Failure affects subjective estimates of cognitive load through a negative carry-over effect in virtual reality simulation of hip fracture surgery

Abstract

BackgroundCognitive overload can impair learning, and different factors might affect cognitive load during simulation-based training. In this study, we investigate the role of failure in repeated practice of virtual reality (VR) simulation of hip fracture surgery on cognitive load (CL) estimated by secondary-task reaction time test and two questionnaires.MethodsThe VR simulation training program consisted of three competency levels of increasing complexity starting with the placement of a Kirschner wire in a fractured hip of one patient, adding clinical variability at the intermediate level, and performing the entire dynamic hip screw procedure in 24 different patients at the highest level. Thirteen consecutive passed simulations were required to advance to the next level. Performance was measured as passing/failing a procedure and the number of failed procedures within the latest three and five simulations. CL was measured objectively using reaction time testing during simulation and subjectively using the NASA-TLX and PAAS questionnaires. The study was carried out at a simulation center from November 2016 to March 2019. Forty-two first-year orthopedic surgery residents from the Central Denmark Region and the North Denmark Region participated in the training program.ResultsA failing performance in the simulated procedure was associated with a higher CL than passing a procedure. The subjective CL estimates were affected by the number of failures during last three and five procedures with a higher number of failures being associated with a higher CL. In contrast, relative reaction time estimates of CL were not affected by previous failures.ConclusionsQuestionnaires for estimation of CL seem to be affected by participant frustration after failure—a meta-cognitive “carry-over” effect. This could be a general limitation of the subjective questionnaire approach to estimate CL. Reducing CL through instructional design and handling of participant frustration might improve the learning outcome of simulation training programs.

Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis

“…Respondents were prompted to “reflect on a day [they] performed clinical work during the last 1-2 weeks that is representative of a typical current clinical work day” and rate their perception of each subscale demand type on a scale of 0 to 100 (with 100 being the highest level of demand) [ 38 , 39 ]. The 4 scores were summed for a composite score ranging from 0 to 400 [ 40 ].…”

HipSim — hip fracture surgery simulation utilizing the Learning Curve–Cumulative Summation test (LC-CUSUM)

“…From a medical education point of view, future studies are needed to investigate whether a summative LC-CUSUM test promotes or hinders formative acquisition of technical competencies. The latter might be the case, because the LC-CUSUM test punishes failed simulations harshly, causing frustration (Rölfing et al 2019 ). Thus, it is relevant to investigate if LC-CUSUM should be included or if other more motivating learning strategies should be applied in simulation-based training programs.…”

Virtual reality simulation in orthopaedic surgical training during periods of restricted clinical hours: a systematic review

“…The second theme discusses learning curves and changes in performance using these simulations. A total of 14 papers [26][27][28][29][30][31][32][33][34][35][36][37][38][39] investigated this theme (Table 2). The third theme reports on reviews of orthopaedic VR simulators and evidence of their usefulness in orthopaedic training.…”

“…Conversely, Camp et al 28 found that residents who trained on cadaveric specimens improved twice as fast as those who had VR-based training, for diagnostic knee arthroscopies. Rolfing et al 35 noted participant frustration to be a barrier for simulation training programmes. Nevertheless, a cost analysis showed VR simulation to be more cost-effective if utilized properly.…”