Safe Surgery – Start Gaming!

Maurits Graafland

Willem Bemelman

Marlies Schijven

The effect of a serious game on the surgeon’s ability to

solve equipment-related problems in the OR

Defense: November 19th, 12.00 a.m. Agnietenkapel, University of Amsterdam

Introduction Methods Results Discussion

Equipment-related problems during (laparoscopic) surgery are common

0,9 problems per procedure (median; IQR 0.3 – 3.6) 1

1,9 per laparoscopic procedure 2

Potentially serious consequences

Delays, adverse events

20% of major surgical errors associated with equipment failure 1

1. Weerakkoody et al. BMJ Qual Saf 2013;22(9):710-8

2. Verdaasdonk et al. Surg Endosc 2007;21(2):275-9

Introduction Methods Results Discussion

Surgeon must divide attention between surgery, OR team & environment

Human brain has limited ability to recognize unexpected events3

Training problem-solving ability is limited Basic laparoscopy course

Knowledge-retention regarding laparoscopic equipment is poor4

3. Drew T et al. Psychol Science 2013;24(9):1848-53

4. Menezes et al. J Surg Educ 2011;68(1):3-5

Introduction Methods Results Discussion

Serious Game trains surgeons in recognizing andsolving equipment-related problems

Serious Game

Weirdbeard B.V.

Fun, challenging and motivating

Learning occurs effortlessly Stealth learning

Introduction Methods Results Discussion

Aim:

Objectify effect of serious game on how surgical trainees deal with equipment-related problems during surgery

Hypothesis:

Trainees who completed a game-enhanced curriculum are better in recognizing and solving equipment-related problemsthan trainees trained the regular way

Introduction Methods Results Discussion

Randomized controlled trial

Inclusion:

Residents in surgical training

No laparoscopic experience as primary surgeon

Basic laparoscopy course

Academic Medical Centre (single centre)

May 2013 - April 2014

Theory laparoscopyLaparoscopic box trainer

Randomisation‘closed enveloppe’

Intervention – THE GAME- 2x30 min serious game

Control group

Practical sessions- Animal model

Practical sessions- Animal model

Test- Animal model

Test- Animal model

Basic laparoscopy course

Introduction Methods Results Discussion

Primary outcome

% problems recognized

% problems solved

Secondary outcome

Time to recognition

Time to solving

Introduction Methods Results Discussion

Test Complete surgical task in animal model (10 minutes)

3 standardized equipment problem scenario’s

Measurement Technical skills

Surgeon (blinded)

Problems recognized, solved, time

Trained Assessor (blinded)

Power analysis: minimum of 12 participants per group

Randomizedn = 31

Interventionn = 15

Controln = 16

Lost to follow-upn = 3- No test (2)- Test inadequate (1)

Lost to follow-upn = 4- No test (2)- Test inadequate (2)

Participants

Test completedn = 12

Test completedn = 12

Includedn = 31

Problems Recognized (%) Problems Solved (%)

p = 0,14 p = 0,029*

100%

75%

50%

25%

0

Game Control Game Control

Time(s)

Time to recognition Time to solving

p = 0,14p = 0,24

Game Control Game Control

Introduction Methods Results Discussion

Trainees solve significantly more equipment-related problems after only 10 sessions of gaming

Improvement problem-recognition (trend) Not statistically significant

… Valid way to train surgeons

Introduction Methods Results Discussion

Study Limitations

Underpowered?

High loss to follow-up 25% both groups

Test depends on quality of execution

Introduction Methods Results Discussion

Product

Available on mobile platforms

Gamification layer (beat your boss, leaderboards, etc.)

Use in “official” surgical training

And elsewhere (“voluntary play”)

Introduction Methods Results Discussion

The future…

Effects on problem recognition Larger numbers

Longterm Learning effect

‘Voluntary play’

Thank You

SponsorsDevelopers Research partners

Introduction Methods Results Discussion

Serious game content Insufflation + gas transport

Lighting + camera

Electrosurgery

Recognizing complications laparoscopic surgery

Content validated Surgeons

Technical specialists (equipment manufacturer)

Same type equipment used as during the course

Introduction Methods Results DiscussionGame Control

Group size (n) 12 12

Age (mean) 29 29

M/F M 58.3% 58.3%F 41.7% 41.7%

Specialty Gen. Surgery 5 3Other surgical spec. 7 9

Technical skill (OSATS) (median, IQR) 2,4 (2,2 – 3,2) 2,8 (2,2 – 3,2)

Year 0 1 21 10 102 1 0

Laparoscopic Experience

(n = 19)

None 11 8

Experience non-

laparoscopic surgery

(n = 19)

None 3 3

1-20 procedures 5 321-50 procedures 3 2

No. Gaming Sessies

completed

(Mean, SD) 11,8 (± 1,7) -

n

Type opgeloste problemen

Random effects model:

2,3% improvement Game Score per Session (p = 0.000)

Learning curve in Game group

Problems Solved (%)

0 5 10 15

0

20

40

60

80

100

Problems solved after game session

session

Pro

ble

m s

olv

ed (

%)

Game session