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Ursat G, Corda M, Ryard J, Guillet C, Guigou C, Tissier C, Bozorg Grayeli A. Virtual-reality-enhanced mannequin to train emergency physicians to examine dizzy patients using the HINTS method. Front Neurol 2024; 14:1335121. [PMID: 38249749 PMCID: PMC10796789 DOI: 10.3389/fneur.2023.1335121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Acute vertigo is a frequent chief complaint in the emergency departments, and its efficient management requires thorough training. The HINTS protocol is a valid method to screen patients in the emergency room, but its application in routine is hindered by the lack of training. This study aimed to evaluate the training of emergency physicians for the HINTS method based on a mannequin-based virtual reality simulator (MBVRS). Methods We conducted a monocenter, prospective, longitudinal, and randomized cohort study in an Emergency Department at a regional university hospital. We included 34 emergency physicians randomized into two equal groups matched by age and professional experience. The control group attended a theoretical lesson with video demonstrations and the test group received a simulation-based training in addition to the lecture. Results We showed that the test group had a higher diagnosis performance for the HINTS method compared to the control group as evaluated by the simulator at 1 month (89% sensitivity versus 45, and 100% specificity versus 86% respectively, p < 001, Fisher's exact test). Evaluation at 6 months showed a similar advantage to the test group. Discussion The MBVRS is a useful pedagogic tool for the HINTS protocol in the emergency department. The advantage of a unique training session can be measured up to 6 months after the lesson.
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Affiliation(s)
- Guillaume Ursat
- Emergency Department, Dijon University Hospital, Dijon, France
| | - Morgane Corda
- Otolaryngology Department, Dijon University Hospital, Dijon, France
| | - Julien Ryard
- Institut Image, Ecole Nationale d’Arts-et-Métiers, Chalon-sur-Saône, France
| | - Christophe Guillet
- Institut Image, Ecole Nationale d’Arts-et-Métiers, Chalon-sur-Saône, France
| | - Caroline Guigou
- Otolaryngology Department, Dijon University Hospital, Dijon, France
- ICMUB, CNRS, Université Bourgogne-Franche-Comté, Dijon, France
| | - Cindy Tissier
- Emergency Department, Dijon University Hospital, Dijon, France
| | - Alexis Bozorg Grayeli
- Otolaryngology Department, Dijon University Hospital, Dijon, France
- ICMUB, CNRS, Université Bourgogne-Franche-Comté, Dijon, France
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Bahaidarah SA, Boker AM. Comparison of Cardiac Auscultation Features on Four Different Simulation Mannequins Performed by Pediatric Residents. Cureus 2023; 15:e45127. [PMID: 37842489 PMCID: PMC10569741 DOI: 10.7759/cureus.45127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Cardiac murmurs are a common problem in pediatric clinical practice. Studies demonstrated low accuracy in detecting and diagnosing various cardiac murmurs at all levels of medical training. So, supplementary training methods started to evolve, including simulation for auscultation skills training. Over the years, mannequins have evolved with different types of technology. Therefore, we decided to compare cardiac auscultation accuracy among high-fidelity mannequins as the primary objective and compare the performance of various postgraduate-level residents as a secondary objective. METHOD Pediatric residents at King Abdulaziz University Hospital were given a lecture on the basics of cardiac auscultation and then requested to auscultate four mannequins, namely SimJumior® (Laerdal Medical, Stavanger, Norway), SimBaby™ (Laerdal Medical), Pediatric HAL® (Gaumard Scientific, Miami, FL, USA), and Cardiac Patient Simulator K-Plus (Kyoto Kagaku Co. Ltd., Kyoto, Japan). The accuracies of murmur type, diagnosis, and auscultation time were compared. Results: A total of 56 pediatric residents were enrolled. Median murmur accuracy ranged from 50% to 53% (p-value 0.79), and median diagnosis accuracy ranged from 33% to 36% (p-value 0.77), with a nonsignificant difference between mannequins. Comparing resident levels in all mannequins, median murmur accuracy ranged from 49% to 56% (p-value 0.70), and median diagnosis accuracy ranged from 29% to 41% (p-value 0.09). While the median average auscultation time was between 41 and 50 seconds (p-value 0.34). CONCLUSION Auscultation skills can be taught through simulation on any mannequin used in this comparison, not necessarily the cardiac one. For better accuracy, future comparisons might include more advanced cardiac mannequins based on cardiac auscultation expertise (i.e., consultant level). The introduction of an auscultation program from the undergraduate level throughout the training process and monitoring of these skills are mandated.
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Affiliation(s)
- Saud A Bahaidarah
- Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Abdulaziz M Boker
- Clinical Skills and Simulation Centre, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
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Davis G, Malka RE, Moore A, Cook SL, Blackburn M, Dion GR. Quantifying Intubation Forces on Incisors and Tongue Base Across Exposure Difficulty and Experience in a Simulator. Cureus 2023; 15:e41611. [PMID: 37575794 PMCID: PMC10412742 DOI: 10.7759/cureus.41611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
OBJECTIVE Laryngoscopy simulators quantifying forces on critical structures in progressively challenging airways and operator expertise are lacking. We aimed to quantify laryngoscopy forces across expertise and exposure difficulty. STUDY DESIGN Prospective observational study Setting: Tertiary care medical center Methods: Force gauges were affixed to a difficult airway mannequin to quantify teeth and tongue forces across increasingly challenging airway exposure. Medical students (n=10), residents (n=11), and otolaryngology staff (n=10) performed direct laryngoscopy using a Miller size 3 laryngoscope with 1) normal neck/jaw mobility, 2) restricted neck extension, 3) restricted jaw opening, and 4) restricted neck/jaw mobility. Incisor and tongue pounds of force (lbf) were continuously measured. RESULTS As the difficulty setting increased, forces exerted by the students, residents, and staff on the incisors and tongue base increased (p=0.01). Between normal and maximally restricted settings, force delivered to the incisors increased by 6.95 lbf (standard error (SE) 1.29), 5.93 lbf (SE 0.98), and 5.94 lbf (SE 0.70) for the students, residents, and staff, respectively. At the tongue base, force increased by 0.37 lbf (SE 0.18), 0.46 lbf (SE 0.14), and 0.73 lbf (SE 0.15) for the students, residents, and staff, respectively. Esophageal intubations occurred in 50% of the students, 23% of the residents, and 45% of the otolaryngology staff at maximal difficulty, with none at the easiest setting (p=0.33). Compared to the residents, the staff applied significantly increased pressure on the tongue base during laryngoscopy (p=0.02). CONCLUSION Forces exerted on the incisors and tongue base varied across exposure difficulty and expertise levels, suggesting that they may be useful markers for training and competence assessment.
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Affiliation(s)
- Gavin Davis
- Ophthalmology, Brooke Army Medical Center, San Antonio, USA
| | - Ronit E Malka
- Otolaryngology - Head and Neck Surgery, Brooke Army Medical Center, San Antonio, USA
| | - Austin Moore
- Hemorrhage and Edema Control, United States Army Institute of Surgical Research, San Antonio, USA
| | - Stacy L Cook
- Otolaryngology - Head and Neck Surgery, Brooke Army Medical Center, San Antonio, USA
| | - Megan Blackburn
- Hemorrhage and Edema Control, United States Army Institute of Surgical Research, San Antonio, USA
| | - Gregory R Dion
- Otolaryngology, University of Cincinnati Medical Center, Cincinnati, USA
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Torres K, Evans P, Mamcarz I, Radczuk N, Torres A. A manikin or human simulator-development of a tool for measuring students' perception. PeerJ 2022; 10:e14214. [PMID: 36530415 PMCID: PMC9753758 DOI: 10.7717/peerj.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 09/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background Education with the use of medical simulation may involve the use of two modalities: manikins or standardized patients (SPs) to meet specific learning objectives. We have collected students' opinions about the two modalities which can be helpful in planning and evaluating the curriculum process. Although reviews or comparisons of student opinions appear in the literature, it is difficult to find a scale that would be based on a comparison of specific effects that can be obtained in the educational process. In order to fill this gap, an attempt was made to construct a questionnaire. Methods An experimental version of a questionnaire measuring the final-year students' (273) opinions about the effectiveness of both simulation techniques has been designed on the basis of semi-structured interviews. They were conducted with 14 final-year students excluded from the subsequently analyzed cohort. The scale has been completed, tested and validated. Results The authors developed a 33-statement questionnaire which contain two scales: teaching medicine with the manikins and with the SPs. Two factors were identified for each scale: Doctor-patient relationship and practical aspects. The scales can be used complementary or separately, as the article reports independent statistics for each scale. The Cronbach's alpha coefficient for the manikin scale is 0.721 and for the SP scale is 0.758. Conclusions The questionnaire may be applied to medical students to identify their opinions about using manikins and SPs in teaching. It may have an important impact for planning curriculum and implementing particular modalities in accordance with the intended learning objectives.
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Affiliation(s)
- Kamil Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
| | - Phillip Evans
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
| | - Izabela Mamcarz
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
| | - Natalia Radczuk
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
| | - Anna Torres
- Chair and Department of Didactics and Medical Simulation, Medical University of Lublin, Lubelskie, Poland
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Eley C, Hawkes ND, Egan RJ, Robinson DB, Brown C, Murray S, Siau K, Lewis W. Face validity of a virtual reality simulation platform to improve competency in endoscopy: a prospective observational cohort study. Endosc Int Open 2022; 10:E1218-E1224. [PMID: 36118643 PMCID: PMC9473829 DOI: 10.1055/a-1882-4246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 06/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background and study aims Virtual reality endoscopic simulation training has the potential to expedite competency development in novice trainees. However, simulation platforms must be realistic and confer face validity. This study aimed to determine the face validity of high-fidelity virtual reality simulation (EndoSim, Surgical Science, Gothenburg), and establish benchmark metrics to guide the development of a Simulation Pathway to Improve Competency in Endoscopy (SPICE). Methods A pilot cohort of four experts rated simulated exercises (Likert scale score 1-5) and following iterative development, 10 experts completed 13 simulator-based endoscopy exercises amounting to 859 total metric values. Results Expert metric performance demonstrated equivalence ( P = 0.992). In contrast, face validity of each exercise varied among experts (median 4 (interquartile range [IQR] 3-5), P < 0.003) with Mucosal Examination receiving the highest scores (median 5 [IQR 4.5-5], P = 1.000) and Loop Management and Intubation exercises receiving the lowest scores (median 3 [IQR 1-3], P < 0.001, P = 0.004), respectively. The provisional validated SPICE comprised 13 exercises with pass marks and allowance buffers defined by median and IQR expert performance. Conclusions EndoSim Face Validity was very good related to early scope handling skills, but more advanced competencies and translation of acquired clinical skills require further research within an established training program. The existing training deficit with superadded adverse effects of the COVID pandemic make this initiative an urgent priority.
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Affiliation(s)
- Catherine Eley
- Health Education and Improvement Wales. Ty Dysgu, Cefn Coed, Nantgarw, UK
| | | | - Richard J Egan
- Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, UK,Swansea University, Singleton Park, Sketty, Swansea, UK
| | - David B Robinson
- Health Education and Improvement Wales. Ty Dysgu, Cefn Coed, Nantgarw, UK
| | - Chris Brown
- Health Education and Improvement Wales. Ty Dysgu, Cefn Coed, Nantgarw, UK,Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, UK
| | - Sam Murray
- Southmead Hospital, Southmead Road, Bristol, UK
| | - Keith Siau
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Wyn Lewis
- Health Education and Improvement Wales. Ty Dysgu, Cefn Coed, Nantgarw, UK
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Cotter T, Mongrain R, Driscoll M. Vacuum curette lumbar discectomy mechanics for use in spine surgical training simulators. Sci Rep 2022; 12:13517. [PMID: 35933556 PMCID: PMC9357010 DOI: 10.1038/s41598-022-17512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Simulation in surgical training is a growing field and this study aims to understand the force and torque experienced during lumbar spine surgery to design simulator haptic feedback. It was hypothesized that force and torque would differ among lumbar spine levels and the amount of tissue removed by ≥ 7%, which would be detectable to a user. Force and torque profiles were measured during vacuum curette insertion and torsion, respectively, in multiple spinal levels on two cadavers. Multiple tests per level were performed. Linear and torsional resistances of 2.1 ± 1.6 N/mm and 5.6 ± 4.3 N mm/°, respectively, were quantified. Statistically significant differences were found in linear and torsional resistances between all passes through disc tissue (both p = 0.001). Tool depth (p < 0.001) and lumbar level (p < 0.001) impacted torsional resistance while tool speed affected linear resistance (p = 0.022). Average differences in these statistically significant comparisons were ≥ 7% and therefore detectable to a surgeon. The aforementioned factors should be considered when developing haptic force and torque feedback, as they will add to the simulated lumbar discectomy realism. These data can additionally be used inform next generation tool design. Advances in training and tools may help improve future surgeon training.
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Affiliation(s)
- Trevor Cotter
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, H3A 0C4, Canada.,Orthopedic Research Laboratory, Montreal General Hospital, Montreal, QC, H3H 1V8, Canada
| | - Rosaire Mongrain
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, H3A 0C4, Canada
| | - Mark Driscoll
- Musculoskeletal Biomechanics Research Lab, Department of Mechanical Engineering, McGill University, Montreal, H3A 0C4, Canada. .,Orthopedic Research Laboratory, Montreal General Hospital, Montreal, QC, H3H 1V8, Canada.
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Jung AR, Park EA. The Effectiveness of Learning to Use HMD-Based VR Technologies on Nursing Students: Chemoport Insertion Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084823. [PMID: 35457689 PMCID: PMC9028481 DOI: 10.3390/ijerph19084823] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/25/2022]
Abstract
Background: The purpose of this study was to develop a mobile head mounted display (HMD)-based virtual reality (VR) nursing education program (VRP), and to evaluate the effects on knowledge, learning attitude, satisfaction with self-practice, and learning motivation in nursing students. Methods: This was a quasi-experimental study using a nonequivalent control group pretest-posttest design to evaluate the effects of HMD-based VRP on nursing students. A Chemoport insertion surgery nursing scenario was developed with HMD-based VRP. The experimental group consisting of 30 nursing students underwent pre-debriefing, followed by VRP using HMD and debriefing. The control group, consisting of 30 nursing students, underwent pre-debriefing, followed by self-learning using handouts about Chemoport insertion surgery procedures for 30 min, and debriefing. Results: The experimental group that underwent HMD-based VRP showed significantly improved post-intervention knowledge on operating nursing (p = 0.001), learning attitude (p = 0.002), and satisfaction (p = 0.017) compared to the control group. Sub-domains of motivation, attention (p < 0.05), and relevance (p < 0.05) were significantly different between the two groups, post-intervention. Conclusions: HMD-based VRP of Chemoport insertion surgery is expected to contribute to knowledge, learning attitude, satisfaction, attention, and relevance in nursing students.
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Affiliation(s)
- Ae-Ri Jung
- College of Nursing, Bucheon University, Bucheon 14774, Korea;
- College of Nursing, Eulji University, Uijeongbu 11759, Korea
| | - Eun-A Park
- College of Nursing, Bucheon University, Bucheon 14774, Korea;
- Correspondence: ; Tel.: +82-32-610-8309
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Bang SK, Seong KW, Kim MN, Lee JH. Implementation of a 3D position detection system for a medical simulator. Technol Health Care 2021; 29:319-326. [PMID: 33682768 PMCID: PMC8150509 DOI: 10.3233/thc-218029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGOROUND AND OBJECTIVE Cardiovascular disorders are increasing because of poor eating habits, excessive drinking, and lack of exercise. Some of the typical cardiovascular surgical procedures utilize catheters. Catheter-based procedures require the surgeons to have extensive experience and high proficiency at performing vascular interventions. However, the learning period to acquire such proficiency is lengthy and the opportunities for practical training and mastery are insufficient. Therefore, due to insufficient skill, dangerous situations with damage or rupture of the patient's blood vessels may occur, thereby increasing the risk of medical accidents. Hence, it is necessary to have experience and proficiency for performing vascular interventions. Thus, it is necessary to develop a simulator to shorten learning time and reduce medical accidents. METHODS In this study, we developed a position detection system for the simulator to use physical models to learn cardiovascular surgical intervention techniques. The developed system uses changes in the output values of a Hall sensor based on the position of a permanent magnet. RESULTS AND CONCLUSIONS From the changing output values, the distance calculation equation is derived, and the position of the permanent magnet is effectively estimated from the calculations. The performance of the position detecting system was tested, and the results proved that the system could be sufficiently used as a simulator.
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Affiliation(s)
- Sang Kwang Bang
- Department of Medical and Biological Engineering, Graduate School, Kyungpook National University, Daegu, 700-422, Korea
| | - Ki Woong Seong
- Department of Biomedical Engineering, Kyungpook National University Hospital, Daegu, 700-422, Korea
| | - Myoung Nam Kim
- Department of Biomedical Engineering, School of Medicine, Kyungpook National University, Daegu, 700-422, Korea
| | - Jyung Hyun Lee
- Department of Biomedical Engineering, School of Medicine, Kyungpook National University, Daegu, 700-422, Korea
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Abstract
Simulation training plays a paramount role in medicine, especially when it comes to mastering surgical skills. By simulating, students gain not only confidence, but expertise, learning to apply theory in a safe environment. As the technological arsenal improved, virtual reality and physical simulators have developed and are now an important part of the Neurosurgery training curriculum. Based on deliberate practice in a controlled space, simulation allows psychomotor skills augment without putting neither patients nor students at risk. When compared to the master-apprentice ongoing model of teaching, simutation becomes even more appealing as it is time-efficient, shortening the learning curve and ultimately leading to error reduction, which is reflected by diminished health care costs in the long run. In this chapter we will discuss the current state of neurosurgery simulation, highlight the potential benefits of this approach, assessing specific training methods and making considerations towards the future of neurosurgical simulation.
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Affiliation(s)
| | - Eberval Gadelha Figueiredo
- Division of Neurosurgery, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
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MacDonald S, Manuel A, Dubrowski A, Bandrauk N, Law R, Curran V, Lee YW. Emergency Management of Anaphylaxis: A High Fidelity Interprofessional Simulation Scenario to Foster Teamwork Among Senior Nursing, Medicine, and Pharmacy Undergraduate Students. Cureus 2018; 10:e2915. [PMID: 30186720 PMCID: PMC6122644 DOI: 10.7759/cureus.2915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Nursing, medicine, and pharmacy students have limited opportunities during their undergraduate programs to learn and practice together as an interprofessional team. This has prompted faculty at Memorial University of Newfoundland to explore the use of high fidelity simulated interprofessional education (HF-IPE) to help nursing, medicine, and pharmacy students learn about their roles, develop communication and collaboration skills, and foster teamwork. Research has shown that high fidelity simulated education can promote critical thinking, engage learners, improve confidence, and enhance psychomotor skills; however, there is limited data on the impact of HF-IPE on fostering teamwork. This technical report describes one HF-IPE scenario designed to foster teamwork among senior undergraduate nursing, medicine, and pharmacy students. The scenario is designed to promote an understanding of the roles of nursing, medical, and pharmaceutical professionals in an interprofessional team during the emergency management of an adult patient experiencing acute anaphylaxis. Teamwork and communication skills are emphasized, and students are provided with the opportunity to communicate and collaborate within an interprofessional healthcare team.
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Affiliation(s)
- Sandra MacDonald
- School of Nursing, Memorial University of Newfoundland, St. John's, CAN
| | - April Manuel
- School of Nursing, Memorial University of Newfoundland, Conception Bay South, CAN
| | - Adam Dubrowski
- Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Natalie Bandrauk
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, CAN
| | - Rebecca Law
- School of Pharmacy, Memorial University of Newfoundland, St. John's, CAN
| | - Vernon Curran
- Faculty of Medicine, Memorial University of Newfoundland
| | - Young Wah Lee
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, CAN
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Grillo FW, Souza VH, Matsuda RH, Rondinoni C, Pavan TZ, Baffa O, Machado HR, Carneiro AAO. Patient-specific neurosurgical phantom: assessment of visual quality, accuracy, and scaling effects. 3D Print Med 2018; 4:3. [PMID: 29782617 PMCID: PMC5954795 DOI: 10.1186/s41205-018-0025-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/26/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Training in medical education depends on the availability of standardized materials that can reliably mimic the human anatomy and physiology. One alternative to using cadavers or animal bodies is to employ phantoms or mimicking devices. Styrene-ethylene/butylene-styrene (SEBS) gels are biologically inert and present tunable properties, including mechanical properties that resemble the soft tissue. Therefore, SEBS is an alternative to develop a patient-specific phantom, that provides real visual and morphological experience during simulation-based neurosurgical training. RESULTS A 3D model was reconstructed and printed based on patient-specific magnetic resonance images. The fused deposition of polyactic acid (PLA) filament and selective laser sintering of polyamid were used for 3D printing. Silicone and SEBS materials were employed to mimic soft tissues. A neuronavigation protocol was performed on the 3D-printed models scaled to three different sizes, 100%, 50%, and 25% of the original dimensions. A neurosurgery team (17 individuals) evaluated the phantom realism as "very good" and "perfect" in 49% and 31% of the cases, respectively, and rated phantom utility as "very good" and "perfect" in 61% and 32% of the cases, respectively. Models in original size (100%) and scaled to 50% provided a quantitative and realistic visual analysis of the patient's cortical anatomy without distortion. However, reduction to one quarter of the original size (25%) hindered visualization of surface details and identification of anatomical landmarks. CONCLUSIONS A patient-specific phantom was developed with anatomically and spatially accurate shapes, that can be used as an alternative for surgical planning. Printed models scaled to sizes that avoided quality loss might save time and reduce medical training costs.
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Affiliation(s)
- Felipe Wilker Grillo
- Department of Physics, Faculty of Philosophy, Science and Letters at Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP 14040-901 Brazil
| | - Victor Hugo Souza
- Department of Physics, Faculty of Philosophy, Science and Letters at Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP 14040-901 Brazil
| | - Renan Hiroshi Matsuda
- Department of Physics, Faculty of Philosophy, Science and Letters at Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP 14040-901 Brazil
| | - Carlo Rondinoni
- Department of Physics, Faculty of Philosophy, Science and Letters at Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP 14040-901 Brazil
| | - Theo Zeferino Pavan
- Department of Physics, Faculty of Philosophy, Science and Letters at Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP 14040-901 Brazil
| | - Oswaldo Baffa
- Department of Physics, Faculty of Philosophy, Science and Letters at Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP 14040-901 Brazil
| | - Helio Rubens Machado
- Department of Surgery and Anatomy, Faculty of Medicine at Ribeirao Preto, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Antonio Adilton Oliveira Carneiro
- Department of Physics, Faculty of Philosophy, Science and Letters at Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP CEP 14040-901 Brazil
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Riek S, Hill A, Plooy AM, Horswill MS, Cresp ASG, Marinovic W, Christofidis MJ, Burgess-Limerick R, Wallis GM, Watson MO, Hewett DG. A novel training device for tip control in colonoscopy: preliminary validation and efficacy as a training tool. Surg Endosc 2017; 31:5364-5371. [PMID: 28593418 PMCID: PMC5715030 DOI: 10.1007/s00464-017-5617-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 05/16/2017] [Indexed: 12/13/2022]
Abstract
Background Effective control of the colonoscope tip is one of the most fundamental components of colonoscopy skill. Mastering fine tip control can be problematic for novice trainees, yet no validated training regimes exist for developing this specific skill component in isolation. We aimed to conduct a preliminary validation of a novel training device for colonoscopic tip control, and to assess its efficacy as a training tool. Methods In study 1 (validation), 13 experienced colonoscopists and 16 novices used a colonoscope to accurately track 28 targets on each of four concave “training surfaces” as quickly as possible, and we compared their performance. In study 2 (pre–post-training study), another 16 novices were tested before and after a six-session training program. In both studies, the main outcome measurements were completion time (measured automatically by the device) and variability of individual performance (the SD of each individual’s completion times across trials). Results Compared with novices, experienced colonoscopists were faster (P < 0.0001) and their performances less variable (P < 0.0001). With training, novices became faster (P < 0.0001) and more consistent (P = 0.003), and these improvements also generalized to novel training surfaces (P’s < 0.01). After training, the novices’ tip control performance was indistinguishable from that of the experienced colonoscopists (P’s > 0.05). The composite measures of completion time used in both studies all had acceptable to excellent internal consistency reliability (α’s ranged from 0.72 to 0.93). Conclusions We found that performance measures derived from using the device to assess skill can discriminate between experienced colonoscopists and novices in terms of their ability to control and guide the colonoscope tip precisely, providing preliminary evidence to support the construct validity of the metrics. The device is also an effective training tool for this fundamental component of colonoscopy skill.
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Affiliation(s)
- Stephan Riek
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Andrew Hill
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia. .,School of Psychology, The University of Queensland, Brisbane, Australia.
| | - Annaliese M Plooy
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Mark S Horswill
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Alanna St G Cresp
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Welber Marinovic
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | | | | | - Guy M Wallis
- School of Human Movement Studies, The University of Queensland, Brisbane, Australia
| | - Marcus O Watson
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | - David G Hewett
- Clinical Skills Development Service, Metro North Hospital and Health Service, Brisbane, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
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13
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Arab A, Alatassi A, Alattas E, Alzoraigi U, AlZaher Z, Ahmad A, Albabtain H, Boker A. Integration of simulation in postgraduate studies in Saudi Arabia: The current practice in anesthesia training program. Saudi J Anaesth 2017; 11:208-214. [PMID: 28442961 PMCID: PMC5389241 DOI: 10.4103/1658-354x.203059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The educational programs in the Saudi Commission for Health Specialties are developing rapidly in the fields of technical development. Such development is witnessed, particularly in the scientific areas related to what is commonly known as evidence-based medicine. This review highlights the critical need and importance of integrating simulation into anesthesia training and assessment. Furthermore, it describes the current utilization of simulation in anesthesia and critical care assessment process.
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Affiliation(s)
- Abeer Arab
- Consultant and Assistant Professor, Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulaleem Alatassi
- Consultant and Assistant Professor of Pediatric Anesthesia and Critical Care Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Elias Alattas
- Consultant, Department of Anesthesia, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Usamah Alzoraigi
- Consultant, Department of Anesthesia, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Zaki AlZaher
- Cardiac Anesthesiologist, Department of Anesthesia, King Fahad Specialist Hospital Dammam, Saudi Arabia
| | - Abdulaziz Ahmad
- Consultant and Assistant professor, Department of Anesthesia, King Saud university, Riyadh, Saudi Arabia
| | - Hesham Albabtain
- Consultant, Department of Anesthesiology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdulaziz Boker
- Consultant and Associate Professor, Department of Anesthesia and Critical Care, Director, Clinical Skills and Simulation Center, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Badash I, Burtt K, Solorzano CA, Carey JN. Innovations in surgery simulation: a review of past, current and future techniques. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:453. [PMID: 28090509 DOI: 10.21037/atm.2016.12.24] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
As a result of recent work-hours limitations and concerns for patient safety, innovations in extraclinical surgical simulation have become a desired part of residency education. Current simulation models, including cadaveric, animal, bench-top, virtual reality (VR) and robotic simulators are increasingly used in surgical training programs. Advances in telesurgery, three-dimensional (3D) printing, and the incorporation of patient-specific anatomy are paving the way for simulators to become integral components of medical training in the future. Evidence from the literature highlights the benefits of including simulations in surgical training; skills acquired through simulations translate into improvements in operating room performance. Moreover, simulations are rapidly incorporating new medical technologies and offer increasingly high-fidelity recreations of procedures. As a result, both novice and expert surgeons are able to benefit from their use. As dedicated, structured curricula are developed that incorporate simulations into daily resident training, simulated surgeries will strengthen the surgeon's skill set, decrease hospital costs, and improve patient outcomes.
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Affiliation(s)
- Ido Badash
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Karen Burtt
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Carlos A Solorzano
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Joseph N Carey
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
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Ott T, Schmidtmann I, Limbach T, Gottschling PF, Buggenhagen H, Kurz S, Pestel G. [Simulation-based training and OR apprenticeship for medical students : A prospective, randomized, single-blind study of clinical skills]. Anaesthesist 2016; 65:822-831. [PMID: 27678137 DOI: 10.1007/s00101-016-0221-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/05/2016] [Accepted: 08/15/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Simulation-based training (SBT) has developed into an established method of medical training. Studies focusing on the education of medical students have used simulation as an evaluation tool for defined skills. A small number of studies provide evidence that SBT improves medical students' skills in the clinical setting. Moreover, they were strictly limited to a few areas, such as the diagnosis of heart murmurs or the correct application of cricoid pressure. Other studies could not prove adequate transferability from the skills gained in SBT to the patient site. Whether SBT has an effect on medical students' skills in anesthesiology in the clinical setting is controversial. To explore this issue, we designed a prospective, randomized, single-blind trial that was integrated into the undergraduate anesthesiology curriculum of our department during the second year of the clinical phase of medical school. OBJECTIVES This study intended to explore the effect of SBT on medical students within the mandatory undergraduate anesthesiology curriculum of our department in the operating room with respect to basic skills in anesthesiology. MATERIALS AND METHODS After obtaining ethical approval, the participating students of the third clinical semester were randomized into two groups: the SIM-OR group was trained by a 225 min long SBT in basic skills in anesthesiology before attending the operating room (OR) apprenticeship. The OR-SIM group was trained after the operating room apprenticeship by SBT. During SBT the students were trained in five clinical skills detailed below. Further, two clinical scenarios were simulated using a full-scale simulator. The students had to prepare the patient and perform induction of anesthesia, including bag-mask ventilation after induction in scenario 1 and rapid sequence induction in scenario 2. Using the five-point Likert scale, five defined skills were evaluated at defined time points during the study period. 1) application of the safety checklist, 2) application of basic patient monitoring, 3) establishment of intravenous access, 4) bag-and-mask ventilation, and 5) adjustment of ventilatory parameters after the patients' airways were secured. A cumulative score of 5 points was defined as the best and a cumulative score of 25 as the worst rating for a defined time point. The primary endpoint was the cumulative score after day 1 in the operating room apprenticeship and the difference in cumulative scores from days 1 to 4. Our hypothesis was that the SIM-OR group would achieve a better score after day 1 in the operating room apprenticeship and would gain a larger increase in score from day 1 to day 4 than the OR-SIM group. RESULTS 73 students were allocated to the OR-SIM group and 70 students to the SIM-OR group. There was no significant difference between the two groups after day 1 of the operating room apprenticeship and no difference in increase of the cumulative score from day 1 to day 4 (median of cumulative score on day 1: 'SIM-OR' 11.2 points vs. 'OR-SIM' 14.6 points; p = 0.067; median of difference from day 1 to day 4: 'SIM-OR' -3.7 vs. 'OR-SIM' -6.4; p = 0.110). CONCLUSION With the methods applied, this study could not prove that 225 min of SBT before the operating room apprenticeship increased the medical students' clinical skills as evaluated in the operating room. Secondary endpoints indicate that medical students have better clinical skills at the end of the entire curriculum when they have been trained through SBT before the operating room apprenticeship. However, the authors believe that simulator training has a positive impact on students' acquisition of procedural and patient safety skills, even if the methods applied in this study may not mirror this aspect sufficiently.
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Affiliation(s)
- T Ott
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - I Schmidtmann
- Institut für Medizinische Biometrie, Epidemiologie und Informatik, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T Limbach
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - P F Gottschling
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - H Buggenhagen
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - S Kurz
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - G Pestel
- Klinik für Anästhesiologie, Universitätsmedizin Mainz, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Nácul MP, Cavazzola LT, de Melo MC. Current status of residency training in laparoscopic surgery in Brazil: a critical review. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 28:81-5. [PMID: 25861077 PMCID: PMC4739245 DOI: 10.1590/s0102-67202015000100020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 12/11/2014] [Indexed: 11/26/2022]
Abstract
Introduction The surgeon's formation process has changed in recent decades. The increase in
medical schools, new specialties and modern technologies induce an overhaul of
medical education. Medical residency in surgery has established itself as a key
step in the formation of the surgeon, and represents the ideal and natural way for
teaching laparoscopy. However, the introduction of laparoscopic surgery in the
medical residency programs in surgical specialties is insufficient, creating the
need for additional training after its termination. Objective To review the surgical teaching ways used in services that published their
results. Methods Survey of relevant publications in books, internet and databases in PubMed, Lilacs
and Scielo through july 2014 using the headings: laparoscopy; simulation;
education, medical; learning; internship and residency. Results The training method for medical residency in surgery focused on surgical
procedures in patients under supervision, has proven successful in the era of open
surgery. However, conceptually turns as a process of experimentation in humans.
Psychomotor learning must not be developed directly to the patient. Training in
laparoscopic surgery requires the acquisition of psychomotor skills through
training conducted initially with surgical simulation. Platforms based teaching
problem solving as the Fundamentals of Laparoscopic Surgery, developed by the
American Society of Gastrointestinal Endoscopic Surgery and the Laparoscopic
Surgical Skills proposed by the European Society of Endoscopic Surgery has been
widely used both for education and for the accreditation of surgeons worldwide.
Conclusion The establishment of a more appropriate pedagogical process for teaching
laparoscopic surgery in the medical residency programs is mandatory in order to
give a solid surgical education and to determine a structured and safe
professional activity.
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Affiliation(s)
- Miguel Prestes Nácul
- Faculty of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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Abstract
Simulator training in interventional cardiology is becoming a central part of early career acquisition of technical and non-technical skills. Its use is now mandated by national training organisations. Haptic simulators, part-task trainers, immersive environments and simulated patients can provide benchmarked, reproducible and safe opportunities for trainees to develop without exposing patients to the learning curve. However, whilst enthusiasm persists and trainee-centred evidence has been encouraging, simulation does not yet have a clear link to improved clinical outcomes. In this article we describe the range of simulation options, review the evidence for their efficacy in training and discuss the delivery of training in technical skills as well as human factor training and crisis resource management. We also review the future direction and barriers to the progression of simulation training.
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Affiliation(s)
- Abhishek Joshi
- Barts and The London NHS Trust, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| | - Andrew Wragg
- Barts and The London NHS Trust, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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Quilici AP, Bicudo AM, Gianotto-Oliveira R, Timerman S, Gutierrez F, Abrão KC. Faculty perceptions of simulation programs in healthcare education. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2015; 6:166-71. [PMID: 26590951 PMCID: PMC4662865 DOI: 10.5116/ijme.5641.0dc7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/09/2015] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To identify faculty perceptions of simulation insertion in the undergraduate program, considering the advantages and challenges posed by this resource. METHODS We conducted a qualitative study with intentional sampling according to pre-defined criteria, following a semi-structured outline regarding data saturation. We have interviewed 14 healthcare instructors from a teaching institution that employs simulation in its syllabi. RESULTS The majority of the faculty interviewed considered the use of scenario, followed by debriefing, as an excellent teaching tool. However, the faculty also noted a number of difficulties, such as the workload necessary to assemble the scenario, the correlation between scenario goals and the competences of the program, the time spent with the simulation, and the ratio of students to faculty members. CONCLUSIONS Faculties consider simulation an effective tool in the healthcare program and maintain that the main obstacle faced by them is the logistical demand.
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Affiliation(s)
- Ana P. Quilici
- School of Medicine, Anhembi Morumbi University, Sao Paulo, Brazil
| | - Angélica M. Bicudo
- Pediatric Department, Medical Science College, UNICAMP, Campinas, Brazil
| | | | - Sergio Timerman
- School of Medicine, Anhembi Morumbi University, Sao Paulo, Brazil
| | | | - Karen C. Abrão
- School of Medicine, Anhembi Morumbi University, Sao Paulo, Brazil
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Abstract
In the last three decades, simulation has become a key tool in the training of doctors and the maintenance of patient safety. Simulation offers an immersive, realistic way of learning technical skills. Recent changes to the training schemes in many surgical specialities mean that the hours spent working between senior house officer and consultant have been reduced. This, combined with other pressures (such as reduced operating hours), means that surgery has moved away from its traditional apprenticeship model and toward a competency-based one. Simulation can be a standardized and safe method for training and assessing surgeons. Use of simulation for training has become significant alongside the development of laparoscopic techniques, and evidence suggests that skills obtained in simulation are applicable in real clinical scenarios. Simulation allows trainees to make mistakes, to ask the "what if?" questions, and to learn and reflect on such situations without risking patient safety. Virtual reality simulators have been used to allow experts to plan complicated operations and assess perioperative risks. Most recently, fully immersive simulations, such as those with whole theater teams involved, and patient-centered simulations allow development of other key skills aside from purely technical ones. Use of simulation in isolation from traditional teaching methods will furnish the surgeon in training with skills, but the best time and place to use such skills comes only with experience. In this article we examine the role of simulation in surgical training and its impact in the context of reduced training time.
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Affiliation(s)
- Riaz A Agha
- 1 Department of Plastic Surgery, Pinderfields Hospital, Wakefield, United Kingdom
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20
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C M, E S, F B, A S, P S, G L, F B, S A S, S S. Development of a bio-inspired mechatronic chest wall simulator for evaluating the performances of opto-electronic plethysmography. Open Biomed Eng J 2015; 8:120-30. [PMID: 25624954 PMCID: PMC4302486 DOI: 10.2174/1874120701408010120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 11/22/2022] Open
Abstract
Instrumented gait analysis based on optoelectronic systems is an expensive technique used to objectively measure the human movement features and it is generally considered as the gold standard. Opto-electronic plethysmography (OEP) is a particular motion analysis system able to: (i) determine chest wall kinematic via the evaluation of marker displacements placed on the thorax and (ii) compute respiratory volumes during breathing.
The aim of this work is to describe the performances of a custom made, bio-inspired, mechatronic chest wall simulator (CWS), specifically designed to assess the metrological performances of the OEP system. The design of the simulator is based on the chest wall kinematic analysis of three healthy subjects previously determined.
Two sets of experiments were carried out: (i) to investigate the CWS dynamic response using different target displacements (1 - 12 mm), and (ii) to assess the CWS accuracy and precision in simulating quite breathing, covering the physiological range of respiratory frequency and tidal volume.
Results show that the CWS allows simulating respiratory frequency up to ~ 60 bpm. The difference between the actual displacement and the set one is always < 9 μm. The precision error, expressed as the ratio between measurement uncertainty and the actual displacement, is lower than 0.32 %.
The observed good performances permit to consider the CWS prototype feasible to be employed for assessing the performances of OEP system in periodical validation routines.
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Affiliation(s)
- Massaroni C
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Schena E
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Bastianini F
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Scorza A
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Saccomandi P
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Lupi G
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Botta F
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Sciuto S A
- Department of Engineering, University of ROMA TRE, Via della Vasca Navale 79/81, Roma, Italy
| | - Silvestri S
- Unit of Measurements and Biomedical Instrumentation, Center for Integrated Research, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
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Naimer SA, Prero MY, Freud T, Bartal C. Retrospective study of the incidence of unstable and shock patients presenting to the emergency room. Isr J Health Policy Res 2014; 3:34. [PMID: 25379169 PMCID: PMC4221710 DOI: 10.1186/2045-4015-3-34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over a period of three decades, medical personnel working in our emergency room observed that fewer severe cases presented to the emergency department. The objective of this study is to assess whether a genuine change in the presentation rates of clinically unstable non-trauma patients to the emergency room indeed exists. METHODS We conducted a retrospective review of patients treated in the shock room. Patients' demographic data, diagnoses and outcomes were accessed. Populations of patients presenting to the shock room over a span of four seasons, in two separate periods eight years apart were compared. This rate was compared with the complementary bulk rate of patients presenting to the emergency room at the center. RESULTS While absolute rates of emergency room utilization rose, the rate of unstable patients demanding urgent intensive care showed a clear decline. An absolute reduction of close to 50% across the different seasons of the examined years was found. Per patient, the proportion of those requiring artificial respiration and urgent hemodialysis remained uniform in both periods. All parameters of patient outcomes were similar in both periods of the study. CONCLUSION This unexplored aspect of emergency care demonstrates a dramatic decline in the incidence of unstable patients. While we should continue to reinforce delivery of superior care, our medical educational system should adapt itself to compensate for the diminished exposure of our trainees to emergencies. Further research in this field should explore whether the trend we observed exists in other geographical locations and whether this parameter can be utilized as a quality measure of medical systems.
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Affiliation(s)
- Sody A Naimer
- Elon Moreh Health Center, Clalit Health Services, Shomron, Israel ; Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Emergency Medicine Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel ; Department of Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 653, Beer-Sheva, 84105 Israel
| | - Moshe Y Prero
- The Medical School for International Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Tamar Freud
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Carmi Bartal
- Emergency Medicine Department, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Nacca N, Holliday J, Ko PY. Randomized trial of a novel ACLS teaching tool: does it improve student performance? West J Emerg Med 2014; 15:913-8. [PMID: 25493153 PMCID: PMC4251254 DOI: 10.5811/westjem.2014.9.20149] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 08/11/2014] [Accepted: 09/08/2014] [Indexed: 11/22/2022] Open
Abstract
Introduction Mounting evidence suggests that high-fidelity mannequin-based (HFMBS) and computer-based simulation are useful adjunctive educational tools for advanced cardiac life support (ACLS) instruction. We sought to determine whether access to a supplemental, online computer-based ACLS simulator would improve students’ performance on a standardized Mega Code using high-fidelity mannequin based simulation (HFMBS). Methods Sixty-five third-year medical students were randomized. Intervention group subjects (n = 29) each received a two-week access code to the online ACLS simulator, whereas the control group subjects (n = 36) did not. Primary outcome measures included students’ time to initiate chest compressions, defibrillate ventricular fibrillation, and pace symptomatic bradycardia. Secondary outcome measures included students’ subjective self-assessment of ACLS knowledge and confidence. Results Students with access to the online simulator on average defibrillated ventricular fibrillation in 112 seconds, whereas those without defibrillated in 149.9 seconds, an average of 38 seconds faster [p<.05]. Similarly, those with access to the simulator paced symptomatic bradycardia on average in 95.14 seconds whereas those without access paced on average 154.9 seconds a difference of 59.81 seconds [p<.05]. On a subjective 5-point scale, there was no difference in self-assessment of ACLS knowledge between the control (mean 3.3) versus intervention (mean 3.1) [p-value =.21]. Despite having outperformed the control group subjects in the standardized Mega Code test scenario, the intervention group felt less confident on a 5-point scale (mean 2.5) than the control group. (mean 3.2) [p<.05] Conclusion The reduction in time to defibrillate ventricular fibrillation and to pace symptomatic bradycardia among the intervention group subjects suggests that the online computer-based ACLS simulator is an effective adjunctive ACLS instructional tool.
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Affiliation(s)
- Nicholas Nacca
- SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York
| | - Jordan Holliday
- SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York
| | - Paul Y Ko
- SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York
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Burden AR, Pukenas EW, Deal ER, Coursin DB, Dodson GM, Staman GW, Gratz I, Torjman MC. Using Simulation Education With Deliberate Practice to Teach Leadership and Resource Management Skills to Senior Resident Code Leaders. J Grad Med Educ 2014; 6:463-9. [PMID: 26279770 PMCID: PMC4535209 DOI: 10.4300/jgme-d-13-00271.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 02/02/2014] [Accepted: 03/17/2014] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Cardiopulmonary arrests are rare, high-stakes events that benefit from using crisis resource management (CRM). Simulation-based education with deliberate practice can promote skill acquisition. OBJECTIVE We assessed whether using simulation-based education to teach CRM would lead to improved performance, compared to a lecture format. METHODS We tested third-year internal medicine residents in simulated code scenarios. Participants were randomly assigned to simulation-based education with deliberate practice (SIM) group or lecture (LEC) group. We created a checklist of CRM critical actions (which includes announcing the diagnosis, asking for help/suggestions, and assigning tasks), and reviewed videotaped performances, using a checklist of skills and communications patterns to identify CRM skills and communication efforts. Subjects were tested in simulated code scenarios 6 months after the initial assessment. RESULTS At baseline, all 52 subjects recognized distress, and 92% (48 of 52) called for help. Seventy-eight percent (41 of 52) did not succeed in resuscitating the simulated patient or demonstrate the CRM skills. After intervention, both groups (n = 26 per group) improved. All SIM subjects announced the diagnosis compared to 65% LEC subjects (17 of 26, P = .01); 77% (20 of 26) SIM and 19% (5 of 26) LEC subjects asked for suggestions (P < .001); and 100% (26 of 26) SIM and 27% (7 of 26) LEC subjects assigned tasks (P < .001). CONCLUSIONS The SIM intervention resulted in significantly improved team communication and cardiopulmonary arrest management. During debriefing, participants acknowledged the benefit of the SIM sessions.
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Jalink MB, Goris J, Heineman E, Pierie JPEN, ten Cate Hoedemaker HO. Construct and concurrent validity of a Nintendo Wii video game made for training basic laparoscopic skills. Surg Endosc 2013; 28:537-42. [PMID: 24061627 DOI: 10.1007/s00464-013-3199-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 08/16/2013] [Indexed: 01/25/2023]
Abstract
BACKGROUND Virtual reality (VR) laparoscopic simulators have been around for more than 10 years and have proven to be cost- and time-effective in laparoscopic skills training. However, most simulators are, in our experience, considered less interesting by residents and are often poorly accessible. Consequently, these devices are rarely used in actual training. In an effort to make a low-cost and more attractive simulator, a custom-made Nintendo Wii game was developed. This game could ultimately be used to train the same basic skills as VR laparoscopic simulators ought to. Before such a video game can be implemented into a surgical training program, it has to be validated according to international standards. METHODS The main goal of this study was to test construct and concurrent validity of the controls of a prototype of the game. In this study, the basic laparoscopic skills of experts (surgeons, urologists, and gynecologists, n = 15) were compared to those of complete novices (internists, n = 15) using the Wii Laparoscopy (construct validity). Scores were also compared to the Fundamentals of Laparoscopy (FLS) Peg Transfer test, an already established assessment method for measuring basic laparoscopic skills (concurrent validity). RESULTS Results showed that experts were 111 % faster (P = 0.001) on the Wii Laparoscopy task than novices. Also, scores of the FLS Peg Transfer test and the Wii Laparoscopy showed a significant, high correlation (r = 0.812, P < 0.001). CONCLUSIONS The prototype setup of the Wii Laparoscopy possesses solid construct and concurrent validity.
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Affiliation(s)
- M B Jalink
- Department of Surgery, University Medical Center Groningen, University of Groningen, De Brug, room 5.062, P.O. Box 30 001, 9700 RB, Groningen, The Netherlands,
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Rey JW, Ott T, Bösebeck D, Welschehold S, Galle PR, Werner C. [Organ protective intensive care treatment and simulation-based training]. Anaesthesist 2012; 61:242-8. [PMID: 22430555 DOI: 10.1007/s00101-012-1990-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In Germany the extent of organ donation is still inadequate and not sufficient to address patients on the waiting lists. Nevertheless, intensive care treatment of potential organ donors does not receive adequate attention. However, because of the increasing age and comorbidities of organ donors in recent years, a sufficient intensive care treatment is indispensable for the success of organ transplantations. Sufficient randomized clinical trials are lacking. This article reviews the current literature and describes approaches for improvement. Multicentre studies and education of medical staff of intensive care units, for example in intensive care simulation for organ protection, could potentially be a successful approach. The improvement and establishment of curricular training and education particularly in simulation workshops might be a promising approach to enhance the quantity and quality of organ donations.
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Affiliation(s)
- J W Rey
- I. Medizinische Klinik und Poliklinik, Universitätsmedizin Mainz, Deutschland.
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Abstract
This year marks 200 years of patient care at the Massachusetts General Hospital (MGH). In celebration of this milestone, a unique Grand Rounds case is presented. A 450-year-old rotund man admitted 60 times presents with a classic triad of periumbilical pain, bilateral plantar burns, and a frozen scalp. Although this triad may at first strike a cord of familiarity among seasoned clinicians, the disease mechanism is truly noteworthy, being clarified only after a detailed occupational history. Ergo, the lessons hark back to the days of yesteryear, when the history and physical served as the cornerstone of Yuletide clinical diagnosis. A discussion of epidemiology and prognosis accompanies a detailed examination of the pathophysiholiday. Although some consider this patient uncouth, as you will see, he is quite a medical sleuth. The long-standing relationship between this patient and the MGH prompted his family to write a letter of appreciation, which will remind the reader of the meaning that our care brings to patients and their families. Harvey Cushing, who completed his internship at the MGH in 1895, professed "A physician is obligated to consider more than a diseased organ, more even than the whole man-he must view the man in his world." We hope this unusual Grand Rounds case intrigues you as it reminds you of Cushing's lesson and wishes you a joyous holiday season.
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Sahu S, Lata I. Simulation in resuscitation teaching and training, an evidence based practice review. J Emerg Trauma Shock 2010; 3:378-84. [PMID: 21063561 PMCID: PMC2966571 DOI: 10.4103/0974-2700.70758] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 07/19/2010] [Indexed: 12/20/2022] Open
Abstract
In the management of a patient in cardiac arrest, it is sometimes the least experienced provider giving chest compressions, intubating the patient, and running the code during the most crucial moment in that patient's life. Traditional methods of educating residents and medical students using lectures and bedside teaching are no longer sufficient. Today's generation of trainees grew up in a multimedia environment, learning on the electronic method of learning (online, internet) instead of reading books. It is unreasonable to expect the educational model developed 50 years ago to be able to adequately train the medical students and residents of today. One area that is difficult to teach is the diagnosis and management of the critically ill patient, specifically who require resuscitation for cardiac emergencies and cardiac arrest. Patient simulation has emerged as an educational tool that allows the learner to practice patient care, away from the bedside, in a controlled and safe environment, giving the learner the opportunity to practice the educational principles of deliberate practice and self-refection. We performed a qualitative literature review of the uses of simulators in resuscitation training with a focus on their current and potential applications in cardiac arrest and emergencies.
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Affiliation(s)
- Sandeep Sahu
- Department of Anaesthesiology and Maternal and Reproductive Health, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Indu Lata
- Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
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Lam G, Ayas NT, Griesdale DE, Peets AD. Medical simulation in respiratory and critical care medicine. Lung 2010; 188:445-57. [PMID: 20865270 DOI: 10.1007/s00408-010-9260-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 09/08/2010] [Indexed: 01/09/2023]
Abstract
Simulation-based medical education has gained tremendous popularity over the past two decades. Driven by the patient safety movement, changes in the educational opportunities available to trainees and the rapidly evolving capabilities of computer technology, simulation-based medical education is now being used across the continuum of medical education. This review provides the reader with a perspective on simulation specific to respiratory and critical care medicine, including an overview of historical and modern simulation modalities and the current evidence supporting their use.
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Affiliation(s)
- Godfrey Lam
- Faculty of Medicine, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada
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Santhanam I, Kissoon N, Kamath SR, Ranjit S, Ramesh J, Shankar J. GAP between knowledge and skills for the implementation of the ACCM/PALS septic shock guidelines in India: is the bridge too far? Indian J Crit Care Med 2010; 13:54-8. [PMID: 19881184 PMCID: PMC2772250 DOI: 10.4103/0972-5229.56049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To determine whether physicians were aware of and had the skills to implement the American College of Critical Care Medicine/Pediatric Advanced Life Support Course septic shock protocol. Design: A cross-sectional questionnaire survey. Setting: Four academic institutions in Chennai, Manipal, Mangalore, and Trivandrum - cities representing the three southern states of Tamil Nadu, Karnataka, and Kerala, respectively, between February and April 2006. Interventions: Pre and post lecture questions. They were evaluated using 11 questions testing knowledge and 10 questions testing their comfort level in performing interventions related to the initial resuscitation in septic shock. Measurement and Main Result: The ACCM/PALS sepsis guidelines were taught during the PALS course conducted in the four academic institutions. A total of 118 delegates participated, of whom 114 (97%) were pediatricians and four (3%) were anaesthetists. The overall mean number of correct responses for the 11 questions testing knowledge before and after the lecture was 2.1 and 4.07, respectively P=0.001(paired t test). Although, 42% of the respondents (n=50) were aware of the ACCM guidelines, 88% (n=104) did not adhere to it in their practice. A total of 86% (n=101) and 66% (n=78) did not feel comfortable titrating inotropes or intubating in the ED; 78% (n=92) and 67% (n=78), respectively felt that central venous access (CVA) and arterial pressure (AP) monitoring were unimportant in the management of fluid refractory shock. Of the physicians, 20% (n=24) had never intubated a patient, 78% (n=92) had not introduced a central venous catheter, and 76% (n=90) had never introduced an intra-arterial catheter. Conclusions: In view of the lack of skills and suboptimal knowledge, the ACCM/PALS sepsis guidelines may be inappropriate in its current format in the Indian setting. More emphasis needs to be placed on educating community pediatricians with a simpler clinical protocol, which has the potential to save many more children.
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Affiliation(s)
- Indumathy Santhanam
- Pediatric Emergency Department, Institute of Child Health and Hospital for Children, Madras Medical College, Chennai, India.
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Okuda Y, Quinones J. The use of simulation in the education of emergency care providers for cardiac emergencies. Int J Emerg Med 2008; 1:73-7. [PMID: 19384655 PMCID: PMC2657247 DOI: 10.1007/s12245-008-0034-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Accepted: 05/02/2008] [Indexed: 11/27/2022] Open
Abstract
Background Traditional methods of educating residents and medical students using lectures and bedside teaching are no longer sufficient. Today’s generation of trainees grew up in a multimedia environment, learning on the World Wide Web instead of reading books. It is unreasonable to expect the educational model developed 50 years ago to be able to adequately train the medical students and residents of today. One area that is difficult to teach is the diagnosis and management of the critically ill patient, specifically cardiac emergencies and cardiac arrest. Rationale In the management of a patient in cardiac arrest, it is sometimes the least experienced provider giving chest compressions, intubating the patient, and running the code during the most crucial moment in that patient’s life. Methods Patient simulation has emerged as an educational tool that allows the learner to practice patient care, away from the bedside, in a controlled and safe environment, giving the learner the opportunity to practice the educational principles of deliberate practice and self-refection. We performed a qualitative literature review of the uses of simulators in medical training with a focus on their current and potential applications in cardiac emergencies.
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Affiliation(s)
- Yasuharu Okuda
- Department of Emergency Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Development of an educational simulator system, ECCSIM-Lite, for the acquisition of basic perfusion techniques and evaluation. J Artif Organs 2007; 10:201-5. [PMID: 18071848 DOI: 10.1007/s10047-007-0396-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2007] [Accepted: 08/08/2007] [Indexed: 10/22/2022]
Abstract
A training system with quantitative evaluation of performance for training perfusionists is valuable for preparation for rare but critical situations. A simulator system, ECCSIM-Lite, for extracorporeal circulation (ECC) training of perfusionists was developed. This system consists of a computer system containing a simulation program of the hemodynamic conditions and the training scenario with instructions, a flow sensor unit, a reservoir with a built-in water level sensor, and an ECC circuit with a soft bag representing the human body. This system is relatively simple, easy to handle, compact, and reasonably inexpensive. Quantitative information is recorded, including the changes in arterial flow by the manipulation of a knob, the changes in venous drainage by handling a clamp, and the change in reservoir level; the time courses of the above parameters are presented graphically. To increase the realism of the training, a numerical-hydraulic circulatory model was applied. Following the instruction and explanation of the scenario in the form of audio and video captions, it is possible for a trainee to undertake self-study without an instructor or a computer operator. To validate the system, a training session was given to three beginners using a simple training scenario; it was possible to record the performance of the perfusion sessions quantitatively. In conclusion, the ECCSIM-Lite system is expected to be useful for perfusion training, since quantitative information about the trainee's performance is recorded and it is possible to use the data for assessment and comparison.
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