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Article Citation - WoS: 3Evaluation of the Effects of Avatar on Learning Temporomandibular Joint in a Metaverse-Based Training(Wiley, 2024) Basmaci, Fulya; Bulut, Ali Can; Ozcelik, Erol; Ekici, Saliha Zerdali; Kilicarslan, Mehmet Ali; Cagiltay, Nergiz ErcilPurposeAvatars, representing users in the digital world, can influence users' behavior and attitudes. This study evaluates the impact of representing dental students receiving temporomandibular joint (TMJ) education in the metaverse via an anonymous or identified avatar.MethodsParticipants included 80 dental students in their fourth and fifth years of study. They were randomly assigned to either the avatar group (identified avatar) or the control group (anonymous avatar). Prior to training, participants completed a demographic questionnaire and a pretraining knowledge assessment. TMJ training was conducted in the metaverse for both groups. Pre- and post-training assessments included the Spielberger State-Trait Anxiety Inventory and a shyness scale to ensure group comparability. A post-test consisting of five questions was administered to both groups after 2 weeks of training.ResultsThere were no significant differences in pretraining scores for prior knowledge (p = 0.67), trait anxiety (p = 0.28), state anxiety (p = 0.92), or shyness (p = 0.42) between the avatar and control groups, indicating comparability at baseline. Post-training analysis revealed significantly higher post-test scores in the avatar group (median = 80) compared to the control group (median = 60) (p = 0.03).ConclusionsMetaverse environments offer various benefits for students, educators, and educational institutions in health education programs. Representing learners and their identities in training environments can enhance learning outcomes.Article Citation - WoS: 21Citation - Scopus: 30Quantification of the Effects of Transcutaneous Electrical Nerve Stimulation With Functional Magnetic Resonance Imaging: a Double-Blind Randomized Placebo-Controlled Study(W B Saunders Co-elsevier inc, 2010) Kara, Murat; Ozcakar, Levent; Gokcay, Didem; Ozcelik, Erol; Yorubulut, Mehmet; Guneri, Sinem; Cetin, AlpObjective: To evaluate the effects of transcutaneous electric nerve stimulation (TENS) by using functional magnetic resonance imaging (fMRI) in patients with carpal tunnel syndrome (CTS). Design: Randomized controlled trial. Settings: University medical center and an outpatient imaging center. Participants: Female patients with CTS (n=20) were randomized into 2 groups receiving either TENS (n=10) or sham TENS (n=10). In both groups, an initial baseline fMRI session was performed via stimulating digits 2, 5, and 3 in turn, I scan run for each. TENS versus sham TENS treatment was given, and a repeat imaging was performed starting 20 minutes after the treatment as follows: second finger on the 20th minute, fifth finger on the 25th minute (ulnar nerve innervated control finger), and third finger on the 30th min. Interventions: Not applicable. Main Outcome Measure: Differences in fMRI activation between the 2 groups were evaluated. Results: Our results demonstrated that 20 to 25 minutes after TENS treatment-but not in the sham TENS group-a significant fMRI signal decrease for digit 2 (post-TENS vs baseline) was observed in the secondary somatosensory regions, ipsilateral primary motor cortex (M1), contralateral supplementary motor cortex (SMA), contralateral parahippocampal gyrus, contralateral lingual gyrus, and bilateral superior temporal gyrus. Measurements on the 25th to 30th minutes for digit 5 were similar between the groups, with presence of activities in areas other than generally activated regions because of painful stimuli. Thirty to 35 minutes after TENS treatment, a significant fMRI signal decrease for digit 3 was detected in the contralateral M1 and contralateral SMA only in the TENS group. Conclusions: Our findings showed that TENS treatment significantly decreased the pain-related cortical activations caused by stimulation of the median nerve innervated fingers up to 35 minutes after treatment.Article Citation - WoS: 13Citation - Scopus: 14The Effect of Training, Used-Hand, and Experience on Endoscopic Surgery Skills in an Educational Computer-Based Simulation Environment (ece) for Endoneurosurgery Training(Sage Publications inc, 2019) Cagiltay, Nergiz Ercil; Ozcelik, Erol; Isikay, Ilkay; Hanalioglu, Sahin; Suslu, Ahmet E.; Yucel, Taskin; Berker, MustafaToday, virtual simulation environments create alternative hands-on practice opportunities for surgical training. In order to increase the potential benefits of such environments, it is critical to understand the factors that influence them. This study was conducted to determine the effects of training, used-hand, and experience, as well as the interactions between these variables, on endoscopic surgery skills in an educational computer-based surgical simulation environment. A 2-hour computer-based endoneurosurgery simulation training module was developed for this study. Thirty-one novice- and intermediate-level resident surgeons from the departments of neurosurgery and ear, nose, and throat participated in this experimental study. The results suggest that a 2-hour training during a 2-month period through computer-based simulation environment improves the surgical skills of the residents in both-hand tasks, which is necessary for endoscopic surgical procedures but not in dominant hand tasks. Based on the results of this study, it can be concluded that computer-based simulation environments potentially improve surgical skills; however, the scenarios for such training modules need to consider especially the bimanual coordination of hands and should be regularly adapted to the individual skill levels and progresses.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, HakanThe 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.Article Citation - WoS: 16Citation - Scopus: 15Construct and Face Validity of the Educational Computer-Based Environment (ece) Assessment Scenarios for Basic Endoneurosurgery Skills(Springer, 2017) Cagiltay, Nergiz Ercil; Ozcelik, Erol; Sengul, Gokhan; Berker, MustafaBackground In neurosurgery education, there is a paradigm shift from time-based training to criterion-based model for which competency and assessment becomes very critical. Even virtual reality simulators provide alternatives to improve education and assessment in neurosurgery programs and allow for several objective assessment measures, there are not many tools for assessing the overall performance of trainees. This study aims to develop and validate a tool for assessing the overall performance of participants in a simulation-based endoneurosurgery training environment. Methods A training program was developed in two levels: endoscopy practice and beginning surgical practice based on four scenarios. Then, three experiments were conducted with three corresponding groups of participants (Experiment 1, 45 (32 beginners, 13 experienced), Experiment 2, 53 (40 beginners, 13 experienced), and Experiment 3, 26 (14 novices, 12 intermediate) participants). The results analyzed to understand the common factors among the performance measurements of these experiments. Then, a factor capable of assessing the overall skill levels of surgical residents was extracted. Afterwards, the proposed measure was tested to estimate the experience levels of the participants. Finally, the level of realism of these educational scenarios was assessed. Results The factor formed by time, distance, and accuracy on simulated tasks provided an overall performance indicator. The prediction correctness was very high for the beginners than the one for experienced surgeons in Experiments 1 and 2. When non-dominant hand is used in a surgical procedure-based scenario, skill levels of surgeons can be better predicted. The results indicate that the scenarios in Experiments 1 and 2 can be used as an assessment tool for the beginners, and scenario-2 in Experiment 3 can be used as an assessment tool for intermediate and novice levels. It can be concluded that forming the balance between perceived action capacities and skills is critical for better designing and developing skill assessment surgical simulation tools.
