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Varas J, Coronel BV, Villagrán I, Escalona G, Hernandez R, Schuit G, Durán V, Lagos-Villaseca A, Jarry C, Neyem A, Achurra P. Innovations in surgical training: exploring the role of artificial intelligence and large language models (LLM). Rev Col Bras Cir 2023; 50:e20233605. [PMID: 37646729 PMCID: PMC10508667 DOI: 10.1590/0100-6991e-20233605-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/14/2023] [Indexed: 09/01/2023] Open
Abstract
The landscape of surgical training is rapidly evolving with the advent of artificial intelligence (AI) and its integration into education and simulation. This manuscript aims to explore the potential applications and benefits of AI-assisted surgical training, particularly the use of large language models (LLMs), in enhancing communication, personalizing feedback, and promoting skill development. We discuss the advancements in simulation-based training, AI-driven assessment tools, video-based assessment systems, virtual reality (VR) and augmented reality (AR) platforms, and the potential role of LLMs in the transcription, translation, and summarization of feedback. Despite the promising opportunities presented by AI integration, several challenges must be addressed, including accuracy and reliability, ethical and privacy concerns, bias in AI models, integration with existing training systems, and training and adoption of AI-assisted tools. By proactively addressing these challenges and harnessing the potential of AI, the future of surgical training may be reshaped to provide a more comprehensive, safe, and effective learning experience for trainees, ultimately leading to better patient outcomes. .
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Affiliation(s)
- Julian Varas
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Brandon Valencia Coronel
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Ignacio Villagrán
- - Pontificia Universidad Católica de Chile, Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina - Santiago - Región Metropolitana - Chile
| | - Gabriel Escalona
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Rocio Hernandez
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Gregory Schuit
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Valentina Durán
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Antonia Lagos-Villaseca
- - Pontificia Universidad Católica de Chile, Department of Otolaryngology - Santiago - Región Metropolitana - Chile
| | - Cristian Jarry
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
| | - Andres Neyem
- - Pontificia Universidad Católica de Chile, Computer Science Department, School of Engineering - Santiago - Región Metropolitana - Chile
| | - Pablo Achurra
- - Pontificia Universidad Católica de Chile, Experimental Surgery and Simulation Center, Department of Digestive Surgery - Santiago - Región Metropolitana - Chile
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Villagrán I, Rammsy F, Del Valle J, Gregorio de Las Heras S, Pozo L, García P, Torres G, Varas J, Mandrusiak A, Corvetto M, Fuentes-Cimma J. Remote, asynchronous training and feedback enables development of neurodynamic skills in physiotherapy students. BMC Med Educ 2023; 23:267. [PMID: 37081551 PMCID: PMC10116106 DOI: 10.1186/s12909-023-04229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 04/03/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, face-to-face teaching and learning of physiotherapy practical skills was limited. Asynchronous, remote training has been effective in development of clinical skills in some health professions. This study aimed to determine the effect of remote, asynchronous training and feedback on development of neurodynamic skills in physiotherapy students. METHODS Longitudinal repeated measurements study, across four training sessions. Participants engaged in a remote training program for development of upper limb neurodynamic techniques. In this sequential training, participants viewed the online tutorial, practiced independently, and uploaded a video of their performance for formative assessment and feedback from a trained instructor via a checklist and rubric. RESULTS Intra-subject analyses of 60 third-year physiotherapy students showed that the target standard of performance, with no further significant change in scores, was attained following session 2 for the checklist and session 3 for the rubric. This shows that two sessions are required to learn the procedures, and three sessions yield further improvements in performance quality. CONCLUSION The remote, asynchronous training and feedback model proved to be an effective strategy for students' development of neurodynamic testing skills and forms a viable alternative to in-person training. This study contributes to the future of acquiring physiotherapy clinical competencies when distance or hybrid practice is required.
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Affiliation(s)
- Ignacio Villagrán
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Francisca Rammsy
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Javiera Del Valle
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Sofía Gregorio de Las Heras
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Liliana Pozo
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Patricio García
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Gustavo Torres
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile
| | - Julián Varas
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Allison Mandrusiak
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Marcia Corvetto
- Centro de Simulación y Cirugía experimental, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Fuentes-Cimma
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, Santiago, Chile.
- School of Health Professions Education (SHE), Maastricht University, Maastricht, the Netherlands.
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Belmar F, Gaete MI, Durán V, Chelebifski S, Jarry C, Ortiz C, Escalona G, Villagrán I, Alseidi A, Zamorano E, Pimentel F, Crovari F, Varas J. Taking advantage of asynchronous digital feedback: development of an at-home basic suture skills training program for undergraduate medical students that facilitates skills retention. Global Surg Educ 2023; 2:32. [PMID: 38013870 PMCID: PMC9900196 DOI: 10.1007/s44186-023-00112-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 09/27/2022] [Accepted: 01/28/2023] [Indexed: 02/08/2023]
Abstract
Purpose To date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the effectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback. Methods Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsupervised practice as needed at their homes. When they felt competent, trainees uploaded a video of themselves practicing the skill. In < 72 h, they received expert asynchronous digital feedback. The course had two theoretical stages and five video-based assessments, where trainees performed different suturing exercises. For the assessment, a global (GRS) and specific rating scale (SRS) were used, with a passing score of 20 points (max:25) and 15 (max:20), respectively. Results were compared to previously published work with in-person expert feedback (EF) and video-guided learning without feedback (VGL). A subgroup of trainees underwent a 6-month skills retention assessment. Results Two-hundred and forty-three trainees underwent the course between March and December 2021. A median GRS of 24 points was achieved in the final assessment, showing significantly higher scores (p < 0.001) than EF and VGL (20.5 and 15.5, respectively). Thirty-seven trainees underwent a 6-month skills retention assessment, improving in GRS (23.38 vs 24.03, p value = 0.06) and SRS (18.59 vs 19, p value = 0.07). Conclusion It is feasible to teach basic suture skills to undergraduate medical students using an unsupervised training course with remote and asynchronous feedback through a digital platform. This methodology allows continuous training with the repetition of quality practice, personalized feedback, and skills retention at 6 months.
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Affiliation(s)
- Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Slavka Chelebifski
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Cristián Jarry
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Catalina Ortiz
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, CA USA
| | - Elga Zamorano
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
| | - Fernando Pimentel
- Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Fernando Crovari
- Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, 8330024 Santiago, Chile
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Gaete MI, Belmar F, Cortés M, Alseidi A, Asbun D, Durán V, Escalona G, Achurra P, Villagrán I, Crovari F, Pimentel F, Varas J. Remote and asynchronous training network: from a SAGES grant to an eight-country remote laparoscopic simulation training program. Surg Endosc 2023; 37:1458-1465. [PMID: 35764838 DOI: 10.1007/s00464-022-09386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/06/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Limitations in surgical simulation training include lack of access to validated training programs with continuous year-round training and lack of experts' ongoing availability for feedback. A model of simulation training was developed to address these limitations. It incorporated basic and advanced laparoscopic skills curricula from a previously validated program and provided instruction through a digital platform. The platform allowed for remote and asynchronous feedback from a few trained instructors. The instructors were continuously available and provided personalized feedback using a variety of different media. We describe the upscaling of this model to teach trainees at fourteen centers in eight countries. METHODS Institutions with surgical programs lacking robust simulation curricula and needing instructors for ongoing education were identified. The simulation centers ("skills labs") at these sites were equipped with necessary simulation training hardware. A remote training-the-administrators (TTA) program was developed where personnel were trained in how to manage the skills lab, schedule trainees, set up training stations, and use the platform. A train-the-trainers (TTT) program was created to establish a network of trained instructors, who provided objective feedback through the platform remotely and asynchronously. RESULTS Between 2019 and 2022, seven institutions in Chile and one in each of the USA, Bolivia, Brazil, Ecuador, El Salvador, México, and Perú implemented a digital platform-based remote simulation curriculum. Most administrators were not physicians (19/33). Eight Instructors were trained with the TTT program and became active proctors. The platform has been used by 369 learners, of whom 57% were general surgeons and general surgery residents. A total of 6729 videos, 28,711 feedback inputs, and 233.7 and 510.2 training hours in the basic and advanced programs, respectively, were registered. CONCLUSION A remote and asynchronous method of giving instruction and feedback through a digital platform has been effectively employed in the creation of a robust network of continuous year-round simulation-based training in laparoscopy. Training centers were successfully run only with trained administrators to assist in logistics and setup, and no on-site instructors were necessary.
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Affiliation(s)
- María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Matías Cortés
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California, San Francisco, USA
| | - Domenech Asbun
- Hepatobiliary & Pancreatic Surgery, Miami Cancer Institute, Miami, USA
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Pablo Achurra
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Fernando Pimentel
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Marcoleta 377, 2nd floor, Zip Code: 8330024, Santiago, Chile.
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Belmar F, Gaete MI, Escalona G, Carnier M, Durán V, Villagrán I, Asbun D, Cortés M, Neyem A, Crovari F, Alseidi A, Varas J. Artificial intelligence in laparoscopic simulation: a promising future for large-scale automated evaluations. Surg Endosc 2022:10.1007/s00464-022-09576-1. [PMID: 36192656 PMCID: PMC9529161 DOI: 10.1007/s00464-022-09576-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022]
Abstract
Introduction A limitation to expanding laparoscopic simulation training programs is the scarcity of expert evaluators. In 2019, a new digital platform for remote and asynchronous laparoscopic simulation training was validated. Through this platform, 369 trainees have been trained in 14 institutions across Latin America, collecting 6729 videos of laparoscopic training exercises. The use of artificial intelligence (AI) has recently emerged in surgical simulation, showing usefulness in training assessment, virtual reality scenarios, and laparoscopic virtual reality simulation. An AI algorithm to assess basic laparoscopic simulation training exercises was developed. This study aimed to analyze the agreement between this AI algorithm and expert evaluators in assessing basic laparoscopic-simulated training exercises. Methods The AI algorithm was trained using 400-bean drop (BD) and 480-peg transfer (PT) videos and tested using 64-BD and 43-PT randomly selected videos, not previously used to train the algorithm. The agreement between AI and expert evaluators from the digital platform (EE) was then analyzed. The exercises being assessed involve using laparoscopic graspers to move objects across an acrylic board without dropping any objects in a determined time (BD < 24 s, PT < 55 s). The AI algorithm can detect object movement, identify if objects have fallen, track grasper clamps location, and measure exercise time. Cohen’s Kappa test was used to evaluate the agreement between AI assessments and those performed by EE, using a pass/fail nomenclature based on the time to complete the exercise. Results After the algorithm was trained, 79.69% and 93.02% agreement were observed in BD and PT, respectively. The Kappa coefficients test observed for BD and PT were 0.59 (moderate agreement) and 0.86 (almost perfect agreement), respectively. Conclusion This first approach of AI use in basic laparoscopic skills simulated training assessment shows promising results, providing a preliminary framework to expand the use of AI to other basic laparoscopic skills exercises. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-022-09576-1.
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Affiliation(s)
- Francisca Belmar
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - María Inés Gaete
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Gabriel Escalona
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Martín Carnier
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Valentina Durán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Ignacio Villagrán
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile.,Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Domenech Asbun
- Hepatobiliary & Pancreatic Surgery, Miami Cancer Institute, Miami, USA
| | - Matías Cortés
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile
| | - Andrés Neyem
- Department of Computer Science, Engineering Faculty, Catholic University of Chile, Santiago, Chile
| | - Fernando Crovari
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile.,Faculty of Medicine, Catholic University of Chile, Santiago, Chile
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Julián Varas
- Experimental Surgery and Simulation Center, Department of Digestive Surgery, Catholic University of Chile, Santiago, Chile. .,Faculty of Medicine, Catholic University of Chile, Santiago, Chile.
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Villagrán I, Jeldez P, Calvo F, Fuentes J, Moya J, Barañao P, Irarrázabal L, Rojas N, Soto P, Barja S, Fuentes-López E. Spanish version of the readiness for interprofessional learning scale (RIPLS) in an undergraduate health sciences student context. J Interprof Care 2021; 36:318-326. [PMID: 34006180 DOI: 10.1080/13561820.2021.1888902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The Readiness for Interprofessional Learning Scale (RIPLS) has been widely used to measure students' and professionals' attitudes toward interprofessional learning. However, inconsistencies have been reported concerning its validity and reliability. This study aimed to translate, adapt, and validate the RIPLS questionnaire to be applied to Spanish-speaking health sciences students in Chile. Content and construct validity evidence of the newly created Spanish version of the RIPLS scale were analyzed. An exploratory (EFA) and confirmatory (CFA) analysis were conducted, determining goodness-of-fit indexes. Reliability was evaluated through Cronbach's Alpha Coefficient. We assessed sensitivity to change of the RIPLS scale by comparing pre- and post-interprofessional education workshop scores. The EFA showed that there were three factors. In the CFA, most of the standardized factor loadings were higher than 0.3. Regarding internal consistency, Cronbach's Alpha was 0.86. The differences between the total RIPLS scores before and after the workshops were statistically significant. The Spanish version of RIPLS showed evidence of validity and reliability for use amongst health sciences students. The construct was adequately measured and was shown that it could be used to assess the impact of interprofessional education workshops.
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Affiliation(s)
- Ignacio Villagrán
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Facultad De Medicina, Pontificia Universidad Católica De Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Paz Jeldez
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Facultad De Medicina, Pontificia Universidad Católica De Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Fernanda Calvo
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Facultad De Medicina, Pontificia Universidad Católica De Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Javiera Fuentes
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Facultad De Medicina, Pontificia Universidad Católica De Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - José Moya
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Facultad De Medicina, Pontificia Universidad Católica De Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile
| | - Patricio Barañao
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Facultad De Medicina, Pontificia Universidad Católica De Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile.,Hospital Josefina Martínez, Puente Alto, Chile
| | - Lisette Irarrázabal
- Escuela de Enfermería, Facultad De Medicina, Pontificia Universidad Católica De Chile, Santiago, Chile
| | - Noelia Rojas
- Escuela de Enfermería, Facultad De Medicina, Pontificia Universidad Católica De Chile, Santiago, Chile
| | - Paula Soto
- Escuela de Enfermería, Facultad De Medicina, Pontificia Universidad Católica De Chile, Santiago, Chile
| | - Salesa Barja
- Hospital Josefina Martínez, Puente Alto, Chile.,Departamento De Gastroenterología Y Nutrición Pediátrica, División De Pediatría. Facultad De Medicina, Pontificia Universidad Católica De Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Departamento de Ciencias de la Salud, Carrera de Fonoaudiología, Facultad De Medicina, Pontificia Universidad Católica De Chile, Avenida Vicuña Mackenna 4860, Macul, Santiago, Chile
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Villagrán I, Moënne-Loccoz C, Aguilera V, García V, Reyes JT, Rodríguez S, Miranda C, Altermatt F, Fuentes-López E, Delgado M, Neyem A. Biomechanical analysis of expert anesthesiologists and novice residents performing a simulated central venous access procedure. PLoS One 2021; 16:e0250941. [PMID: 33930076 PMCID: PMC8087019 DOI: 10.1371/journal.pone.0250941] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 04/11/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Central venous access (CVA) is a frequent procedure taught in medical residencies. However, since CVA is a high-risk procedure requiring a detailed teaching and learning process to ensure trainee proficiency, it is necessary to determine objective differences between the expert's and the novice's performance to guide novice practitioners during their training process. This study compares experts' and novices' biomechanical variables during a simulated CVA performance. METHODS Seven experts and seven novices were part of this study. The participants' motion data during a CVA simulation procedure was collected using the Vicon Motion System. The procedure was divided into four stages for analysis, and each hand's speed, acceleration, and jerk were obtained. Also, the procedural time was analyzed. Descriptive analysis and multilevel linear models with random intercept and interaction were used to analyze group, hand, and stage differences. RESULTS There were statistically significant differences between experts and novices regarding time, speed, acceleration, and jerk during a simulated CVA performance. These differences vary significantly by the procedure stage for right-hand acceleration and left-hand jerk. CONCLUSIONS Experts take less time to perform the CVA procedure, which is reflected in higher speed, acceleration, and jerk values. This difference varies according to the procedure's stage, depending on the hand and variable studied, demonstrating that these variables could play an essential role in differentiating between experts and novices, and could be used when designing training strategies.
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Affiliation(s)
- Ignacio Villagrán
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristóbal Moënne-Loccoz
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Aguilera
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vicente García
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Tomás Reyes
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Rodríguez
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Constanza Miranda
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - Fernando Altermatt
- Anesthesiology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail:
| | - Eduardo Fuentes-López
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Mauricio Delgado
- Health Sciences Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Neyem
- Computer Science Department, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
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Böhm P, Soffia A, Díaz LA, Villagrán I, Pizarro M, Collins LM, Riquelme A, Monrroy H. [Teaching innovation in an undergraduate theoretical medicine course]. Rev Med Chil 2021; 148:1659-1667. [PMID: 33844773 DOI: 10.4067/s0034-98872020001101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The School of Medicine of the Pontificia Universidad Católica de Chile implemented diverse curricular changes addressing teaching challenges, including those related to generational diversity. AIM To describe the implementation and results of curricular innovation in the Theoretic Gastroenterology Course (CTG) imparted between 2008 and 2020. MATERIALS AND METHODS The new teaching methods consisted in the implementation of interactive sessions, research conferences, video-recorded classes, and a learning management/assessment platform. An assessment of the learning model was implemented. As bibliographic material we incorporated self-instructive material and the CTG manual was re-edited. We registered the course syllabi, evaluation surveys, and final grades. RESULTS Students dedicated more time to attend the course, from 12.2 hours before to 18 hours after the implementation of video lessons (p < 0.05). They reported improvements in the areas "Feedback" (from 6.2 to 6.6, on a scale of 1 to 7; p < 0.05) and "Grades" (from 6.3 to 6.4; p < 0.05), after implementing a learning model assessment. The score for "Information sources" increased from 6.5 to 6.6 after the re-edition of the manual (p < 0.05). The final grades were similar or significantly higher than the average grades of all the theoretical courses imparted in the same period. CONCLUSIONS The CTG underwent a series of curricular modifications, allowing for a rapid adaptation to extremely dynamic academic conditions.
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Affiliation(s)
- Pauline Böhm
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrés Soffia
- Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luis Antonio Díaz
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Villagrán
- Departamento de Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margarita Pizarro
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Luz María Collins
- Centro de Educación Médica y Ciencias de la Salud, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Hugo Monrroy
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Miranda C, Altermatt F, Villagrán I, Goñi J. Developing an Innovative Medical Training Simulation Device for Peripheral Venous Access: A User-Centered Design Approach. Healthcare (Basel) 2020; 8:healthcare8040420. [PMID: 33105754 PMCID: PMC7712721 DOI: 10.3390/healthcare8040420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/04/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Nurses and other health students may lack the proper time for training procedural tasks, such as peripheral venous access. There is a need to develop these abilities in novices so that errors can be avoided when treating real patients. Nonetheless, from an experiential point of view, the simulation devices offered in the market do not always make sense for educators and trainees. This could make the adoption of new technology difficult. The purpose of this case study is to describe the development of an innovative simulation device and to propose concrete tactics for the involvement of the educators and trainees. We used a participative design based approach, with an ethnographic basis, where incremental cycles of user testing, development and iteration were involved. The study showcases methods from the field of design and anthropology that can be used to develop future simulation devices that resonate with students and educators to achieve a long term learning experience. Results could shed a light on new ways for the involvement of educators and students to create devices that resonate with them, making learning significant and effective.
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Affiliation(s)
- Constanza Miranda
- DILAB School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
- Correspondence: ; Tel.: +56-2-23545253
| | - Fernando Altermatt
- Department of Anestesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Ignacio Villagrán
- Health Sciences Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
| | - Julián Goñi
- DILAB School of Engineering, Pontificia Universidad Católica de Chile, Santiago 7820436, Chile;
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Torres G, Villagrán I, Fuentes J, Araya JP, Jouannet C, Fuentes-López E. Interactive virtual scenarios as a technological resource to improve musculoskeletal clinical reasoning skills of undergraduate physiotherapy students. Physiother Theory Pract 2020; 38:1016-1026. [PMID: 32814476 DOI: 10.1080/09593985.2020.1809043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Clinical reasoning is a fundamental competency in the learning process of health professionals. Since learning with traditional methods presents difficulties, teaching with interactive virtual scenarios is a good alternative. OBJECTIVE To describe the impact of a blended training with interactive virtual scenarios for the development of clinical reasoning skills in undergraduate physiotherapy students. METHODS A sample of 92 students solved eight storylines. Assessment error percentage, clinical pattern recognition, satisfaction, and the perception of difficulty were obtained. A proportions test was used to compare baseline and final assessments. To analyze the relationship between the variables, multilevel univariate logistic regression models were built. RESULTS A significant difference was observed in the error percentage between baseline and final assessment (p < .001). Comparing the last storyline to the first one, there were 2.63 times more possibilities to correctly recognize the pattern. The error percentage was associated with the opportunity to recognize the pattern precisely (p < .001). Thus, for each increasing unit in the error percentage, the possibility to correctly recognize the pattern decreased by 11% (OR = 0.89). CONCLUSIONS The use of this innovative blended training with virtual scenarios allowed students to systematically improve their recognition abilities of clinical patterns and decrease mistakes in the decision-making process.
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Affiliation(s)
- Gustavo Torres
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ignacio Villagrán
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javiera Fuentes
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Araya
- Carrera de Kinesiología, Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Chantal Jouannet
- Centro de Desarrollo Docente, Vicerrectoría Académica, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Carrera de Fonoaudiología, Departamento de Ciencias de La Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Tejos R, Chahuán J, Uslar T, Inzunza M, Villagrán I, Riquelme V, Padilla O, Pizarro M, Corvetto M, Varas J, Riquelme A. Simulated training program in abdominal paracentesis for undergraduate medical students. Gastroenterol Hepatol 2018; 42:239-247. [PMID: 30471721 DOI: 10.1016/j.gastrohep.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/10/2018] [Accepted: 10/10/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Abdominal paracentesis is an area that every general physician should know about, and the current learning model is unsafe for patients. Simulation allows students to develop their skills prior to clinical confrontation with minimal risks. The aims of this study were to design and evaluate a paracentesis simulation workshop for undergraduate students. METHODS A workshop was implemented using a specially designed and validated simulation model for abdominal paracentesis. The simulated technique considered the recognition of materials, operator equipment, asepsis, anesthesia, puncture and obtaining liquid, collecting samples for analysis, withdrawal of the material and occlusion. A 24-point direct observation checklist was administered to assess the student. We assessed two students at the beginning of the workshop and all the students at the end. A perception survey was applied to attendees at the end of the workshop. RESULTS 247 students were included and a workshop that involved 8 students per session was held. Students significantly improved their skills comparing pre- and post-evaluation results [13.36±4.46 (55.7%) vs. 22.3±1.83 (92.9%) respectively (n=69) p<0.001]. The students' perception questionnaire (n=38) showed that the training sessions were highly valued, averaging 4.8±0.38 on a Likert scale of 1-5. CONCLUSIONS Simulated training in abdominal paracentesis is a very good teaching method. This teaching methodology should be highly recommended as an educational strategy in medicine because it could accelerate the acquisition of clinical skills in a safe learning environment.
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Affiliation(s)
- Rodrigo Tejos
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Javier Chahuán
- Departamento Medicina Interna, Escuela de Medicina. Pontificia Universidad Católica de Chile, Chile
| | - Thomas Uslar
- Departamento Medicina Interna, Escuela de Medicina. Pontificia Universidad Católica de Chile, Chile
| | - Martin Inzunza
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Ignacio Villagrán
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Valentina Riquelme
- Escuela de Arte, Facultad de Artes, Pontificia Universidad Católica de Chile, Chile
| | - Oslando Padilla
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Margarita Pizarro
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
| | - Marcia Corvetto
- Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Julián Varas
- Departamento Cirugía Digestiva, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Cirugía Experimental y Simulación, Pontificia Universidad Católica de Chile, Chile
| | - Arnoldo Riquelme
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Chile; Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile; Centro de Educación Médica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile.
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12
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Villagrán I, Tejos R, Chahuan J, Uslar T, Pizarro M, Varas J, Achurra P, Leiva I, Nazar C, Sirhan M, Uribe J, Ruz C, Villafranca C, Soza R, Solís N, Fuentes-López E, Padilla O, Corvetto M, Riquelme A. [Undergraduate student's perception of clinical simulation workshops: assessment of an instrument]. Rev Med Chil 2018; 146:786-795. [PMID: 30148911 DOI: 10.4067/s0034-98872018000600786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 05/31/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Simulation is a useful training tool for undergraduate medical students. A valid instrument is needed to assess students' perception of simulation workshops. AIM To adapt and validate an instrument to assess the undergraduate medical student's perception of simulation workshops of clinical procedures. MATERIAL AND METHODS Delphi Methodology was used to adapt the instrument. Exploratory and confirmatory analyses were performed to determine the construct validity and Cronbach's Alpha (0 to 1) for internal consistency of the instrument. RESULTS A Delphi panel of 10 experts adapted a seven-item questionnaire (Likert scale 1-5; ranging from 7 to 35) and four open-questions. After 3-delphi-rounds, the instrument was administered to 210 students in six simulation training programs (Paracentesis, Cardiopulmonary Resuscitation, Airway management, Sutures, Thoracentesis and Nursing Procedures). The instrument was considered unidimensional in the factorial analysis. The overall median (Q1-Q3) score was 34 ranging from 32 to 35 and the Cronbach Alpha coefficient was 0.72, indicating a good reliability. CONCLUSIONS The perception questionnaire is a useful and reliable instrument to assess students' perceptions of clinical simulations.
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Affiliation(s)
- Ignacio Villagrán
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Tejos
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Chahuan
- Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Thomas Uslar
- Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margarita Pizarro
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Julián Varas
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Achurra
- Departamento de Cirugía Digestiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Isabel Leiva
- Departamento de Enfermedades Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Claudio Nazar
- Departamento de Anestesia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marisol Sirhan
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Javier Uribe
- Escuela Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Ruz
- Escuela Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Villafranca
- Escuela Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Romina Soza
- Departamento de Medicina Interna, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nancy Solís
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Oslando Padilla
- Departamento de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcia Corvetto
- Departamento de Anestesia, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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