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

Published online by Cambridge University Press:  28 October 2021

A Frithioff ,
M Frendø ,
J Hastrup von Buchwald ,
P Trier Mikkelsen ,
M Sølvsten Sørensen  and
S Arild Wuyts Andersen
A Frithioff*
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Aarhus, Denmark
M Frendø
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Aarhus, Denmark
J Hastrup von Buchwald
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Aarhus, Denmark
P Trier Mikkelsen
Affiliation:
The Alexandra Institute, Aarhus, Denmark
M Sølvsten Sørensen
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark
S Arild Wuyts Andersen
Affiliation:
Department of Otorhinolaryngology – Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen, Denmark Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Aarhus, Denmark
*
Author for correspondence: Dr A Frithioff, Department of Otorhinolaryngology – Head and Neck Surgery, Rigshospitalet, Blegdamsvej 9, Copenhagen Ø DK-2100, Denmark E-mail: [email protected]
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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

Temporal BoneOtologic Surgical Procedures
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 136 , Issue 1 , January 2022 , pp. 29 - 36
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr A Frithioff takes responsibility for the integrity of the content of the paper

References

Reznick, RK. Teaching and testing technical skills. Am J Surg 1993;165:358–61CrossRefGoogle ScholarPubMed
George, AP, De, R. Review of temporal bone dissection teaching: how it was, is and will be. J Laryngol Otol 2010;124:119–25CrossRefGoogle Scholar
Frithioff, A, Sørensen, MS, Andersen, SAW. European status on temporal bone training: a questionnaire study. Eur Arch Otorhinolaryngol 2018;275:357–63CrossRefGoogle ScholarPubMed
Zhao, YC, Kennedy, G, Yukawa, K, Pyman, B, O'Leary, S. Improving temporal bone dissection using self-directed virtual reality simulation: results of a randomized blinded control trial. Otolaryngol Head Neck Surg 2011;144:357–64CrossRefGoogle ScholarPubMed
Andersen, SAW, Foghsgaard, S, Konge, L, Cayé-Thomasen, P, Sørensen, MS. The effect of self-directed virtual reality simulation on dissection training performance in mastoidectomy. Laryngoscope 2016;126:1883–8CrossRefGoogle ScholarPubMed
Javia, L, Deutsch, ES. A systematic review of simulators in otolaryngology. Otolaryngol Head Neck Surg 2012;147:999–1011CrossRefGoogle ScholarPubMed
Brydges, R, Dubrowski, A, Regehr, G. A new concept of unsupervised learning: directed self-guided learning in the health professions. Acad Med 2010;85:S49–55CrossRefGoogle ScholarPubMed
Brydges, R, Nair, P, Ma, I, Shanks, D, Hatala, R. Directed self-regulated learning versus instructor-regulated learning in simulation training. Med Educ 2012;46:648–56CrossRefGoogle ScholarPubMed
Frendø, M, Thingaard, E, Konge, L, Sølvsten, M, Steven, S. Decentralized virtual reality mastoidectomy simulation training: a prospective, mixed-methods study. Eur Arch Otorhinolaryngol 2019;276:2783–9CrossRefGoogle ScholarPubMed
Cook, DA, Brydges, R, Zendejas, B, Hamstra, SJ, Hatala, R. Technology-enhanced simulation to assess health professionals: a systematic review of validity evidence. Acad Med 2013;88:872–83CrossRefGoogle ScholarPubMed
Issenberg, SB, Mcgaghie, WC, Petrusa, ER, Gordon, DL, Scalese, RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach 2005;27:10–28CrossRefGoogle ScholarPubMed
Wijewickrema, S, Zhou, Y, Ioannou, I, Copson, B, Piromchai, P et al. Presentation of automated procedural guidance in surgical simulation: results of two randomised controlled trials. J Laryngol Otol 2018;132:257–63CrossRefGoogle ScholarPubMed
Kerwin, T, Stredney, D, Wiet, GJ, Shen, HW. Virtual Mastoidectomy performance evaluation through multi-volume analysis. Computer Assist Radiol Surg 2013;8:51–61CrossRefGoogle ScholarPubMed
Andersen, SAW, Mikkelsen, PT, Sørensen, MS. Expert sampling of VR simulator metrics for automated assessment of mastoidectomy performance. Laryngoscope 2019;129:2170–7CrossRefGoogle ScholarPubMed
Zirkle, M, Roberson, DW, Leuwer, R, Dubrowski, A. Using a virtual reality temporal bone simulator to assess otolaryngology trainees. Laryngoscope 2007;117:258–63CrossRefGoogle ScholarPubMed
Andersen, SAW, Konge, L, Cayé-Thomasen, P, Sørensen, MS. Learning curves of virtual mastoidectomy in distributed and massed practice. JAMA Otolaryngol Head Neck Surg 2015;141:913–18Google ScholarPubMed
Andersen, SAW, Konge, L, Mikkelsen, PT. Mapping the plateau of novices in virtual reality simulation training of mastoidectomy. Laryngoscope 2017;127:907–14CrossRefGoogle ScholarPubMed
Park, J, Shea, CH, Wright, DL, Shea, CH, Reduced-frequency, DLW, Park, J et al. Reduced-frequency concurrent and terminal feedback: a test of the guidance hypothesis. J Mot Behav 2000;32:287–96CrossRefGoogle ScholarPubMed
Hatala, R, Cook, D, Zendajas, B, Hamstra, S, Brydges, R. Feedback for simulation-based procedural skills training: a meta-analysis and critical narrative synthesis. Adv Heal Sci Educ Theory Pract 2014;19:251–72CrossRefGoogle ScholarPubMed
Sweller, J. Cognitive load during problem solving: effects on learning. Cognitive Science 1988;12:257–85CrossRefGoogle Scholar
Haji, FA, Cheung, JJH, Woods, N, Regehr, G, de Ribaupierre, S, Dubrowski, A. Thrive or overload? The effect of task complexity on novices’ simulation-based learning. Med Educ 2016;50:955–68CrossRefGoogle ScholarPubMed
Frithioff, A, Frendø, M, Mikkelsen, PT, Sørensen, MS, Andersen, SAW. Ultra-high-fidelity virtual reality mastoidectomy simulation training: a randomized, controlled trial. Eur Arch Otorhinolaryngol 2020;277:1335–41CrossRefGoogle ScholarPubMed
Van Merriënboer, JJG, Sweller, J. Cognitive load theory in health professional education: design principles and strategies. Med Educ 2010;44:85–93CrossRefGoogle ScholarPubMed
Sethia, R, Kerwin, TF, Wiet, GJ. Performance assessment for mastoidectomy. Otolaryngol Head Neck Surg. 2017;156:61–69CrossRefGoogle ScholarPubMed
Al-Shahrestani, F, Sørensen, MS, Andersen, SAW. Performance metrics in mastoidectomy training: a systematic review. Eur Arch Otorhinolaryngol 2019;276:657–64CrossRefGoogle ScholarPubMed
Vilmann, AS, Norsk, D, Bo, M, Svendsen, S. Computerized feedback during colonoscopy training leads to improved performance: a randomized trial. Gastrointest Endosc 2018;88:869–76CrossRefGoogle ScholarPubMed
Ahmed, OMA, Niessen, T, Gallagher, AG, Breslin, DS, Dunngalvin, A, Shorten, GD. The effect of metrics-based feedback on acquisition of sonographic skills relevant to performance of ultrasound-guided axillary brachial plexus block. Anaesthesia 2017;9:1117–24CrossRefGoogle Scholar
Sørensen, MS, Mosegaard, J, Trier, P. The visible ear simulator: a public PC application for GPU-accelerated haptic 3D simulation of ear surgery based on the visible ear data. Otol Neurotol 2009;30:484–7CrossRefGoogle ScholarPubMed
Andersen, SAW, Cayé-Thomasen, P, Sørensen, MS. Mastoidectomy performance assessment of virtual simulation training using final-product analysis. Laryngoscope 2015;125:431–5CrossRefGoogle ScholarPubMed
Naismith, LM, Cavalcanti, RB. Validity of cognitive load measures in simulation-based training: a systematic review. Acad Med 2015;90:24–35CrossRefGoogle ScholarPubMed
Andersen, SAW, Mikkelsen, PT, Konge, L, Cayé-Thomasen, P, Sørensen, MS. Cognitive load in mastoidectomy skills training: virtual reality simulation and traditional dissection compared. J Surg Educ 2016;73:45–50CrossRefGoogle ScholarPubMed
Leppink, J. Data analysis in medical education research: a multilevel perspective. Perspect Med Educ 2015;4:14–24CrossRefGoogle ScholarPubMed
Zirkle, M, Taplin, MA, Anthony, R, Dubrowski, A. Objective assessment of temporal bone drilling skills. Ann Otol Rhinol Laryngol 2007;116:793–8CrossRefGoogle ScholarPubMed
Davaris, M, Wijewickrema, S, Zhou, Y, Piromchai, P, Bailey, J, Kennedy, G et al. The importance of automated real-time performance feedback in virtual reality temporal bone surgery training. In: Isotani, S, Millán, E, Ogan, A, Hastings, P, McLaren, B, Luckin, R, eds. Artificial Intelligence in Education. Cham: Springer International Publishing, 2019;96–109CrossRefGoogle Scholar
Wijewickrema, S, Piromchai, P, Zhou, Y, Ioannou, I, Bailey, J, Kennedy, G et al. Developing effective automated feedback in temporal bone surgery simulation. Otolaryngol Head Neck Surg 2015;152:1082–8CrossRefGoogle ScholarPubMed
Andersen, SAW, Mikkelsen, PT, Sørensen, MS. The Effect of simulator-integrated tutoring for guidance in virtual reality simulation training. Simul Healthc 2020;15:147–53CrossRefGoogle ScholarPubMed
Andersen, SAW, Frendø, M, Guldager, M, Sørensen, MS. Understanding the effects of structured self-assessment in directed, self-regulated simulation-based training of mastoidectomy: a mixed methods study. J Otol 2020;15:117–23CrossRefGoogle ScholarPubMed
Andersen, SAW, Frendø, M, Sørensen, MS. Effects on cognitive load of tutoring in virtual reality simulation training. MedEdPublish 2020;9:1–6CrossRefGoogle Scholar
Van Merriënboer, JJG, Kester, L, Pass, F. Teaching complex rather than simple tasks: balancing intrinsic and germane load to enhance transfer of learning. Appl Cogn Psychol 2006;20:343–52CrossRefGoogle Scholar
Gawecki, W, Wegrzyniak, M, Mickiewicz, P, Talar, M, Wierzbicka, M, Gawłowska, MB. The impact of virtual reality training on the quality of real antromastoidectomy performance. J Clin Med. 2020;9:3197CrossRefGoogle ScholarPubMed
Andersen, SAW, Foghsgaard, S, Cayé-Thomasen, P, Sørensen, MS. The effect of a distributed virtual reality simulation training program on dissection mastoidectomy performance. Otol Neurotol 2018;39:1277–84CrossRefGoogle ScholarPubMed
Smith, S, Lonie, J. Mastery learning: how is it helpful? An analytical review. Adv Med Educ Pract 2017;8:269–75Google Scholar