title: A new virtual-reality training module for laparoscopic surgical skills and equipment handling: can multitasking be trained? A randomized controlled trial.
abstract: OBJECTIVE
  During laparoscopic surgery distractions often occur and multitasking between surgery and other tasks, such as technical equipment handling, is a necessary competence. In psychological research, reduction of adverse effects of distraction is demonstrated when specifically multitasking is trained. The aim of this study was to examine whether multitasking and more specifically task-switching can be trained in a virtual-reality (VR) laparoscopic skills simulator.
  
  
  METHODS
  After randomization, the control group trained separately with an insufflator simulation module and a laparoscopic skills exercise module on a VR simulator. In the intervention group, insufflator module and VR skills exercises were combined to develop a new integrated training in which multitasking was a required competence. At random moments, problems with the insufflator appeared and forced the trainee to multitask. During several repetitions of a different multitask VR skills exercise as posttest, performance parameters (laparoscopy time, insufflator time, and errors) were measured and compared between both the groups as well with a pretest exercise to establish the learning effect. A face-validity questionnaire was filled afterward.
  
  
  METHODS
  University Medical Centre Utrecht, The Netherlands.
  
  
  METHODS
  Medical and PhD students (n = 42) from University Medical Centre Utrecht, without previous experience in laparoscopic simulation, were randomly assigned to either intervention (n = 21) or control group (n = 21).
  
  
  RESULTS
  All participants performed better in the posttest exercises without distraction of the insufflator compared with the exercises in which multitasking was necessary to solve the insufflator problems. After training, the intervention group was significantly quicker in solving the insufflator problems (mean = 1.60Log(s) vs 1.70Log(s), p = 0.02). No significant differences between both the groups were seen in laparoscopy time and errors.
  
  
  CONCLUSIONS
  Multitasking has negative effects on the laparoscopic performance. This study suggests an additional learning effect of training multitasking in VR laparoscopy simulation, because the trainees are able to handle a secondary task (solving insufflator problems) quicker. These results may aid the development of laparoscopy VR training programs in approximating real-life laparoscopic surgery.
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors.forename: Pim J
authors.initials: PJ
authors.lastname: Bongers
authors.affiliation: Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: Diederick van Hove
authors.affiliation: Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Laurents P S
authors.initials: LP
authors.lastname: Stassen
authors.affiliation: Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands.
authors.forename: Jenny
authors.initials: J
authors.lastname: Dankelman
authors.affiliation: Department of Reproductive Medicine and Gynaecology, University Medical Centre Utrecht, Utrecht, The Netherlands. Electronic address: h.w.r.schreuder@umcutrecht.nl.
authors.forename: Henk W R
authors.initials: HW
authors.lastname: Schreuder
mesh_terms: D000328:Adult; D001288:Attention; D016009:Chi-Square Distribution; D002983:Clinical Competence; D003198:Computer Simulation; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D020706:Laparoscopes / Q000706:statistics & numerical data; D010535:Laparoscopy / Q000193:education* / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D013647:Task Performance and Analysis; D014584:User-Computer Interface; D055815:Young Adult
keywords: Medical Knowledge; Practise-Based Learning and Improvement; distraction; education; laparoscopy; multitasking; simulation; virtual reality