Health Sciences Education Symposium
Presentation Format
Poster
Type of Activity
Innovation
Original Presentation Date
2023
Date of Submission
March 2023
Abstract/Short Description
Purpose and background: Procedures like the midurethral sling, performed without open visual or camera access rely on the surgeon’s spatial orientation of anatomical landmarks and haptic sensation. The “Blind” nature of this technique can results in serious complications^1–4. Surgeons are typically trained via an apprenticeship on live patients, static models, or, cadaver labs. These methods carry higher potential risks for patient safety, significant expense, often require travel, and are limited by distortion of anatomy after multiple uses. Adding haptics and AI to VR simulators has been shown to improve fidelity, realism, and educational value^ 5–10.We formed a transdisciplinary team to develop an innovative, low-risk, cost-effective method to teach operations that require “learning by feel”. The objective of this study was to evaluate the usability and potential of this SlingVR training system.
Description of Innovative Practice: SlingVR Development. A transdisciplinary team of surgeons, engineers, motor control scientists, human factors experts, and programmers representing the College of Engineering, School of Medicine, and College of Health Professions was assembled. A clear development plan was created including required expertise, resource availability, and communication schedule to facilitate collaboration. To begin, deidentified CT/MRI images using artificial intelligence algorithms to provide high accuracy of anatomy in a 3D VR model. High-resolution haptic and visual alerts were then integrated to provide real-time feedback when approaching at-risk anatomy and generate a competency score. Weekly surgeon feedback lead to iterative development and generated a prototype for broader user evaluation. SlingVR EvaluationPilot evaluation was conducted using multi-trial testing to collect initial perceptions from subject matter expert surgeons. A cognitive task analysis using a think aloud protocol was used to understand how design characteristics impacted learning and fidelity of the SlingVR system. Qualitative comments and investigator observations during the sessions were reviewed and summarized into themes by the study investigators.
Results: Three surgeons participated in feedback sessions: Two were expert subspecialists: fellowship-trained and board-certified in urogynecology with 5 and 7 years of community practice experience. Third surgeon was a PGY3 urology resident from an academic center. Both experts are high-volume, performing weekly retropubic slings, but trained at different programs with different approaches (gynecology focused vs urology focused) and currently used different manufacturers’ devices. The resident has assisted and performed many retropubic slings using the device and technique featured in the curriculum. 6 main themes were initially identified.
Cognitive tasks, instruction, knowledge improvement
I would break down steps for each level even further: like lighting the optimal pathway initially for a novice to follow exactly”
System Feedback amount and type (ex. Continuous vs. intermittent, audio vs. visual)
“I like continuous visual and audio alerts but would save the scoring feedback until a final one at the end”
Scoring and Competency
“I would like to see a comparison of the perfect pathway vs. mine at the end”
Immersion and Realism
“I would like to feel with my nondominant hand too, I use that one more during a case”
Design elements and Aesthetics
“I am colorblind and can’t read that shade of green well”
Gestalt/Impression
“This technology is great, the haptics add a lot, it could be used for hernias or trigger point injections too”
Conclusion: Most valuable in evaluation was including surgeons with diverse training, practice settings, procedure approaches and commercial products used. All 3 consense in the key elements of learning the procedure and the importance of realistic haptics. Our transdisciplinary team and diverse participants are key to successfully identifying themes that provide the blueprint for next steps in the iterative device development of SlingVR.
Rights
© The Author(s)
Is Part Of
VCU Medical Education Symposium
First Author Information
Lauren Siff, MD, Virginia Commonwealth University School of Medicine, College of Engineering Central Virginia VA Health System