Development of three simulations for training dietetic practitioners.
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Allied Health Personnel↗
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Results for “simulation training”
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Special training under simulated stat lab conditions.
A course has been devised to simulate a hospital stat lab environment for students in a 2-year MLT Associate Degree program. This course ensures that each student will individually perform a wide variety of laboratory procedures and report results under hospital-like circumstances. This course, which has received favorable comment from NAACLS, circumvents problems of insufficient placement situations, inadequate supervision, and limited variety of student experience in hospital sites. Course procedures, objectives, and student evaluation methods are described.
Clinical Laboratory Techniques↗
[We admire nurses: communication training with simulated patients].
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Communication↗
The use of patient simulation in training medical students in history-taking skills.
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Education, Medical, Undergraduate↗
Simulated patients for the practical examination of medical students: intentions, procedures and experiences.
This paper presents intentions, procedures and experiences related to a simple method for training simulated patients for undergraduate examinations set up as clinical consultations. The examinations took place in the final year of medical school, at the Division for General Practice, University of Bergen, Norway. Thirty-six medical students were assessed by the use of five primary-school teachers serving as simulated patients and 18 authentic patients. Field notes from the process, observations during the examinations, written evaluation from the students and transcript of audiotape from focus group setting with the simulants are presented. Simulants were trained and prepared to simulate common health problems during a brief procedure which seemed to be sufficient as long as standardization was not aimed for. Simulants were not detected from among the ordinary patients by the students. Even the authentic patients did some level of role playing, which must be accounted for in future preparation. Simulants may by means of brief preparatory instructions serve as useful and realistic supplements to authentic patients in the practical examination of undergraduate medical students.
Adult↗
Self-assessment in simulation-based surgical skills training.
BACKGROUND: Simulation-based training provides minimal feedback and relies heavily on self-assessment. Research has shown medical trainees are poor self-assessors. The purpose of this study was to examine trainees' ability to self-assess technical skills using a simulation-trainer. METHODS: Twenty-one medical students performed 10 repetitions of a simulated task. After each repetition they estimated their time and errors made. These were compared with the simulator data. RESULTS: Task time (P < 0.0001) and errors made (P < 0.0001) improved with repetition. Both self-assessment curves reflected their actual performance curves (P < 0.0001). Self-assessment of time did not improve in accuracy (P = 0.26) but error estimation did (P = 0.01) when compared with actual performance. CONCLUSIONS: Novices demonstrated improved skill acquisition using simulation. Their estimates of performance and accuracy of error estimation improved with repetition. Clearly, practice enhances technical skill self-assessment. These results support the notion of self-directed skills training and could have significant implications for residency training programs.
Clinical Competence↗
Validation and learning in the Procedicus KSA virtual reality surgical simulator.
BACKGROUND: Advanced simulator training within medicine is a rapidly growing field. Virtual reality simulators are being introduced as cost-saving educational tools, which also lead to increased patient safety. METHODS: Fifteen medical students were included in the study. For 10 medical students performance was monitored, before and after 1 h of training, in two endoscopic simulators (the Procedicus KSA with haptic feedback and anatomical graphics and the established MIST simulator without this haptic feedback and graphics). Five medical students performed 50 tests in the Procedicus KSA in order to analyze learning curves. One of these five medical students performed multiple training sessions during 2 weeks and performed more than 300 tests. RESULTS: There was a significant improvement after 1 h of training regarding time, movement economy, and total score. The results in the two simulators were highly correlated. CONCLUSION: Our results show that the use of surgical simulators as a pedagogical tool in medical student training is encouraging. It shows rapid learning curves and our suggestion is to introduce endoscopic simulator training in undergraduate medical education during the course in surgery when motivation is high and before the development of "negative stereotypes" and incorrect practices.
Computer Simulation↗
The interaction of spatial ability and motor learning in the transfer of training from a simulator to a real task.
Virtual Reality (VR) based simulators have been used as a training tool in many settings, although very few studies examine transfer of training from simulators to a real world task, particularly for manipulation tasks. Simulators could play a key role as an enabling technology for manipulation tasks related to teleoperation, and medical procedure training. We investigated the relationship between motor tasks and participants' spatial abilities. This relationship was further examined with respect to learning in a simulator and to transfer of training from the simulator to the real world on a pick-and-place task. Spatial abilities were characterized using a battery of recognition and manipulation figural tests. Subjects with lower spatial abilities demonstrated significant positive transfer from a simulator based training task to a similar real world robotic operation task. Subjects with higher spatial skills did not respond as positively from training in a simulated environment.
Aptitude↗
Structural flexibility of laparoscopic instruments: implication for the design of virtual reality simulators.
Laparoscopic training, under simulated settings, benefits from high fidelity models of the actual environment. This study was aimed at reducing uncertainty in the displacement and loads experienced by a laparoscopic instrument during surgical training. Infrared tracking of laparoscopic instruments is ineffective when real tissues attenuate the infrared signals. Incorporating the use of strain gauges for tip deflection measurements allows for online motion and load tracking during a procedure. Strain gauge voltages and infrared markers indicating displacement were both linear with respect to loads up to 700 grams. The resultant strain gauge voltage was equated to deflection values with a calibration constant. The results serve two purposes. First, it may enable the tracking and analysis of the skill level of novice surgeons using bench models. Second, the mechanical model of each instrument can be quantified and incorporated into virtual simulations, thus increasing model fidelity, effectively leading to better learning.
Computer Simulation↗
The performance of standard vertical S-1 flight maneuvers by student U.S. Naval helicopter pilots.
BACKGROUND: During flight training, student U.S. Naval helicopter pilots learn the use of flight instruments through a prescribed series of simulator training events. We recorded the training flights of 76 student U.S. Naval helicopter pilots undergoing the simulator phase of basic flight instrument training. From the final basic instrument simulator flight, the Vertical S-I (VS) flight maneuver, a standard flight maneuver required of the students, was selected for analysis. This maneuver was chosen because the ideal performance was well described. METHODS: The training simulator is the 2B42 training device, a 6 degrees of freedom, motion-based, high-fidelity instrument trainer. The quality of the flight performance of the cohort of student aviators executing the VS was described using objective measures of deviation from the ideal flight path. The measures included air speed, altitude, and heading average error from target values and standard deviations. RESULTS: The distributions of these scores for the 76 student pilots were described and used to calculate a composite score that summarized a student's overall performance of the maneuver. The worst four, the best four, and a group of four average pilots were identified from their composite scores and their relative performance was compared. CONCLUSIONS: A graphical summary of each pilot's flight performance was developed, and from this performance summary a pattern became evident that suggested that differences in performance levels were related to the use of flight instruments.
Aircraft↗
GOLEM--multimedia simulator for medical education.
We created multimedia medical training simulator "GOLEM" for learning diagnostics and therapy of the critical clinical disorders. The theoretical basis of the simulator is the mathematical formulation of the relationship of homeostasis of the internal environment (acid/base and electrolyte equilibrium, of transport of blood gases, of osmotic and volume homeostasis), respiration, circulation and kidneys including regulatory influence of relevant hormones and the influence of some therapeutic procedures. Mathematical description consists of 39 non-linear differential equations and containing 89 input and 179 output variables. For the development of the simulation models developer's tools from MathWorks (Matlab and Simulink) has been used. The integration of the multimedia components, hypertext and simulation models interface was achieved by using Control Web, developed by Moravian Instruments, originally designed for long distance controls using PC and Internet. We have used our simulator as an efficient educational tool to help medical students learn circulatory, respiratory, acid-base, electrolyte, osmotic and volume disorders and train the diagnostic and therapeutic decisions by executing simulated interventions on virtual "patients".
Acid-Base Imbalance↗
Simulator sickness in an army simulator.
Simulator sickness describes a symptom reported by aircrew during or after flight simulator training. Some features are common to motion sickness but others, which are unusual during real flight, are believed to result specifically from the simulator environment. This paper describes the results of a questionnaire study examining the incidence and factors influencing simulator sickness in any army training system. Case histories are described and conclusions drawn with respect to health and safety, training and the effect on flight operations. One hundred and fifteen aircrew were registered in the questionnaire study. Data were collected from a history questionnaire, a post-sortie report and a delayed report form. Sixty-nine per cent of aircrew gave a history of symptoms in the simulator and 59.9 per cent experienced at least one symptom during the study period although few symptoms were rated as being other than slight. Only 3.6 per cent of subjects reported symptoms of disequilibrium. Comparative analysis of the results was performed after scoring symptoms to produce a sickness rating. This showed: association between simulator-induced sickness and greater flying experience; adaptation to the simulator environment; a history of sea sickness may predict susceptibility to simulator sickness; and no association of crew role and simulator sickness. Although some authorities believe simulator sickness to be a potential flight safety hazard there was little evidence from this study. Guidelines for the prevention of the problem are presented now that many factors have been identified. A general policy to 'ground' aircrew for a period following simulator training is not necessary, but severe cases should be assessed individually.
Adult↗
Use of computer graphics simulation for teaching of flexible sigmoidoscopy.
The concept of simulation training in endoscopy is now well-established. The systems currently under development employ either computer graphics simulation or interactive video technology; each has its strengths and weaknesses. A flexible sigmoidoscopy training device has been designed which uses graphic routines--such as object oriented programming and double buffering--in entirely new ways. These programming techniques compensate for the limitations of currently available desk-top microcomputers. By boosting existing computer 'horsepower' with next generation coprocessors and sophisticated graphics tools such as intensity interpolation (Gouraud shading), the realism of computer simulation of flexible sigmoidoscopy is being greatly enhanced. The computer program has teaching and scoring capabilities, making it a truly interactive system. Use has been made of this ability to record, grade and store each trainee encounter in computer memory as part of a multi-center, prospective trial of simulation training being conducted currently in the USA. A new input device, a dummy endoscope, has been designed that allows application of variable resistance to the insertion tube. This greatly enhances tactile feedback, such as resistance during looping. If carefully designed trials show that computer simulation is an attractive and effective training tool, it is expected that this technology will evolve rapidly and be made widely available to trainee endoscopists.
Computer Graphics↗
Development of simulators in medical education.
The historical development of simulators is presented in respect to their application in medical training. Simulators allow, to some extent, practical training without any inconvenience for patients. The earliest simulators in the history of medicine were the obstetrical manikins introduced towards 1700 by father and son Grégoire of Paris and primarily intended for the instruction of lay people, i.e. midwives. Their further development is followed up to contemporary models of highly specialized use. Since 1960 simulators are more and more used for the training of doctors, nurses and laymen in resuscitation techniques. In combination with computers, high-fidelity simulators were created which, e.g., react to anaesthetics like real human beings. Conclusions about future developments and uses of simulators in medical education, in view of their history, are provided.
Computer Simulation↗
The Neo-Papilla: a new modification of porcine ex vivo simulators for ERCP training (with videos).
BACKGROUND: Computer simulators, live pigs, and ex vivo porcine simulators are used for training in ERCP. The location of the porcine biliary orifice in the proximal duodenum is dissimilar to human anatomy, making the endoscopy experience less realistic. In addition, in native porcine anatomy, the pancreatic duct enters the duodenum distal to the biliary orifice, limiting the teaching of pancreatic techniques and selective duct cannulation. OBJECTIVE: To overcome these limitations, we aimed to construct a Neo-Papilla that could be incorporated into an ex vivo model. DESIGN: We attached chicken heart tissue to the porcine duodenum, with integrated porcine arteries that resembled an artificial common bile duct and a pancreatic duct. SETTING: The simulator was presented and evaluated at 2 major GI endoscopy conferences. MAIN OUTCOME MEASUREMENTS: The feasibility and the realism of this prototype was tested by 9 recognized ERCP experts who rated this model in comparison to other teaching models for ERCP by recollection of prior experience. RESULTS: The Neo-Papilla was more prominent and more distally located than the native porcine papilla. The experts rated this modification superior to existing models in its usefulness as an educational tool. LIMITATIONS: Pilot study. CONCLUSIONS: We demonstrated the technical feasibility of a real-tissue Neo-Papilla modification of porcine ex vivo simulators, more closely approximating the natural anatomy. This new model should facilitate ERCP training. Formal validation studies are warranted.
Ampulla of Vater↗
Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training.
BACKGROUND: Human patient simulation (HPS) has been used since 1969 for teaching purposes. Only recently has technology advanced to allow application to the complex field of trauma resuscitation. The purpose of our study was to validate an advanced HPS as an evaluation tool of trauma team resuscitation skills. METHODS: The pilot study evaluated 10 three-person military resuscitation teams from community hospitals that participated in a 28-day rotation at a civilian trauma center. Each team consisted of physicians, nurses, and medics. Using the HPS, teams were evaluated on arrival and again on completion of the rotation. In addition, the 10 trauma teams were compared with 5 expert teams composed of experienced trauma surgeons and nurses. Two standardized trauma scenarios were used, representing a severely injured patient with multiple injuries and with an Injury Severity Score of 41 (probability of survival, 50%). Performance was measured using a unique human performance assessment tool that included five scored and eight timed tasks generally accepted as critical to the initial assessment and treatment of a trauma patient. Scored tasks included airway, breathing, circulation, and disability assessments as well as overall organizational skills and a total score. The nonparametric Wilcoxon test was used to compare the military teams' scores for scenarios 1 and 2, and the comparison of the military teams' final scores with the expert teams. A value of p < 0.05 was considered significant. RESULTS: The 10 military teams demonstrated significant improvement in four of the five scored (p < or = 0.05) and six of the eight timed (p < or = 0.05) tasks during the final scenario. This improvement reflects the teams' cumulative didactic and clinical experience during the 28-day trauma refresher course as well as some degree of simulator familiarization. Improved final scores reflected efficient and coordinated team efforts. The military teams' initial scores were worse than the expert group in all categories, but their final scores were only lower than the expert groups in 2 of 13 measurements (p < or = 0.05). CONCLUSION: No studies have validated the use of the HPS as an effective teaching or evaluation tool in the complex field of trauma resuscitation. These pilot data demonstrate the ability to evaluate trauma team performance in a reproducible fashion. In addition, we were able to document a significant improvement in team performance after a 28-day trauma refresher course, with scores approaching those of the expert teams.
Computer Simulation↗
Noise autocorrelation and jamming avoidance performance in pulse type electric fish.
The amplitude and the autocorrelation level of the noise affecting the interval between successive electric organ discharges were estimated in isolated fish and in socially interacting fish of the species Gymnotus carapo. Both quantities increased in the fish with the slower discharging rate of the pair during the interaction, and we aim to assess whether they have some functional implication for the efficiency of the jamming avoidance response performed by the fish having the faster discharging rate of the pair. For this purpose, the noisy variability of the intervals around its mean value was simulated using autoregressive models estimated from experimental recordings of isolated and interacting fish. The simulation was implemented using two autoregressive models, each representing one fish of the pair. The jamming avoidance response was included by adding transient interval shortenings to the train simulating the fish of the pair that discharges at a faster rate whenever the two trains were close to discharge simultaneously. The number of double coincidences (i.e., simultaneous discharges occurring in two successive firing cycles) of the two simulated trains was used to measure the efficiency of the jamming avoidance. This quantity was evaluated separately as a function of the autocorrelation level and amplitude of the simulated variability, in realizations with and without jamming avoidance response. Only if jamming avoidance response was included in the simulation have we found that (i) the number of coincidences decreased with the increasing of the autocorrelation and (ii) the increase in the amplitude determined a growth of the coincidence number at a rate that is inversely proportional to the autocorrelation level. We argue that the persistent correlations of the fish variability constitute an adaptation that improves the efficiency of transient interval shortenings as a jamming avoidance strategy. The long autocorrelation time prevents the disruption of the jamming avoidance performance due to increases in the variability amplitude.
Animals↗
Integrating simulation into a busy residency program.
A mandatory program of computer-driven simulation training was instituted in a medium-sized surgical training program in order to achieve the goal of increased resident performance outside the setting of direct patient care. Postgraduate year (PGY) 1-5 residents received mentored instruction on a virtual reality (VR) laparoscopic surgical trainer in performance of specific tasks appropriate to training level. Training for PGY 1-2 residents consisted of basic manipulative VR tasks. Training for PGY 3-5 residents consisted of VR suturing and intracorporeal knot-tying tasks. Each resident received two to four mentored one-hour sessions, and was instructed to return for self-directed practice during blocked and unscheduled time. PGY 3-5 residents had laparoscopic suturing and knot-tying skills evaluated in an animal model prior to onset of VR training and two to four months after start of training. After seven months of availability of training, PGY 1-2 residents had undertaken significantly more training sessions than PGY 3-5 residents (18+/-3 vs. 9+/-2; p<0.01). All PGY 1-2 residents demonstrated improved task performance, and six achieved expert performance relative to experienced laparoscopic surgeons. The suturing task in the animal lab was accomplished faster post-training (91+/-9 seconds vs. 154+/-16 seconds; p<0.01). Early results suggest that broadly applied VR training is of significant benefit in increasing resident technical skills. Based on early success, a broader program of computer-based simulation has been implemented, using more advanced devices for technical skills training, and a human patient simulator for training critical decision-making skills.
Journal Article↗