title: Developing effective automated feedback in temporal bone surgery simulation.
abstract: OBJECTIVE
  We aim to test the effectiveness, accuracy, and usefulness of an automated feedback system in facilitating skill acquisition in virtual reality surgery.
  
  
  METHODS
  We evaluate the performance of the feedback system through a randomized controlled trial of 24 students allocated to feedback and nonfeedback groups.
  
  
  METHODS
  The feedback system was based on the Melbourne University temporal bone surgery simulator. The study was conducted at the simulation laboratory of the Royal Victorian Eye and Ear Hospital, Melbourne.
  
  
  METHODS
  The study participants were medical students from the University of Melbourne, who were asked to perform virtual cortical mastoidectomy on the simulator. The extent to which the drilling behavior of the feedback and nonfeedback groups differed was used to evaluate the effectiveness of the system. Its accuracy was determined through a postexperiment observational assessment of recordings made during the experiment by an expert surgeon. Its usability was evaluated using students' self-reports of their impressions of the system.
  
  
  RESULTS
  A Friedman's test showed that there was a significant improvement in the drilling performance of the feedback group, χ(2)(1) = 14.450, P < .001. The postexperiment assessment demonstrated that the system provided timely feedback (when trainee behavior was detected) 88.6% of the time and appropriate feedback (accurate advice) 84.2% of the time. Participants' opinions about the usefulness of the system were highly positive.
  
  
  CONCLUSIONS
  The automated feedback system was observed to be effective in improving surgical technique, and the provided feedback was found to be accurate and useful.
authors: Department of Otolaryngology, University of Melbourne, Australia swijewickrem@unimelb.edu.au.
authors: Sudanthi
authors: S
authors: Wijewickrema
authors: Department of Otolaryngology, University of Melbourne, Australia.
authors: Patorn
authors: P
authors: Piromchai
authors: Department of Computing & Information Systems, University of Melbourne, Australia.
authors: Yun
authors: Y
authors: Zhou
authors: Department of Otolaryngology, University of Melbourne, Australia.
authors: Ioanna
authors: I
authors: Ioannou
authors: Department of Computing & Information Systems, University of Melbourne, Australia.
authors: James
authors: J
authors: Bailey
authors: Centre for the Study of Higher Education, University of Melbourne, Australia.
authors: Gregor
authors: G
authors: Kennedy
authors: Department of Otolaryngology, University of Melbourne, Australia.
authors: Stephen
authors: S
authors: O'Leary
mesh_terms: D000328:Adult; D001315:Australia; D001331:Automation / Q000379:methods*; D002983:Clinical Competence; D003198:Computer Simulation; D016001:Confidence Intervals; D004504:Education, Medical, Undergraduate / Q000379:methods; D004521:Educational Measurement; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008416:Mastoid / Q000601:surgery; D013506:Otologic Surgical Procedures / Q000193:education; D013337:Students, Medical / Q000706:statistics & numerical data; D013701:Temporal Bone / Q000033:anatomy & histology / Q000601:surgery*; D014584:User-Computer Interface
keywords: automated feedback in surgery simulation; simulation-based surgical training; virtual reality temporal bone surgery