Artificial intelligence tutoring outperforms expert instructors in neurosurgical training

VOA training

Against the backdrop of remote learning technologies becoming increasingly important within medical training during the COVID-19 pandemic, a new study has found that—in a remote environment—an artificial intelligence (AI) tutoring system can outperform expert human instructors.

The Neurosurgical Simulation and Artificial Intelligence Learning Centre at The Neuro (Montreal Neurological Institute and Hospital, Montreal, Canada) recruited 70 medical students to perform virtual brain tumour removals on a neurosurgical simulator in a randomised clinical trial. Students were randomly assigned to receive instruction and feedback by either an AI tutor or a remote expert instructor, with a third control group receiving no instruction.

An AI-powered tutor called the virtual operative assistant (VOA) used a machine learning algorithm to teach safe and efficient surgical techniques, as well as providing personalised feedback, while a deep learning-based intelligent continuous expertise monitoring system (ICEMS) and a panel of experts assessed student performance. In the other group, remote instructors watched a live feed of the surgical simulations and provided feedback based on the student’s performance.

The researchers found that students who received VOA instruction and feedback learned surgical skills 2.6 times faster and achieved significantly higher (36%) performance scores compared to those who received instruction and feedback from remote instructors. And, while the researchers expected students instructed by VOA to experience greater stress and negative emotion, they found no significant difference between the two groups in that regard.

Concluding their study, which has been published in the Journal of the American Medical Association (JAMA Network Open), the researchers state: “In this randomised clinical trial, VOA feedback demonstrated superior performance outcome and skill transfer, with equivalent OSATS [Objective Structured Assessment of Technical Skills] ratings, and cognitive and emotional responses compared with remote expert instruction, indicating advantages for its use in simulation training.”

The researchers also claim that, in addition to offering an effective way to increase neurosurgeon performance, VOA may enable improved patient safety while reducing the burden on human instructors.

“Artificially intelligent tutors like the VOA may become a valuable tool in the training of the next generation of neurosurgeons,” said Rolando Del Maestro (Montreal Neurological Institute and Hospital, Montreal, Canada), the study’s senior author. “The VOA significantly improved expertise while fostering an excellent learning environment. Ongoing studies are assessing how in-person instructors and AI-powered, intelligent tutors can most effectively be used together to improve the mastery of neurosurgical skills.”

“Intelligent tutoring systems can use a variety of simulation platforms to provide almost unlimited chances for repetitive practice without the constraints imposed by the availability of supervision,” added Ali Fazlollahi (Montreal Neurological Institute and Hospital, Montreal, Canada), the study’s first author. “With continued research, increased development, and dissemination of intelligent tutoring systems, we can be better prepared for ever-evolving future challenges.”


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