Indirect vision through a mirror, while bi-manually manipulating both the mirror and another tool is a relatively common way to perform operations in various types of surgery. However, learning such psychomotor skills requires extensive training; they are difficult to teach; and they can be quite costly, for instance, for dentistry schools. In order to study the effectiveness of VR simulators for learning these kinds of skills, we developed a simulator for training dental surgery procedures, which supports tracking of eye gaze and tool trajectories (mirror and drill), as well as automated outcome scoring. We carried out a pre-/post-test study in which 30 fifth-year dental students received six training sessions in the access opening stage of the root canal procedure using the simulator. In addition, six experts performed three trials using the simulator. The outcomes of drilling performed on realistic plastic teeth showed a significant learning effect due to the training sessions. Also, students with larger improvements in the simulator tended to improve more in the real-world tests. Analysis of the tracking data revealed novel relationships between several metrics w.r.t. eye gaze and mirror use, and performance and learning effectiveness: high rates of correct mirror placement during active drilling and high continuity of fixation on the tooth are associated with increased skills and increased learning effectiveness. Larger time allocation for tooth inspections using the mirror, i.e., indirect vision, and frequency of inspection are associated with increased learning effectiveness. Our findings suggest that eye tracking can provide valuable insights into student learning gains of bi-manual psychomotor skills, particularly in indirect vision environments.

During arthroscopic surgeries, surgeons are faced with challenges like cognitive re-projection of the 2D screen output into the 3D operating site or navigation through highly similar tissue. Training of these cognitive processes takes much time and effort for young surgeons, but is necessary and crucial for their education. In this study we want to show how to recognize states of confusion of young surgeons during an arthroscopic surgery, by looking at their eye and head movements and feeding them to a machine learning model. With an accuracy of over 94% and detection speed of 0.039 seconds, our model is a step towards online diagnostic and training systems for the perceptual-cognitive processes of surgeons during arthroscopic surgeries.

With the minute margins of error in endodontic surgery, training in manual dexterity and proper instrument handling are crucial components in the dental curriculum. Important parameters include tool path, tool angulation, and force applied. In this work, we focus on training of correct application of force. This is particularly challenging since the amounts of force used are on the order of tenths of Newtons, requiring a highly refined tactile sense and incorrect force can cause irreversible damage. Too great a force can cause overdrilling or in extreme cases perforation of the tooth. Too small a force can cause thermal irritation possibly resulting in tissue necrosis. Despite the importance of correct use of force, this is the dimension on which students receive the least tutorial feedback since force information is typically not available in traditional training settings. In this paper, we present an approach to using haptic feedback as a means to convey formative feedback on the correct application of force. Feedback is conveyed to the student graphically and the correct amount of force to apply is trained haptically. The simulator is rewound and the student is asked to redo the stage where the error occurred. Preliminary evaluation against a control group of students who received only feedback concerning outcome shows the feedback mechanism to be effective.

Numerous VR simulators have been developed as a means of addressing limitations of the traditional apprenticeship approach to dental surgical skill training. Most existing simulators support intra- and extra-coronal procedures such as carries removal. In this paper we address the problem of automated outcome assessment for endodontic surgery. Outcome assessment is an essential component of any system that provides formative feedback, which requires assessing the outcome, relating it to the procedure, and communicating in a language natural to dental students. This paper takes a first step toward automated generation of such comprehensive feedback. Our system automatically computes reference templates based on tooth anatomy, which provides flexibility to adjust parameters such as tolerance and to create new templates on demand. Detailed scores are transformed into the standard scoring language used by dental schools. Preliminary evaluation of our system on fifteen outcome samples with three expert endodontists shows a high degree of agreement with expert scores.