Exploring the Presence of Core Skills for Surgical Practice Through Simulation.

OBJECTIVE: The ability to simulate procedures in silico has transformed surgical training and practice. Today's simulators, designed for the training of a highly specialized set of procedures, also present a powerful scientific tool for understanding the neural control processes that underpin the learning and application of surgical skills. Here, we examined whether 2 simulators designed for training in 2 different surgical domains could be used to examine the extent to which fundamental sensorimotor skills transcend surgical specialty. DESIGN, SETTING & PARTICIPANTS: We used a high-fidelity virtual reality dental simulator and a laparoscopic box simulator to record the performance of 3 different groups. The groups comprised dentists, laparoscopic surgeons, and psychologists (each group n = 19). RESULTS: The results revealed a specialization of performance, with laparoscopic surgeons showing the highest performance on the laparoscopic box simulator, while dentists demonstrated the highest skill levels on the virtual reality dental simulator. Importantly, we also found that a transfer learning effect, with laparoscopic surgeons and dentists showing superior performance to the psychologists on both tasks. CONCLUSIONS: There are core sensorimotor skills that cut across surgical specialty. We propose that the identification of such fundamental skills could lead to improved training provision prior to specialization.

Frontal theta brain activity varies as a function of surgical experience and task error.

OBJECTIVE: Investigations into surgical expertise have almost exclusively focused on overt behavioral characteristics with little consideration of the underlying neural processes. Recent advances in neuroimaging technologies, for example, wireless, wearable scalp-recorded electroencephalography (EEG), allow an insight into the neural processes governing performance. We used scalp-recorded EEG to examine whether surgical expertise and task performance could be differentiated according to an oscillatory brain activity signal known as frontal theta-a putative biomarker for cognitive control processes. DESIGN SETTING AND PARTICIPANTS: Behavioral and EEG data were acquired from dental surgery trainees with 1 year (n=25) and 4 years of experience (n=20) while they performed low and high difficulty drilling tasks on a virtual reality surgical simulator. EEG power in the 4-7 Hz range in frontal electrodes (indexing frontal theta) was examined as a function of experience, task difficulty and error rate. RESULTS: Frontal theta power was greater for novices relative to experts (p=0.001), but did not vary according to task difficulty (p=0.15) and there was no Experience × Difficulty interaction (p=0.87). Brain-behavior correlations revealed a significant negative relationship between frontal theta and error in the experienced group for the difficult task (r=-0.594, p=0.0058), but no such relationship emerged for novices. CONCLUSION: We find frontal theta power differentiates between surgical experiences but correlates only with error rates for experienced surgeons while performing difficult tasks. These results provide a novel perspective on the relationship between expertise and surgical performance.

Early assessment with a virtual reality haptic simulator predicts performance in clinical practice.

Background: Prediction of clinical training aptitude in medicine and dentistry is largely driven by measures of a student's intellectual capabilities. The measurement of sensorimotor ability has lagged behind, despite being a key constraint for safe and efficient practice in procedure-based medical specialties. Virtual reality (VR) haptic simulators, systems able to provide objective measures of sensorimotor performance, are beginning to establish their utility in facilitating sensorimotor skill acquisition, and it is possible that they may also inform the prediction of clinical performance. Methods: A retrospective cohort study examined the relationship between student performance on a haptic VR simulator in the second year of undergraduate dental study with subsequent clinic performance involving patients 2 years later. The predictive ability was tested against a phantom-head crown test (a traditional preclinical dental assessment, in the third year of study). Results: VR scores averaged across the year explained 14% of variance in clinic performance, while the traditional test explained 5%. Students who scored highly on this averaged measure were ~10 times more likely to be high performers in the clinical crown test. Exploratory analysis indicated that single-trial VR scores did not correlate with real-world performance, but the relationship was statistically significant and strongest in the first half of the year and weakened over time. Conclusions: The data demonstrate the potential of a VR haptic simulator to predict clinical performance and open up the possibility of taking a data-driven approach to identifying individuals who could benefit from support in the early stages of training.

Special care dentistry for patients diagnosed with sickle cell disease: an update for dentists.

Sickle cell disease (SCD) is a relatively common genetic disorder. Patients diagnosed with SCD may encounter barriers to dental care. Consequently, dental care providers should update their knowledge regarding the management of patients with SCD to reduce the possibility of triggering sickling events and potential damage to the body. The purpose of this article is to discuss the oral and dental management of patients with SCD and to clarify the risk factors that can lead to the sickling of the red blood cells during dental care. Adherence to clinical guidelines for preventive dentistry, effective pain and anxiety control, and stress reduction is crucial. Conscious sedation techniques, such as inhalation sedation with nitrous oxide and oxygen, can help to reduce episodes of stress and the potential for sickling. For patients with SCD, intravenous sedation should be provided only in a secondary care setting by a suitably experienced specialist in dental sedation.

The factors that count in selecting future dentists: sensorimotor and soft skills.

Introduction Dental schools across the world are increasingly adopting 'multiple mini interview' (MMI) approaches to evaluate prospective students. But what skills and abilities are being assessed within these short, structured 'interview' stations and do they map on to the requirements of dental practice? Understanding the fundamental processes being measured is important if these assessments are to serve the purpose of identifying the students with the greatest potential to succeed in dental practice.Materials and methods To this end, we performed factor analysis on data from 239 participants on ten MMI stations used for undergraduate selection at a UK dental school.Results The analysis revealed that this assessment approach captured two fundamental underlying traits. The first factor captured scores on six stations that could be labelled usefully as a 'soft skill' factor. The second captured scores on four stations that could be described usefully as a 'sensorimotor' factor.Conclusion The present study demonstrates that the structure of at least one MMI used within the UK for dental school entry can be parsed into two distinct factors relating to soft skills and sensorimotor abilities. This finding has implications for the efficiency of the interview process, the refinement of MMI assessment in dental schools across the world and understanding of the critical skills that a successful dental practitioner must possess.

Drilling into the functional significance of stereopsis: the impact of stereoscopic information on surgical performance.

PURPOSE: One suggested advantage of human binocular vision is the facilitation of sophisticated motor control behaviours via stereopsis - but little empirical evidence exists to support this suggestion. We examined the functional significance of stereopsis by exploring whether stereopsis is used to perform a highly skilled real-world motor task essential for the occupational practice of dentistry. METHODS: We used a high fidelity virtual reality simulator to study how dentists' performance is affected by the removal of horizontal retinal image disparities under direct and indirect (mirror) observation. Thirteen qualified dentists performed a total of four different dental tasks under non-stereoscopic and stereoscopic vision conditions, with two levels of task complexity (direct and indirect observation) using a virtual reality dental simulator. RESULTS: Depth related errors were significantly higher under non-stereoscopic viewing but lateral errors did not differ between conditions. Indirect observation led to participants drilling less of the target area compared to direct viewing, but this did not interact with the stereopsis manipulation. CONCLUSIONS: The data confirm that dental practitioners use stereopsis and its presence results in improved dental performance. It remains to be determined whether individuals with stereo-deficits can compensate adequately. Nevertheless, these findings suggest an important role for stereopsis within at least one occupation and justify the design of simulators with 3D displays.