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Simulator performance, psychometrics and personality testing guiding the choice of clinical discipline
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
Linköping University, Department of Medicine and Health Sciences, Anesthesiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
Linköping University, Department of Clinical and Experimental Medicine, Surgery . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Urology in Östergötland.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

The complexity of surgical training has increased and surgery put high demands on personal abilities that cannot be met by all even after training. Selection of personnel is critical to many professions, including surgery, but the selection procedure of surgical apprenticeship is not well developed. It would be of value to get an early assessment of important personal features like the ability to learn complex procedures. Further, individuals learn in different ways and the personality may influence this ability. Other important aspects are visuospatial abilities, working memory and executive functioning. These variables are measured in the present study by: learning curves in a TURP VR-simulator, scores from the personality test TCI-R, Rey complex figure and recognition trial, Tower of London (dx) and tests from WAISIII.

Twenty-four residents in urology performed three real TUR-P procedures and their performances were analyzed with OSATS and video-recordings. The learning curves from the OR were compared with the results from the simulation practice, personality tests and psychometrics using multiple linear regression. The findings from personality and psychometric data were also compared with the general population to see if there are any indications of a “surgical personality”. The urology residents in this sample have a welldeveloped character (effective, mature, reliable, goal-oriented, empathetic, tolerant, supportive, cooperative) and with high reward dependence (tender-hearted, dedicated, sociable) together with better executive planning abilities and better verbal working memory than normal.

The connections between the operation learning curves and the variables above indicate that a better learning score is associated with a good learning score in a simulated environment, goal-directedness, a high level of impulse control, anticipation of harmful events and responsibility, a balanced attachment style and a good visual spatial memory.

Keyword [en]
Surgical training, simulator, transurethral resection of prostate, psychometric tests, personality
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54464OAI: oai:DiVA.org:liu-54464DiVA: diva2:304109
Available from: 2010-03-17 Created: 2010-03-17 Last updated: 2010-03-17Bibliographically approved
In thesis
1. Construction, Validation and Application of a Virtual Reality Simulator for the Training of Transurethral Resection of the Prostate
Open this publication in new window or tab >>Construction, Validation and Application of a Virtual Reality Simulator for the Training of Transurethral Resection of the Prostate
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The fundamental of surgical training is the traditional apprenticeship method introduced by William Halsted which has been used for the last 100 years. It is based on learning in the operating room (OR) where the resident is guided by an experienced surgeon and gradually and methodically exposed to surgery. The continuous development of surgical methods together with the growing awareness of medical errors and ethical considerations have made the Halsted method outdated and there is an obvious need to be able to learn the skills of surgery without risking patient safety. New methods such as laparoscopy and endoscopy demand specific skills and abilities that may not be met by everyone. At the same time, the physical limitations of these new methods have made it possible to construct virtual reality (VR) simulators to practise and learn the skills necessary.

This study is about the construction and evaluation of a VR-simulator for the training of transurethral resection of the prostate (TURP). It also concerns the specific abilities needed to become a good surgeon.

A simulator for training TURP was developed after a face validity study where 17 experienced urologists gave their opinion of the specific content necessary for the training of this procedure. After a content validity study by nine experienced urologists and application of necessary improvements, a group of 11 medical students and nine experienced urologists performed a construct validity test where the urologists showed significantly higher levels of both skill and effectiveness compared to the inexperienced students when performing a simulated TURP procedure. The students showed a positive learning curve, but did not reach the levels of the urologists. The results of the experienced urologists were used as the minimal criterion level when 24 urology residents practised the procedure. Training took place while on a course on benign enlargement of the prostate and its treatment options, with emphasis on the “gold standard” treatment – TURP. During the course they performed three guided and video-taped TURP-procedures each on selected patients. Between two of the procedures they performed criterion-based training in the simulator. This VR-to-OR study showed improvement in operative skills with the same patient outcome as in the normal clinical situation. It also showed that simulator training improved their skills even more. During their time on the course their personality traits (TCI) and cognitive abilities (Rey complex figure and recognition trial, tower of London, WAIS-III) were tested. The results showed that a better learning curve in the OR was associated with a better simulator learning curve and a good visuospatial memory. The associated personality traits were high levels of goal directedness, impulse control, responsibility, anticipation of harmful events and a balanced attachment style.

In conclusion, we have demonstrated that it was technically possible to construct a useful simulator for the training of TURP (PelvicVision®) which may now be considered clinically validated for this purpose. Novice training and performance in the simulator improves the learning curve and predicts the resident’s performance in the OR. The results support the implementation of validated simulation technology in a criterion-based training curriculum for residents. Furthermore, the results showed preliminary data on personality traits and visuospatial abilities that are important for learning a complex surgical procedure.

Place, publisher, year, edition, pages
Linköping University Electronic Press, 2010. 86 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1167
Keyword
Surgical education, simulation, transurethral resection of prostate, psychometric tests, personality, validation, virtual reality, proficiency based training, objective assessment
National Category
Surgery
Identifiers
urn:nbn:se:liu:diva-54466 (URN)978-91-7393-444-2 (ISBN)
Public defence
2010-04-30, Berzeliussalen, Hälsouniversitetet, Campus Valla, Linköpings universitet, Linköping, 13:00 (English)
Opponent
Supervisors
Available from: 2010-03-17 Created: 2010-03-17 Last updated: 2015-11-19Bibliographically approved

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Källström, ReidarRousseau, AndreasHjertberg, HansSvanvik, Joar

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Källström, ReidarRousseau, AndreasHjertberg, HansSvanvik, Joar
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Surgery Faculty of Health SciencesDepartment of Urology in ÖstergötlandAnesthesiology Department of PsychiatryDepartment of Surgery in Östergötland
Medical and Health Sciences

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