No abstract

Surgical flow disruptions affect surgeons' intra-operative workload. Increased mental workload was associated with inferior technical performance. Our simulation-based findings emphasize the need to establish smooth surgical flow which is characterized by a low level of process deviations and disruptions.

Background Until a few years ago, surgical professionals mainly practiced using a combination of cadaver or (live) animal training, 1,2 complemented by clinical observations and hands-on training with real patients. 3,4 The idea to introduce simulations for medical teaching is not new. Simple forms of physical models have been used for teaching the human anatomy long before computerassisted exercises were possible. 5 Yet, technical progress nowadays opens up further opportunities, particularly through the introduction of high-fidelity virtual reality (VR) patient simulators. 6 The benefits of technology-enhanced simulations in surgical education include simulations that yield opportunities to repeat certain procedure steps multiple times to target specific skill sets. 7 Patient safety is safeguarded since surgeons are allowed to prepare themselves specifically for certain cases, and novices are trained in safe 822869S RIXXX10.

We present a medical Augmented Reality (AR) edutainment system for bone anatomy learning. This learning environment, called AR bone puzzle, is a metaphor for bone anatomy learning with AR visualization and intuitive interaction. AR bone puzzle uses its user's body as a puzzle frame and computer generated virtual bones as puzzle pieces. Users learn bone anatomy by assembling the virtual bone pieces on their body. Key features of this system are 3D AR visualization and intuitive gesture based user interaction.

We present a unique simulator-based methodology for assessing both technical and nontechnical (cognitive) skills for surgical trainees while immersed in a complete medical simulation environment. Further, we have included two crisis scenarios which allow for the evaluation of the effect of cognitive strategy selection on the low-level surgical skills. Training these mixed-mode scenarios can thereby be evaluated on our platform, allowing for improved assessment and a stronger foundation for credentialing, with the potential to reduce the occurrence of adverse events in the operating room. Scientific evaluation and validation of our work is conducted together with 19 junior surgeons in order to achieve the following goals: 1) to provide a qualitative measure of usability, 2) to assess vertebroplasty technical performance of the surgeon, and 3) to explore the relationship between mental workload and surgical performance during crisis. Our results indicate that: 1) the surgeons scored the face validity of our modeled simulation environment very highly ( 4.68 ±0.48, using a 5-point Likert scale), 2) surgeon training enabled completion of tasks more quickly, and 3) the introduction of crisis scenarios negatively affected the surgeons' objective performance. Taken together, our results underscore the need to develop realistic simulation environments that prepare young residents to respond to emergent events in the operating room.