Background: Orthopaedic surgery is underrepresented in the United Kingdom medical school curriculum, with an average of less than 3 weeks of exposure over the five-year degree. This study evaluates the effectiveness of high-fidelity virtual reality (VR) and physical model simulation in teaching undergraduate orthopaedic concepts. Methods: A modified randomised crossover trial was used. Forty-nine students were randomly allocated to two groups, with thirty-three finishing the six-week follow-up assessment. All undergraduate medical students were eligible for inclusion. Both groups were given introductory lectures, before completing a pre-test with questions on the principles of fracture fixation and osteotomy. Each group then received a lecture on these topics with the same content, but one was delivered with VR and the other with physical models. Both groups completed the post-course assessments. Knowledge was assessed by way of questionnaire immediately before, immediately after, and six-weeks after. Results: In the VR group, participants improved their post-training score by 192.1% (U=32; p<0.00001). In the physical models group, participants improved their post-training scores by 163.1% (U=8.5; p<0.00001). Overall, there was no statistically significant difference in the total means of post-training test scores between the VR and the physical models study groups (U=260.5; p=0.4354). Conclusion: Both VR and physical models represent valuable educational adjuncts for the undergraduate medical curriculum. Both have demonstrated improvements in immediate and long-term knowledge retention of key orthopaedic concepts.

Aim The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDex™ laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems. Method In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDex™ and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves. Results The intervention group that used FlexDex™ and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDex™ with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P &lt; 0.001). Conclusion Combination of 3D visual systems and the FlexDex™ laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance.

Aim The aim of this study was to evaluate the novice performance of advanced bimanual laparoscopic skills using the articulating FlexDex TM laparoscopic needle holder in two-dimensional (2D) and three-dimensional (3D) visual systems. Methods In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited from a university cohort and randomised into two groups, which used the FlexDex TM and 2D or the FlexDex™ and 3D. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were measured, and assessments were made based on completion times, error rates and learning curves. Results The intervention group that used FlexDex TM and 3D visual output completed 10 attempts of the standardised laparoscopic task quicker than the control group that used FlexDex TM with standard 2D visual output (268 seconds vs 415 seconds taken for the first three attempts and 176 seconds vs 283 seconds taken for the last three attempts, respectively). Moreover, each attempt was completed faster by the intervention group compared to the control group. The difference in average time for the first three and last three attempts reached statistical significance (P < 0.001). Conclusion Combination of 3D visual systems and the FlexDex TM laparoscopic needle holder resulted in superior task performance speed, leading to shorter completion times and quicker learning effect. Although the 3D group demonstrated lower mean error rates, it did not reach statistical significance. Key Statement 3D visual systems lead to faster task completion times when combined with an articulating laparoscopic needle holder compared to 2D vision. This effect however is not seen in error rates.

Aim This study aims to compare novice performance of advanced bimanual laparoscopic skills using an articulating laparoscopic device (FlexDex™) compared to a standard rigid needle holder amongst surgical novices in 2-dimension (2D) visualisation. Method In this prospective randomised trial, novices (n=40) without laparoscopic experience were recruited and randomised into two groups, which used either traditional rigid needle holders or the FlexDex™. Both groups performed 10 repetitions of a validated assessment task. Times taken and error rates were recorded, and results were evaluated based on completion times, error rates, and learning curves. Results The intervention group that used the FlexDex™ completed 10 attempts of the standardised laparoscopic task slower than the control group that used traditional rigid needle holder (415 seconds vs 267 seconds taken for the first three attempts and 283 seconds vs 187 seconds taken for the last three attempts, respectively). The difference in average time for the first three and last three attempts reached statistical significance (P &lt; 0.001). Furthermore, the intervention group demonstrated a higher error rate when compared to the control group (9.2 vs 6.3 errors per individual). Conclusions When compared to the FlexDex™, the traditional rigid needle holder was observed to be superior in task performance speed, leading to shorter completion times and quicker learning effect, as well as fewer errors.

Introduction With cancelled student placements due to the COVID-19 pandemic, there is a shift towards non-patient-facing methods to deliver medical education. The aim was to design, deliver and evaluate an ENT course for undergraduate medical students. Method A three-part simulation course on common and emergency ENT conditions was delivered by ENT trainees to undergraduate medical students (n = 50). It involved theoretical and hands-on experience with otoscopy on head models; nasoendoscopy and epistaxis management with upper airway head models and nasal packing kits; and management of compromised airways using critical airway models, airway adjuncts, intubation and cricothyroidotomy kits. Delegates were given pre- and post-course questionnaires, with another at six-weeks to test knowledge retention. Results were statistically analysed using paired and independent sample t-tests. Results A statistically significant improvement in post-test knowledge of 55% (p&lt;0.01) was observed. Delegates also demonstrated a sustained improvement of 51% (p&lt;0.01) six-weeks later compared to baseline knowledge. 76% and 80% reported improved confidence managing epistaxis and performing intubation respectively; 46% reported increased interest in pursuing ENT as a potential career. Conclusions This study demonstrated statistically significant and sustained improvements in knowledge about common and emergency ENT concepts. ENT simulation therefore represents an efficacious mechanism for teaching key ENT concepts and improving confidence in undergraduate medical students, whilst improving interest in pursuing ENT as a career. Additionally, simulation is an invaluable educational adjunct that may foster more realistic, impactful, and safer educational experiences for medical students whilst exposure to patients is minimised due to the current pandemic.