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Article Citation - WoS: 9Citation - Scopus: 7The Underlying Reasons of the Navigation Control Effect on Performance in a Virtual Reality Endoscopic Surgery Training Simulator(Taylor & Francis inc, 2019) Cagiltay, Nergiz Ercil; Ozcelik, Erol; Berker, Mustafa; Dalveren, Gonca Gokce Menekse; Menekse Dalveren, Gonca GokceNavigation control skills of surgeons become very critical for surgical procedures. Strategies improving these skills are important for developing higher-quality surgical training programs. In this study, the underlying reasons of the navigation control effect on performance in a virtual reality-based navigation environment are evaluated. The participants' performance is measured in conditions: navigation control display and paper-map display. Performance measures were collected from 45 beginners and experienced residents. The results suggest that navigation display significantly improved performance of the participants. Also, navigation was more beneficial for beginners than experienced participants. The underlying reason of the better performance in the navigation condition was due to lower number of looks to the map, which causes attention shifts between information sources. Accordingly, specific training scenarios and user interfaces can be developed to improve the navigation skills of the beginners considering some strategies to lower their number of references to the information sources.Article Citation - WoS: 24Citation - Scopus: 27Insights From Surgeons' Eye-Movement Data in a Virtual Simulation Surgical Training Environment: Effect of Experience Level and Hand Conditions(Taylor & Francis Ltd, 2018) Dalveren, Gonca Gokce Menekse; Cagiltay, Nergiz Ercil; Menekse Dalveren, Gonca GokceToday, with the advancements in the eye-tracking technology, it has become possible to follow surgeons' eye movements while performing surgical tasks. Despite the availability of studies providing a better understanding of surgeons' eye movements, research in the particular field of endoneurosurgery is very limited. Analysing surgeons' eye-movement data can provide general insights into how to improve surgical education programmes. In this study, four simulation-based task-oriented endoscopic surgery training scenarios were developed and implemented by 23 surgical residents using three different hand conditions; dominant, non-dominant, and both. The participants' recorded eye data comprised fixation number, fixation duration, saccade number, saccade duration, pursuit number, pursuit duration, and pupil size. This study has two main contributions: First, it reports on the eye-movement behaviours of surgical residents, demonstrating that novice residents tended to make more fixations and saccades than intermediate residents. They also had a higher fixation duration and followed the objects more frequently compared to the intermediates. Furthermore, hand conditions significantly affected the eye movements of the participants. Based on these results, it can be concluded that eye-movement data can be used to assess the skill levels of surgical residents and would be an important measure to better guide trainees in surgical education programmes. The second contribution of this study is the eye-movement event classifications of 10 different algorithms. Although the algorithms mostly provided similar results, there were a few conflicted values for some classifications, which offers a clue as to how researchers can utilise these algorithms with low sampling frequency eye trackers.Article Citation - WoS: 23Citation - Scopus: 27Insights From Pupil Size To Mental Workload of Surgical Residents: Feasibility of an Educational Computer-Based Surgical Simulation Environment (ece) Considering the Hand Condition(Sage Publications inc, 2018) Dalveren, Gonca Gokce Menekse; Cagiltay, Nergiz Ercil; Ozcelik, Erol; Maras, Hakan; Menekse Dalveren, Gonca GokceThe advantage of simulation environments is that they present various insights into real situations, where experimental research opportunities are very limited-for example, in endoscopic surgery. These operations require simultaneous use of both hands. For this reason, surgical residents need to develop several motor skills, such as eye-hand coordination and left-right hand coordination. While performing these tasks, the hand condition (dominant, nondominant, both hands) creates different degrees of mental workload, which can be assessed through mental physiological measures-namely, pupil size. Studies show that pupil size grows in direct proportion to mental workload. However, in the literature, there are very limited studies exploring this workload through the pupil sizes of the surgical residents under different hand conditions. Therefore, in this study, we present a computer-based simulation of a surgical task using eye-tracking technology to better understand the influence of the hand condition on the performance of skill-based surgical tasks in a computer-based simulated environment. The results show that under the both-hand condition, the pupil size of the surgical residents is larger than the one under the dominant and nondominant hand conditions. This indicates that when the computer-simulated surgical task is performed with both hands, it is considered more difficult than in the dominant and nondominant hand conditions. In conclusion, this study shows that pupil size measurements are sufficiently feasible to estimate the mental workload of the participants while performing surgical tasks. The results of this study can be used as a guide by instructional system designers of skill-based training programs.
