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PubMed2003

Simulation laboratories for training in obstetrics and gynecology.

Simulations have been used by the military, airline industry, and our colleagues in other medical specialties to educate, evaluate, and prepare for rare but life-threatening scenarios. Work hour limits for residents in obstetrics and gynecology and decreased patient availability for teaching of students and residents require us to think creatively and practically on how to optimize their education. Medical simulations may address scenarios in clinical practice that are considered important to know or understand. Simulations can take many forms, including computer programs, models or mannequins, virtual reality data immersion caves, and a combination of formats. The purpose of this commentary is to call attention to a potential role for medical simulation in obstetrics and gynecology. We briefly describe an example of how simulation may be incorporated into obstetric and gynecologic residency training. It is our contention that educators in obstetrics and gynecology should be aware of the potential for simulation in education. We hope this commentary will stimulate interest in the field, lead to validation studies, and improve training in and the practice of obstetrics and gynecology.

Clinical Competence↗

PubMed2006

Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice.

BACKGROUND: Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. OBJECTIVE: To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. DESIGN: Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. PARTICIPANTS: Forty-one PGY-2 internal medicine residents in a university-affiliated program. MEASUREMENTS: Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. RESULTS: Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. CONCLUSIONS: A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education.

Adult↗

PubMedDate not supplied

[Physiological aspects of altitude training and the use of altitude simulators].

Altitude training in various forms is widely practiced by athletes and coaches in an attempt to improve sea level endurance. Training at high altitude may improve performance at sea level through altitude acclimatisation, which improves oxygen transport and/or utilisation, or through hypoxia, which intensifies the training stimulus. This basic physiological aspect allows three training modalities: live high and train high (classic high-altitude training), live low and train high (training through hypoxia), and live high and train low (the new trend). In an effort to reduce the financial and logistical challenges of travelling to high-altitude training sites, scientists and manufactures have developed artificial high-altitude environments, which simulate the hypoxic conditions of moderate altitude (2000-3000 meters). Endurance athletes from many sports have recently started using nitrogen environments, or hypoxic rooms and tents as part of their altitude training programmes. The results of controlled studies on these modalities of high-altitude training, their practical approach, and ethics are summarised.

Acclimatization↗

PubMed2006

The complementary Erlangen active simulator for interventional endoscopy training is superior to solely clinical education in endoscopic hemostasis--the French training project: a prospective trial.

BACKGROUND: The Erlangen Active Simulator for Interventional Endoscopy (EASIE) using ex-vivo porcine organs was introduced in 1997. The present study should analyze whether repeated EASIE simulator training in endoscopic hemostasis led to superior performance compared with a traditionally educated group. The results were compared with a similar project in New York. METHODS: Thirty-five French GI fellows were enrolled. Baseline skills evaluation was performed in four disciplines (manual skills, injection/coagulation, clip application and variceal ligation) using the compactEASIE-simulator equipped with an upper gastrointestinal organ package for bleeding simulation. The same, translated evaluation forms (from the prior New York project) were used. Subsequently, fellows were randomized into group A (n=17, only clinical education) and group B (n=18, additional three simulator trainings). Group B was trained the next day and after 4 and 7 months by experts of the French Society of Gastrointestinal Endoscopy. Both groups performed routine and emergency endoscopies at their home hospitals during the study period. Both groups were re-evaluated blindly after 9 months. RESULTS: The learning curve for group B showed a significant improvement in all disciplines (P<0.004) whereas group A improved significantly in only two of four disciplines at blinded final evaluation (manual skills P=0.02, injection/coagulation P=0.013). The direct comparison of groups B and A at blinded final evaluation showed significantly superior ratings for group B in all disciplines (P<0.006) and significantly shorter performance times in two disciplines (P=0.016 each). The comparison with the similar 'New York project' revealed that preexisting differences in skills were adjusted by the training. CONCLUSION: Complementary trainings (three workshops in 7 months) in endoscopic hemostasis using the compactEASIE improved skills compared with a solely clinical education. The results of the 'New York project' were confirmed and benefits were independent from the medical educational system.

Animals↗

PubMed2005

Faking it? Simulation in the training of obstetricians and gynaecologists.

PURPOSE OF REVIEW: This paper discusses the use of simulation as a training tool in obstetrics and gynaecology. RECENT FINDINGS: Modern medical training and patient pressure for treatment by more experienced clinicians have contributed to a reduction in the training opportunities available to junior doctors. Advances in information technology have led to the successful introduction of simulator-based training in many safety-critical industries such as aviation and nuclear power. In this editorial we describe simulation devices that are available to obstetrics and gynaecology and explain how simulation can benefit the patient, trainee and educator. We also explore how simulation could be integrated into obstetrics and gynaecology training programmes. SUMMARY: At present simulation is very much underused as a training tool in medicine, and features little in the postgraduate training curriculum. In obstetrics and gynaecology simulation could be used as an educational tool to assist in (1) transfer of knowledge, (2) practising diagnostic and simple practical skills, (3) surgical skills training, (4) emergency drill training and (5) human factors and team training. Whereas simulation should not be perceived as a replacement for training with real patients, educators should embrace the opportunities that simulation provides and integrate it into current training programmes to maximize training opportunities and patient safety.

Clinical Competence↗

PubMed1992

Joint task force "forward care" multicomponent health service support for an Army Reserve separate infantry brigade (mechanized)--Part III.

At the conclusion of 4 years' careful study of the health services support of a separate infantry brigade (mechanized) during the unit's annual training periods, the authors report on the effectiveness of a support team consisting of Army Reserve medical elements, an Active Army field unit, and a Public Health Service Clearing/Staging unit joining forces in a field environment to provide real world medical care to the same unit in a follow-on annual training period. The emphasis of the team created was on validating the forward care concept of field medical support. The result of this effort was "state of the art" medical service to the troops in the most forward areas, and a savings of 0.66 training days per soldier out of 10 days possible field training time. The cross-training of joint elements was enhanced by providing hands-on treatment of soldiers in a tactical environment, training that cannot be adequately replaced by simulated training.

Decision Making↗

PubMedDate not supplied

Virtual simulator as a training tool for endonasal surgery.

BACKGROUND: Virtual simulation could be an important tool for medical and surgical training as well as education. The efficacy of a simulator for endoscopic nasal procedures in a training program was evaluated. METHODS: The simulator is a medical and scientific tool for visualizing and interacting with three-dimensional volumetric data. Twenty endonasal operations with chronic rhinosinusitis were simulated by two 3rd-year residents and proctored by the senior surgeon 1 day before the actual surgery was performed with an endoscope and computer-aided surgery. A questionnaire was established. RESULTS: The surgical simulator may provide a better understanding of the morphology of the paranasal sinuses with a minor impact on performance of endoscopy by junior residents. Disadvantages identified were time consumption, absence of force feedback, and subtle handling of the joysticks. CONCLUSION: The virtual simulator allows the nonendoscopically nasal trained surgeon to understand and practice endonasal surgery using real-patient data but failed to make an impact on operating room performance. Furthermore, the simulator's effectiveness was limited by the absence of force feedback, subtle handling of the joysticks, and considerable time consumption.

Clinical Competence↗

PubMed2004

Almost the real thing.

Simulation training offers tuition that is constructive, realistic and highly participatory, and by representing believable working environments, simulators are ideal for undertaking technical and behavioural training, for individuals, small groups or entire teams. With current government led changes in healthcare provision such as implementing the European working time directive (DoH 2003), healthcare training opportunities with real patients are likely to become scarcer. The challenge will then be to train skilled, knowledgeable and proficient individuals in other ways. Simulation centres should offer part of the solution.

Education, Nursing↗

PubMed2002

Real-time soft tissue modelling for web-based surgical simulation: SurfaceChainMail.

The Web provides a useful environment for simple surgical training simulations. A combination of VRML for 3D rendering, and Java code for the simulation engine, has been used for a range of simple neurosurgical demonstrators. However the elements in these simulators are rigid, to avoid the computational complexity of deformable modelling. In this paper we describe a variation of the ChainMail technique that allows us to provide real-time deformable modelling, even in a Web browser environment on a PC. Our new algorithm, SurfaceChainMail, has been used to develop a simulator for the cutting of two layers of tissue, and separating the layers by pulling them apart.

Algorithms↗

PubMed2002

Simulators and endourological training.

Acquisition of skills laboratory training seems to be of importance in the training of surgeons, and is intended to cover the gap between theoretical learning and real practice. Economic and ethical reasons limit the use of animals during the learning process, while trends in medical change have severely restricted the available time to teach and to learn. With the incorporation of laparoscopy and the blossoming of minimally invasive techniques, mainly endoscopy, simulators have gained wide acceptance as an important tool in the surgeon's learning process. Two types of simulators are currently available: inanimates or mannequins and virtual reality simulators. A review of the recent literature shows that there is generally a significant improvement in dexterity after using simulators, whichever type is used. It is still unknown whether training simulation influences the patient's outcome positively.

Clinical Competence↗

PubMed1999

Intelligent split menus for data entry: a simulation study in general practice medicine.

A compelling notion in menu design is that a few of the most frequently selected items should be placed as a hot list at the top of the menu. A few researchers have explored this type of interface control, known as a split menu, and have investigated the identification of the hot-list items by statistical analysis of past data. We extend the technique to automated development of dynamic hot-lists for entry of medication data in a General Practice setting. Using clinical data from 113,000 visits, a statistical model is developed and evaluated by simulated data entry of cases held back from training. Simulated SOAP note entry shows 12-item hot lists to hold over 70% of desired drug and diagnosis selections. Intelligent split menus should improve user efficiency if current selection methods require 3 seconds or more per item. A demonstration prototype can be downloaded over the Web.

Artificial Intelligence↗

PubMed1995

Developing interactive computer-based simulations: an object-oriented development methodology enhances computer-assisted instruction.

The purpose of this research was to investigate the application of object-oriented technology and AI techniques to enhance development of computer-based training simulations. Towards that end, a comprehensive computer-assisted instructional unit was developed to teach the skills and concepts of window-based applications, the OS/2 desktop, and the use of a patient care information system. By taking advantage of sophisticated computer graphics for the visual representation of objects and the behavioral modeling capabilities of the object-oriented language, domain knowledge modeling and human-computer interactions were implemented without complex natural language processing techniques. The results of this research indicate that nurses and physicians are able to learn the basic skills and concepts of computer systems and how to query for patient information. The new methodology described for building these computer-assisted instructional simulations significantly eased the training and teaching of large numbers of nurses and physicians and simplified their transition to a complex, computer-based hospital information system environment.

Computer Graphics↗

PubMed1992

The uses of simulation in anesthesiology training: a review of the current literature.

Can anesthesia simulation be used successfully in training to improve the abilities of anesthesiologists and so result in decreased morbidity and mortality due to human error? In this review, computer simulation is examined as a training technique to reduce human error during the administration of anesthesia and as a method for studying how anesthetic accidents occur. Simulation is used successfully in other fields, such as aviation pilot training. A discussion of what defines human error will enable understanding of how computer simulation may be used to reduce it. Simulation of the anesthesia environment has been only recently developed. At this time there are at least two simulators which have been developed for the anesthesia environment. The two simulations are different in that one is strictly computer based. One reproduces the anesthesia monitors using computer graphics. The other, the Comprehensive Anesthesia Simulation Environment (CASE) simulation, attempts to reproduce the entire operating room. These two available simulators are discussed. It is presently unknown whether or not the use of simulation in anesthesia training improves the quality of that training. However, simulators necessary to answer this question are either available now or will be in the near future.

Anesthesia↗

PubMed2004

Computer-enhanced laparoscopic training system (CELTS): bridging the gap.

BACKGROUND: There is a large and growing gap between the need for better surgical training methodologies and the systems currently available for such training. In an effort to bridge this gap and overcome the disadvantages of the training simulators now in use, we developed the Computer-Enhanced Laparoscopic Training System (CELTS). METHODS: CELTS is a computer-based system capable of tracking the motion of laparoscopic instruments and providing feedback about performance in real time. CELTS consists of a mechanical interface, a customizable set of tasks, and an Internet-based software interface. The special cognitive and psychomotor skills a laparoscopic surgeon should master were explicitly defined and transformed into quantitative metrics based on kinematics analysis theory. A single global standardized and task-independent scoring system utilizing a z-score statistic was developed. Validation exercises were performed. RESULTS: The scoring system clearly revealed a gap between experts and trainees, irrespective of the task performed; none of the trainees obtained a score above the threshold that distinguishes the two groups. Moreover, CELTS provided educational feedback by identifying the key factors that contributed to the overall score. Among the defined metrics, depth perception, smoothness of motion, instrument orientation, and the outcome of the task are major indicators of performance and key parameters that distinguish experts from trainees. Time and path length alone, which are the most commonly used metrics in currently available systems, are not considered good indicators of performance. CONCLUSION: CELTS is a novel and standardized skills trainer that combines the advantages of computer simulation with the features of the traditional and popular training boxes. CELTS can easily be used with a wide array of tasks and ensures comparability across different training conditions. This report further shows that a set of appropriate and clinically relevant performance metrics can be defined and a standardized scoring system can be designed.

Clinical Competence↗

PubMed2003

Identification of metaphors for virtual environment training systems.

The objective of this effort was to develop potential metaphors for assisting wayfinding and navigation in current virtual environment (VE) training systems. Although VE purports a number of advantages over traditional, full-scale simulator training devices (deployability, footprint, cost, maintainability, scalability, networking), little design guidance exists beyond individual instantiations with specific platforms. A review of metaphors commonly incorporated into human-computer interactive systems indicated that existing metaphors have largely been used as orientation aids, mainly in the form of guided navigational assistance, with some position guidance. Advanced metaphor design concepts were identified that would not only provide trainees with a useful orienting framework but also enhance visual access and help differentiate an environment. The effectiveness of these concepts to aid navigation and wayfinding in VEs must be empirically validated.

Computer Simulation↗

PubMed2002

[A biomechanical research of neuromuscular electrical stimulation to simulate muscular force training].

Based on the theoretical and experimental researches of neuromuscular electrical stimulation to simulate muscular force training, the results showed: The effect of neuromuscular electrical stimulation (NMES) is much better than that of muscular electrical stimulation (MES); The increase of muscle force is closely related to the mode and electro properties of electrical stimulation; NMES can fulfill the muscle force training with lower energy consuming, so it is practical helpful method before, during and post training muscle force training; The method of NMES simulating muscle force training can meet the synchronous and harmonious ability of muscle group.

Electric Stimulation↗

PubMed2005

[The nurse as endoscopist].

INTRODUCTION: A new diagnostic strategy for evaluation of patients with symptoms suggestive of colorectal cancer involves an increased use of flexible sigmoidoscopy. The number of endoscopists is declining, and therefore we found it interesting to describe a endoscopy training programme for the first two Danish nurses. MATERIALS AND METHODS: Two nurses were enrolled in a five-module practical training programme including a multiple-choice test and simulator training. After their completion of at least 100 sigmoidoscopies, a questionnaire on patient satisfaction was administered together with recording of technical details of the sigmoidoscopies during a three-month period. RESULTS: During the three-month period, the nurses performed 69 sigmoidocopies. Of these, 88% reached a triangular lumen, the median examination time was 25 minutes, intubation of the sigmoid was successful in all cases and video review of the sigmoidoscopies revealed that no significant pathology had been misdiagnosed. Patient satisfaction among those examined by nurses showed that fewer patients experienced pain during the endoscopy than those examined by doctors. DISCUSSION: The training programme was completed as planned, and the nurses obtained endoscopic skills comparable to that of doctors concerning patient satisfaction. Sigmodoscopy can be performed at an acceptably high standard by nurses. Training nurses to perform endoscopy requires a significant number of teaching hours and close supervision.

Clinical Competence↗

PubMed2005

FEM-based soft tissue destruction model for ablation simulator.

In surgical procedures, ablation is one of the most difficult skills to train and acquire. For the risk of ablation failure, ablation training environments are desired. This paper proposes FEM-based deformation and destruction soft tissue model for ablation training simulator. The proposed model employs shearing stress hypothesis. The result of simulation experiments shows that the model can express different destruction progression by manipulation.

Catheter Ablation↗