title: Game-based training improves the surgeon's situational awareness in the operation room: a randomized controlled trial.
abstract: Equipment-related malfunctions directly relate to one-fourth of the adverse events in the surgical theater. A serious game trains residents to recognize and respond to equipment problems in minimally invasive surgery (MIS). These include disturbed vision, gas transport, electrocautery, and pathophysiological disturbances. This randomized controlled trial explores whether game-based training improves surgical residents' response to equipment-related problems during surgery.
  
  
  
  Thirty-one surgical residents with no previous experience in MIS took part in a standardized basic laparoscopy training course. Fifteen residents were randomly assigned to the game-enhanced curriculum (intervention) and sixteen were assigned to the regular curriculum (control). Participants performed a MIS task in a live anesthetized pig model, during which three standardized equipment malfunction scenarios occurred. Observers recorded the problems recognized and solved, time, and participants' technical performance.
  
  
  
  Twenty-four participants completed the post-test (n = 12 per group). The intervention group solved more problems than the control group (59 vs. 33%, p = 0.029). The intervention group also recognized a larger proportion of problems, although this parameter was non-significant (67 vs. 42%, p = 0.14). Random effects modeling showed a significant improved game performance per participant over time.
  
  
  
  Surgical residents, who play for only 1 h on a custom-made serious game, respond significantly better to equipment-related problems during surgery than residents trained by a standard training curriculum. These results imply that entertaining serious games can indeed be considered for use in official training for surgeons and other medical specialists.
authors.affiliation: Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. maurits.graafland@gmail.com.
authors.forename: Maurits
authors.identifier: 0000-0003-1059-698X
authors.initials: M
authors.lastname: Graafland
authors.affiliation: Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
authors.forename: Willem A
authors.initials: WA
authors.lastname: Bemelman
authors.affiliation: Department of Surgery, Academic Medical Centre, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. m.p.schijven@amc.uva.nl.
authors.forename: Marlies P
authors.initials: MP
authors.lastname: Schijven
mesh_terms: D000328:Adult; D000818:Animals; D001364:Awareness; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003479:Curriculum; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D059032:Learning Curve; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000193:education*; D009873:Operating Rooms; D011340:Problem Solving; D000066908:Simulation Training / Q000379:methods; D013552:Swine; D018910:Video Games
keywords: Cholecystectomy; Medical education; Minimally invasive surgery; Smartphone; Videogame; eHealth