title: Early exposure to haptic feedback enhances performance in surgical simulator training: a prospective randomized crossover study in surgical residents.
abstract: BACKGROUND
  In the literature of skill acquisition and transfer of skills, it often is assumed that the rate of skill acquisition depends on what has been learned in a similar context (i.e., surgical simulators providing haptic feedback). This study aimed to analyze whether the addition of haptic feedback early in the training phase for image-guided surgical simulation improves performance.
  
  
  METHODS
  A randomized crossover study design was used, in which 38 surgical residents were randomized to begin a 2-h simulator training session with either haptic or nonhaptic training followed by crossover after 1 h. The graphic context was a virtual upper abdomen. The residents performed two diathermy tasks. Two validated tests were used to control for differences in visual-spatial ability: the BasIQ general cognitive ability test and Mental Rotation Test A (MRT-A).
  
  
  RESULTS
  After 2 h of training, the group that had started with haptic feedback performed the two diathermy tasks significantly better (p < 0.05, unpaired t-test). Only the group that had started with haptic training significantly improved during the last 1-h session (p < 0.01, paired t-test).
  
  
  CONCLUSIONS
  The findings indicate that haptic feedback could be important in the early training phase of skill acquisition in image-guided surgical simulator training.
authors.affiliation: Division of Orthopaedics, Department for Science Intervention and Technology, Center for Advanced Medical Simulation, Karolinska Institutet at Karolinska University Hospital Huddinge, SE 141 86, Stockholm, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Ström
authors.forename: L
authors.initials: L
authors.lastname: Hedman
authors.forename: L
authors.initials: L
authors.lastname: Särnå
authors.forename: A
authors.initials: A
authors.lastname: Kjellin
authors.forename: T
authors.initials: T
authors.lastname: Wredmark
authors.forename: L
authors.initials: L
authors.lastname: Felländer-Tsai
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D003198:Computer Simulation; D018592:Cross-Over Studies; D004867:Equipment Design; D005246:Feedback; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D025321:Surgery, Computer-Assisted / Q000193:education*; D013664:Teaching Materials; D014110:Touch; D014584:User-Computer Interface