Introduction
Materials and methods
Development of home simulation kits
Study design and participants
Main study parameters
Statistical analysis
Qualitative interviews
Results
Demographics
Variable | Cohort, n = 29 | Home simulation kit group (experimental), n = 15 | No home simulation kit group (control), n = 14 | p value |
---|---|---|---|---|
Age, yrs (SD) | 24.86 (1.84) | 25.14 (2.07) | 24.57 (1.60) | 0.42 |
Gender, N | ||||
Male | 16 | 8 | 8 | NC* |
Female | 12 | 6 | 6 | |
Non-Binary | 1 | 1 | 0 | |
Year in medical school, N | ||||
1st | 14 | 7 | 7 | NC* |
2nd | 10 | 7 | 3 | |
Higher level | 5 | 1 | 4 | |
Handedness, N | ||||
Right | 25 | 12 | 13 | 0.60 |
Left | 4 | 3 | 1 | |
Played video games regularly, N | ||||
Yes | 19 | 8 | 11 | 0.25 |
No | 10 | 7 | 3 | |
Assisted in OR, N | ||||
Yes | 9 | 4 | 5 | 0.70 |
No | 20 | 11 | 9 | |
Experience in robotic surgery, N | ||||
Yes | 7 | 4 | 3 | 1.0 |
No | 22 | 11 | 11 | |
Experience in laparoscopic surgery, N | ||||
Yes | 9 | 4 | 5 | 0.70 |
No | 20 | 11 | 9 |
SimNow performance
Group Receiving Home Simulation Kits (n = 15) | p value1 | Control Group (n = 14) | p value1 | |||
---|---|---|---|---|---|---|
Average Score Session 1 | Average Score Session 2 | Average Score Session 1 | Average Score Session 2 | |||
Sea Spikes 1 | ||||||
Overall SimNow Score (SD) | 37.67 (24.60) | 67.93 (16.22) | 0.00046 | 52.43 (20.37) | 66.71 (20.16) | 0.070 |
Economy of motion, cm (SD) | 474.3 (134.0) | 349.9 (62.50) | 0.0036 | 386.16 (67.72) | 341.26 (51.19) | 0.057 |
Time to completion, s (SD) | 284.1 (128.7) | 185.9 (37.78) | 0.0033 | 231.23 (61.57) | 199.5 (66.27) | 0.11 |
Penalty subtotal (SD) | – 21.13 (27.58) | – 6.07 (7.80) | 0.060 | – 10.36 (8.14) | – 6.00 (8.31) | 0.127 |
Big Dipper Needle Driving | ||||||
Overall SimNow Score (SD) | 1.27 (4.91) | 11.53 (14.89) | 0.016 | 3.64 (7.30) | 22.79 (22.24) | 0.0020 |
Economy of motion, cm (SD) | 889.0 (214.8) | 696.2 (165.9) | 0.0020 | 765.5 (186.6) | 615.1 (124.8) | 0.0034 |
Time to completion, s (SD) | 792.9 (226.9) | 610.59 (185.8) | 0.0011 | 753.1 (227.4) | 550.34 (149.3) | 0.00016 |
Penalty subtotal (SD) | – 31.00 (16.85) | – 25.60 (11.79) | 0.075 | – 24.71 (10.61) | – 16.07 (5.38) | 0.0024 |
Qualitative interviews
Themes | Subthemes | Exemplar quotes |
---|---|---|
Novices encounter initial challenges with the robotic simulator that improve with exposure | 1. Lack of Familiarity – Orienting to the robot – Understanding goals and rules 2. Lack of technical skills – Body positioning – Instrument control – Needle handling 3. Visuospatial challenges – Depth perception | Familiarity—“I wasn’t fully cognizant of all the rules and also just conceptually figuring out how to use the clutch, when to use it, and how to orient yourself while you’re using it was a little bit tricky for me.” Technical skills—“The first time it was hard to maintain both of the arms of the robot in a distance so they don’t collide with themselves, that was challenging. I think I did that a couple times and…I was penalized.” Technical skills—“Just getting used to the clutch was really hard.” Technical skills—“I had a really hard time figuring out the orientation for the needle.” Visuospatial skills—“I feel like just getting used to the disconnect between what you’re seeing and then where your hands are, because not seeing your actual hands while you’re doing something.” |
Practice with the home simulation kit impacts the robotic simulator experience | 1. Technical skills – Needle handling – Wristed movements – Ambidexterity 2. Familiarity | Technical skills—“The needle threading for the home kit was pretty good because you get the dexterity of how to go about putting the needle in one hole and getting it out the other one.” Technical skills—“[The kit helped] needle control and kind of determining which ways I needed to twist my wrist and my fingers in order to get [the needle] to drive through, which definitely translated over here [at the robotic simulator].” Technical skills—“Just being a little bit more ambidextrous with how I did the needle driving activity and trying to use the other hand because I’m predominantly right–handed and I think for the first time I was using predominantly my right hand, but I was…more conscious of which hand I was using [during the second session].” Familiarity—“I learned how to go about the needle driving activity most efficiently, how to angle my hands so that I could basically just put the needle through very easily and seamlessly.” |
The fidelity of the home simulation kit could be improved | 1. Model design transferability – No clutch on home model – More resistance than robot 2. Mechanical challenges | Model design—“If you’re actually threading the needle through the real sponge, you’re going to feel resistance, but here [on the robotic simulator], you don’t feel anything.” Mechanical challenges—“The tips of the tweezers didn’t have much grip either, and so you’re… pressing really, really hard to hold the needle in place, because otherwise it was just slipping out of place. So I guess maybe swap to a different type of tweezer that might have more grip.” |
Novices encounter initial challenges with the robotic simulator that improve with exposure
“I would say at first the most challenging is just being intentional with all of my hand movements. I wasn’t fully cognizant of all the rules and also just conceptually figuring out how to use the clutch, when to use it, and how to orient yourself while you’re using it was a little bit tricky for me.” (Experimental Participant #18)
“The first time it was hard to maintain both of the arms of the robot in a distance so they don't collide with themselves, that was challenging. I think I did that a couple times and…I was penalized.” (Control Participant #1)
“Just getting used to the clutch was really hard. I usually forgot to engage the clutch and so I would twist myself into like 35 positions, which made it hard.” (Experimental Participant #27)
“I had a really hard time figuring out orientation for the needle…so that I could insert it correctly, and that it came out exactly where I wanted it to, because I would put the needle into the sponge and pretty much have no idea how to turn my hand or where it was basically in the surface.” (Control Participant #16)
“I feel like just getting used to the disconnect between what you’re seeing and then where your hands are, because not seeing your actual hands while you’re doing something.” (Control Participant #22)
Practice with the home simulation kit impacts the robotic simulator experience
“[The home simulation kit was] helpful to do the motion; just have your fingers in the right place and kind of pick things up and put things down. The sponge was helpful in judging the needle orientation, and the hand motions you need to do the scoop.” (Experimental Participant #12)“[The kit helped] needle control and kind of determining which ways I needed to twist my wrist and my fingers in order to get [the needle] to drive through, which definitely translated over here [at the robotic simulator].” (Experimental Participant #17)
“Just being a little bit more ambidextrous with how I did the needle driving activity and trying to use the other hand because I’m predominantly right-handed and I think for the first time I was using predominantly my right hand, but I was…more conscious of which hand I was using [during the second session].” (Experimental Participant #18)
“It's definitely a different haptic feeling. I felt like it was harder to drive the needle through the sponge than it is to drive the needle through the fake robotic sponge. But, just having the haptic feedback was helpful and that is something you get with the home kit.” (Experimental Participant #12)
“I learned how to go about the needle driving activity most efficiently, how to angle my hands so that I could basically just put the needle through very easily and seamlessly.” (Experimental Participant #18)“I think that I was a little bit like, I wouldn’t say slower, but more kind of methodical, and that's something that came from the practice.” (Experimental Participant #4)
The fidelity of the home simulation kit could be improved
“If you’re actually threading the needle through the real sponge, you’re going to feel resistance, but here [on the robotic simulator], you don’t feel anything.” (Participant #14)
“Maybe put some type of pad for the clutch, because this basically felt slightly different…I got used to pressing with my finger curled up and when I was like, ‘Oh wait, where’s the clutch?’ and I had to re-find the clutch.” (Experimental Participant #26)
“The tips of the tweezers didn’t have much grip either, and so you’re… pressing really, really hard to hold the needle in place, because otherwise it was just slipping out of place. So I guess maybe swap to a different type of tweezer that might have more grip.” (Experimental Participant #17)