Date post: | 08-Jul-2015 |
Category: |
Healthcare |
Upload: | games-for-health-europe |
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Safe Surgery – Start Gaming!
Maurits Graafland
Willem Bemelman
Marlies Schijven
The effect of a serious game on the surgeon’s ability to
solve equipment-related problems in the OR
Defense: November 19th, 12.00 a.m. Agnietenkapel, University of Amsterdam
Introduction Methods Results Discussion
Equipment-related problems during (laparoscopic) surgery are common
0,9 problems per procedure (median; IQR 0.3 – 3.6) 1
1,9 per laparoscopic procedure 2
Potentially serious consequences
Delays, adverse events
20% of major surgical errors associated with equipment failure 1
1. Weerakkoody et al. BMJ Qual Saf 2013;22(9):710-8
2. Verdaasdonk et al. Surg Endosc 2007;21(2):275-9
Introduction Methods Results Discussion
Surgeon must divide attention between surgery, OR team & environment
Human brain has limited ability to recognize unexpected events3
Training problem-solving ability is limited Basic laparoscopy course
Knowledge-retention regarding laparoscopic equipment is poor4
3. Drew T et al. Psychol Science 2013;24(9):1848-53
4. Menezes et al. J Surg Educ 2011;68(1):3-5
Introduction Methods Results Discussion
Serious Game trains surgeons in recognizing andsolving equipment-related problems
Serious Game
Weirdbeard B.V.
Fun, challenging and motivating
Learning occurs effortlessly Stealth learning
Introduction Methods Results Discussion
Aim:
Objectify effect of serious game on how surgical trainees deal with equipment-related problems during surgery
Hypothesis:
Trainees who completed a game-enhanced curriculum are better in recognizing and solving equipment-related problemsthan trainees trained the regular way
Introduction Methods Results Discussion
Randomized controlled trial
Inclusion:
Residents in surgical training
No laparoscopic experience as primary surgeon
Basic laparoscopy course
Academic Medical Centre (single centre)
May 2013 - April 2014
Theory laparoscopyLaparoscopic box trainer
Randomisation‘closed enveloppe’
Intervention – THE GAME- 2x30 min serious game
Control group
Practical sessions- Animal model
Practical sessions- Animal model
Test- Animal model
Test- Animal model
Basic laparoscopy course
Introduction Methods Results Discussion
Primary outcome
% problems recognized
% problems solved
Secondary outcome
Time to recognition
Time to solving
Introduction Methods Results Discussion
Test Complete surgical task in animal model (10 minutes)
3 standardized equipment problem scenario’s
Measurement Technical skills
Surgeon (blinded)
Problems recognized, solved, time
Trained Assessor (blinded)
Power analysis: minimum of 12 participants per group
Randomizedn = 31
Interventionn = 15
Controln = 16
Lost to follow-upn = 3- No test (2)- Test inadequate (1)
Lost to follow-upn = 4- No test (2)- Test inadequate (2)
Participants
Test completedn = 12
Test completedn = 12
Includedn = 31
Problems Recognized (%) Problems Solved (%)
p = 0,14 p = 0,029*
100%
75%
50%
25%
0
Game Control Game Control
Time(s)
Time to recognition Time to solving
p = 0,14p = 0,24
Game Control Game Control
Introduction Methods Results Discussion
Trainees solve significantly more equipment-related problems after only 10 sessions of gaming
Improvement problem-recognition (trend) Not statistically significant
… Valid way to train surgeons
Introduction Methods Results Discussion
Study Limitations
Underpowered?
High loss to follow-up 25% both groups
Test depends on quality of execution
Introduction Methods Results Discussion
Product
Available on mobile platforms
Gamification layer (beat your boss, leaderboards, etc.)
Use in “official” surgical training
And elsewhere (“voluntary play”)
Introduction Methods Results Discussion
The future…
Effects on problem recognition Larger numbers
Longterm Learning effect
‘Voluntary play’
Thank You
SponsorsDevelopers Research partners
Introduction Methods Results Discussion
Serious game content Insufflation + gas transport
Lighting + camera
Electrosurgery
Recognizing complications laparoscopic surgery
Content validated Surgeons
Technical specialists (equipment manufacturer)
Same type equipment used as during the course
Introduction Methods Results DiscussionGame Control
Group size (n) 12 12
Age (mean) 29 29
M/F M 58.3% 58.3%F 41.7% 41.7%
Specialty Gen. Surgery 5 3Other surgical spec. 7 9
Technical skill (OSATS) (median, IQR) 2,4 (2,2 – 3,2) 2,8 (2,2 – 3,2)
Year 0 1 21 10 102 1 0
Laparoscopic Experience
(n = 19)
None 11 8
Experience non-
laparoscopic surgery
(n = 19)
None 3 3
1-20 procedures 5 321-50 procedures 3 2
No. Gaming Sessies
completed
(Mean, SD) 11,8 (± 1,7) -
n
Type opgeloste problemen
Random effects model:
2,3% improvement Game Score per Session (p = 0.000)
Learning curve in Game group
Problems Solved (%)
0 5 10 15
0
20
40
60
80
100
Problems solved after game session
session
Pro
ble
m s
olv
ed (
%)
Game session