Retention of Mastoidectomy Skills After Virtual Reality Simulation Training

Abstract

IMPORTANCEThe ultimate goal of surgical training is consolidated skills with a consistently high performance. However, surgical skills are heterogeneously retained and depend on a variety of factors, including the task, cognitive demands, and organization of practice. Virtual reality (VR) simulation is increasingly being used in surgical skills training, including temporal bone surgery, but there is a gap in knowledge on the retention of mastoidectomy skills after VR simulation training.OBJECTIVES To determine the retention of mastoidectomy skills after VR simulation training with distributed and massed practice and to investigate participants' cognitive load during retention procedures. DESIGN, SETTING, AND PARTICIPANTSA prospective 3-month follow-up study of a VR simulation trial was conducted from February 6 to September 19, 2014, at an academic teaching hospital among 36 medical students: 19 from a cohort trained with distributed practice and 17 from a cohort trained with massed practice.INTERVENTIONS Participants performed 2 virtual mastoidectomies in a VR simulator a mean of 3.2 months (range, 2.4-5.0 months) after completing initial training with 12 repeated procedures. Practice blocks were spaced apart in time (distributed), or all procedures were performed in 1 day (massed). MAIN OUTCOMES AND MEASURESPerformance of the virtual mastoidectomy as assessed by 2 masked senior otologists using a modified Welling scale, as well as cognitive load as estimated by reaction time to perform a secondary task.RESULTS Among 36 participants, mastoidectomy final-product skills were largely retained at 3 months (mean change in score, 0.1 points; P = .89) regardless of practice schedule, but the group trained with massed practice took more time to complete the task. The performance of the massed practice group increased significantly from the first to the second retention procedure (mean change, 1.8 points; P = .001), reflecting that skills were less consolidated. For both groups, increases in reaction times in the secondary task (distributed practice group: mean pretraining relative reaction time, CONCLUSIONS AND RELEVANCE Mastoidectomy skills acquired under time-distributed practice conditions were retained better than skills acquired under massed practice conditions. Complex psychomotor skills should be regularly reinforced to consolidate both motor and cognitive aspects. Virtual reality simulation training provides the opportunity for such repeated training and should be integrated into training curricula.

Microvascular anastomosis simulation using a chicken thigh model: Interval versus massed training

“…Interestingly, it was postulated that students of both groups practiced sufficiently to reach a level of proficiency, possibly eliminating any notable advantage between training styles. This agrees with other studies that demonstrate an additional advantage to interval training when learning increasingly complex tasks like intracorporeal suturing on laparoscopic simulators and mastoidectomy in virtual reality training . Some studies have further argued that interval training additionally results in increased transferability and retention of skills learned in this fashion …”

Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload

“…In addition, these are obtrusive and may interfere with a surgeon's primary tasks in the operating room. Finally, a series of secondary task studies assessed surgeons' cognitive load associated with training modality, surgical technique, task complexity, expertise and dexterity metrics. However, the secondary task can also be a distraction from the primary task, making it unreasonable to assess surgeons' cognitive load in the operating theatre.…”

Otologic Skills Training

“…Also, VR simulation training allows for self-directed training of mastoidectomy with an acceptable level of performance, minimizing the need for human instructional resources 38 . Finally, repeated VR simulation practice results in improved learning curves, 39,40 acceptable retention of the procedure skills 41 , and significantly increased cadaveric dissection performance 42 .…”

“…In self-directed training, repeated practice steeply increased the performance of novices, plateauing after nine repetitions 39 with intact retention after 3 months of non-practice 41 . Simulator-integrated tutoring in VR simulation training of mastoidectomy increases the slope of the initial part of the learning curve further supporting directed, self-regulated learning 39 .…”

“…In other words, practice sessions should be short (3–4 procedures per session) and spaced (by at least 3 days) for optimal learning 39 . In reality, dissection training is often organized as short and intense courses; massed practice consistently leads to suboptimal skills acquisition, retention and transfer 41,55–57 . The positive effect of distributed practice can be attributed to time dependent consolidation of memory 57 and even for a simple procedure such as myringotomy, spacing practice by a single day is insufficient in improving novice performance 58 .…”