Prospective, randomized assessment of transfer of training (ToT) and transfer effectiveness ratio (TER) of virtual reality simulation training for laparoscopic skill acquisition.

OBJECTIVES: We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation. Concordance between simulated and in-vivo procedure performance was also assessed. DESIGN: Prospective, randomized, and blinded. PARTICIPANTS: In Study 1, experienced laparoscopic surgeons (n = 195) and in Study 2 laparoscopic novices (n = 30) were randomized to either train on VR simulation before completing an equivalent real-world task or complete the real-world task only. RESULTS: Experienced laparoscopic surgeons and novices who trained on the simulator performed significantly better than their controls, thus demonstrating ToT. Their performance showed a TER between 7% and 42% from the virtual to the real tasks. Simulation training impacted most on procedural error reduction in both studies (32-42%). The correlation observed between the VR and real-world task performance was r > 0·96 (Study 2). CONCLUSIONS: VR simulation training offers a powerful and effective platform for training safer skills.

Prospective, randomized assessment of the acquisition, maintenance, and loss of laparoscopic skills.

BACKGROUND: Laparoscopic skills are difficult to learn. We, therefore, assessed the factors involved in skill acquisition, maintenance, and loss in 2 prospective, randomized studies. METHODS: In study 1, 24 laparoscopic novices were randomly assigned to a control condition who performed the laparoscopic assessment task; Massed condition who trained on virtual reality (VR) simulation during 1 day or Interval condition who had the same amount of VR training distributed over 3 consecutive days. All groups also completed a novel laparoscopic box-trainer task on 5 consecutive days. In study 2, 16 laparoscopic novices were randomly assigned to a Practice or a No-practice condition. All subjects were required to train on a VR simulation curriculum for the same duration and skill attainment level. The week after completion of training, subjects in the Practice condition were allowed 1 complete practice trial on the simulator. Both groups completed the same tasks 2 weeks after completion of the training. RESULTS: In study 1, the Interval trained group showed the fastest rate of learning and on completion of training significantly outperformed both the Massed and Control groups (P < 0.0001). In study 2, both groups showed significant skills improvement from training trial T1 to T3 (P < 0.0001). The subjects in the Practice group maintained or improved their skills at 1 week but those in the No practice group showed significant decline of skills at 2 weeks after training completion (P < 0.0001). CONCLUSIONS: Laparoscopic skills are optimally acquired on an Interval training schedule. They significantly decline with 2 weeks of nonuse.

The effect of month of birth on the attainments of primary and secondary school pupils.

BACKGROUND: Previous research has produced conflicting results regarding the effects of season of birth and age-position on cognitive attainments. In Northern Ireland the school year divides the summer season into two providing an opportunity to evaluate the relative contribution of season of birth and age-position effects. AIMS: To investigate the relationship between attainment in literacy skills and month of birth for primary and secondary school pupils and to determine the relationship between motor skills and month of birth in primary school pupils. SAMPLE: One thousand one hundred and twenty four primary school pupils participated, and results for key stage 3 (KS3) English and GCSE English Language, for 3,493 Year 10 and 3,697 Year 12 secondary school pupils, respectively, were obtained. METHOD: Primary school pupils were individually assessed using standardised reading and spelling tests, as well as tests of motor skill. They were also assessed using a standardised group reading test in their class groups. For the secondary school pupils, the results for two year cohorts, in KS3 English and GCSE English language, respectively, were analysed. RESULTS: For the primary school pupils there was evidence of both a season of birth and an age-position effect on all of the cognitive measures, particularly in the early years of schooling. There was, also, evidence of a significant age-position effect at both KS3 and GCSE in favour of the older pupils. For the younger primary school pupils there was evidence of significant age-position effects on both motor measures. CONCLUSIONS: The findings from the present study suggest that month of birth may be related to both season of birth and age-position effects. These effects may be compounded, particularly in the early years of primary school, when summer born children are youngest in their year, as in England. In Northern Ireland, age-position effects are also evident in secondary school public examination results, which may have implications for long-term life choices.

The effect of social disadvantage on motor development in young children: a comparative study.

BACKGROUND: Empirical research suggests that social disadvantage has a negative effect on the development of language, and related cognitive skills such as reading. There is, however, no corresponding body of research on the impact of social disadvantage on motor development. The primary purpose of this study was to investigate the impact of social disadvantage on motor development in young children. In addition, we explored a possible link between an early neuromotor indicator and attainments in language, and reading. METHODS: The Northern Ireland Multiple Deprivation Measure was used to identify two contrasting districts based on a composite measure of social disadvantage. We investigated the effect of social disadvantage on the motor attainments of a sample of 239 children aged 4-5 years, and 276 children aged 7-8 years attending mainstream schools in each district using a standardised motor assessment battery, and a motor neurodevelopmental measure. We used standardised receptive language and reading assessments to evaluate possible associations between motor and language/reading attainments. RESULTS: There was a significant negative effect of social disadvantage on motor skills, for both age groups, and for both males and females. A similar negative effect of social disadvantage on attainments in language, and reading was also found. Children from areas of social disadvantage had significant deficits in motor and receptive language attainments relative to their more advantaged peers. In addition, we revealed a significant predictive relationship between a neurodevelopmental measure of early motor development and reading attainment. CONCLUSIONS: Children growing up in socially disadvantaged areas may be at particular risk of motor, including neurodevelopmental, delay, as well as language and reading difficulties. The determinants of motor and neuromotor deficits in children from disadvantaged backgrounds should be explored, and the relationship between early neuromotor development and language/reading development requires further investigation.

Primary reflex persistence in children with reading difficulties (dyslexia): a cross-sectional study.

The primary reflex system emerges during fetal life and is inhibited during the first year after birth. Our aim was to examine the effects of persistence of this early neurological system on the attainment of core literacy skills in dyslexic and non-dyslexic poor readers. We assessed the prevalence of a persistent primary reflex in a cross-sectional, representative sample of children (n=739) aged 7-9 years old attending mainstream primary school in Northern Ireland using standardised educational tests, and a clinical diagnostic test for a primary reflex (the asymmetrical tonic neck reflex (ATNR)). Multiple regression analyses, involving all of the sample children, revealed that persistence of the ATNR was significantly predictive of attainments in reading (t=-8.34, p<.001), spelling (t=-8.00, p<.001), non-word reading (t=-16.15, p<.001), and verbal IQ (t=-4.71, p<.001). ANOVA tests revealed that there were no differences between the performance of dyslexic and non-dyslexic poor readers on any of the outcome measures (reading (F(1, 289)=0.51, p=.48), spelling (F(1, 289)=0.02, p=.90), non-word reading (F(1, 289)=0.76, p=.38), ATNR level (F(1, 289)=2.54, p=.11)). Further ANOVA tests revealed that males had significantly higher levels of persistent reflex than females (F(1, 737)=15.21, p<.001), and that children from socially disadvantaged backgrounds had significantly higher levels of reflex than children who were not socially disadvantaged (F(1, 737)=20.84, p<.001). The findings suggest that for many children in mainstream schooling, the attainment of core educational skills may be affected by the persistence of a brainstem mediated reflex system that should have been inhibited in the first year after birth. Furthermore, these findings suggest that dyslexia is not a distinct category of poor reading, and that it may be more valid to term all poor readers as dyslexic irrespective of IQ.