A combination of the "brainstorming" format and 3d - tracking techniques for developing muscle memory during surgery training Ivano-Frankivsk National Medical University (Ivano-Frankivsk, Ukraine)

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A combination of the "brainstorming" format and 3d - tracking techniques for developing muscle memory during surgery training Ivano-Frankivsk National Medical University (Ivano-Frankivsk, Ukraine)

Pantus A. V.

The main task of the credit-module system of the organization of the educational process is the selection of forms and methods that can provide students with new knowledge and involve them in the system of continuous professional education. One of these learning methods in higher education is "brainstorming", the most accessible form of discussion. It is a good way to quickly involve all group members in work based on the free expression of their thoughts. In addition to "brainstorming" techniques, the training of a surgical specialist also includes a practical part that ensures the development of the so-called "muscle memory", the coordination of the surgeon's movements and the feeling when working with living tissues. This work aims to analyze the conduct of a practical lesson on surgical dentistry in the format of "brainstorming" in combination with interactive reality technologies. In the individual assessment of students' work, attention should be paid to the following criteria: 1) compliance with work rules, principles and methods of "brainstorming"; 2) sufficient activity in the generation of ideas and their examination; 3) knowledge of known ways of solving a given clinical situation, offering original non-stereotypical solution methods (or ideas that became the basis for the development of such ways and methods); 4) the ability to integrate (interdisciplinary integration) the acquired knowledge. The final element of solving surgical tasks for students should be the application of manual skills by developing the so-called "muscle memory". Using the Motion Capture and Hand Capture system with an interactive environment made it possible to focus students' attention on cognitive and sensory corrections, namely, eliminating tremors and memorizing the coordination of instrument movements during manipulation. The pedagogical effectiveness of the interactive methods of "brainstorming" and "muscle memory" lies in the fact that this method achieves the goals of medical education. interactive teaching professional training

Key words: interactive teaching methods, professional training, surgical dentistry.

Introduction

The European credit-module system aims to optimise the educational process, connected with the growing demands on the student, his ability to analyse and process large amounts of information in a limited period, and the formation of practical skills and abilities. Therefore, the main task of the credit-module system of organising the educational process is the selection of forms and methods that can not only provide students with new knowledge but also involve them in the system of continuous professional education and self-education [1, 2].

Ukrainian realities of higher medical education, following global trends, require, along with the traditional system of training students, to give preference to innovative technologies in the pedagogical process at clinical departments. The interactive learning model involves using a set of interactive technologies with common principles of interaction: multilateral communication; interaction and mutual education of students; cooperative educational activity with corresponding changes in the roles and functions of both students and teachers [3].

One of the most popular methods of interactive learning in higher education is brainstorming. In educational and pedagogical practice, this method is the most accessible form of discussion, a good way to quickly include all members of the group in work based on the free expression of their thoughts.

The analysis of publications allows us to ascertain the fact that this method of "brainstorming" is in demand in practical classes [4].

In addition to "brainstorming" techniques, the training of a surgical specialist also includes a practical part, which ensures the development of the so-called "muscle memory", the coordination of the surgeon's movements and the feeling when working with living tissues. The last stage of training provides only the student's manual skills, which can be obtained when working with a patient or on special medical phantoms. The narrow range of manipulations and the high phantoms' cost limit their use. The optimal solution is interactive 3D technologies [5, 6]. The capabilities of computer graphics, simulation of physical properties of various materials, realistic skeletal animation, and systems of augmented and virtual reality in combination with sensors for tracking movement in real time make it possible to create medical simulators with the simulation of a wide range of surgical pathologies and integrate into the operator's virtual environment [7, 8, 9].

The aim of the study

To analyze the conduct of a practical class on surgical dentistry in the format of "brainstorming" in combination with the technologies of interactive reality.

Main part

The term "brainstorming" was introduced by the head of the advertising agency Alex Osborne in the USA in the late 1930s as a method of the team search for a solution, and finally took shape and became known to a wide range of specialists with the publication in 1953 of his book "Guided Imagination", in which revealed principles and procedures of creative thinking. A significant difference between brainstorming and other forms of group activity is the absence of criticism and feedback [3, 4].

As a rule, brainstorming is conducted in groups of 7-9 students. Technological stages of brainstorming in the educational process: preparatory, idea generation stage, idea analysis stage, idea evaluation and selection stage brainstorming participants' work analysis and evaluation stage.

The main elements of brainstorming are topic (problem), list of operations and rules for their implementation, role positions of participants (critic, idea generator, analyst, speaker), constructive criticism, combination of group and collective forms of work.

The learning model in the brainstorming mode is presented as a scheme (plan) of the teacher's actions, who moderates communicative and dialogic activity in the educational process, with the predominant activity of students [4].

Structurally, the method is a two-stage procedure for solving the problem. A shorter sequence of actions, the essence of the brainstorming method, has gained wide popularity. The method includes two main stages:

- stage of puffing forth (generation) of ideas;

- the stage of analysis of the proposed ideas.

Work within the framework of these stages must comply with several basic rules, namely: prohibition of criticism; prohibition of substantiation of proposed ideas; encouragement of all submitted ideas, including unrealistic and fantastic ones.

At the analysis stage, the basic rule is to identify a rational basis for each analyzed idea.

It is essential to form a detailed definition of brainstorming. The following definition variant can be considered the most accurate: the method of group nominating alternative ways of solving the problem with a systematic assessment and developing their hidden possibilities.

It is important to state that brainstorming, and even more so the stage of generating ideas, is not a means of solving problems but a method of finding alternative solutions. Such a search is carried out at the initial stage of the solution, at a time when there is no data on possible ways and means of solution, that is, in conditions of zero or deliberately insufficient information [3, 10].

Students of the Faculty of Dentistry begin to study surgical dentistry at the III year. By this time, they already know the basic theoretical fundamental sciences and are ready for the meaningful perception of specific clinical concepts and actions.

Students of the IV, and especially the V course, theoretically already have their own limited clinical experience, so they are more willing to go to the discussion of clinical situations. In this regard, we consider it more reasonable to use the "brainstorming" method during practical classes in surgical dentistry in the IV and V courses.

The program in maxillofacial traumatology in the IV and V courses involves studying the treatment tactics of peacetime injuries and gunshot wounds, the organization of assistance in extreme situations: disasters, natural disasters, in which the lower jaw is often damaged. Diagnosing fractures of the lower jaw does not cause any particular difficulties. It is more difficult to diagnose fractures of the upper jaw, which are often combined with closed craniocerebral trauma of various degrees of severity. The nature of these injuries can be different: concussion, contusion of the brain, fracture of the skull base, intracranial hematoma and other combinations of cranial and maxillofacial injuries. When analyzing this topic using "brainstorming", students will understand the importance of careful anamnesis collection, a comprehensive examination of the patient with the obligatory involvement of a neurosurgeon in the examination. This is especially important in detecting retrograde amnesia in the patient, loss of consciousness at the time of injury and the presence of alcohol intoxication when insufficient examination or underestimation of symptoms can lead to tragic consequences. In addition, injuries to the bones of the face are sometimes combined with injuries to other areas of the body (neck, upper limbs, etc.). And then, taking into account the leading damage prevailing in severity, it is necessary to determine the sequence of stages and the scope of providing specialized care by a dental surgeon together with a neurosurgeon and other specialists (according to indications). These questions can also be worked out effectively using the "brainstorming" method".

The issues of oncology studied by students of the IV and V courses cover a large area of various pathological processes, ranging from easy-to-diagnose radicular and follicular cysts to severe, difficult-to-diagnose malignant tumours of facial tissues. The most common neoplastic processes on the face are a cancer of the lower lip, tongue, mucous membrane of the cheeks, malignant parotid gland tumours and upper jaw cancer [11].

When analyzing these nosological forms with students, the teacher should, in our opinion, focus on the most characteristic symptoms and complaints - first of all, on the practical absence of the last ones, especially in the case of clinical manifestations of the process. When analyzing this material, you can also use "brainstorming" to discuss vital issues such as the operation's scope, medical tactics for non-standard clinical courses, and the possibility of implementing reconstructive methods during surgery [2, 10].

Brainstorming aims to get many options on a given topic from the group in a short time. Brainstorming can demonstrate what students know; in the course of it, ideas capable of solving the problem can be proposed, and a structure for the exchange of views on the general experience and the students' wishes can be expressed.

The main goal and meaning are to accustom the student to a thorough examination of any patient according to the principle: look - see - think - decide, to consciously choose treatment tactics and, if the clinical picture of the disease does not fit into his scope of knowledge on the diagnosis of "familiar diseases", to refer to consultation or invite a more experienced specialist. An equally important criterion is the development of manual skills, namely, the so-called muscle memory, which should be an integral part of "brainstorming". And as a result - high-quality training of specialists, their training and development of clinical thinking, professional skills and abilities [3].

For a few minutes, students talk about the proposed topic and everything that comes to mind is written down on the board with chalk or on a flip-up notebook with a felt-tip pen. Everything is written down, no matter how vague, silly or controversial. For now, everything is just expressed, and there is no discussion yet since the goal is to receive many proposals. The first suggestions are followed by other ideas, as the imagination works unhindered. At this time, there are no bans, and no assessments are given; participants can later analyze the proposals, express disagreement and discuss all the proposed ideas. If the activity is weak, then the lead-

ing teacher can offer to write down some of his ideas, but before that, he must endure a pause. All opinions are recorded in words used by the one who proposes them; it is not allowed to give a negative assessment of any idea either to the teacher or to any group members; the group works not on quality but on quantity; the longer the list, the better; radical ideas are accepted; after all suggestions are collected, students should express their comments or their disagreement with the proposed comments or discuss other suggestions; it is useful when reviewing and evaluating the list to arrange the proposals in a certain order, for example, by grouping similar ideas.

It is also important not to allow the group to disrupt the order and thereby distract from the task; even a group accustomed to brainstorming tends to discuss proposals before all the ideas or thoughts have been collected. It is advisable to allocate one person to write down the suggestions, which will help the teacher manage the process and organize the group's suggestions. It will allow the leading teacher not to be distracted, to maintain visual contact with the group and not to slow down the pace of the group's mental process.

A sample of a clinical case description according to the topic proposed for discussion at a practical class of the III year.

A 35-year-old patient complains of pain when biting in the area of tooth 46. Objectively: the crown part of tooth 46 is destroyed by 2/3. A fistula is present on the mucous membrane of the gums in the area of tooth 46. On the X-ray, there is a focus of the destruction of bone tissue with indistinct contours up to 7 mm in size.

Examples of questions for generating ideas:

1) What is the most likely diagnosis?

2) What help should be given to this patient?

3) What type of pain relief would be the most rational in this case?

4) What tools and materials should be used during the manipulation?

After discussing the given situation, the teacher should provide a general and individual evaluation of the work. In the general assessment of the group's work, attention should be paid to the following criteria:

1) group generation of up to a hundred ideas in two academic hours is considered the norm; 2) compliance with work rules, principles and methods of brainstorming, the sufficient activity of all group members; 3) solution of the proposed task, all known ways of solving it are named, and original non-stereotypical methods of solution from this clinical case are proposed.

The final element of this task is the application of students' manual skills or the development of so-called "muscle memory". The analysis of manipulations should include such details as the presence or absence of hand tremors, the smoothness of movement of the tool, clear coordination of movements, the presence or absence of damage to anatomical structures, and the speed of manipulation. For such testing, we developed an interactive environment based on the example of trigeminal nerve block injections. The technique of conducting the blockades in the virtual environment was recorded in the trajectory of the tool concerning the three-dimensional model of the bones and soft tissues of the maxillofacial area. We used Leap Motion, which works on Motion Capture and Hand Capture technology, to duplicate and record the operator's movements in three-dimensional space in real time. Leap Motion works exclusively on Windows, MAC OS and Linux platforms. The sensory characteristics of the manipulation were analyzed and recorded by the computer in real-time and compared with the tool's template animation's movement trajectory.

An essential stage in creating a virtual training system was the visualization and control of not only one tool but also the construction of a virtual brush together with the tool, i.e. ensuring the operator's sense of presence in an interactive environment and maximum freedom of movement. According to the results of the observations, about 73% of the students experienced a 32% deviation from the initial trajectory of the tool during the first 20 minutes of practising the skills. 34% of students also had jump-like deviations, which indicated hand tremors during the skill performance. After 40 minutes, the deviation from standard movements decreased to 14%. An essential stage of this technique is creating an animated reference movement of a tool or the sequence of movements of a group of tools concerning a three-dimensional model of the operating field. On the three-dimensional models created by us, bone tissue, muscle, blood vessels and nerve endings of priority areas for manipulation were displayed. At the same time, the operator must correctly manipulate the three-dimensional virtual space without affecting critical anatomical structures, repeating the most identical trajectory of the tool's movement on the computer. Further development of such approaches will allow the surgeon's hand movements to be broadcast in a threedimensional environment in real-time directly from the operating room and combined with the hand movements of a learning operator.

In the individual assessment of students' work, attention should be paid to the following criteria: 1) compliance with work rules, principles and methods of "brainstorming"; 2) sufficient activity in the generation of ideas and their examination; 3) knowledge of known ways of solving a given clinical situation, offering original non-stereotypical solution methods (or ideas that became the basis for the development of such ways and methods); 4) the ability to integrate (interdisciplinary integration) the acquired knowledge.

Nevertheless, the main disadvantages of this method are the possibility of dominance by one or two leaders; "fixation" on the same type of idea; lack of guarantees of receiving strong opinions; limitation of time for holding; lack of criteria that provide the main direction for the production of ideas; solutions to simple tasks.

It should also be noted that this interactive method has several advantages: all students have equal opportunities to offer ideas; the possibility of a visual representation of the problem, since all proposed ideas are constantly recorded; creating a "chain reaction" effect; cognitive interest is created; the method offers a competitive atmosphere, promotes the possession of a sufficient level of knowledge, which stimulates cognition and creativity to improve the quality of education [2, 3].

Conclusions

The pedagogical effectiveness of the interactive method of "brainstorming" is that this method achieves the goals of medical education. Students are interested in learning by taking part in active classes. They develop clinical thinking, analytical abilities, oratorical skills are formed and professional language is improved. Of course, not all groups can use non-traditional teaching methods, as they are designed for sufficient basic student competence and good academic performance. However, it is necessary to strive to implement active forms of education among "weak" groups, activating their potential for self-development and self-improvement. It is possible that not everything will work out immediately and qualitatively, the goal will not always be achieved, and the topic fully disclosed, but students will feel the need for improvement, and they will develop an interest in learning. All this is extremely important when students study such a rather complex clinical discipline as surgical dentistry and maxillofacial surgery. Using an interactive environment allows you to conduct a simulation with almost all surgical pathological conditions, and using medical scanner data will allow you to move away from the template version of pathologies. Integration into the virtual environment of the Motion Capture and Hand Capture systems will allow practising manual skills with almost any surgical pathology without high economic costs.

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