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PubMed2006

Using simulation for training and to change protocol during the outbreak of severe acute respiratory syndrome.

INTRODUCTION: During the 2003 severe acute respiratory syndrome (SARS) crisis, we proposed and tested a new protocol for cardiac arrest in a patient with SARS. The protocol was rapidly and effectively instituted by teamwork training using high-fidelity simulation. METHODS: Phase 1 was a curriculum design of a SARS-specific cardiac arrest protocol in three steps: planning the new protocol, repeated simulations of this protocol in a classroom, and a subsequent simulation of a cardiac arrest on a hospital ward. Phase 2 was the training of 275 healthcare workers (HCWs) using the new protocol. Training involved a seminar, practice in wearing the mandatory personal protection system (PPS), and cardiac arrest simulations with subsequent debriefing. RESULTS: Simulation provided insights that had not been considered in earlier phases of development. For example, a single person can don a PPS worn for the SARS patient in 1 1/2 minutes. However, when multiple members of a cardiac arrest team were dressing simultaneously, the time to don the PPS increased to between 3 1/2 and 5 1/2 minutes. Errors in infection control as well as in medical management of advanced cardiac life support (ACLS) were corrected. CONCLUSION: During the SARS crisis, real-time use of a high-fidelity simulator allowed the training of 275 HCWs in 2 weeks, with debriefing and error management. HCWs were required to manage the SARS cardiac arrest wearing unfamiliar equipment and following a modified ACLS protocol. The insight gained from this experience will be valuable for future infectious disease challenges in critical care.

Canada↗

PubMed2006

Evidence-based assessment of endoscopic simulators for training.

This article focuses on some important key questions: Can the currently available simulators distinguish between the skill levels of a novice who has never performed endoscopic procedures and an expert who teaches the procedure? Do the cases on the simulator accurately simulate the difficulty of the procedure and the skill required to perform therapeutic maneuvers? What is the evidence that the currently available simulators can supplement or even replace bedside training? When are simulators most useful in the learning period? This article examines the published evidence regarding the efficacy of the current generation of endoscopic simulators in endoscopic training.

Animals↗

PubMed2004

Effectiveness of a simulator in training anesthesiology residents. 1969.

The educational potential of a computer-controlled patient simulator was tested by the University of Southern California School of Medicine. The results of the experiment suggest unequivocally that there is a twofold advantage to the use of such a simulator in training anesthesiology residents in the skill of endotracheal intubation: (a) residents achieve proficiency levels in a smaller number of elapsed days of training, thus effecting a saving of time in the training of personnel, and (b) residents achieve a proficiency level in a smaller number of trials in the operating room, thus posing significantly less threat to patient safety. The small number of subjects in the study and the large within-group variability were responsible for a lack of statistical significance in 4 of 6 of the analyses performed; however, all differences were substantial and in the hypothesized direction. Thus, despite the narrowly circumscribed tasks to be learned by the experimental subjects, the findings suggest that the use of simulation devices should be considered in planning for future education and training not only in medicine but in other health care professions as well.

Anesthesiology↗

PubMed1996

The teleos virtual environment toolkit for simulation-based surgical education.

In the past, surgical simulations have largely been created through the development of dedicated applications that require considerable programming and computer graphics skills. Advances in simulation-based surgical education have been limited by this dependence on computer graphics programming expertise. To lower barriers to the adoption of simulation-based training, we are developing tools based on Teleos, software technology that allows a wide variety of medical content developers to author surgical training simulations without programming.

Computer Graphics↗

PubMed2004

The use of simulation for training teamwork skills in health care: how low can you go?

High fidelity simulation has become a popular technique for training teamwork skills in high risk industries such as aviation, health care, and nuclear power production. Simulation is a powerful training tool because it allows the trainer to systematically control the schedule of practice, presentation of feedback, and introduction (or suppression) of environmental distractions within a safe, controlled learning environment. Unfortunately, many within the training community have begun to use the terms simulation and high fidelity simulation almost synonymously. This is unfortunate because doing so overemphasises the instructional technology to the detriment of more substantive issues, such as the training's goals, content, and design. It also perpetuates several myths: simulation fidelity is unidimensional, or higher levels of simulation fidelity lead to increased training effectiveness. The authors propose a typology of simulation fidelity and provide examples of how the different classes of simulation have been successfully used to train teamwork skills in high risk industries. Guidelines are also provided to maximise the usefulness of simulation for training teamwork skills in health care.

Inservice Training↗

PubMed2005

Developing a simulation-based training program for medical first responders.

A major stumbling block for widespread incorporation of simulators into EMT training includes the limited availability of curricula infrastructure linking the key components of skills, scenarios, and measures as well as the expertise required to run such programs. To meet these needs we are developing a training program for first responders that uses mannequin-based simulator technology effectively to fill the identified training need for valid meaningful scenarios that can be integrated into the curriculum and are applicable for a variety of EMT skill levels. The program will provide detailed scenarios, instructions for administering the program, and measures for performance feedback. Each scenario will exercise a combination of task work and cognitive skills and the set of scenarios will span all of the higher-level skills that have been identified as benefiting from targeted training.

Computer Simulation↗

PubMed2003

Patient simulation for training basic and advanced clinical skills.

INTRODUCTION: Patient simulators are increasingly used in the education and training of healthcare professionals. This paper describes the history of human patient simulator development, the features of contemporary simulators, the acquisition of basic and advanced clinical skills using patient simulators, and the benefits, cost, limitations and effectiveness of this innovative learning modality. SIMULATOR DEVELOPMENT: The development of human patient simulators began in the late 1960s, and accelerated in the late 1980s and early 1990s. Several simulator systems are now professionally manufactured, commercially available, and used at hundreds of medical centres, universities and colleges in the USA and throughout the world. Contemporary patient simulators have many clinical features, and look and respond to interventions with ever-increasing degrees of realism because sophisticated physiological and pharmacological models automatically control many features. SIMULATOR USE IN MEDICAL EDUCATION: Simulators are used to teach basic skills, such as respiratory physiology and cardiovascular haemodynamics, and advanced clinical skills, e.g. management of difficult airways, tension pneumothorax, pulmonary embolism and shock. BENEFITS, COSTS AND LIMITATIONS: The simulation laboratory offers distinct educational advantages, especially for learning how to recognise and to treat rare, complex, clinical problems. Costs of simulator-based educational programmes include facility, equipment and personnel. Current limitations include clinical realism of the patient manikin and faculty development.

Clinical Competence↗

PubMed2006

Effectiveness of haptic feedback in open surgery simulation and training systems.

This paper presents progress in the development of an untethered haptic feedback system for open surgery simulation and training being developed by Energid Technologies. A key innovation in our simulation is an untethered haptic feedback method. In this paper, we describe our approach to developing an effective untethered haptic feedback system, and our current progress. We also present the results of a haptic feedback effectiveness study which explores how haptic rendering accuracy behaves as a function of sampling rate for tool tracking.

Computer Simulation↗

PubMed1998

Use of a computer simulator for training children with disabilities in the operation of a powered wheelchair.

OBJECTIVE: The purpose of this study was to evaluate the ability of a basic driving simulator program to evaluate and train children with disabilities in their ability to operate a powered wheelchair. METHOD: With a rating scale of skills considered essential for safe and efficient wheelchair operation, 22 children 7 to 22 years of age with either progressive muscular dystrophy or cerebral palsy were evaluated in their ability to drive a powered wheelchair through a driving course. They were divided into two groups: one without prior experience driving a powered wheelchair and the other with experience. After the driving assessment with an actual powered wheelchair, the inexperienced drivers were trained on a joystick-controlled computer game in which they navigated through labyrinths similar in layout to their own school environment. A test maze was administered before and after this training. Both groups were then evaluated on their ability to drive a powered wheelchair through the driving course. RESULTS: The inexperienced drivers significantly increased their simulator scores over the training period. Their wheelchair driving performance was significantly better after the simulator training, although their performance remained poorer than that of the experienced drivers. CONCLUSION: A simulator program can assist in the development and evaluation of the skills required to operate a powered wheelchair.

Adolescent↗

PubMed2006

[New perspectives for simulator-based training in paediatric anaesthesia and emergency medicine].

Anaesthesia and emergency medical care for infants and toddlers is often associated with high clinical demands and specific challenges. Nevertheless, a significant proportion of interventions is performed by anaesthetists and emergency physicians with no specialised paediatric training and little experience in the management of anaesthetic incidents and emergencies specific to these age groups. Extensive studies have demonstrated a close inverse correlation between the level of specialisation and perioperative morbidity and mortality. However, clinical circumstances and the relatively small number of paediatric cases at many institutions often hinder the establishment of improved training concepts. Recently, high-fidelity infant simulators have become available, which permit authentic exposure to a large spectrum of scenarios in paediatric anaesthesia and emergency medicine. A multimodular concept of training, including such simulator-based techniques, may relieve the widespread shortage in clinical experience, and hence greatly facilitate improvement of quality of care and patient safety.

Anesthesiology↗

PubMed2005

Validation of a bovine rectal palpation simulator for training veterinary students.

Bovine rectal palpation is a necessary skill for a veterinary student to learn. However, lack of resources and welfare issues currently restrict the amount of training available to students in this procedure. Here we present a virtual reality based teaching tool -- the Bovine Rectal Palpation Simulator -- that has been developed as a supplement to existing training methods. When using the simulator, the student palpates virtual objects representing the bovine reproductive tract, receiving feedback from a PHANToM haptic device (inside a fibreglass model of a cow), while the teacher follows the student's actions on the monitor and gives instruction. We present a validation experiment that compares the performance of a group of traditionally trained students with a group whose training was supplemented with a simulator training session. The subsequent performance in the real task, when examining cows for the first time, was assessed with the results showing a significantly better performance for the simulator group.

Animals↗

PubMed2005

The effects of driver training on simulated driving performance.

Given that the beneficial effects of driver training on accident risk may not be an appropriate criterion measure, this study investigates whether professionally trained and experienced drivers exhibit safer driving behaviour in a simulated driving task compared with drivers without professional driver training. A sample of 54 police trained drivers and a sample of 56 non-police trained drivers were required to complete two tasks. Firstly to overtake a slow-moving bus on a hazardous stretch of single-lane road with bends and hills and secondly to follow a lead vehicle travelling at 55mph in a built-up section with a speed limit of 30mph. Results showed that in comparison with non-police trained drivers, police drivers were significantly less likely to cross the central division of the road at unsafe locations during the overtaking task and reduced their speed on approach to pedestrians at the roadside in the following task to a greater extent. Police drivers also adopted a more central lane position compared with non-police trained drivers on urban roads and at traffic lights during the following task. Driver group differences in simulated driving performance are discussed with reference to the implications for driver training assessment and skill development.

Adult↗

PubMed2006

The pretrained novice: using simulation-based training to improve learning in the operating room.

Enabling trainees to acquire advanced technical skills before they begin the operating room experience benefits both trainee and patient. Whether medical students who had received exclusively simulation-based training could perform laparoscopic suturing and knot-tying as well as senior surgery residents was determined. Simulators were used to train 11 fourth-year medical students with no previous suturing experience to perform intracorporeal suturing and to successfully tie a free-hand intracorporeal knot. Students' skills were assessed by the performance of the fundal suturing portion of a Nissen fundoplication in a porcine model. Their operative performance was evaluated for time, needle manipulations, and total errors. Results were compared to those of 11 senior-level surgery residents performing the same task. The study concluded that trainees could learn advanced technical skills such as laparoscopic suturing and knot tying by using simulation exclusively. The trainees and senior level surgery residents had a similar number of needle manipulations.

Clinical Competence↗

PubMed1987

A computer simulation for behavior therapy training.

Computer simulation technology has been applied to a wide variety of learning tasks; however, behavior therapy training has not been among them. A computer simulation has recently been developed for use in behavior therapy training. The simulation written for Apple II microcomputers reflects possible referral, assessment, and intervention procedures encountered by a behavior therapist in a mental health center. Forty-two pieces of assessment information may be drawn from 8 general areas, while 6 different interventions may be chosen after a diagnosis is reached. Simulation content and utility were rated highly by both practicing behavior therapists and trainees.

Behavior Therapy↗

PubMed1996

Laboratory simulations and training in endovascular embolotherapy with a swine arteriovenous malformation model.

We assessed the suitability of a swine experimental arteriovenous malformation model for laboratory simulations and training in endovascular embolotherapy. Embolizations with liquid glue or particles were performed in 10 animals. The parameters of injection (microcatheter position, concentration and volume of embolic agent, injection rate) were deliberately varied to simulate results that may be observed in clinical practice. A range of successful and less desirable therapeutic outcomes or complications was simulated. In one model, intravascular mean blood pressure in the "terminal feeder" rose after "nidus" embolization, consistent with observations in feeders of cerebral arteriovenous malformations. Experience in the technical aspects of embolotherapy was gained by repeated performances using this model. Simplicity of creation, clear angiographic visibility of feeders, a nidus and a draining vein, and hemodynamic similarities with cerebral arteriovenous malformations make this an attractive in vivo experimental model for learning the principles of embolotherapy, testing new embolic agents, and training/gaining experience in embolization techniques.

Animals↗

PubMed2006

Comparison of results of virtual-reality simulator and training model for basic ureteroscopy training.

BACKGROUND AND PURPOSE: The traditional method of acquiring surgical skills is by apprenticeship and involves an extensive period of training with patients. Model-based and virtual reality simulation is gaining interest as alternative training, allowing repetitive practice in a low-risk environment. The objective of this study was to determine if a materials, model-based training format and an interactive virtual-reality simulator could provide equivalent teaching of basic ureteroscopy skills to the inexperienced medical student. SUBJECTS AND METHODS: Sixteen first-year medical students received the same didactic session and video viewing on cystoscopy, guidewire access to the upper urinary tract, and ureteroscopy with intracorporeal laser lithotripsy and stone extraction by the same instructor. The participants were then randomized into two study groups: Group 1 was trained on the ureteroscopy training model (TMU) from Limbs & Things and Group 2 on the Simbionix UROMentor virtual-reality simulator (VRS) until the participants could perform the procedure independently. Two months later, the participants independently performed a ureteroscopic procedure on a pig kidney/ureter model and were graded from 1 to 5 on their ability to complete the steps of the procedure and the quality of their performance (handling of tissue, efficiency, instrument handling, knowledge of instruments, flow of operation, use of assistants, and knowledge of the specific procedure) for a possible total of 35 points. RESULTS: All participants were able to perform the steps of the procedure correctly. The TMU group and the VRS group received a mean of 22.9 +/- 4.8 and 23.6 +/- 5.4 points, respectively (P = 0.38) for their qualitative assessment. CONCLUSION: The medical students' skills and ability to perform a basic ureteroscopic stone-management procedure was independent of the training modality (VRS or TMU). Incorporating either of these devices into the preliminary training of urology residents may improve their initial clinical performance of these skills.

Adult↗

PubMed1987

A flight simulator for general anesthesia training.

A simulator of general anesthesia is described. It consists of an integrated set of physiologic computer models and a graphics display. The model predicts many of the physiologic and pharmacodynamic changes associated with general anesthesia. It is a multiple model consisting of circulatory, respiratory, pharmacokinetic, and pharmacodynamic models and their interactions. The model can account for many pathologic states of the cardiorespiratory system plus poor renal and hepatic function. Both intravenous and inhalation agents are included. Examples of its capabilities are presented, including pharmacokinetic changes associated with thiopental administration to a hypovolemic subject, administration of oxygen in several pulmonary pathologic conditions, and a simulation of an induction using fentanyl or thiopental. The model, combined with the graphics interface, becomes a real-time simulator useful for training students and residents.

Anesthesia, General↗

PubMed2006

Training for shoulder dystocia: a trial of simulation using low-fidelity and high-fidelity mannequins.

OBJECTIVE: To evaluate the effectiveness of simulation training for shoulder dystocia management and compare training using a high-fidelity mannequin with that using traditional devices. METHODS: Training was undertaken in six hospitals and a medical simulation center in the United Kingdom. Midwives and obstetricians working for participating hospitals were eligible for inclusion. One hundred forty participants (45 doctors, 95 midwives) were randomized to training with a high-fidelity training mannequin (incorporating force perception training) or traditional low-fidelity mannequins. Performance was assessed pre- and posttraining, using a videoed, standardized shoulder dystocia simulation. Outcome measures were delivery, head-to-body delivery time, use of appropriate and inappropriate actions, force applied, and communication. RESULTS: One hundred thirty-two participants completed the posttraining assessment. All training was associated with improved performance: use of basic maneuvers 114 of 140 (81.4%) to 125 of 132 (94.7%) (P=.002), successful deliveries 60 of 140 (42.9%) to 110 of 132 (83.3%) (P<.001), good communication with the patient 79 of 139 (56.8%) to 109 of 132 (82.6%) (P<.001), pre- and posttraining, respectively. Training with the high-fidelity mannequin was associated with a higher successful delivery rate than training with traditional devices: 94% compared with 72% (odds ratio 6.53, 95% confidence interval 2.05-20.81; P=.002). Total applied force was significantly lower for those who had undergone force training (2,030 Newton seconds versus 2,916 Newton seconds; P=.006) but there was no significant difference in the peak applied force 102 Newtons versus 112 Newtons (P=.242). CONCLUSION: This study verifies the need for shoulder dystocia training; before training only 43% participants could achieve delivery. All training with mannequins improved the management of simulated shoulder dystocia. Training on a high-fidelity mannequin, including force perception teaching, offered additional training benefits. LEVEL OF EVIDENCE: I.

Dystocia↗