Department of Surgery, Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA.
Mil Med. 2024 Aug 30;189(9-10):e2248-e2256. doi: 10.1093/milmed/usae103.
The uses of on-demand, interactive tablet-based surgical training environments are of interest as potential resources for both the acquisition and maintenance of rarely performed, critical procedures for expeditionary surgical care. This study examined the effectiveness of a tablet-based augmented reality (AR) procedural training environment for lower leg fasciotomy with a cohort of novice surgical trainees in (1) procedural knowledge, (2) tablet-based procedural skills, (3) tablet-based procedural time, and (4) procedural performance on a cadaver. We hypothesized that engaging with the AR procedural training would increase procedural knowledge and tablet-based skills and procedural time. We hypothesized that the tablet-based AR training environment would be insufficient to acquire the ability to perform lower leg fasciotomy on a cadaver.
This study was approved as exempt by the Institutional Review Board at USU. Surgical interns, sub-interns, and independent duty corpsman (n = 30) with no prior lower leg fasciotomy experience voluntarily participated. Tablet-based training activities included pre-training assessment, engagement with instruction, interactive procedural practice, and post-training assessment. Tablet-based knowledge assessment included 17 multiple choice questions covering concepts, reasoning, and judgment associated with the procedure. Tablet-based procedural completion and time were assessed within the training environment. Within 1 week of completing the tablet activities, participants were assessed by fellowship-trained trauma surgeons while performing cadaver-based lower leg fasciotomy. Statistical analysis included paired t-tests and effect size (Cohen's d). Statistical significance was set at P < .05.
Tablet-based AR procedural training significantly improved procedural knowledge (P < .001), tablet-based procedural skills (P < .001), and reduced tablet-based procedural time (P < .002). Effect sizes were very large for tablet-based procedural knowledge (d = 1.75) and skills (d = 3.2) and small (d = 0.42) for procedural time. There were no significant effects of procedural knowledge, tablet-based procedural skills, or time on cadaver-based performance. No participant was able to accurately and independently complete lower leg fasciotomy procedure on a cadaver.
Tablet-based AR procedural training improved procedural knowledge and tablet-based skills; however, those gains did not transfer to the ability to perform the procedure on a cadaver. The tablet's limited AR interface did not support the acquisition of requisite surgical technique, tissue handling, and decision-making in novice surgical trainees. Experienced surgeons may have different outcomes because their mature understanding of surgical constructs would allow extrapolation of abilities to other procedural contexts. Further investigation of the tablet-based training environments for surgical care is necessary before distributing such resources to support clinical readiness.
按需、互动的基于平板电脑的手术培训环境的使用作为远征手术护理中获取和维持很少进行的关键程序的潜在资源引起了人们的兴趣。本研究通过新手外科受训者，检查了基于平板电脑的增强现实（AR）程序训练环境在小腿筋膜切开术中的有效性，包括（1）程序知识，（2）基于平板电脑的程序技能，（3）基于平板电脑的程序时间，以及（4）在尸体上的程序表现。我们假设与 AR 程序培训的接触将增加程序知识和基于平板电脑的技能和程序时间。我们假设基于平板电脑的 AR 培训环境不足以获得在尸体上进行小腿筋膜切开术的能力。
该研究经美国犹他州立大学机构审查委员会批准为豁免。没有小腿筋膜切开术经验的外科实习医师、副实习医师和独立值班水手（n=30）自愿参加。基于平板电脑的培训活动包括培训前评估、参与指导、互动程序练习和培训后评估。基于平板电脑的知识评估包括 17 个多项选择题，涵盖与程序相关的概念、推理和判断。在培训环境中评估基于平板电脑的程序完成和时间。在完成平板电脑活动后的 1 周内， fellowship 培训的创伤外科医生评估参与者在尸体上进行小腿筋膜切开术的能力。统计分析包括配对 t 检验和效应量（Cohen's d）。统计学意义设为 P<0.05。
基于平板电脑的 AR 程序培训显著提高了程序知识（P<0.001）、基于平板电脑的程序技能（P<0.001）和缩短了基于平板电脑的程序时间（P<0.002）。基于平板电脑的程序知识（d=1.75）和技能（d=3.2）的效应量非常大，而程序时间的效应量较小（d=0.42）。程序知识、基于平板电脑的程序技能或时间对尸体表现均无显著影响。没有参与者能够准确和独立地在尸体上完成小腿筋膜切开术。
基于平板电脑的 AR 程序培训提高了程序知识和基于平板电脑的技能；但是，这些收益并未转移到在尸体上进行该程序的能力。平板电脑有限的 AR 界面不支持新手外科受训者获得必要的手术技术、组织处理和决策能力。经验丰富的外科医生可能会有不同的结果，因为他们对手术结构的成熟理解可以将能力推断到其他程序环境中。在向临床准备分发此类资源以支持之前，有必要对基于平板电脑的手术培训环境进行进一步研究。
