Speaker at Games for Health Europe Conference 2014

1. Safe Surgery–Start Gaming!
Maurits Graafland
Willem Bemelman
Marlies Schijven
The effect of a seriousgame on the surgeon’sabilitytosolveequipment-relatedproblemsin the OR

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

4. Introduction
Methods
Results
Discussion
Equipment-relatedproblemsduring(laparoscopic) surgeryare common
0,9 problemsper procedure (median; IQR 0.3 –3.6)1
1,9 per laparoscopicprocedure2
Potentiallyseriousconsequences
Delays, adverse events
20% of major surgicalerrorsassociatedwithequipment failure 1
1.Weerakkoodyet al.BMJ QualSaf2013;22(9):710-8
2.Verdaasdonk et al. SurgEndosc2007;21(2):275-9

5. Introduction
Methods
Results
Discussion
Surgeonmust divideattention betweensurgery, OR team & environment
Human brainhas limitedabilitytorecognizeunexpectedevents3
Training problem-solvingabilityis limited
Basic laparoscopycourse
Knowledge-retentionregardinglaparoscopicequipment is poor4
3. Drew T et al. PsycholScience 2013;24(9):1848-53
4. Menezeset al. J SurgEduc2011;68(1):3-5

6. Introduction
Methods
Results
Discussion
SeriousGame trainssurgeonsin recognizingandsolvingequipment-relatedproblems
SeriousGame
WeirdbeardB.V.
Fun, challengingandmotivating
Learning occurseffortlessly
Stealthlearning

12. Introduction
Methods
Results
Discussion
Aim:
Objectifyeffect of seriousgame on howsurgicaltrainees deal withequipment-relatedproblemsduringsurgery
Hypothesis:
Trainees whocompleteda game-enhancedcurriculum are betterin recognizingandsolvingequipment-relatedproblemsthantrainees trainedthe regularway

13. Introduction
Methods
Results
Discussion
Randomizedcontrolledtrial
Inclusion:
Residentsin surgicaltraining
No laparoscopicexperienceas primarysurgeon
Basic laparoscopycourse
AcademicMedicalCentre (single centre)
May 2013 -April 2014

14. Theorylaparoscopy
Laparoscopicbox trainer
Randomisation
‘closedenveloppe’
Intervention–THE GAME
-2x30 min seriousgame
Control group
Practical sessions
-Animalmodel
Practical sessions
-Animalmodel
Test
-Animalmodel
Test
-Animalmodel
Basic laparoscopycourse

15. Introduction
Methods
Results
Discussion
Primaryoutcome
% problemsrecognized
% problemssolved
Secondaryoutcome
Time torecognition
Time tosolving

16. Introduction
Methods
Results
Discussion
Test
Complete surgicaltaskin animalmodel (10 minutes)
3 standardizedequipment problemscenario’s
Measurement
Technical skills
Surgeon(blinded)
Problemsrecognized, solved, time
TrainedAssessor (blinded)
Power analysis: minimum of 12 participantsper group

17. Randomized
n = 31
Intervention
n= 15
Control
n= 16
Lost tofollow-up
n= 3
-No test (2)
-Test inadequate (1)
Lost tofollow-up
n= 4
-No test (2)
-Test inadequate (2)
Participants
Test completed
n= 12
Test completed
n= 12
Included
n = 31

18. Problems Recognized (%)
Problems Solved (%)
p= 0,14
p= 0,029*
100%
75%
50%
25%
0
Game Control
Game Control

19. Time
(s)
Time to recognition
Time to solving
p= 0,14
p= 0,24
Game Control
Game Control

20. Introduction
Methods
Results
Discussion
Trainees solvesignificantlymore equipment-relatedproblems
afteronly10 sessionsof gaming
Improvementproblem-recognition(trend)
Notstatisticallysignificant
… Validway totrain surgeons

21. Introduction
Methods
Results
Discussion
StudyLimitations
Underpowered?
High losstofollow-up
25% bothgroups
Test dependson qualityof execution

22. Introduction
Methods
Results
Discussion
Product
Availableon mobile platforms
Gamificationlayer(beat yourboss, leaderboards, etc.)
Usein “official” surgicaltraining
Andelsewhere(“voluntaryplay”)

23. Introduction
Methods
Results
Discussion
The future…
Effectson problemrecognition
Largernumbers
LongtermLearning effect
‘Voluntaryplay’

24. ThankYou
Sponsors
Developers
Research partners

25. Introduction
Methods
Results
Discussion
Seriousgame content
Insufflation+ gas transport
Lighting+ camera
Electrosurgery
Recognizingcomplicationslaparoscopicsurgery
Content validated
Surgeons
Technical specialists(equipment manufacturer)
Same type equipment usedas duringthe course

26. Introduction
Methods
Results
Discussion
Game
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
3
Othersurgicalspec.
7
9
Technical skill(OSATS)
(median, IQR)
2,4 (2,2 –3,2)
2,8 (2,2 –3,2)
Year
0
1
2
1
10
10
2
1
0
LaparoscopicExperience(n = 19)
None
11
8
Experiencenon- laparoscopicsurgery
(n = 19)
None
3
3
1-20 procedures
5
3
21-50 procedures
3
2
No. Gaming Sessies completed
(Mean, SD)
11,8 (±1,7)
-

27. n
Type opgelosteproblemen

28. 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
Problem solved (%)
Game session