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Nitsche JF, Conrad S, Hoopes S, Carrel M, Bebeau K, Brost BC. Continued Validation of Ultrasound Guidance Targeting Tasks: Relationship with Procedure Performance. Acad Radiol 2021; 28:1433-1442. [PMID: 33036898 DOI: 10.1016/j.acra.2020.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/15/2022]
Abstract
RATIONALE AND OBJECTIVES To determine if deliberative practice with novel ultrasound guidance targeting tasks improves simulated procedural skill. MATERIALS AND METHODS In a nonrandomized interventional trial first year medical students practiced the previous described dowel and straw targeting tasks 1 hour a week for 4 weeks (training group) or had no training (controls). Afterward, they each performed a simulated amniocentesis (AMN) and chorionic villus sampling (CVS) procedure. Procedures were scored using a global rating scale (GRS) and compared between groups with Mann-Whitney U tests. Two-way random effects intraclass correlation coefficients for the inter- and intra-rater variability were calculated for each item in both GRS's. RESULTS The training group (n = 22) had higher scores on several aspects and overall performance of AMN compared to controls (n = 15). There were no differences between groups for CVS. The inter-rater and intra-rater reliability of the GRS's for both AMN and CVS ranged from 0.16 to 0.89 with most values demonstrating good to excellent agreement. CONCLUSION This study demonstrates validity evidence in the content and internal structure domains for the AMN and CVS simulators and their accompanying GRS's. Repetitive practice of the targeting tasks improved student performance in simulated AMN, but modifications are needed for it to be relevant to other procedures such as CVS.
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Affiliation(s)
- Joshua Franklin Nitsche
- Division of Maternal Fetal Medicine, Department of OB-GYN, Wake Forest School of Medicine, Winston-Salem, NC 27157.
| | - Sarah Conrad
- Division of Maternal Fetal Medicine, Department of OB-GYN, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Sarah Hoopes
- Division of Maternal Fetal Medicine, Department of OB-GYN, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Meredith Carrel
- Division of Maternal Fetal Medicine, Department of OB-GYN, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Katherine Bebeau
- Division of Maternal Fetal Medicine, Department of OB-GYN, Wake Forest School of Medicine, Winston-Salem, NC 27157
| | - Brian C Brost
- Division of Maternal Fetal Medicine, Department of OB-GYN, Wake Forest School of Medicine, Winston-Salem, NC 27157
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Tenewitz C, Le RT, Hernandez M, Baig S, Meyer TE. Systematic review of three-dimensional printing for simulation training of interventional radiology trainees. 3D Print Med 2021; 7:10. [PMID: 33881672 PMCID: PMC8059217 DOI: 10.1186/s41205-021-00102-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
RATIONALE AND OBJECTIVES Three-dimensional (3D) printing has been utilized as a means of producing high-quality simulation models for trainees in procedure-intensive or surgical subspecialties. However, less is known about its role for trainee education within interventional radiology (IR). Thus, the purpose of this review was to assess the state of current literature regarding the use of 3D printed simulation models in IR procedural simulation experiences. MATERIALS AND METHODS A literature query was conducted through April 2020 for articles discussing three-dimensional printing for simulations in PubMed, Embase, CINAHL, Web of Science, and the Cochrane library databases using key terms relating to 3D printing, radiology, simulation, training, and interventional radiology. RESULTS We identified a scarcity of published sources, 4 total articles, that appraised the use of three-dimensional printing for simulation training in IR. While trainee feedback is generally supportive of the use of three-dimensional printing within the field, current applications utilizing 3D printed models are heterogeneous, reflecting a lack of best practices standards in the realm of medical education. CONCLUSIONS Presently available literature endorses the use of three-dimensional printing within interventional radiology as a teaching tool. Literature documenting the benefits of 3D printed models for IR simulation has the potential to expand within the field, as it offers a straightforward, sustainable, and reproducible means for hands-on training that ought to be standardized.
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Affiliation(s)
- Chase Tenewitz
- Mercer University School of Medicine, Savannah, GA, USA.
| | - Rebecca T Le
- University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | - Saif Baig
- UF Health Jacksonville, Jacksonville, FL, USA
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Mashar M, Nanapragasam A, Haslam P. Interventional radiology training: where will technology take us? BJR Open 2019; 1:20190002. [PMID: 33178937 PMCID: PMC7592432 DOI: 10.1259/bjro.20190002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/17/2019] [Accepted: 08/01/2019] [Indexed: 12/26/2022] Open
Abstract
Interventional radiology is a relatively young specialty, and it is undergoing a period of considerable growth. The benefits of a minimally invasive approach are clear, with smaller incisions, less pain, and faster recovery times being the principal benefits compared to surgical alternatives. Trainees need to acquire the technical skills and the clinical acumen to accurately deliver targeted treatment and safely follow up patients after the procedure. The need to maintain an efficient interventional radiology service whilst also giving sufficient time for trainee education is a challenge. In order to compensate for this, novel technologies like virtual reality (VR), augmented reality (AR), cadaveric simulation, and three-dimensional (3D) printing have been postulated as a means of supplementing training. In this article, we outline the main features of these innovative strategies and discuss the evidence base behind them. Benefits of these techniques beyond pure clinical training include the standardization of educational cases, access to training at any time, and less risk to patients. The main disadvantage is the large financial outlay required. Therefore, before widespread uptake can be recommended, further research is needed to confirm the educational benefit of these novel techniques, both in and of themselves and in comparison to existing clinical-based education.
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Affiliation(s)
- Meghavi Mashar
- Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Philip Haslam
- The Newcastle Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
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Novaes AKB, Dalamura R, Menon T, Pazeli JM, Bastos MG. Homemade ultrasound phantom for simulation of hydronephrosis. ACTA ACUST UNITED AC 2018; 40:206-208. [PMID: 29738039 PMCID: PMC6533979 DOI: 10.1590/2175-8239-jbn-3916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/24/2017] [Indexed: 02/02/2023]
Abstract
In this article, we describe the development of a simple and inexpensive
simulation phantom as a surrogate of human hydronephrosis for the identification
of urinary tract obstruction at bedside to be used in undergraduate training of
medical students.
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Affiliation(s)
| | - Ramon Dalamura
- Fundação Instituto Mineiro de Estudos e Pesquisas em Nefrologia, Juiz de Fora, MG, Brasil
| | - Talita Menon
- Fundação Instituto Mineiro de Estudos e Pesquisas em Nefrologia, Juiz de Fora, MG, Brasil
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Mirza S, Athreya S. Review of Simulation Training in Interventional Radiology. Acad Radiol 2018; 25:529-539. [PMID: 29221857 DOI: 10.1016/j.acra.2017.10.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/14/2017] [Accepted: 10/09/2017] [Indexed: 01/04/2023]
Abstract
Simulation training has evolved and is now able to offer numerous training opportunities to supplement the practice of and overcome some of the shortcomings of the traditional Master-Apprentice model currently used in medical training. Simulation training provides new opportunities to practice skills used in clinical procedures, crisis management scenarios, and everyday clinical practice in a risk-free environment. Procedural and nonprocedural skills used in interventional radiology can be taught with the use of simulation devices and technologies. This review will inform the reader of which clinical skills can be trained with simulation, the types of commercially available simulators and their educational validity, and the assessment tools used to evaluate simulation training.
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Affiliation(s)
- Souzan Mirza
- Institute of Biological and Biomedical Engineering, University of Toronto, Princess Margaret Cancer Research Tower, 110 College St, Room 7-1001 Toronto, Ontario, M5G 2C4, Canada.
| | - Sriharsha Athreya
- McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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Saunders A, Keefe L, Birch S, Wierzbicki M, Maitland D. Perceptions of transcatheter device closure of patent ductus arteriosus in veterinary cardiology and evaluation of a canine model to simulate device placement: a preliminary study. J Vet Cardiol 2017; 19:268-275. [DOI: 10.1016/j.jvc.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/23/2017] [Accepted: 04/17/2017] [Indexed: 10/19/2022]
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Patel R, Dennick R. Simulation based teaching in interventional radiology training: is it effective? Clin Radiol 2016; 72:266.e7-266.e14. [PMID: 27986263 DOI: 10.1016/j.crad.2016.10.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 08/14/2016] [Accepted: 10/06/2016] [Indexed: 01/22/2023]
Abstract
AIM To establish the educational effectiveness of simulation teaching in interventional radiology training. MATERIALS AND METHODS Electronic databases (MEDLINE, ERIC, Embase, OvidSP, and Cochrane Library) were searched (January 2000 to May 2015). Studies specifically with educational outcomes conducted on radiologists were eligible. All forms of simulation in interventional training were included. Data were extracted based on the population, intervention, comparison, and outcome (PICO) model. Kirkpatrick's hierarchy was used to establish educational intervention effectiveness. The quality of studies was assessed using the Cochrane risk of bias tool. RESULTS Search resulted in 377 articles, of which 15 met the inclusion criteria. Thirteen of the 15 studies achieved level 2 of Kirkpatrick's hierarchy with only one reaching level 4. Statistically significant improvements in performance metrics as objective measures, demonstrating trainee competence were seen in 12/15 studies. Subjective improvements in confidence were noted in 13/15. Only one study demonstrated skills transferability and improvements in patient outcomes. CONCLUSION Results demonstrate the relevance of simulated training to current education models in improving trainee competence; however, this is limited to the simulated environment as there is a lack of literature investigating its predictive validity and the effect on patient outcomes. The requirement for further research in this field is highlighted. Simulation is thus currently only deemed useful as an adjunct to current training models with the potential to play an influential role in the future of the interventional radiology training curriculum.
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Affiliation(s)
- R Patel
- Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK.
| | - R Dennick
- University of Nottingham, Medical School, Nottingham NG7 2UH, UK
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Francesconi M, Freschi C, Sinceri S, Carbone M, Cappelli C, Morelli L, Ferrari V, Ferrari M. New training methods based on mixed reality for interventional ultrasound: Design and validation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:5098-101. [PMID: 26737438 DOI: 10.1109/embc.2015.7319538] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Currently the learning model for ultrasound imaging diagnosis and intervention follows a traditional approach based on learning by doing but this model exposes the patient to the whole learning curve of the novice. In order to enable training in a safe environment without compromising patient's health we have developed and demonstrated face, content and construct validity of a hybrid simulator for ultrasound-guided biopsy. This hybrid simulator is able to provide a support to acquire skills in term of 3D perception and hand-eye coordination thanks to a mixed reality visualization that allows accurate and easy planning of probe position/orientation and needle trajectory to reach the target.
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O'Reilly MK, Reese S, Herlihy T, Geoghegan T, Cantwell CP, Feeney RNM, Jones JFX. Fabrication and assessment of 3D printed anatomical models of the lower limb for anatomical teaching and femoral vessel access training in medicine. ANATOMICAL SCIENCES EDUCATION 2016; 9:71-79. [PMID: 26109268 DOI: 10.1002/ase.1538] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/27/2015] [Accepted: 04/13/2015] [Indexed: 06/04/2023]
Abstract
For centuries, cadaveric dissection has been the touchstone of anatomy education. It offers a medical student intimate access to his or her first patient. In contrast to idealized artisan anatomical models, it presents the natural variation of anatomy in fine detail. However, a new teaching construct has appeared recently in which artificial cadavers are manufactured through three-dimensional (3D) printing of patient specific radiological data sets. In this article, a simple powder based printer is made more versatile to manufacture hard bones, silicone muscles and perfusable blood vessels. The approach involves blending modern approaches (3D printing) with more ancient ones (casting and lost-wax techniques). These anatomically accurate models can augment the approach to anatomy teaching from dissection to synthesis of 3D-printed parts held together with embedded rare earth magnets. Vascular simulation is possible through application of pumps and artificial blood. The resulting arteries and veins can be cannulated and imaged with Doppler ultrasound. In some respects, 3D-printed anatomy is superior to older teaching methods because the parts are cheap, scalable, they can cover the entire age span, they can be both dissected and reassembled and the data files can be printed anywhere in the world and mass produced. Anatomical diversity can be collated as a digital repository and reprinted rather than waiting for the rare variant to appear in the dissection room. It is predicted that 3D printing will revolutionize anatomy when poly-material printing is perfected in the early 21st century.
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Affiliation(s)
- Michael K O'Reilly
- Anatomy in the Biomedical Section, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Sven Reese
- Department of Veterinary Sciences, Section of Anatomy, Histology, and Embryology, Faculty of Veterinary Medicine, University of Munich, Munich, Germany
| | - Therese Herlihy
- Diagnostic Imaging, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Tony Geoghegan
- Department of Interventional Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Colin P Cantwell
- Department of Radiology, St. Vincent's University Hospital, Dublin, Ireland
| | - Robin N M Feeney
- Anatomy in the Biomedical Section, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - James F X Jones
- Anatomy in the Biomedical Section, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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Freschi C, Parrini S, Dinelli N, Ferrari M, Ferrari V. Hybrid simulation using mixed reality for interventional ultrasound imaging training. Int J Comput Assist Radiol Surg 2014; 10:1109-15. [PMID: 25213270 DOI: 10.1007/s11548-014-1113-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/24/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Ultrasound (US) imaging offers advantages over other imaging modalities and has become the most widespread modality for many diagnostic and interventional procedures. However, traditional 2D US requires a long training period, especially to learn how to manipulate the probe. A hybrid interactive system based on mixed reality was designed, implemented and tested for hand-eye coordination training in diagnostic and interventional US. METHODS A hybrid simulator was developed integrating a physical US phantom and a software application with a 3D virtual scene. In this scene, a 3D model of the probe with its relative scan plane is coherently displayed with a 3D representation of the phantom internal structures. An evaluation study of the diagnostic module was performed by recruiting thirty-six novices and four experts. The performances of the hybrid (HG) versus physical (PG) simulator were compared. After the training session, each novice was required to visualize a particular target structure. The four experts completed a 5-point Likert scale questionnaire. RESULTS Seventy-eight percentage of the HG novices successfully visualized the target structure, whereas only 45% of the PG reached this goal. The mean scores from the questionnaires were 5.00 for usefulness, 4.25 for ease of use, 4.75 for 3D perception, and 3.25 for phantom realism. CONCLUSIONS The hybrid US training simulator provides ease of use and is effective as a hand-eye coordination teaching tool. Mixed reality can improve US probe manipulation training.
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Affiliation(s)
- C Freschi
- EndoCAS Center, Università di Pisa, Pisa, Italy
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11
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A tissue phantom model for training residents in ultrasound-guided liver biopsy. Acad Radiol 2014; 21:902-8. [PMID: 24928159 DOI: 10.1016/j.acra.2014.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/16/2014] [Accepted: 03/04/2014] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES The apprenticeship model for training of percutaneous liver biopsy has limitations, and costs of commercially available simulation models can be prohibitive. We created an inexpensive tissue phantom for liver biopsy simulation and evaluated the utility of this model for training radiology residents. MATERIALS AND METHODS A bovine-porcine tissue phantom was devised as a simulation model and consisted of bovine liver with a porcine rib layer and inserted pimento olives simulating target lesions. Training sessions (a 20-minute didactic lecture and a 90-minute practice session) were offered to all residents in a diagnostic radiology residency. Effect of training was assessed by questionnaire before and after training. Level of knowledge of topics covered in the didactic session, confidence in technical skills, and anxiety level were evaluated on a five-point scale (1, poor to 5, excellent). RESULTS Thirty-five of 38 residents received training on the models (~$40). Mean reported value score for training was 4.88/5. Improvement was greatest for knowledge of technique (2.3-4.1/5, P < .001) and knowledge of postprocedure care (2.2-4.1/5, P < .001). Technical confidence increased (2.4-3.8/5, P < .001) and anxiety related to performing liver biopsy improved (2.7-3.7/5, P < .001). Residents with no prior experience in liver biopsy (n = 21) had significantly greater increases in all categories than residents with prior experience (n = 14), except for knowledge about obtaining informed consent and anxiety levels. CONCLUSIONS Utilization of an inexpensively created bovine/porcine liver biopsy simulation model was well perceived by radiology residents and can be used as an educational tool during residency.
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Interventional radiology virtual simulator for liver biopsy. Int J Comput Assist Radiol Surg 2013; 9:255-67. [PMID: 23881251 DOI: 10.1007/s11548-013-0929-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Training in Interventional Radiology currently uses the apprenticeship model, where clinical and technical skills of invasive procedures are learnt during practice in patients. This apprenticeship training method is increasingly limited by regulatory restrictions on working hours, concerns over patient risk through trainees' inexperience and the variable exposure to case mix and emergencies during training. To address this, we have developed a computer-based simulation of visceral needle puncture procedures. METHODS A real-time framework has been built that includes: segmentation, physically based modelling, haptics rendering, pseudo-ultrasound generation and the concept of a physical mannequin. It is the result of a close collaboration between different universities, involving computer scientists, clinicians, clinical engineers and occupational psychologists. RESULTS The technical implementation of the framework is a robust and real-time simulation environment combining a physical platform and an immersive computerized virtual environment. The face, content and construct validation have been previously assessed, showing the reliability and effectiveness of this framework, as well as its potential for teaching visceral needle puncture. CONCLUSION A simulator for ultrasound-guided liver biopsy has been developed. It includes functionalities and metrics extracted from cognitive task analysis. This framework can be useful during training, particularly given the known difficulties in gaining significant practice of core skills in patients.
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Johnson SJ, Guediri SM, Kilkenny C, Clough PJ. Development and validation of a virtual reality simulator: human factors input to interventional radiology training. HUMAN FACTORS 2011; 53:612-625. [PMID: 22235524 DOI: 10.1177/0018720811425042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE This study developed and validated a virtual reality (VR) simulator for use by interventional radiologists. BACKGROUND Research in the area of skill acquisition reports practice as essential to become a task expert. Studies on simulation show skills learned in VR can be successfully transferred to a real-world task. Recently, with improvements in technology, VR simulators have been developed to allow complex medical procedures to be practiced without risking the patient. METHOD Three studies are reported. In Study I, 35 consultant interventional radiologists took part in a cognitive task analysis to empirically establish the key competencies of the Seldinger procedure. In Study 2, 62 participants performed one simulated procedure, and their performance was compared by expertise. In Study 3, the transferability of simulator training to a real-world procedure was assessed with 14 trainees. RESULTS Study I produced 23 key competencies that were implemented as performance measures in the simulator. Study 2 showed the simulator had both face and construct validity, although some issues were identified. Study 3 showed the group that had undergone simulator training received significantly higher mean performance ratings on a subsequent patient procedure. CONCLUSION The findings of this study support the centrality of validation in the successful design of simulators and show the utility of simulators as a training device. APPLICATION The studies show the key elements of a validation program for a simulator. In addition to task analysis and face and construct validities, the authors highlight the importance of transfer of training in validation studies.
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Affiliation(s)
- Sheena Joanne Johnson
- University of Manchester, Manchester Business School, Booth Street East, Manchester, UK MI5 6PB; sheena. . sheena
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