Biomedical subjects

Pamela J Morgan

Publications and source records attributed to Pamela J Morgan.

9 recordsLinked to original sources

PubMed2006

Applying theory to practice in undergraduate education using high fidelity simulation.

High-fidelity patient simulation allows students to apply their theoretical knowledge of pharmacology and physiology to practice. The purpose of this study was to determine if experiential education using high-fidelity simulation improves undergraduate performance scores on simulation-based and written examinations. After receiving research ethics board approval, students completed a consent form and then answered a ten question multiple-choice quiz to identify their knowledge regarding the management of cardiac arrhythmias. Four simulation scenarios were presented and students worked through each scenario as a team. Faculty facilitated the sessions and feedback was given using students' videotaped performances as a template for discussion. Performance evaluation scores using predetermined checklists and global rating scales were completed. Students then reviewed the American Heart Association guidelines for the management of unstable cardiac arrhythmias. The afternoon session involved repetition of the four case scenarios with the same teams involved but different team leaders. Students then repeated the quiz they received in the morning. Descriptive statistics, paired t-test and repeated measures analysis of variance (ANOVA) were used to analyse results. Two hundred and ninety-nine students completed the study. There was a statistically significant improvement in performance on the pharmacology written test. Simulation team performance also statistically improved and a good correlation between checklist and global rating scores were demonstrated in all but one scenario. Student evaluation of the experience was extremely positive. High-fidelity simulation can be used to allow students to apply theoretical knowledge to practice in a safe and realistic environment. Results of this study indicate that simulation is a valuable learning experience and bridges the gap between theory and practice. Simulation technology has the potential to provide an enriching venue to examine the role of communication and dynamics of novice learners in team environments.

Anesthesiology↗

PubMed2005

Barriers to use of simulation-based education.

PURPOSE: Barriers to simulation-based education in postgraduate and continuing education for anesthesiologists have not been well studied. We hypothesized that the level of training may influence attitudes towards simulation-based education and impact on the use of simulation. This study investigated this issue at the University of Toronto which possesses two sites equipped with high-fidelity patient simulators. METHODS: A 40-question survey of experiences, perceptions, motivations and perceived barriers to simulation-based education, was distributed to 154 anesthesiologists attending a departmental conference. Data were analyzed using descriptive statistics and associations between responses were assessed using either the Chi-Square statistic or a one-way analysis of variance. RESULTS: The rate of response was 58%. Residents had experienced simulation-based education (96%) more often than staff (58%) and fellows (36%), (P < 0.001 respectively). Residents had also attended more simulation sessions than staff and fellows (mean 2.8 vs 1.05 and 1.04, P < 0.001 respectively). Residents and fellows found simulation-based education more relevant for their training than staff (88% vs 65%, P < 0.05). Eighty-one percent of the respondents identified at least one significant barrier that prevents or limits them from attending simulator sessions. Staff anesthesiologists perceived multiple barriers and identified 'time' and 'financial issues' as significant barriers. CONCLUSION: Anesthesiologists' level of training influences their attitudes towards and their perceptions of simulation-based education. This survey has identified perceived barriers that may limit a wider utilization of simulation. These results may be used to implement targeted actions such as course design, incentives, and information strategies, which could improve access and future use of simulation.

Anesthesiology↗

PubMed2005

Simulation technology in training students, residents and faculty.

PURPOSE OF REVIEW: We provide an overview of the developments in medical education and assessment using high-fidelity simulation. Both descriptive and research papers recently published in the English language are included in this review. RECENT FINDINGS: The majority of articles reviewed are descriptive in nature, outlining the use of simulation for various educational purposes in undergraduate, postgraduate and continuing medical education. Some articles focus on the use of simulation for the acquisition of technical skills in different surgical disciplines using part-task simulation. Other disciplines such as emergency medicine, critical care, paediatrics and nursing have also contributed to the literature in this area. Very little research in the area of simulation is evident in the literature addressing the actual value or the reliability and validity of high-fidelity simulation as an evaluation tool during this time period. A strong interest in decreasing human error and the improvement in patient safety may indicate the future direction of high-fidelity simulation. SUMMARY: Simulation is receiving increasing support as an educational tool and in its use for evaluation purposes. Research into this area is still somewhat limited. As the research impetus increases in the future, we may see simulation as a major focus in all disciplines with respect to its use in the improvement of patient safety. Team training, including both personality and attitudinal issues similar to those performed in other high hazard industries, may become increasingly evident in the literature in the coming decade.

Journal Article↗

PubMed2003

Identification of gaps in the achievement of undergraduate anesthesia educational objectives using high-fidelity patient simulation.

UNLABELLED: In this study we sought to identify educational gaps in medical students' knowledge using human patient simulation. The Undergraduate Committee developed 10 scenarios based on anesthesia curriculum objectives. Checklists were designed by asking 15 faculty members involved in undergraduate education to propose expected performance items at a level appropriate for medical students. These items consisted of essential performance items as well as critical management omissions. Checklists were used to score students' videotaped performances. Checklist items common to more than one scenario were grouped for data analysis and identification of gaps in achievement of educational objectives. Eighteen groupings of expected performance criteria and 8 groupings of critical management omissions were established. Performance data of 165 students were analyzed. Common management omissions were lack of adequate airway management, failure to check blood pressure, and failure to stop the anesthetic. Students reliably performed defibrillation, notation of vital signs, auscultation of lung fields, and administration of IV fluids. The most common critical omissions were failing to a). call for help, b). take a history/do physical examination, and c). prepare airway equipment. Management and critical omissions noted during performance assessments provide information regarding students' educational needs, enabling faculty to focus attention on demonstrated areas of weakness. IMPLICATIONS: This study involved the use of high-fidelity patient simulation that offers standardized clinical experiences that can detect gaps in medical students' knowledge base and clinical performance. This information can be used by faculty to focus their teaching efforts to ensure competency in important educational areas.

Anesthesiology↗

PubMed2002

Nitroglycerin as a uterine relaxant: a systematic review.

OBJECTIVE: To evaluate the effectiveness of nitroglycerin as a uterine relaxant for preterm labour, fetal extraction at Caesarean section, external version, embryo transfer, cervical dilation for first trimester pregnancy termination, and primary dysmenorrhea. DESIGN: A systematic review of randomized control trials (RCTs) of nitroglycerin in obstetrics and gynaecology. METHODS: We searched PubMed (1966-2001), the Cochrane Controlled Trials Register, and the International Journal of Obstetric Anesthesia using text terms quot:nitroglycerin," "glyceryl trinitrate," "uterus," "uterine," and "relaxation." The last search was conducted in January 2001. References from review articles and abstracts from major scientific meetings (1997-2000) were reviewed for relevant publications. RCTs comparing nitroglycerin to either placebo or another therapeutic intervention (ritodrine, magnesium sulphate, and prostaglandin) and whose quality score was equal to or greater than 2 were included (Class I evidence as described in the Report of the Canadian Task Force on the Periodic Health Exam). RESULTS: Sixty articles were retrieved of which 13 were RCTs. Nitroglycerin was more effective for arresting preterm labour than placebo but not more effective when compared to ritodrine or magnesium. Nitroglycerin was not superior to placebo for uterine relaxation for either fetal extraction at Caesarean section or for external version. There were no differences in ease of embryo transfers when nitroglycerin spray was compared to placebo. In first trimester pregnancy terminations, less force was required to dilate the cervix when nitroglycerin was compared to no treatment. The incidence of preeclampsia was not reduced by nitroglycerin but fewer complications were noted when compared to the placebo group. In patients with primary dysmenorrhea, nitroglycerin significantly decreased pain. CONCLUSION: Although nitroglycerin is widely used, its superiority over currently used tocolytic agents is unproven. (Class C recommendation) Nitroglycerin has been demonstrated to decrease pain associated with dysmenorrhea. (Class A recommendation)

Cesarean Section↗

PubMed2002

Experiential learning in an anaesthesia simulation centre: analysis of students' comments.

The anesthesia computer-controlled patient simulator offers a valuable experiential learning experience for undergraduate medical students. The purpose of this study was to gather students' opinions of the simulator learning experiences and to study and analyze their comments regarding the nature of the learning. All fourth-year medical students were invited to participate in a simulator session during their anesthesia rotation. A satisfaction survey was administered and the qualitative data were analyzed. A total of 145 students completed the questionnaire (100% return rate). Most students (88%) reported the session to be a positive learning experience that provided opportunities for applying their knowledge in a realistic environment. Some students indicated a lack of comfort in the environment but this did not appear to inhibit performance. Student comments highlighted the value of the learning experience and provided insights into the nature of the learning. The computer-controlled patient simulator offers new and challenging opportunities for medical students to apply their knowledge and practice working through an Anesthesia case without endangering patient safety.

Anesthesiology↗

PubMed2002

Misexpression of genes in mouse tooth germs using in vitro electroporation.

Mouse mandible primodia in vitro explant cultures are an excellent model for investigating tooth development. Mandibular arch epithelial-mesenchymal tissue recombinations and implantation of beads soaked in signaling proteins have revealed much about the early events of odontogenesis. These approaches do, however, suffer from several disadvantages, in particular the nonphysiological nature of beads soaked in very high concentrations of proteins and the inability to directly manipulate receptor and transcription factor gene expression. We have utilized the technique of DNA electroporation to deliver targeted gene expression to defined areas of mandibular arch epithelium or mesenchyme. This approach is being used to (a) ectopically express epithelial signals such as Shh and Bmp-4, (b) inhibit BMP and FGF signaling by expression of dominant negative receptors and antagonists, and (c) misexpress transcriptional factors in the mesenchyme. The technical aspects of electroporation are discussed, as well as preliminary findings.

Animals↗

PubMed2002

Simulation technology: a comparison of experiential and visual learning for undergraduate medical students.

BACKGROUND: The availability of simulator technology at the University of Toronto (Toronto, Ontario, Canada) provided the opportunity to compare the efficacy of video-assisted and simulator-assisted learning. METHODS: After ethics approval from the University of Toronto, all final-year medical students were invited to participate in the current randomized trial comparing video-based to simulator-based education using three scenarios. After an introduction to the simulator environment, a 5-min performance-based pretest was administered in the simulator operating room requiring management of a critical event. A posttest was administered after students had participated in either a faculty-facilitated video or simulator teaching session. Standardized 12-point checklist performance protocols were used for assessment purposes. As well, students answered focused questions related to the educational sessions on a final examination. Student opinions regarding the value of the teaching sessions were obtained. RESULTS: One hundred forty-four medical students participated in the study (scenario 1, n = 43; scenario 2, n = 48; scenario 3, n = 53). There was a significant improvement in posttest scores over pretest scores in all scenarios. There was no statistically significant difference in scores between simulator or video teaching methods. There were no differences in final examination marks when the two educational methods were compared. Student opinions indicated that the experiential simulator sessions were more enjoyable and valuable than the video teaching sessions. CONCLUSIONS: Both simulator and video types of faculty-facilitated education offer a valuable learning experience. Future work is needed that addresses the long-term effects of experiential learning in the retention of knowledge and acquired skills.

Adult↗

PubMedDate not supplied

A worldwide survey of the use of simulation in anesthesia.

PURPOSE: To gather information regarding the global use of simulation technology in education, evaluation and research in anesthesia. METHODS: The WorldWide Web was searched and located sites with simulation centres (n = 158) were mailed a 67-item questionnaire requesting information regarding demographics, personnel, education use and research involvement. Comments were solicited. Medical school data only are reported in this article. RESULTS: Two web sites were used to generate the list of simulation centres. Sixty responses were received (38%), with 41 emanating from medical schools. Seventy-seven percent of centres were involved in undergraduate education and 85% in postgraduate education. Few centres were involved in evaluation and/or competency assessments. Sixty-one percent of centres indicated ongoing research with a further 25% interested in international collaboration. University or university departmental-based funding largely supported simulation technology used in medical schools. The lack of financial and human resources was the single most common problem identified by respondents. CONCLUSIONS: From the survey responses received, opportunities for the simulator to be used for the assessment of performance appear to be under-utilized. This may be due to the lack of research in this area, lack of standardized, valid and reliable tests and the fact that most centres have only recently acquired this technology. Further research supporting the use of the simulator in education and evaluation is required.

Anesthesiology↗