from semi-structured interviews with experts and residents revealed that the advantages of current simulators include haptic feedback and disadvantages include lack of realism and visualizations. Results also showed that the most common challenges experienced by residents include camera navigation and trocar insertion. Results from user testing show that the AR simulator was perceived to have the ability to improve trocar insertion and laparoscopic surgery skills and practices more than current simulators. Thus, the AR simulator may be beneficial in improving skills in laparoscopic surgery.

OBJECTIVE: A standardized ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) using online- and simulation-based training was first designed and then large-scale deployed at a teaching hospital institution to improve CVC surgical education. To understand the impact that the standardized training might have on patient complications, this study focuses on identifying the impact of the integration of an iteratively designed US-IJCVC training on clinical complications at a teaching hospital. DESIGN AND PARTICIPANTS: A comparative study was conducted using TriNetX, a global health research network. Using Current Procedural Terminology (CPT) codes and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes, we identified the total number of patients with a CVC and mechanical, infectious, and thrombosis complications with and without billable ultrasound between July 1 to June 30 in 2016, 2017, and 2022. SETTING: A teaching hospital institution in Pennsylvania. RESULTS: Results showed a correlation between years and complications indicating, (1) mechanical complications billable ultrasound, (2) infectious complications billable ultrasound, and (3) thrombosis complications billable ultrasound were significantly lower with the large-scale deployment. Results also showed that (4) mechanical, infectious, and thrombosis complications with and without billable ultrasound are within the range that prior work has reported. CONCLUSION: These results indicate that there has been a decrease in mechanical, infectious, and thrombosis complications, which correlates with the US-IJCVC training large-scale deployment. (J Surg Ed 81:444-455. (c) 2023 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Central Venous Catheterization (CVC) is conducted in more than 5 million patients annually in the United States. Currently, CVC theoretical knowledge is typically taught with didactic lectures with minimal assessment of knowledge before simulation training and clinical environment. To assess CVC theoretical knowledge, virtual reality (VR) can develop residents’ surgical skills and can provide feedback on performance. While all types of VR can be used to assess improvements in residents’ knowledge prior to simulation training, few studies have compared the impact of non-immersive VR on improving resident knowledge. The current study was developed to identify the utility of a non-immersive CathSim VR on improvements in resident CVC theoretical knowledge, self-efficacy, and satisfaction when compared to a traditional multiple-choice assessment This was completed through an empirical investigation with 34 medical residents. The results showed that when compared to a traditional multiple-choice assessment, the non-immersive CathSim VR assessment led to improvements in self-efficacy and potentially better learning experience. Meanwhile, results also showed that there were no differences in assessment score, number of attempts, and overall satisfaction. Thus, we can conclude that non-immersive VR has the potential to be more effective than traditional multiple-choice test in improving self-efficacy and is as effective for residents’ assessment score, number of attempts, and overall satisfaction.

Abstract Background Simulation-based training (SBT) is vital to complex medical procedures such as ultrasound guided central venous catheterization (US-IJCVC), where the experience level of the physician impacts the likelihood of incurring complications. The Dynamic Haptic Robotic Trainer (DHRT) was developed to train residents in CVC as an improvement over manikin trainers, however, the DHRT and manikin trainer both only provide training on one specific portion of CVC, needle insertion. As such, CVC SBT would benefit from more comprehensive training. An extended version of the DHRT was created, the DHRT + , to provide hands-on training and automated feedback on additional steps of CVC. The DHRT + includes a full CVC medical kit, a false vein channel, and a personalized, reactive interface. When used together, the DHRT and DHRT + systems provide comprehensive training on needle insertion and catheter placement for CVC. This study evaluates the impact of the DHRT + on resident self-efficacy and CVC skill gains as compared to training on the DHRT alone. Methods Forty-seven medical residents completed training on the DHRT and 59 residents received comprehensive training on the DHRT and the DHRT + . Each resident filled out a central line self-efficacy (CLSE) survey before and after undergoing training on the simulators. After simulation training, each resident did one full CVC on a manikin while being observed by an expert rater and graded on a US-IJCVC checklist. Results For two items on the US-IJCVC checklist, “verbalizing consent” and “aspirating blood through the catheter”, the DHRT + group performed significantly better than the DHRT only group. Both training groups showed significant improvements in self-efficacy from before to after training. However, type of training received was a significant predictor for CLSE items “using the proper equipment in the proper order”, and “securing the catheter with suture and applying dressing” with the comprehensive training group that received additional training on the DHRT + showing higher post training self-efficacy. Conclusions The integration of comprehensive training into SBT has the potential to improve US-IJCVC education for both learning gains and self-efficacy.

INTRODUCTION:Performance assessment and feedback are critical factors in successful medical simulation-based training. The Dynamic Haptic Robotic Trainer (DHRT) allows residents to practice ultrasound-guided needle insertions during simulated central venous catheterization (CVC) procedures while providing detailed feedback and assessment. A study was performed to examine the effectiveness of the DHRT in training the important skills of needle tip tracking and aspiration and how these skills impact procedural complications in simulated CVC. METHODS:The DHRT data were collected for 163 residents at 2 hospitals for 6 simulated needle insertions. Users were given automated feedback on 5 performance metrics, which measure aspiration rate, arterial punctures, punctures through and through the vein, loss of access to the vein, and successful access to the vein. Aspiration rates and tip tracking rates were analyzed to determine their significance in preventing CVC complications and improving performance. RESULTS:Tip tracking rates higher than 40% were 2.3 times more likely to result in successful venous access than rates less than 10%. Similarly, aspiration rates higher than 80% were 2.6 times more likely to result in successful venous access than rates less than 10%. Proper tip tracking and aspiration both reduced mechanical complications. Resident performance improved for all metrics except tip tracking. CONCLUSIONS:Proper tip tracking and aspiration both reduced complications and increased the likelihood of success. However, the skill of tip tracking was not effectively learned through practice without feedback. Therefore, ultrasound-guided needle-based procedures, including CVC, can be improved by providing specific feedback to users on their ultrasound usage to track needle insertions.

Colonoscopy can reduce the risk of colon cancer by 90%. Due to the lack of surgeon experience, the miss rate of cancerous polyps can reach up to 20%. While simulators have been developed to reduce the high learning curve, these simulators lack real-time feedback needed for successful colonoscopies. The goal of the study was to improve upon colonoscopy training by designing a graphical user interface (GUI) through a two-phase study that included 10 semi-structured interviews and a usability study with 10 participants. Results showed that simulators do not mimic colonoscopy in patients and lack real-time feedback. Additionally, medical residents experience challenges like navigating the scope and loop reduction. User testing results show that users were satisfied with the GUI. Additionally, feedback on polyp detection, cecal intubation time, and force was perceived as useful. As such, the GUI with real-time and post-training feedback has the potential to improve performance in colonoscopy.

Progressive learning gradually increases task difficulty as students advance in their education. One area that can benefit from it is medical education since it can optimize medical trainees’ skill acquisition. While progressive learning can allow for skill transfer to patient encounters, personalized learning increases the efficiency and effectiveness of learning. However, it is not well understood the number of practice trials needed to reach proficiency. To evaluate whether progressive and personalized learning can enhance medical trainees’ learning gains, the learning interface of the Dynamic Haptic Robotic Trainer (DHRT) for Central Venous Catheterization was assessed. Results showed that residents’ performance on the DHRT did not differ based on task difficulty and residents’ performance was as effective with less number of trials. The findings imply a need to integrate progressive and personalized learning on the DHRT simulator to ensure that residents are fully prepared for any patient scenario in a real-life encounter.

A Computer Vision enabled Smart Tray (CVST) was designed for use in medical training for Central Venous Catheterization (CVC). The effects of background color on the ability of the computer vision algorithm to distinguish between tools and the tray was investigated. In addition, the computer vision algorithm was evaluated for accuracy in tool detection. Results indicate that a white monochromatic background is the most useful for segregating background from medical tools, and the algorithm was successfully able to detect 5 different CVC tools both individually and as a group in various arrangements, even when tools overlapped or touched. When the system was in error, it was nearly always due to one tool which has a color similar to that of the background. The CVST shows promise as a CVC training tool and demonstrates that computer vision can be used to accurately detect medical tools.

Measuring walking speed is becoming a more useful tool for assessing overall patient health along with the other five vital signs: temperature, blood pressure, pulse, respiratory rate, and pain. Clinicians consider walking speed to be the “sixth vital sign”. Standardization in measuring walking speed remains elusive and current methods may lead to inconsistent and inaccurate results. This study focused on testing an interface prototype that provides the user with a record-based platform for analyzing walking speed. Two usability studies were conducted with two separate iterations of interfaces. This paper focuses on the second interface, which was a refined version of the first interface. Data obtained through usability metrics and verbal protocol analyses (VPAs) was analyzed. Results from this study provided suggestions for improving the second interface’s ease of use and overall task interaction. Future work will address improving the interface prototype and converting it to a fully-programmed version.

Instructional design is the theory surrounding how learners perceive information and is prevalent in simulation-based medical education. Simulation is used for a variety of medical procedures including central venous catheterization (CVC). The dynamic haptic robotic trainer (DHRT) is a CVC teaching simulator developed to specifically focus on training the needle insertion portion of CVC. While the DHRT has been validated to teach CVC as well as other training methods, an opportunity was seen to redesign the instructions of the DHRT to increase the learnability of the system. A hands-on instructional walkthrough was designed. A group trained with the hands-on instructions was compared to a previous group to assess initial insertion performance. Results indicate that changing the instructional method to be hands-on may have an impact on system learnability and help reinforce development of core components of CVC.

Over the last several decades we have seen a shift from in-person to online training that has been exasperated by the COVID-19 pandemic. Researchers believe that many of these effects will be lasting which makes it even more important that the Human Factors community seek to step back and understand how to best train complex skills in a virtual world. The current paper is focused on understanding the utility of Virtual Reality (VR) in medical education for a hands-on procedural heavy procedure - ultrasound-guided Internal Jugular Central Venous Catheterization. Specifically, the objective of this study is to identify the potential utility of VR in US-IJCVC training through the design of a low-fidelity prototype and user interviews with three subject-matter experts. Results showed that the VR prototype designed is useful and provides a depth of knowledge and educational value which can be used to design innovative VR training approaches.

Background: This study compares surgical residents' knowledge acquisition of ultrasound-guided Internal Jugular Central Venous Catheterization (US-IJCVC) between in-person and online procedural training cohorts before receiving independent in-person Dynamic Haptic Robotic Simulation training. Methods: Three surgical residency procedural training cohorts, two in-person (N = 26) and one online (N = 14), were compared based on their performance on a 24-item US-IJCVC evaluation checklist completed by an expert physician completed after training. Pre- and post-training US-IJCVC knowledge was also compared for the online cohort. Results: No significant change in the pass rates on the US-IJCVC checklist was found between in-person and online cohorts (p = 0.208). There were differences in the Economy of Time and Motion between in-person and online cohorts (p < 0.005). The online cohort had significant increases in US-IJCVC knowledge pre-to post-training (p < 0.008). Conclusion: Online training with independent simulation practice was as effective as in-person training for US-IJCVC.

Gamification, or adding elements of games to training systems, has the potential to increase learner engagement and information retention. However, the use of gamification has yet to be explored in Central Venous Catheterization (CVC) trainers which teach a commonly performed medical procedure with high incidence rates. In order to combat these errors, a Dynamic Haptic Robotic Trainer (DHRT) was developed, which focuses on vessel identification and access. A DHRT+ system is currently under development that focuses on whole procedure training (e.g. sterilization and catheter insertion), including a gamified Graphical User Interface. The goal of this paper was to (1) develop a game-like, patient-centered interface to foster personalized learning and (2) understand the perceived utility of gamification for CVC skill development with expert doctors. This paper outlines some of the potential benefits and deficits of the use of gamification in medical trainers that can be used to drive simulation design.

The Dynamic Haptic Robotic Trainer (DHRT) was developed to minimize the up to 39% of adverse effects experienced by patients during Central Venous Catheterization (CVC) by standardizing CVC training, and provide automated assessments of performance. Specifically, this system was developed to replace manikin trainers that only simulate one patient anatomy and require a trained preceptor to evaluate the trainees' performance. While the DHRT system provides automated feedback, the utility of this system with real-world scenarios and expertise has yet to be thoroughly investigated. Thus, the current study was developed to determine the validity of the current objective assessment metrics incorporated in the DHRT system through expert interviews. The main findings from this study are that experts do agree on perceptions of patient case difficulty, and that characterizations of patient case difficulty is based on anatomical characteristics, multiple needle insertions, and prior catheterization.

A concept for a sensorized medical tray in conjunction with real-time visual cues to aid medical residents in learning the steps of complicated tray-based medical procedures, such as central venous catheterization, was designed and tested as a first iteration. This paper outlines the selection of an LED screen to illuminate various medical devices and the testing of simple magnetic reed switches to use as sensors to track the movement of various medical tools from a tray. While this concept was designed around central venous catheterization, this work is translatable to any medical procedure using a pre-packaged plastic tray.

An advanced surface for Central Venous Catheterization (CVC) training and evaluation was designed using sensorization techniques, including the use of a hall effect sensor array to measure the insertion depth of a catheter. The sensor array was tested for accuracy in both static and dynamic scenarios, and was found to be sufficiently accurate; measuring position with an accuracy of ±1.1 mm on average. The highest deviations in measured positions were located at the extreme ends of the array where calculations rely on only a single sensor. The maximum deviation in measured position was found to be 3.5 mm. This low-cost system of catheter measurement has the potential to improve feedback and assessment of CVC training.

An Incremental Needle Insertion System (INIS) which simultaneously measures the force and position of a needle during insertion was designed and fabricated for use in a tissue deformation study to improve realism in medical simulation. The INIS was tested in a fresh frozen cadaver experiment and the position of the needle was plotted and compared to the expected needle path. It was found that the INIS is sufficiently accurate with an average path deviation of 1.55 mm. In addition, INIS was shown to successfully measure the maximum Central Venous Catheterization needle insertion force which ranged from 3.02 N to 3.73 N.