| 1. |
- Ahlborg, Liv
(author)
-
Go with the flow : to facilitate learning in laparoscopic gynecology
- 2013
-
Doctoral thesis (other academic/artistic)abstract
- Background: Education in medicine, particularly in surgical disciplines, is crucial since it affects patient safety. The learning process is dependent on individual abilities, prior knowledge and the learning environment. Evidence of simulators’ positive impact on actual laparoscopic performance is mounting. However, less attention has been given to non-technical factors that might have direct effect on both simulated and real laparoscopic performance. Aims of the thesis: 1. To evaluate if visuospatial ability, as measured by the Mental rotation test A, correlates with gynecological simulated laparoscopic performance (paper I); 2. To examine if self-efficacy and flow are associated with simulated laparoscopic performance (paper II); 3. To investigate if visuospatial ability, self-efficacy, flow and simulator training in LapSimGyn®, with or without mentorship with feedback influence performance in laparoscopic tubal occlusion (paper III); 4. To evaluate the effect of mentorship with feedback on simulated laparoscopic performance using both quantitative and qualitative methods (paper IV). Materials and methods: The participants in the studies were consultants or residents in obstetrics and gynecology or medical students. Validated tests, questionnaires and scales assessed visuospatial ability, self-efficacy and flow. Simulator training was conducted in LapSimGyn®. Laparoscopic performance was measured as duration of surgery in the laparoscopic tubal occlusions. Group interviews and inductive thematic analyses were used to evaluate mentorship. Results: This thesis demonstrates that visuospatial ability correlated with duration of surgery in early gynecological laparoscopic simulator performance (r: -0.64, p<0.05) as well as in early laparoscopic performance (rho: -0.98, p<0.05), Papers I-III. Simulator training appeared to enhance both self-efficacy and flow, Papers II & III. Moreover, the findings suggested that laparoscopic performance was improved by simulator training with, or without, structured mentorship and by increased flow and self-efficacy among the trainees. Duration of surgery was significantly shorter in the trained groups (median 340 s, IQR: 285-537) as compared to the control group (median 760 s, IQR: 573-1218), Paper III. Mentorship with feedback influenced laparoscopic simulator performance. Right instrument path length was shorter in the mentor group (median 3.9 m, IQR: 3.3-4.9) as compared to the control group (median 5.9 m, IQR: 5.0-8.1). Students in the mentor and non-mentor groups expressed the importance of getting support and being acknowledged, Paper IV. Conclusions: Simulator training, supportive mentorship with feedback, visuospatial ability, self-efficacy and flow are all tools or factors that have the potential to facilitate learning in gynecological laparoscopy and improve the surgical performance. Creating a learning environment with these factors in mind might therefore lead to improved patient safety.
|
|
| 2. |
- Ahlborg, Liv, et al.
(author)
-
Individualized feedback during simulated laparoscopic training : a mixed methods study.
- 2015
-
In: International Journal of Medical Education. - : International Journal of Medical Education. - 2042-6372. ; 6, s. 93-100
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: This study aimed to explore the value of individualized feedback on performance, flow and self-efficacy during simulated laparoscopy. Furthermore, we wished to explore attitudes towards feedback and simulator training among medical students.METHODS: Sixteen medical students were included in the study and randomized to laparoscopic simulator training with or without feedback. A teacher provided individualized feedback continuously throughout the procedures to the target group. Validated questionnaires and scales were used to evaluate self-efficacy and flow. The Mann-Whitney U test was used to evaluate differences between groups regarding laparoscopic performance (instrument path length), self-efficacy and flow. Qualitative data was collected by group interviews and interpreted using inductive thematic analyses.RESULTS: Sixteen students completed the simulator training and questionnaires. Instrument path length was shorter in the feedback group (median 3.9 m; IQR: 3.3-4.9) as compared to the control group (median 5.9 m; IQR: 5.0-8.1), p<0.05. Self-efficacy improved in both groups. Eleven students participated in the focus interviews. Participants in the control group expressed that they had fun, whereas participants in the feedback group were more concentrated on the task and also more anxious. Both groups had high ambitions to succeed and also expressed the importance of getting feedback. The authenticity of the training scenario was important for the learning process.CONCLUSIONS: This study highlights the importance of individualized feedback during simulated laparoscopy training. The next step is to further optimize feedback and to transfer standardized and individualized feedback from the simulated setting to the operating room.
|
|
| 3. |
- Ahlborg, Liv, et al.
(author)
-
Non-technical factors influence laparoscopic simulator performance among OBGYN residents
- 2012
-
In: Gynecological Surgery. - : Springer. - 1613-2076 .- 1613-2084. ; 9:4, s. 415-420
-
Journal article (peer-reviewed)abstract
- In addition to technical skills, nontechnical factors appear to influence surgical results. This study aims to analyze how visuospatial ability, self-efficacy, and flow are associated with simulated laparoscopic performance of residents in obstetrics and gynecology (OBGYN). In this cohort study, 28 residents in obstetrics and gynecology were tested for visuospatial ability and self-efficacy prior to simulator training. All participants subsequently conducted a basic set of tasks in the simulator. Self-efficacy, once again, and flow were assessed after training. Nineteen of the subjects then completed a 2-day course with identical simulator tasks, although now to a predefined credential level. Visuospatial ability correlated with simulator performance in the technically most advanced simulator task in the basic set ("total time," r=-0.40, p=0.039). Flow correlated with: "right instrument pathway"(r=-0.40, p=0.004) in that same task and with the 2-day overall training results (r=-0.56, p=0.017). Self-efficacy correlated with the 2-day result (r=-0.56, p=0.013) and significantly improved after training (p=0.011). When constructing a curriculum for OBGYN residents, visuospatial abilities and non-technical factors like flow and self-efficacy should be considered.
|
|
| 4. |
- Ahlborg, Liv, et al.
(author)
-
Simulator training and non-technical factors improve laparoscopic performance among OBGYN trainees
- 2013
-
In: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley-Blackwell. - 0001-6349 .- 1600-0412. ; 92:10, s. 1194-1201
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate how simulator training and non-technical factors affect laparoscopic performance among residents in obstetrics and gynecology. DESIGN: In this prospective study, trainees were randomized into three groups. The first group was allocated to proficiency-based training in the LapSimGyn(®) virtual reality simulator. The second group received additional structured mentorship during subsequent laparoscopies. The third group served as control group. At baseline an operation was performed and visuospatial ability, flow and self-efficacy were assessed. All groups subsequently performed three tubal occlusions. Self-efficacy and flow were assessed before and/or after each operation. SETTING: Simulator training was conducted at the Center for Advanced Medical Simulation and Training, Karolinska University Hospital. Sterilizations were performed at each trainee's home clinic. POPULATION: Twenty-eight trainees/residents from 21 hospitals in Sweden were included. METHODS/MAIN OUTCOME MEASURES: Visuospatial ability was tested by the Mental Rotation Test-A. Flow and self-efficacy were assessed by validated scales and questionnaires. Laparoscopic performance was measured as the duration of surgery. Visuospatial ability, self-efficacy and flow were correlated to the laparoscopic performance using Spearman's correlations. Differences between groups were analyzed by the Mann-Whitney U-test. RESULTS: No differences across groups were detected at baseline. Self-efficacy scores before and flow scores after the third operation were significantly higher in the trained groups. Duration of surgery was significantly shorter in the trained groups. Flow and self-efficacy correlate positively with laparoscopic performance. CONCLUSIONS: Simulator training and non-technical factors appear to improve the laparoscopic performance among trainees/residents in obstetrics and gynecology.
|
|
| 5. |
- Ahlborg, Liv, et al.
(author)
-
Visuospatial ability correlates with performance in simulated gynecological laparoscopy
- 2011
-
In: European Journal of Obstetrics, Gynecology, and Reproductive Biology. - : Elsevier BV. - 0301-2115 .- 1872-7654. ; 157:1, s. 73-77
-
Journal article (peer-reviewed)abstract
- Objective: To analyze the relationship between visuospatial ability and simulated laparoscopy performed by consultants in obstetrics and gynecology (OBGYN). Study design: This was a prospective cohort study carried out at two community hospitals in Sweden. Thirteen consultants in obstetrics and gynecology were included. They had previously independently performed 10-100 advanced laparoscopies. Participants were tested for visuospatial ability by the Mental Rotations Test version A (MRT-A). After a familiarization session and standardized instruction, all participants subsequently conducted three consecutive virtual tubal occlusions followed by three virtual salpingectomies. Performance in the simulator was measured by Total Time, Score and Ovarian Diathermy Damage. Linear regression was used to analyze the relationship between visuospatial ability and simulated laparoscopic performance. The learning curves in the simulator were assessed in order to interpret the relationship with the visuospatial ability. Results: Visuospatial ability correlated with Total Time (r = -0.62; p = 0.03) and Score (r = 0.57; p = 0.05) in the medium level of the virtual tubal occlusion. In the technically more advanced virtual salpingectomy the visuospatial ability correlated with Total Time (r = -0.64; p = 0.02), Ovarian Diathermy Damage (r = -0.65; p = 0.02) and with overall Score (r = 0.64; p = 0.02). Conclusions: Visuospatial ability appears to be related to the performance of gynecological laparoscopic procedures in a simulator. Testing visuospatial ability might be helpful when designing individual training programs.
|
|
