Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice

Steven Arild Wuyts Andersen; Lars Konge; Per Cayé-Thomasen; Mads Sølvsten Sørensen

doi:10.1001/jamaoto.2015.1563

Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice

Steven Arild Wuyts Andersen, Lars Konge, Per Cayé-Thomasen, Mads Sølvsten Sørensen

Institut for Klinisk Medicin

41 Citationer (Scopus)

Abstract

IMPORTANCE: Repeated and deliberate practice is crucial in surgical skills training, and virtual reality (VR) simulation can provide self-directed training of basic surgical skills to meet the individual needs of the trainee. Assessment of the learning curves of surgical procedures is pivotal in understanding skills acquisition and best-practice implementation and organization of training. OBJECTIVE: To explore the learning curves of VR simulation training of mastoidectomy and the effects of different practice sequences with the aim of proposing the optimal organization of training. DESIGN, SETTING, AND PARTICIPANTS: A prospective trial with a 2 × 2 designwas conducted at an academic teaching hospital. Participants included 43 novice medical students. Of these, 21 students completed time-distributed practice from October 14 to November 29, 2013, and a separate group of 19 students completed massed practice on May 16, 17, or 18, 2014. Data analysis was performed from June 6, 2014, to March 3, 2015. INTERVENTIONS: Participants performed 12 repeated virtual mastoidectomies using a temporal bone surgical simulator in either a distributed (practice blocks spaced in time) or massed (all practice in 1 day) training program with randomization for simulator-integrated tutoring during the first 5 sessions. MAIN OUTCOMES AND MEASURES: Performancewas assessed using a modifiedWelling Scale for final product analysis by 2 blinded senior otologists. RESULTS: Compared with the 19 students in the massed practice group, the 21 students in the distributed practice group were older (mean age, 25.1 years), more often male (15 [62%]), and had slightly higher mean gaming frequency (2.3 on a 1-5 Likert scale). Learning curves were established and distributed practice was found to be superior to massed practice, reported as mean end score (95%CI) of 15.7 (14.4-17.0) in distributed practice vs 13.0 (11.9-14.1) with massed practice (P =.002). Simulator-integrated tutoring accelerated the initial performance, with mean score for tutored sessions of 14.6 (13.9-15.2) vs 13.4 (12.8-14.0) for corresponding nontutored sessions (P <.01) but at the cost of a drop in performance once tutoring ceased. The performance drop was less with distributed practice, suggesting a protective effect when acquired skills were consolidated over time. The mean performance of the nontutored participants in the distributed practice group plateaued on a score of 16.0 (15.3-16.7) at approximately the ninth repetition, but the individual learning curves were highly variable. CONCLUSIONS AND RELEVANCE: Novices can acquire basic mastoidectomy competencies with self-directed VR simulation training. Training should be organized with distributed practice, and simulator-integrated tutoring can be useful to accelerate the initial learning curve. Practice should be deliberate and toward a standard set level of proficiency that remains to be defined rather than toward the mean learning curve plateau.

Originalsprog	Engelsk
Tidsskrift	J A M A Otolaryngology. Head & Neck Surgery
Vol/bind	141
Udgave nummer	10
Sider (fra-til)	913-8
Antal sider	6
ISSN	2168-6181
DOI	https://doi.org/10.1001/jamaoto.2015.1563
Status	Udgivet - okt. 2015

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10.1001/jamaoto.2015.1563

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title = "Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice",

abstract = "IMPORTANCE: Repeated and deliberate practice is crucial in surgical skills training, and virtual reality (VR) simulation can provide self-directed training of basic surgical skills to meet the individual needs of the trainee. Assessment of the learning curves of surgical procedures is pivotal in understanding skills acquisition and best-practice implementation and organization of training. OBJECTIVE: To explore the learning curves of VR simulation training of mastoidectomy and the effects of different practice sequences with the aim of proposing the optimal organization of training. DESIGN, SETTING, AND PARTICIPANTS: A prospective trial with a 2 × 2 designwas conducted at an academic teaching hospital. Participants included 43 novice medical students. Of these, 21 students completed time-distributed practice from October 14 to November 29, 2013, and a separate group of 19 students completed massed practice on May 16, 17, or 18, 2014. Data analysis was performed from June 6, 2014, to March 3, 2015. INTERVENTIONS: Participants performed 12 repeated virtual mastoidectomies using a temporal bone surgical simulator in either a distributed (practice blocks spaced in time) or massed (all practice in 1 day) training program with randomization for simulator-integrated tutoring during the first 5 sessions. MAIN OUTCOMES AND MEASURES: Performancewas assessed using a modifiedWelling Scale for final product analysis by 2 blinded senior otologists. RESULTS: Compared with the 19 students in the massed practice group, the 21 students in the distributed practice group were older (mean age, 25.1 years), more often male (15 [62%]), and had slightly higher mean gaming frequency (2.3 on a 1-5 Likert scale). Learning curves were established and distributed practice was found to be superior to massed practice, reported as mean end score (95%CI) of 15.7 (14.4-17.0) in distributed practice vs 13.0 (11.9-14.1) with massed practice (P =.002). Simulator-integrated tutoring accelerated the initial performance, with mean score for tutored sessions of 14.6 (13.9-15.2) vs 13.4 (12.8-14.0) for corresponding nontutored sessions (P <.01) but at the cost of a drop in performance once tutoring ceased. The performance drop was less with distributed practice, suggesting a protective effect when acquired skills were consolidated over time. The mean performance of the nontutored participants in the distributed practice group plateaued on a score of 16.0 (15.3-16.7) at approximately the ninth repetition, but the individual learning curves were highly variable. CONCLUSIONS AND RELEVANCE: Novices can acquire basic mastoidectomy competencies with self-directed VR simulation training. Training should be organized with distributed practice, and simulator-integrated tutoring can be useful to accelerate the initial learning curve. Practice should be deliberate and toward a standard set level of proficiency that remains to be defined rather than toward the mean learning curve plateau.",

keywords = "Adult, Clinical Competence, Computer Simulation, Female, Humans, Learning Curve, Male, Mastoid, Osteotomy, Practice (Psychology), Simulation Training, User-Computer Interface",

author = "Andersen, {Steven Arild Wuyts} and Lars Konge and Per Cay{\'e}-Thomasen and S{\o}rensen, {Mads S{\o}lvsten}",

year = "2015",

month = oct,

doi = "10.1001/jamaoto.2015.1563",

language = "English",

volume = "141",

pages = "913--8",

journal = "Archives of otolaryngology (Chicago, Ill. : 1960)",

issn = "2168-6181",

publisher = "The JAMA Network",

number = "10",

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T1 - Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice

AU - Andersen, Steven Arild Wuyts

AU - Konge, Lars

AU - Cayé-Thomasen, Per

AU - Sørensen, Mads Sølvsten

PY - 2015/10

Y1 - 2015/10

N2 - IMPORTANCE: Repeated and deliberate practice is crucial in surgical skills training, and virtual reality (VR) simulation can provide self-directed training of basic surgical skills to meet the individual needs of the trainee. Assessment of the learning curves of surgical procedures is pivotal in understanding skills acquisition and best-practice implementation and organization of training. OBJECTIVE: To explore the learning curves of VR simulation training of mastoidectomy and the effects of different practice sequences with the aim of proposing the optimal organization of training. DESIGN, SETTING, AND PARTICIPANTS: A prospective trial with a 2 × 2 designwas conducted at an academic teaching hospital. Participants included 43 novice medical students. Of these, 21 students completed time-distributed practice from October 14 to November 29, 2013, and a separate group of 19 students completed massed practice on May 16, 17, or 18, 2014. Data analysis was performed from June 6, 2014, to March 3, 2015. INTERVENTIONS: Participants performed 12 repeated virtual mastoidectomies using a temporal bone surgical simulator in either a distributed (practice blocks spaced in time) or massed (all practice in 1 day) training program with randomization for simulator-integrated tutoring during the first 5 sessions. MAIN OUTCOMES AND MEASURES: Performancewas assessed using a modifiedWelling Scale for final product analysis by 2 blinded senior otologists. RESULTS: Compared with the 19 students in the massed practice group, the 21 students in the distributed practice group were older (mean age, 25.1 years), more often male (15 [62%]), and had slightly higher mean gaming frequency (2.3 on a 1-5 Likert scale). Learning curves were established and distributed practice was found to be superior to massed practice, reported as mean end score (95%CI) of 15.7 (14.4-17.0) in distributed practice vs 13.0 (11.9-14.1) with massed practice (P =.002). Simulator-integrated tutoring accelerated the initial performance, with mean score for tutored sessions of 14.6 (13.9-15.2) vs 13.4 (12.8-14.0) for corresponding nontutored sessions (P <.01) but at the cost of a drop in performance once tutoring ceased. The performance drop was less with distributed practice, suggesting a protective effect when acquired skills were consolidated over time. The mean performance of the nontutored participants in the distributed practice group plateaued on a score of 16.0 (15.3-16.7) at approximately the ninth repetition, but the individual learning curves were highly variable. CONCLUSIONS AND RELEVANCE: Novices can acquire basic mastoidectomy competencies with self-directed VR simulation training. Training should be organized with distributed practice, and simulator-integrated tutoring can be useful to accelerate the initial learning curve. Practice should be deliberate and toward a standard set level of proficiency that remains to be defined rather than toward the mean learning curve plateau.

AB - IMPORTANCE: Repeated and deliberate practice is crucial in surgical skills training, and virtual reality (VR) simulation can provide self-directed training of basic surgical skills to meet the individual needs of the trainee. Assessment of the learning curves of surgical procedures is pivotal in understanding skills acquisition and best-practice implementation and organization of training. OBJECTIVE: To explore the learning curves of VR simulation training of mastoidectomy and the effects of different practice sequences with the aim of proposing the optimal organization of training. DESIGN, SETTING, AND PARTICIPANTS: A prospective trial with a 2 × 2 designwas conducted at an academic teaching hospital. Participants included 43 novice medical students. Of these, 21 students completed time-distributed practice from October 14 to November 29, 2013, and a separate group of 19 students completed massed practice on May 16, 17, or 18, 2014. Data analysis was performed from June 6, 2014, to March 3, 2015. INTERVENTIONS: Participants performed 12 repeated virtual mastoidectomies using a temporal bone surgical simulator in either a distributed (practice blocks spaced in time) or massed (all practice in 1 day) training program with randomization for simulator-integrated tutoring during the first 5 sessions. MAIN OUTCOMES AND MEASURES: Performancewas assessed using a modifiedWelling Scale for final product analysis by 2 blinded senior otologists. RESULTS: Compared with the 19 students in the massed practice group, the 21 students in the distributed practice group were older (mean age, 25.1 years), more often male (15 [62%]), and had slightly higher mean gaming frequency (2.3 on a 1-5 Likert scale). Learning curves were established and distributed practice was found to be superior to massed practice, reported as mean end score (95%CI) of 15.7 (14.4-17.0) in distributed practice vs 13.0 (11.9-14.1) with massed practice (P =.002). Simulator-integrated tutoring accelerated the initial performance, with mean score for tutored sessions of 14.6 (13.9-15.2) vs 13.4 (12.8-14.0) for corresponding nontutored sessions (P <.01) but at the cost of a drop in performance once tutoring ceased. The performance drop was less with distributed practice, suggesting a protective effect when acquired skills were consolidated over time. The mean performance of the nontutored participants in the distributed practice group plateaued on a score of 16.0 (15.3-16.7) at approximately the ninth repetition, but the individual learning curves were highly variable. CONCLUSIONS AND RELEVANCE: Novices can acquire basic mastoidectomy competencies with self-directed VR simulation training. Training should be organized with distributed practice, and simulator-integrated tutoring can be useful to accelerate the initial learning curve. Practice should be deliberate and toward a standard set level of proficiency that remains to be defined rather than toward the mean learning curve plateau.

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KW - Clinical Competence

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KW - Female

KW - Humans

KW - Learning Curve

KW - Male

KW - Mastoid

KW - Osteotomy

KW - Practice (Psychology)

KW - Simulation Training

KW - User-Computer Interface

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DO - 10.1001/jamaoto.2015.1563

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C2 - 26334610

SN - 2168-6181

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SP - 913

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JO - Archives of otolaryngology (Chicago, Ill. : 1960)

JF - Archives of otolaryngology (Chicago, Ill. : 1960)

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ER -

Learning Curves of Virtual Mastoidectomy in Distributed and Massed Practice

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