2016, Number 1
Surgical computer simulation training. Plato’s Cavern, Bacon’s Idols, The McDonaldization of Medicine and poor (self) critique
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ABSTRACTAlthough Technology-Enhanced Simulation (TES) training which implies high fidelity, haptic feedback, and virtual reality (VR) is very attractive, this belief lacks adequate empirical support. Many of the advantages attributed to it seem only apparent, intuitions and erroneous perceptions distorted by common, careless views. The effectiveness of TES is difficult to assess, the existing systematic studies and meta-analysis are imperfect and heterogeneous, highly variable and of inconsistent quality. TES provides some advantages in education, such as a controlled environment, replicability and deliberate practice, to err and learn from mistakes, an objective assessment of skills, and yields better although not significant results in knowledge, learning skills and behaviors, and have a small to moderate effect on overall patient care, findings that could be due to chance. Unimproved simulators allow a limited number of skills, navigation by camera, two-dimensional view, cuts, sutures and knots. Simulators are no placebo, but no panacea; they can be good complements in medical and surgical training, but do not replace an appropriate curriculum, dedicated teachers and rigorous evaluations.
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