Automatic Final-Product Assessment of Virtual Reality Mastoidectomy Performance: A Validity and Reliability Study.

Objective: Assessment is key in modern surgical education to monitor progress and document sufficient skills. Virtual reality (VR) temporal bone simulators allow automated tracking of basic metrics such as time, volume removed, and collisions. However, adequate performance assessment further includes compound rating of the stepwise bony excavation, and exposure and preservation of soft tissue structures.

3D-printed temporal bone models for training: Does material transparency matter?

Purpose: To investigate the impact of 3D-printed temporal bone models with two different material transparencies on trainees' mastoidectomy performance.

Methods: Eleven ORL residents performed two anatomical mastoidectomies with posterior tympanotomy on two 3D-printed models with different transparency and VR simulation training. Participants where divided into two groups based on their experience.

3-D-Printed Models for Temporal Bone Training: A Validity Study.

Objective: 3-D printing offers convenient and low-cost mastoidectomy training; nonetheless, training benefits using 3-D-printed temporal bones remain largely unexplored. In this study, we have collected validity evidence for a low-cost, 3-D-printed temporal bone for mastoidectomy training and established a credible pass/fail score for performance on the model.

Study Design: A prospective educational study gathering validity evidence using Messick's validity framework.

3D-printing a cost-effective model for mastoidectomy training.

Background: 3D-printed temporal bone models can potentially provide a cost-effective alternative to cadaver surgery that can be manufactured locally at the training department. The objective of this study was to create a cost-effective 3D-printed model suitable for mastoidectomy training using entry level and commercially available print technologies, enabling individuals, without prior experience on 3D-printing, to manufacture their own models for basic temporal bone training.

Methods: Expert technical professionals and an experienced otosurgeon identified the best material for replicating the temporal bone and created a cost-effective printing routine for the model using entry-level print technologies.

Cochlear implantation: Exploring the effects of 3D stereovision in a digital microscope for virtual reality simulation training - A randomized controlled trial.

Unlabelled: In cochlear implantation (CI), excellent surgical technique is critical for hearing outcomes. Recent advances in temporal bone Virtual Reality (VR) training allow for specific training of CI and through introduction of new digital microscopes with ultra-high-fidelity (UHF) graphics. This study aims to investigate whether UHF increases performance in VR simulation training of CI electrode insertion compared with conventional, screen-based VR (cVR).

OpenEar Image Data Enables Case Variation in High Fidelity Virtual Reality Ear Surgery.

Background: Virtual reality (VR) simulation is an established option for temporal bone surgical training. Most VR simulators are based on computed tomography imaging, whereas the Visible Ear Simulator (VES) is based on high-fidelity cryosections of a single temporal bone specimen. Recently published OpenEar datasets combine cone-beam computed tomography (CBCT) and micro-slicing to achieve similar model quality.

Assessing competence in cochlear implant surgery using the newly developed Cochlear Implant Surgery Assessment Tool.

Purpose: To develop and gather validity evidence for a novel tool for assessment of cochlear implant (CI) surgery, including virtual reality CI surgery training.

Methods: Prospective study gathering validity evidence according to Messick's framework. Four experts developed the CI Surgery Assessment Tool (CISAT).

Ultra-high-fidelity virtual reality mastoidectomy simulation training: a randomized, controlled trial.

Purpose: Ultra-high-fidelity (UHF) graphics in virtual reality (VR) simulation might improve surgical skill acquisition in temporal bone training. This study aims to compare UHF VR simulation training with conventional, screen-based VR simulation training (cVR) with respect to performance and cognitive load (CL).

Methods: In a randomized trial with a cross-over design, 24 students completed a total of four mastoidectomies in a VR temporal bone surgical simulator: two performances under UHF conditions using a digital microscope and two performances under conventional conditions using screen-based VR simulation.

The Effect of Simulator-Integrated Tutoring for Guidance in Virtual Reality Simulation Training.

Introduction: Simulation-integrated tutoring in virtual reality (VR) simulation training by green lighting is a common learning support in simulation-based temporal bone surgical training. However, tutoring overreliance can negatively affect learning. We therefore wanted to investigate the effects of simulator-integrated tutoring on performance and learning.

The effect of structured self-assessment in virtual reality simulation training of mastoidectomy.

Purpose: Virtual reality (VR) simulation surgical skills training is well established, but self-directed practice is often associated with a learning curve plateau. In this study, we investigate the effects of structured self-assessment as a means to improve performance in mastoidectomy training.

Methods: The study was a prospective, educational study.

Expert sampling of VR simulator metrics for automated assessment of mastoidectomy performance.

Objective: Often the assessment of mastoidectomy performance requires time-consuming manual rating. Virtual reality (VR) simulators offer potentially useful automated assessment and feedback but should be supported by validity evidence. We aimed to investigate simulator metrics for automated assessment based on the expert performance approach, comparison with an established assessment tool, and the consequences of standard setting.

The effect of implementing cognitive load theory-based design principles in virtual reality simulation training of surgical skills: a randomized controlled trial.

Background: Cognitive overload can inhibit learning, and cognitive load theory-based instructional design principles can be used to optimize learning situations. This study aims to investigate the effect of implementing cognitive load theory-based design principles in virtual reality simulation training of mastoidectomy.

Methods: Eighteen novice medical students received 1 h of self-directed virtual reality simulation training of the mastoidectomy procedure randomized for standard instructions (control) or cognitive load theory-based instructions with a worked example followed by a problem completion exercise (intervention).

Mapping the plateau of novices in virtual reality simulation training of mastoidectomy.

Objectives/hypothesis: To explore why novices' performance plateau in directed, self-regulated virtual reality (VR) simulation training and how performance can be improved.

Study Design: Prospective study.

Methods: Data on the performances of 40 novices who had completed repeated, directed, self-regulated VR simulation training of mastoidectomy were included.

Cognitive Load in Mastoidectomy Skills Training: Virtual Reality Simulation and Traditional Dissection Compared.

Objective: The cognitive load (CL) theoretical framework suggests that working memory is limited, which has implications for learning and skills acquisition. Complex learning situations such as surgical skills training can potentially induce a cognitive overload, inhibiting learning. This study aims to compare CL in traditional cadaveric dissection training and virtual reality (VR) simulation training of mastoidectomy.

Cognitive load in distributed and massed practice in virtual reality mastoidectomy simulation.

Objectives/hypothesis: Cognitive load theory states that working memory is limited. This has implications for learning and suggests that reducing cognitive load (CL) could promote learning and skills acquisition. This study aims to explore the effect of repeated practice and simulator-integrated tutoring on CL in virtual reality (VR) mastoidectomy simulation.

[Good experiences with interactive temporal bone surgical simulator].

The Visible Ear Simulator (VES) is a freeware temporal bone surgical simulator utilizing a high-fidelity haptic and graphical voxel model compiled from segmented digital images of fresh frozen sections. A haptic device provides the 3-dimensional handling and drilling with force-feedback in real time. In a multilingual user interface the integrated tutor function provides stepwise instructions during drilling through an intuitive, volumetric approach.