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Duffy CC, Bass GA, Yi W, Rouhi A, Kaplan LJ, O'Sullivan E. Teaching Airway Management Using Virtual Reality: A Scoping Review. Anesth Analg 2024; 138:782-793. [PMID: 37467164 DOI: 10.1213/ane.0000000000006611] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Airway management, a defined procedural and cognitive skillset embracing routine tracheal intubation and emergency airway rescue, is most often acquired through an apprenticeship model of opportunistic learning during anesthesia or acute care residency training. This training engages a host of modalities to teach and embed skill sets but is generally time- and location-constrained. Virtual reality (VR)-based simulation training offers the potential for reproducible and asynchronous skill acquisition and maintenance, an advantage that may be important with restricted trainee work hours and low frequency but high-risk events. In the absence of a formal curriculum from training bodies-or expert guidance from medical professional societies-local initiatives have filled the VR training void in an unstructured fashion. We undertook a scoping review to explore current VR-based airway management training programs to assess their approach, outcomes, and technologies to discover programming gaps. English-language publications addressing any aspect of VR simulation training for airway management were identified across PubMed, Embase, and Scopus. Relevant articles were used to craft a scoping review conforming to the Scale for quality Assessment of Narrative Review Articles (SANRA) best-practice guidance. Fifteen studies described VR simulation programs to teach airway management skills, including flexible fibreoptic bronchoscopic intubation (n = 10), direct laryngoscopy (n = 2), and emergency cricothyroidotomy (n = 1). All studies were single institution initiatives and all reported different protocols and end points using bespoke applications of commercial technology or homegrown technologic solutions. VR-based simulation for airway management currently occurs outside of a formal curriculum structure, only for specific skill sets, and without a training pathway for educators. Medical educators with simulation training and medical professional societies with content expertise have the opportunity to develop consensus guidelines that inform training curricula as well as specialty technology use.
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Affiliation(s)
- Caoimhe C Duffy
- From the Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary A Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William Yi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Armaun Rouhi
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ellen O'Sullivan
- Department of Anaesthesia, Intensive Care, and Pain, St. James' Hospital, Dublin, Ireland
- Department of Anaesthesia, Trinity College, Dublin, Ireland
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Kronborg SH, Karbing DS, Arshad A, Lundgaard AC. Four different models for simulation-based training of bronchoscopic procedures. BMC Pulm Med 2024; 24:23. [PMID: 38195463 PMCID: PMC10777524 DOI: 10.1186/s12890-024-02846-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/04/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Flexible bronchoscopy procedures require detailed anatomical knowledge and advanced technical skills. Simulation-based training offers a patient-safe training environment that can be more efficient than patient-based training. Physical models are cheaper than virtual reality simulators and allow trainees to be acquainted with the equipment used in the clinic. The choice of a physical model for training depends on the local context. The aim of this study was to compare four different bronchoscopy models for flexible bronchoscopy training. METHODS The BronchoBoy manikin, the Koken manikin, a human cadaver, and a preserved porcine lung were included in the study. Seven physicians experienced in bronchoscopy performed a bronchoscopic airway inspection, bronchoalveolar lavage (BAL), and tissue sampling on all four models with performance evaluated by observation and participant evaluation of models by questionnaire. RESULTS Nineteen segments were identified in all human anatomy models, and the only significant difference found was that only the Thiel embedded cadaver allowed all participants to enter RB1 with an instrument in the working channel (p = 0.001). The Thiel embedded cadaver and the BronchoBoy manikin had low fluid return on BAL (22 and 52 ml), whereas the Koken manikin and the preserved porcine lung had high return (132 and 134 ml), (p = 0.017). Tissue samplings were only completed in the preserved porcine lung and the Thiel embedded cadaver (p < 0.001). CONCLUSIONS An anatomically correct bronchoscopy is best simulated with the Koken manikin or the Thiel embedded cadaver. Bronchoalveolar lavage should be simulated with the Koken manikin or the preserved porcine lung. Tissue sampling procedures are best simulated using the Thiel embedded cadaver or the preserved porcine lung.
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Affiliation(s)
- Sissel Højsted Kronborg
- Global Clinical Affairs, Clinical Application, Ambu A/S, Baltorpbakken 13, Ballerup, 2750, Denmark.
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark.
| | - Dan Stieper Karbing
- Department of Health Science and Technology, Aalborg University, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark
| | - Arman Arshad
- Department of Respiratory Medicine, Odense University Hospital, J. B. Winsløvs Vej 4, Odense, Denmark
| | - Anna Charlotte Lundgaard
- Global Clinical Affairs, Clinical Application, Ambu A/S, Baltorpbakken 13, Ballerup, 2750, Denmark
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Bejani M, Taghizadieh A, Samad‐Soltani T, Asadzadeh A, Rezaei‐Hachesu P. The effects of virtual reality-based bronchoscopy simulator on learning outcomes of medical trainees: A systematic review. Health Sci Rep 2023; 6:e1398. [PMID: 37415680 PMCID: PMC10320745 DOI: 10.1002/hsr2.1398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Background and Aims Conventional medical training routes of bronchoscopy may decrease patients' comfort and increase procedure-related morbidity. Virtual reality (VR)-based bronchoscopy is a beneficial and safe solution for teaching trainees. The aim of this systematic review was to study the effectiveness of VR-based bronchoscopy simulators on the learning outcomes of medical trainees. Methods Well-known sources (i.e., Scopus, ISI Web of Science, and Medline via PubMed) were systematically searched using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on December, 2021. Peer-reviewed English papers that used VR-based simulation for bronchoscopy training were included. The articles that were studying other technologies, or those that were unrelated to the topic, were excluded. The risk of bias was assessed using the Joanna Briggs Institute checklists for quasi-experimental studies and randomized controlled trials (RCTs). Results Out of 343 studies, 8 of them met our inclusion criteria. An appropriate control group and statistical analysis were the most common and unavoidable sources of bias in included non-RCTs, and lack of blinding in participants was the most common source of bias in RCTs. The included studies evaluated learning outcomes regarding dexterity (N = 5), speed (N = 3), the accuracy of procedures (N = 1), and the need for verbal assistance (N = 1). Based on the results, 100% (5/5) and 66% (2/3) of studies showed that the use of VR-based simulation on the learning outcomes of medical trainees led to improvement in manual ability (i.e., dexterity) and swiftness of execution (i.e., speed in performance), respectively. Additionally, improving the accuracy of subjects' performance, and reducing the need for verbal guidance and physical assistance was reported in studies that evaluated these variables. Conclusion VR bronchoscopy simulator as a training method for teaching medical trainees, especially for novices has the potential to improve medical trainees' performance and reduce complications. Further studies are needed to evaluate the positive effects of VR-based simulation on the learning outcomes of medical trainees.
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Affiliation(s)
- Mahmud Bejani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Ali Taghizadieh
- Department of Emergency Medicine, Tuberculosis and Lung Research Center, Faculty of MedicineTabriz University of Medical SciencesTabrizIran
| | - Taha Samad‐Soltani
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Afsoon Asadzadeh
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Peyman Rezaei‐Hachesu
- Department of Health Information Technology, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
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Sagalowksy ST, Pahalyants V, Roskind CG, Pusic MV. Building an adaptable resident curriculum for acute pediatric sexual abuse evaluations: A qualitative needs assessment. CHILD ABUSE & NEGLECT 2020; 102:104386. [PMID: 32070488 DOI: 10.1016/j.chiabu.2020.104386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 01/07/2020] [Accepted: 01/18/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Residents are undertrained to perform acute pediatric sexual abuse evaluations. The American Academy of Pediatrics has proposed development of an adaptable child abuse curriculum, though no such curriculum exists. OBJECTIVES Our goal was to perform a needs assessment for pediatric residents performing acute sexual abuse evaluations in an emergency department setting, thus laying groundwork for an adaptable curriculum. The objective was to explore pediatric resident training, knowledge, confidence, expectations, learning needs, and educational goals. PARTICIPANTS AND SETTING We conducted a qualitative exploratory study of pediatric residents, faculty, and program directors at two academic health centers in New York City. METHODS Using purposive and convenience sampling, we conducted focus groups and semi-structured interviews until saturation of ideas was achieved. Through an iterative process using constructivist grounded theory, themes were organized into a curricular model. RESULTS We conducted 3 resident focus groups (n = 21) and 7 interviews with emergency medicine, pediatric, and child abuse faculty. Themes emerged in three categories: barriers (e.g., knowledge deficits), facilitators (e.g., pre-learning), and educational goals. Despite recognizing the importance and increased availability of subspecialists, participants supported gradual autonomy for pediatric residents in the evaluation of suspected sexual abuse, with a goal of independent competency in history and examination skills, and supervised competency of forensic evidence collection. CONCLUSIONS Our data support a multimodal, blended curriculum for the acute sexual abuse evaluation, including: (1) asynchronous pre-learning; (2) live workshops; (3) reference tools; and (4) modeled clinical experiences. Our proposed curricular model may be utilized by a variety of frontline clinicians.
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Affiliation(s)
- Selin T Sagalowksy
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, New York, NY 10032, United States.
| | - Vartan Pahalyants
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, New York, NY 10032, United States.
| | - Cindy G Roskind
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, 3959 Broadway, New York, NY 10032, United States.
| | - Martin V Pusic
- Department of Emergency Medicine, NYU School of Medicine, 550 1st Avenue, New York, NY 10016, United States.
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Bhalla S, Tolley N, Awad Z. Creating a Validated Simulation Training Curriculum in Otolaryngology. CURRENT OTORHINOLARYNGOLOGY REPORTS 2020. [DOI: 10.1007/s40136-020-00275-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Purpose of Review
Simulation-based training is an integral component of surgical training. It allows practice of technical skills within a safe environment without compromising patient safety. This article seeks to review current virtual and non-virtual reality simulation models within the literature and review their validation status.
Recent Findings
Many simulation models exist within otolaryngology and are currently being used for education. New models are also continuously being developed; however, validity should be proven for the models before incorporating their use for educational purposes. Validity should be determined by experts and trainees themselves.
Summary
A validated simulation curriculum should be incorporated within the otolaryngology training programme. A curriculum based on the current training programme at our institution serves as an exemplar for local adoption.
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Abstract
Abstract
Purpose of Review
“Non-technical skills” are critical to patient safety and form an important part of a surgeon’s competency. Inter-disciplinary team training is now considered essential to train these valuable skills. This review discusses the importance of non-technical skills, and the role these skills have in simulation training within Otolaryngology.
Recent Findings
Otolaryngologists are uniquely positioned to encounter airway emergencies. Consequently, team-based training in crisis scenarios is especially important. Simulation can occur in situ or in the simulated setting, with “boot-camps” becoming a popular training intervention. Whilst team training within otolaryngology has been shown to be highly effective, formal assessment of these skills is not currently routine, with no assessment tool specifically tailored to ENT.
Summary
Simulation-based training is an effective and feasible method of teaching non-technical skills in Otolaryngology. With the shift towards competency-based medical education, formal assessment of these skills is important to perform.
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Yokoyama S, Mizunuma K, Kurashima Y, Watanabe Y, Mizota T, Poudel S, Kikuchi T, Kawai F, Shichinohe T, Hirano S. Evaluation methods and impact of simulation-based training in pediatric surgery: a systematic review. Pediatr Surg Int 2019; 35:1085-1094. [PMID: 31396735 DOI: 10.1007/s00383-019-04539-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to identify (1) the type of skill evaluation methods and (2) how the effect of training was evaluated in simulation-based training (SBT) in pediatric surgery. METHODS Databases of PubMed, Cochrane Library, and Web of Science were searched for articles published from January 2000 to January 2017. Search concepts of Medical Subject Heading terms were "surgery," "pediatrics," "simulation," and "training, evaluation." RESULTS Of 5858 publications identified, 43 were included. Twenty papers described simulators as assessment tools used to evaluate technical skills. Reviewers differentiated between experts and trainees using a scoring system (45%) and/or a checklist (25%). Simulators as training tools were described in 23 papers. While the training's effectiveness was measured using performance assessment scales (52%) and/or surveys (43%), no study investigated the improvement of the clinical outcomes after SBT. CONCLUSION Scoring, time, and motion analysis methods were used for the evaluation of basic techniques of laparoscopic skills. Only a few SBT in pediatric surgery have definite goals with clinical effect. Future research needs to demonstrate the educational effect of simulators as assessment or training tools on SBT in pediatric surgery.
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Affiliation(s)
- Shinichiro Yokoyama
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenichi Mizunuma
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yo Kurashima
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan. .,Clinical Simulation Center, Hokkaido University, Sapporo, Japan. .,Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15, Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yusuke Watanabe
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomoko Mizota
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of Surgery, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Saseem Poudel
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,Department of General Surgery, Steel Memorial Muroran Hospital, Muroran, Japan
| | | | - Fujimi Kawai
- St. Luke's International University Library, Tokyo, Japan
| | - Toshiaki Shichinohe
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Hirano
- Department of Gastrointestinal Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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8
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Nguyen LHP, Bank I, Fisher R, Mascarella M, Young M. Managing the airway catastrophe: longitudinal simulation-based curriculum to teach airway management. J Otolaryngol Head Neck Surg 2019; 48:10. [PMID: 30782200 PMCID: PMC6381681 DOI: 10.1186/s40463-019-0332-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/01/2019] [Indexed: 11/18/2022] Open
Abstract
Background A longitudinal curriculum was developed in conjunction with anesthesiologists, otolaryngologists, emergency physicians and experts in medical simulation and education. Methods Residents participated in four different simulation-based training modules using animal models, cadavers, task trainers, and crisis scenarios using high fidelity manikins. Scenarios were based on various clinical settings (i.e. emergency room, operating room) and were followed by video-assisted structured debriefings. Participants completed both a self-assessment questionnaire and an exit survey using five-point Likert scales. Results 31 otolaryngology residents participated in the curriculum. Residents reported simulation training significantly improved technical skills such as tracheostomy, cricothyroidotomy and pediatric intubation (p < 0.05 for all). Non-technical skills, including communication, delegation and management were significantly improved on post-test surveys in simulated crisis scenarios (p < 0.05 for all). 90 (28/31) of participants found simulations to be very realistic. Junior residents placed increased value on didactic teaching and procedural skills, while senior residents on crisis scenarios. Survey results indicated that > 90% (28/31) of participants found the modules of the curriculum to be useful and would recommend them to others. Conclusion A longitudinal simulation-based medical curriculum can be an effective method to teach airway management and teamwork skills to otolaryngology residents.
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Affiliation(s)
- Lily H P Nguyen
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada. .,Centre for Medical Education, McGill University, Montreal, Canada. .,Department of OTL-HNS, Montreal Children's Hospital, 1001 Blvd. Decarie, Room A02-3015, Montreal, Canada.
| | - Ilana Bank
- Centre for Medical Education, McGill University, Montreal, Canada.,Department of Emergency Medicine, McGill University, Montreal, Canada
| | - Rachel Fisher
- Centre for Medical Education, McGill University, Montreal, Canada.,Department of Anesthesia, McGill University, Montreal, Canada
| | - Marco Mascarella
- Department of Otolaryngology - Head and Neck Surgery, McGill University, Montreal, Canada
| | - Meredith Young
- Centre for Medical Education, McGill University, Montreal, Canada
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Veaudor M, Gérinière L, Souquet PJ, Druette L, Martin X, Vergnon JM, Couraud S. High-fidelity simulation self-training enables novice bronchoscopists to acquire basic bronchoscopy skills comparable to their moderately and highly experienced counterparts. BMC MEDICAL EDUCATION 2018; 18:191. [PMID: 30086734 PMCID: PMC6081833 DOI: 10.1186/s12909-018-1304-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 07/30/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND We sought to determine whether a self-training program on a high-fidelity flexible bronchoscopy (FB) simulator would allow residents who were novices in bronchoscopy to acquire competencies similar to those of experienced bronchoscopists as concerns the visualization of the bronchial tree and the identification of its anatomical elements. METHODS We performed a prospective cohort study, categorizing bronchoscopists into three groups according to their experience level: novice (Group A, no FBs performed, n = 8), moderate (Group B, 30 ≤ FBs performed ≤200, n = 17) or high (Group C, > 200 FBs performed, n = 9). All were initially evaluated on their ability to perform on a high-fidelity FB simulator a complete visualization/identification of the bronchial tree in the least amount of time possible. The residents in Group A then completed a simulation-based self-training program and underwent a final evaluation thereafter. RESULTS The median total procedure time for Group A fell from 561 s (IQR = 134) in the initial evaluation to 216 s (IQR = 257) in the final evaluation (P = 0.002). The visualization and identification scores for Group A also improved significantly in the final evaluation. Resultantly, the overall performance score for Group A climbed from 5.9% (IQR = 5.1) before self-training to 25.5% (IQR = 26.3) after (P = 0.002), thus becoming comparable to the overall performance scores of Group B (25.3%, IQR = 13.8) and Group C (22.2%, IQR = 5.5). CONCLUSIONS Novice bronchoscopists who self-train on a high-fidelity simulator acquire basic competencies similar to those of moderately or even highly experienced bronchoscopists. High-fidelity simulation should be rapidly integrated within the learning curriculum and replace traditional, in-patient learning methods.
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Affiliation(s)
- Martin Veaudor
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France
| | - Laurence Gérinière
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France
| | - Pierre-Jean Souquet
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France
| | - Loïc Druette
- Stratégie d'Apprentissage des Métiers de Santé en Environnement Immersif, Université Lyon 1, 69008, Lyon, France
| | - Xavier Martin
- Stratégie d'Apprentissage des Métiers de Santé en Environnement Immersif, Université Lyon 1, 69008, Lyon, France
| | - Jean-Michel Vergnon
- Service de Pneumologie et oncologie thoracique, CHU St Etienne, Hôpital Nord, 42270, Saint-Priest en Jarez, France
| | - Sébastien Couraud
- Service de Pneumologie Aigue Spécialisée et Cancérologie Thoracique, Institut de Cancérologie des Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, 69310, Pierre Bénite, France.
- EMR 3738 Ciblage thérapeutique en oncologie, Faculté de médecine Lyon Sud Charles Mérieux, Université Lyon 1, 69600, Oullins, France.
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10
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Using simulators to teach pediatric airway procedures in an international setting. Int J Pediatr Otorhinolaryngol 2018; 104:178-181. [PMID: 29287862 DOI: 10.1016/j.ijporl.2017.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/06/2017] [Accepted: 11/08/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION There has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology. OBJECTIVES The objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting. METHODS Pediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale. RESULTS Participants reported significant subjective improvement in confidence level after use of the simulation models (p < 0.05). Participants reported realistic representations of human anatomy and pathology. The models' tissue mechanics were adequate to practice operative technique including the ability to incise, suture, and suspend models. CONCLUSION The pediatric laryngeal models demonstrate high quality anatomy, which is easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment.
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11
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Javia L, Sardesai MG. Physical Models and Virtual Reality Simulators in Otolaryngology. Otolaryngol Clin North Am 2017; 50:875-891. [DOI: 10.1016/j.otc.2017.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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12
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Fanous A, Rappaport J, Young M, Park YS, Manoukian J, Nguyen LHP. A longitudinal simulation-based ethical-legal curriculum for otolaryngology residents. Laryngoscope 2017; 127:2501-2509. [DOI: 10.1002/lary.26551] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/30/2016] [Accepted: 01/30/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Amanda Fanous
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Jamie Rappaport
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Meredith Young
- Center for Medical Education; McGill University; Montreal Quebec Canada
- Department of Medicine; McGill University; Montreal Quebec Canada
| | - Yoon Soo Park
- Department of Medical Education; University of Illinois, Chicago; Chicago Illinois U.S.A
| | - John Manoukian
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
| | - Lily H. P. Nguyen
- Department of Otolaryngology-Head and Neck Surgery; McGill University; Montreal Quebec Canada
- Center for Medical Education; McGill University; Montreal Quebec Canada
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Abstract
Simulation is an emerging and viable means to increase pediatric airway surgical training. A variety of simulators currently exist that may be used or modified for laryngoscopy, bronchoscopy, and endoscopic intervention, although anatomic realism and utility for complex procedures are limited. There is a need for further development of improved endoscopic and anatomic models. Innovative techniques are enabling small-scale manufacturing of generalizable and patient-specific simulators. The high acuity of the pediatric airway patient makes the use of simulation an attractive modality for training, competency maintenance, and patient safety quality-improvement studies.
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Affiliation(s)
- Charles M Myer
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2018, Cincinnati, OH 45229-3026, USA.
| | - Noel Jabbour
- Department of Otolaryngology, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, 4401 Penn Avenue, Faculty Pavilion, 7th Floor, Pittsburgh, PA 15224, USA
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14
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Wiebracht ND, Giliberto JP, Myer C, Casper K, Johnson KE. Pilot testing of a novel surgical simulator for endoscopic zenker's diverticulotomy. Laryngoscope 2016; 127:592-596. [DOI: 10.1002/lary.26129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Nathan D. Wiebracht
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
| | - John P. Giliberto
- Department of Otolaryngology-Head and Neck Surgery; University of Washington; Seattle Washington U.S.A
| | - Charles Myer
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati College of Medicine; Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology-Head and Neck Surgery; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio U.S.A
| | - Keith Casper
- Department of Otolaryngology-Head and Neck Surgery; University of Michigan; Ann Arbor Michigan U.S.A
| | - Kaalan E. Johnson
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's and the Department of Otolaryngology-Head and Neck Surgery; University of Washington; Seattle Washington U.S.A
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15
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Woo JA, Malekzadeh S, Malloy KM, Deutsch ES. Are All Manikins Created Equal? A Pilot Study of Simulator Upper Airway Anatomic Fidelity. Otolaryngol Head Neck Surg 2016; 156:1154-1157. [PMID: 28566046 DOI: 10.1177/0194599816674658] [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] [Indexed: 11/16/2022]
Abstract
This study evaluates the anatomic fidelity of several commercially available pediatric and adult manikins, including airway task trainers, which could be used in aerodigestive procedure training. Twenty-three experienced otolaryngologists assessed the aerodigestive anatomy of 5 adult and 5 pediatric manikins in a passive state, using rigid and flexible endoscopy. Anatomic fidelity was rated on a 5-point scale for the following: nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, trachea, esophagus, and neck. Mean scores and standard deviations were tabulated for each manikin at each anatomic site. Ratings by survey participants demonstrated variation in the anatomic fidelity of the aerodigestive tract in a range of manikins. Radar chart display of the results allows comparison of manikin fidelity by anatomic site. Differences in scores may allow instructors to select manikins with the best anatomic fidelity for specific educational purposes, and they may contribute to recommendations to improve future manikin design.
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Affiliation(s)
- Jennifer A Woo
- 1 Georgetown University School of Medicine, Washington, DC, USA
| | - Sonya Malekzadeh
- 1 Georgetown University School of Medicine, Washington, DC, USA.,2 Department of Otolaryngology-Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Kelly M Malloy
- 3 Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Ellen S Deutsch
- 4 Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Al-Ramahi J, Luo H, Fang R, Chou A, Jiang J, Kille T. Development of an Innovative 3D Printed Rigid Bronchoscopy Training Model. Ann Otol Rhinol Laryngol 2016; 125:965-969. [PMID: 27605436 DOI: 10.1177/0003489416667742] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to create a 3D printed airway model simulating the size and mechanical properties of various age groups for foreign body removal training. METHODS Three-dimensional printing technology was used to print the anatomically correct airway from rubber-like translucent material, simulating the mechanical properties of human airway tissue. The model's effectiveness in trainee education was evaluated by otolaryngology residents with varying levels of experience. As part of an Airway Emergencies course, a rigid bronchoscopy procedure was performed on the 3D printed model as well as a porcine model. The participants completed surveys comparing the validity of the 2 models and the effectiveness of the overall training experience. RESULTS The 3D printed model, which is accurate in terms of anatomy and mechanical properties, was found to be comparable to a porcine model in regards to participant satisfaction as well as face validity. CONCLUSIONS The 3D printed airway model is able to be accurately scaled to various sizes and simulate the mechanical properties of the desired age group. The 3D printed model provides an excellent alternative to animal models in terms of practicality, logistics of use, and anatomical accuracy.
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Affiliation(s)
- Jehad Al-Ramahi
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin, USA
| | - Huiping Luo
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin, USA.,EENT Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China
| | - Rui Fang
- EENT Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China
| | - Adriana Chou
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin, USA
| | - Jack Jiang
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin, USA.,EENT Hospital of Fudan University, Department of Otolaryngology-Head and Neck Surgery, Shanghai, China
| | - Tony Kille
- University of Wisconsin School of Medicine and Public Health, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Madison, Wisconsin, USA
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Ex vivoovine model for suspension microlaryngoscopy training. The Journal of Laryngology & Otology 2016; 130:939-942. [DOI: 10.1017/s0022215116008756] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:To develop an ovine model for teaching suspension laryngoscopy and phonosurgery.Methods:The head and neck from 10 pre-pubescent sheep were harvested following humane euthanasia at the end of anin vivoprotocol. No live animals were used in this study. The tissues were saline-perfused and refrigerated for 1–5 days. Suspension laryngoscopy was performed using adolescent Parsons and adult Kantor-Berci laryngoscopes suspended with a Benjamin-Parsons laryngoscope holder. Visualisation was achieved with 0° and 30° telescopes, and a three-chip camera and video system. Shapshay-Ossoff microlaryngeal instruments were used for endolaryngeal dissection.Results:Experienced laryngologists led a second year medical student through several procedures including injection laryngoplasty, hydrodissection and incision, endolaryngeal suturing, and partial cordectomy. Despite expected anatomical differences, the model proved highly realistic for suspension microlaryngoscopy.Conclusion:The sheep head and neck model provides an inexpensive, safe model for developing skills in suspension laryngoscopy and basic phonosurgery.
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Ex vivo ovine model for pediatric flexible endoscopy training. Int J Pediatr Otorhinolaryngol 2015; 79:2196-9. [PMID: 26514929 DOI: 10.1016/j.ijporl.2015.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Medical students and residents in training have limited opportunities to develop pediatric endoscopy skills and would benefit from a realistic simulation model. We sought to develop such a model for flexible endoscopy using fresh head and neck tissue from young sheep. METHODS Tissue was collected from pre-pubescent sheep (n=5; mean age: 4 months; mean mass: 28kg) following humane euthanasia at the end of an in vivo protocol. No live animals were used in this study. The head and neck of the sheep were disarticulated 4-6cm above the sternal notch and stored at 5°C for 1-5 days. With the preparation was supported in supine position, flexible nasopharyngolaryngoscopy and transnasal endoscopic intubation were performed with video recording. RESULTS Five sheep were studied. Endoscopy was performed by a medical student under direct supervision by a pediatric otolaryngologist. Differences between ovine and human pediatric airway anatomy were defined. CONCLUSIONS Despite variations in proportion and structure, the experience of passing a flexible nasopharyngoscope through a sheep's airway is remarkably similar to pediatric endoscopy. The nasal anatomy is elongated, but very much like a child's in terms of anatomy, color and texture. The tactile feedback is nearly identical. Annoying secretions and their associated "whiteout" phenomena nicely simulate these challenges in pediatric endoscopy. When performing transnasal intubation, navigating to the larynx and advancing an endotracheal tube under guidance have the look and feel of the pediatric procedure. Issues of cost, availability, risk of zoonotic infection, and ethics are discussed.
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Best practices across surgical specialties relating to simulation-based training. Surgery 2015; 158:1395-402. [DOI: 10.1016/j.surg.2015.03.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/22/2015] [Indexed: 01/22/2023]
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Ernst A, Wahidi MM, Read CA, Buckley JD, Addrizzo-Harris DJ, Shah PL, Herth FJF, de Hoyos Parra A, Ornelas J, Yarmus L, Silvestri GA. Adult Bronchoscopy Training: Current State and Suggestions for the Future: CHEST Expert Panel Report. Chest 2015; 148:321-332. [PMID: 25674901 DOI: 10.1378/chest.14-0678] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The determination of competency of trainees in programs performing bronchoscopy is quite variable. Some programs provide didactic lectures with hands-on supervision, other programs incorporate advanced simulation centers, whereas others have a checklist approach. Although no single method has been proven best, the variability alone suggests that outcomes are variable. Program directors and certifying bodies need guidance to create standards for training programs. Little well-developed literature on the topic exists. METHODS To provide credible and trustworthy guidance, rigorous methodology has been applied to create this bronchoscopy consensus training statement. All panelists were vetted and approved by the CHEST Guidelines Oversight Committee. Each topic group drafted questions in a PICO (population, intervention, comparator, outcome) format. MEDLINE data through PubMed and the Cochrane Library were systematically searched. Manual searches also supplemented the searches. All gathered references were screened for consideration based on inclusion criteria, and all statements were designated as an Ungraded Consensus-Based Statement. RESULTS We suggest that professional societies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. Bronchoscopy training programs should incorporate multiple tools, including simulation. We suggest that ongoing quality and process improvement systems be introduced and that certifying agencies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. We also suggest that assessment of skill maintenance and improvement in practice be evaluated regularly with ongoing quality and process improvement systems after initial skill acquisition. CONCLUSIONS The current methods used for bronchoscopy competency in training programs are variable. We suggest that professional societies and certifying agencies move from a volume- based certification system to a standardized skill acquisition and knowledge-based competency assessment for pulmonary and thoracic surgery trainees.
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Affiliation(s)
- Armin Ernst
- Reliant Medical Group and Tufts University, Worcester, MA.
| | | | | | | | | | - Pallav L Shah
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefi eld NHS Foundation Trust and Imperial College, London, England
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Piromchai P, Avery A, Laopaiboon M, Kennedy G, O'Leary S. Virtual reality training for improving the skills needed for performing surgery of the ear, nose or throat. Cochrane Database Syst Rev 2015; 2015:CD010198. [PMID: 26352008 PMCID: PMC9233923 DOI: 10.1002/14651858.cd010198.pub2] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Virtual reality simulation uses computer-generated imagery to present a simulated training environment for learners. This review seeks to examine whether there is evidence to support the introduction of virtual reality surgical simulation into ear, nose and throat surgical training programmes. OBJECTIVES 1. To assess whether surgeons undertaking virtual reality simulation-based training achieve surgical ('patient') outcomes that are at least as good as, or better than, those achieved through conventional training methods.2. To assess whether there is evidence from either the operating theatre, or from controlled (simulation centre-based) environments, that virtual reality-based surgical training leads to surgical skills that are comparable to, or better than, those achieved through conventional training. SEARCH METHODS The Cochrane Ear, Nose and Throat Disorders Group (CENTDG) Trials Search Co-ordinator searched the CENTDG Trials Register; Central Register of Controlled Trials (CENTRAL 2015, Issue 6); PubMed; EMBASE; ERIC; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 27 July 2015. SELECTION CRITERIA We included all randomised controlled trials and controlled trials comparing virtual reality training and any other method of training in ear, nose or throat surgery. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by The Cochrane Collaboration. We evaluated both technical and non-technical aspects of skill competency. MAIN RESULTS We included nine studies involving 210 participants. Out of these, four studies (involving 61 residents) assessed technical skills in the operating theatre (primary outcomes). Five studies (comprising 149 residents and medical students) assessed technical skills in controlled environments (secondary outcomes). The majority of the trials were at high risk of bias. We assessed the GRADE quality of evidence for most outcomes across studies as 'low'. Operating theatre environment (primary outcomes) In the operating theatre, there were no studies that examined two of three primary outcomes: real world patient outcomes and acquisition of non-technical skills. The third primary outcome (technical skills in the operating theatre) was evaluated in two studies comparing virtual reality endoscopic sinus surgery training with conventional training. In one study, psychomotor skill (which relates to operative technique or the physical co-ordination associated with instrument handling) was assessed on a 10-point scale. A second study evaluated the procedural outcome of time-on-task. The virtual reality group performance was significantly better, with a better psychomotor score (mean difference (MD) 1.66, 95% CI 0.52 to 2.81; 10-point scale) and a shorter time taken to complete the operation (MD -5.50 minutes, 95% CI -9.97 to -1.03). Controlled training environments (secondary outcomes) In a controlled environment five studies evaluated the technical skills of surgical trainees (one study) and medical students (three studies). One study was excluded from the analysis. Surgical trainees: One study (80 participants) evaluated the technical performance of surgical trainees during temporal bone surgery, where the outcome was the quality of the final dissection. There was no difference in the end-product scores between virtual reality and cadaveric temporal bone training. Medical students: Two other studies (40 participants) evaluated technical skills achieved by medical students in the temporal bone laboratory. Learners' knowledge of the flow of the operative procedure (procedural score) was better after virtual reality than conventional training (SMD 1.11, 95% CI 0.44 to 1.79). There was also a significant difference in end-product score between the virtual reality and conventional training groups (SMD 2.60, 95% CI 1.71 to 3.49). One study (17 participants) revealed that medical students acquired anatomical knowledge (on a scale of 0 to 10) better during virtual reality than during conventional training (MD 4.3, 95% CI 2.05 to 6.55). No studies in a controlled training environment assessed non-technical skills. AUTHORS' CONCLUSIONS There is limited evidence to support the inclusion of virtual reality surgical simulation into surgical training programmes, on the basis that it can allow trainees to develop technical skills that are at least as good as those achieved through conventional training. Further investigations are required to determine whether virtual reality training is associated with better real world outcomes for patients and the development of non-technical skills. Virtual reality simulation may be considered as an additional learning tool for medical students.
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Affiliation(s)
- Patorn Piromchai
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
- Faculty of Medicine, Khon Kaen UniversityDepartment of OtolaryngologyKhon KaenThailand40002
| | - Alex Avery
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Biostatistics and Demography, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Gregor Kennedy
- University of MelbourneCentre for the Study of Higher EducationParkvilleVictoriaAustralia3052
| | - Stephen O'Leary
- Royal Victorian Eye and Ear Hospital/University of MelbourneDepartment of OtolaryngologyMelbourneAustralia
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Bigelow AM, Gothard MD, Schwartz HP, Bigham MT. Intubation in Pediatric/Neonatal Critical Care Transport: National Performance. PREHOSP EMERG CARE 2015; 19:351-7. [PMID: 25664667 DOI: 10.3109/10903127.2014.980481] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There are nearly 200,000 US infants/children transported annually for specialty care and there are no published best practices in transport intubation. OBJECTIVE Respiratory interventions are a priority in pediatric and neonatal critical care transport (PNCCT). A recent Delphi study identified intubation performance as an important PNCCT quality metric, though data are insufficient. The objective of the study is to determine multi-center rates of first attempt intubation success in pediatric/neonatal transport and identify practice processes associated with higher performing centers. METHODS Retrospective chart review where data was collected from the 9 participating centers over a 6-month period from January-June 2013. Data describing intubation training and practices were gathered using SurveyMonkey® (Palo Alto, CA). Data were tabulated in Microsoft Excel (Redmond, WA) and analyzed using descriptive statistics. Through the determination of 1(st) intubation success rate across multiple pediatric/neonatal critical care transport programs, we hypothesized that the features of higher and lower performing centers can be identified to inform practice. RESULTS 9 of 14 invited institutions participated. The median (IQR) 6-month transport volume for neonates(neo) was 289(35-646) and pediatric (ped) 510(122-831). On average, 7%(+/-3.0) of neo and 1.6%(+/-0.7) of ped transport patients required intubation. Individual centers had their initial success rate calculated and a 95% confidence interval was determined for those centers satisfying the np > 5 and n(1-p) > 5 sample size requirement for normality assumption of proportions. Since the overall success rate was 64%, it was determined that n = 14 initial intubation attempts would be the minimum number needed per center in order to fulfill the sample size requirement for normality assumption. Centers whose 95% confidence interval did not contain the initial overall success rate were identified. CONCLUSION This represents the first multi-center neo/ped intubation dataset in PNCCT. First attempt intubation success lags behind reported anesthesia intubation rates but parallels pediatric emergency department intubation success rates. Training and operational processes are variable in PNCCT, though top performing teams require live-patient intubation success to achieve initial intubation competency.
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Cheng A, Lang TR, Starr SR, Pusic M, Cook DA. Technology-enhanced simulation and pediatric education: a meta-analysis. Pediatrics 2014; 133:e1313-23. [PMID: 24733867 DOI: 10.1542/peds.2013-2139] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Pediatrics has embraced technology-enhanced simulation (TES) as an educational modality, but its effectiveness for pediatric education remains unclear. The objective of this study was to describe the characteristics and evaluate the effectiveness of TES for pediatric education. METHODS This review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards. A systematic search of Medline, Embase, CINAHL, ERIC, Web of Science, Scopus, key journals, and previous review bibliographies through May 2011 and an updated Medline search through October 2013 were conducted. Original research articles in any language evaluating the use of TES for educating health care providers at any stage, where the content solely focuses on patients 18 years or younger, were selected. Reviewers working in duplicate abstracted information on learners, clinical topic, instructional design, study quality, and outcomes. We coded skills (simulated setting) separately for time and nontime measures and similarly classified patient care behaviors and patient effects. RESULTS We identified 57 studies (3666 learners) using TES to teach pediatrics. Effect sizes (ESs) were pooled by using a random-effects model. Among studies comparing TES with no intervention, pooled ESs were large for outcomes of knowledge, nontime skills (eg, performance in simulated setting), behaviors with patients, and time to task completion (ES = 0.80-1.91). Studies comparing the use of high versus low physical realism simulators showed small to moderate effects favoring high physical realism (ES = 0.31-0.70). CONCLUSIONS TES for pediatric education is associated with large ESs in comparison with no intervention. Future research should include comparative studies that identify optimal instructional methods and incorporate pediatric-specific issues into educational interventions.
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Affiliation(s)
- Adam Cheng
- Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Canada;
| | - Tara R Lang
- Division of Neonatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Martin Pusic
- Office of Medical Education, Division of Educational Informatics, New York University School of Medicine, New York, New York
| | - David A Cook
- Department of Medicine and Office of Education Research, Mayo Clinic College of Medicine, Rochester, Minnesota; and
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Fielding DI, Maldonado F, Murgu S. Achieving competency in bronchoscopy: Challenges and opportunities. Respirology 2014; 19:472-82. [DOI: 10.1111/resp.12279] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 01/01/2023]
Affiliation(s)
- David I. Fielding
- Department of Thoracic Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Fabien Maldonado
- Division of Pulmonary and Critical Care Medicine; Mayo Clinic; Rochester Minnesota USA
| | - Septimiu Murgu
- Bronchoscopy Unit; University of Chicago; Chicago Illinois USA
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Harrop J, Lobel DA, Bendok B, Sharan A, Rezai AR. Developing a Neurosurgical Simulation-Based Educational Curriculum. Neurosurgery 2013; 73 Suppl 1:25-9. [DOI: 10.1227/neu.0000000000000101] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kennedy CC, Maldonado F, Cook DA. Simulation-based bronchoscopy training: systematic review and meta-analysis. Chest 2013; 144:183-192. [PMID: 23370487 DOI: 10.1378/chest.12-1786] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Simulation-based bronchoscopy training is increasingly used, but effectiveness remains uncertain. We sought to perform a comprehensive synthesis of published work on simulation-based bronchoscopy training. METHODS We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011. We included all original studies involving health professionals that evaluated, in comparison with no intervention or an alternative instructional approach, simulation-based training for flexible or rigid bronchoscopy. Study selection and data abstraction were performed independently and in duplicate. We pooled results using random effects meta-analysis. RESULTS From an initial pool of 10,903 articles, we identified 17 studies evaluating simulation-based bronchoscopy training. In comparison with no intervention, simulation training was associated with large benefits on skills and behaviors (pooled effect size, 1.21 [95% CI, 0.82-1.60]; n=8 studies) and moderate benefits on time (0.62 [95% CI, 0.12-1.13]; n=7). In comparison with clinical instruction, behaviors with real patients showed nonsignificant effects favoring simulation for time (0.61 [95% CI, -1.47 to 2.69]) and process (0.33 [95% CI, -1.46 to 2.11]) outcomes (n=2 studies each), although variation in training time might account for these differences. Four studies compared alternate simulation-based training approaches. Inductive analysis to inform instructional design suggested that longer or more structured training is more effective, authentic clinical context adds value, and animal models and plastic part-task models may be superior to more costly virtual-reality simulators. CONCLUSIONS Simulation-based bronchoscopy training is effective in comparison with no intervention. Comparative effectiveness studies are few.
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Affiliation(s)
| | | | - David A Cook
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Office of Education Research, Mayo Medical School, Mayo Foundation for Medical Education and Research, Rochester, MN.
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Javia L, Deutsch ES. A Systematic Review of Simulators in Otolaryngology. Otolaryngol Head Neck Surg 2012; 147:999-1011. [DOI: 10.1177/0194599812462007] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective To conduct a systematic review of published articles that describe simulators that could be used in otolaryngology for education, skill acquisition, and/or skill improvement. Data Sources Ovid and Embase databases searched July 14, 2011. Review Methods Three hundred fifty-three abstracts were independently reviewed by both authors, then 154 eligible articles were reviewed by both authors, and 95 articles were categorized by organ system (eg, otologic); type of simulator (eg, physical, virtual); whether the simulator was a prototype, could be purchased, or was constructed; validation; and level of learning assessment. Discrepancies were resolved by re-review and discussion. Results In addition to 11 overview articles, 28 articles described 16 otology simulators, most of which are virtual and prototypes. Ninteen articles described 10 sinus/rhinology simulators; most are virtual surgery simulators and prototypes. Eight articles described 8 oral cavity simulators, and 8 articles described neck simulators. Seventeen articles described 13 bronchoscopy simulators; several are full-body high-technology manikins adapted from other purposes. Five articles described eclectic simulators, including some for learning nontechnical and teamwork skills. Half of the simulators have been validated. Learning levels were often not assessed or assessment was limited to the learners’ perceptions. Conclusion A wide variety of simulators are available or under development. Lack of unified validation concepts and limited descriptions restricted our ability to assess model characteristics, availability, and validation. Simulators are emerging as powerful tools to facilitate learning; this review may provide a platform for discussion and refinement of the information reported and analyzed in evaluating simulators.
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Affiliation(s)
- Luv Javia
- Division of Pediatric Otolaryngology, The Children’s Hospital of Philadelphia, Department of Otorhinolaryngology/Head and Neck Surgery, The Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ellen S. Deutsch
- Center for Simulation, Advanced Education and Innovation, Department of Anesthesiology and Critical Care Medicine, the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Griffin GR, Hoesli R, Thorne MC. Validity and Efficacy of a Pediatric Airway Foreign Body Training Course in Resident Education. Ann Otol Rhinol Laryngol 2011; 120:635-40. [DOI: 10.1177/000348941112001002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: We evaluated the validity and efficacy of a pediatric airway foreign body simulation for otolaryngology resident training. Methods: We created a course using a high-fidelity toddler mannequin designed to instruct and evaluate otolaryngology residents in pediatric airway foreign body management. Seven junior and 5 senior residents participated. Their performance was evaluated by 2 observers using an Objective Structured Assessment of Technical Skills (OSATS) instrument. Results: By the third trial, all junior and senior residents scored a proficiency level of “independent without errors” or “independent and efficient,” and the performance of the junior residents was not different from that of the senior residents. After completing the course, the junior residents self-rated their abilities as commensurate with those of a senior resident, and senior residents rated themselves capable of performing foreign body extraction without supervision. All participants felt that the course and simulator had good overall realism and a realistic feel, demonstrating face validity. Perhaps most importantly, the residents' highest ratings were for “facilitated management of complications” and “facilitated working with the operating room team” — areas difficult to teach during live surgical procedures. Conclusions: This pediatric airway foreign body course using a high-fidelity simulator has face and construct validity, and results in statistically improved performance and self-evaluation of all participants.
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Abstract
Simulation is revolutionizing medical education, certification, and ongoing professional development. Simulation encompasses a variety of technologies as well as nontechnical approaches to improve individual psychomotor skills, group effectiveness, and systems processes, all without direct risk to patients. Simulation-enhanced learning experiences, addressing learning objectives based on the needs of the individual or the group and following the principles of adult education, can be used to ensure consistent and comprehensive learning opportunities, thereby creatively complementing didactic and clinical learning experiences. Pockets of simulation expertise are already present in the field of otolaryngology; more will develop as these exciting and important innovations blossom.
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Affiliation(s)
- Ellen S. Deutsch
- Center for Simulation, Advanced Education, and Innovation, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Abstract
Bronchoscopy for paediatric respiratory disease is a routine procedure in paediatric pulmonology. Rigid bronchoscopy is now much less commonly used than flexible bronchoscopy. Technological advances have brought better picture quality and easier storage of video documentation. Indications with clear clinical benefit are congenital or acquired unexplained airway obstruction. In pulmonary infections or infiltrates in immunodeficient or immunosuppressed children not responding to empirical treatment a pathogen may be identified by bronchoscopy and bronchoalveolar lavage (BAL). Bronchoscopy and BAL can be indicated in children with unusual presentations of chronic cough or wheeze, and cystic fibrosis. The use of transbronchial biopsies (TBB) is established in paediatric lung transplantation. New applications and techniques are being developed, such as endobronchial ultrasound and transbronchial needle biopsy of lymph nodes and the role of airway stent placement have become better understood.
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Affiliation(s)
- T Nicolai
- University Kinderklinik München im Dr. von Haunerschen Kinderspital, München, Germany.
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