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Results for “simulation training”

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PubMed1995

Extravehicular activity training and hardware design consideration.

Preparing astronauts to perform the many complex extravehicular activity (EVA) tasks required to assemble and maintain Space Station will be accomplished through training simulations in a variety of facilities. The adequacy of this training is dependent on a thorough understanding of the task to be performed, the environment in which the task will be performed, high-fidelity training hardware and an awareness of the limitations of each particular training facility. Designing hardware that can be successfully operated, or assembled, by EVA astronauts in an efficient manner, requires an acute understanding of human factors and the capabilities and limitations of the space-suited astronaut. Additionally, the significant effect the microgravity environment has on the crew members' capabilities has to be carefully considered not only for each particular task, but also for all the overhead related to the task and the general overhead associated with EVA. This paper will describe various training methods and facilities that will be used to train EVA astronauts for Space Station assembly and maintenance. User-friendly EVA hardware design considerations and recent EVA flight experience will also be presented.

Astronauts↗

PubMed2005

Application of a virtual reality-enhanced exercise protocol in patients after coronary bypass.

OBJECTIVE: To determine whether, by using training enhanced by virtual reality (VR) displays, patients who had undergone coronary artery bypass graft (CABG) surgery could more effectively attain long-term cardiopulmonary results than those not using VR technology. DESIGN: Randomized controlled trial. SETTING: Exercise testing laboratory in a medical center. PARTICIPANTS: Consecutive sample of 32 patients who had undergone CABG surgery. INTERVENTIONS: All subjects were randomly assigned to 1 of 2 submaximal endurance programs, with or without simulated training. In all other respects, the 2 programs were identical. Each section lasted for 30 minutes and was conducted twice a week for about 3 months. Graded exercise tests, conducted before and after training, evaluated cardiorespiratory changes. MAIN OUTCOME MEASURES: The cardiorespiratory and hemodynamic parameters were evaluated at both peak and submaximal exertion. RESULTS: At the follow-up exercise tests (performed at 5.4 mo after surgical intervention), the VR group achieved significantly higher value in peak oxygen consumption (VO2peak), peak metabolic equivalents (METS), and amount of VO2 at anaerobic threshold than the non-VR group. Significant gain was attained in VO2peak and peak MET value accrued to those who participated in simulation-based aerobic training. CONCLUSIONS: Our study outcomes clearly support the perceived benefits of rehabilitation programs that incorporate VR to augment patients' recovery of their physical capacity.

Aged↗

PubMed1999

Perceptual-motor coordination in an endoscopic surgery simulation.

BACKGROUND: This study examined perceptual-motor coordination with an apparatus that simulated a situation representative of endoscopic surgery. METHODS: Participants were trained with one arrangement of the apparatus, then tested with an alternative arrangement in which either the positions of the camera, the surgeon, or the objects in the surgical field were altered. RESULTS: Results showed that changes of either the camera's position or the surgeon's position disrupted performance. However, when the camera and surgeon positions were changed together, skilled performance was maintained. CONCLUSIONS: This suggests that skill depends on a consistent mapping between the virtual hands and eyes, but not on the particular visual or motor orientations. The results suggest that movements of the camera during surgery can disrupt coordinated action. Also, in the design of training simulators, the mapping between camera and instruments may be more important than the static appearance of the displays or the topology of the movements.

Analysis of Variance↗

PubMed2004

Knowledge and skill after brief ACLS training.

OBJECTIVES: To determine the knowledge level and skill base in nurse anesthetists before and after brief ACLS training, and again three months later. METHOD: Thirty nurse anesthetists were tested for knowledge and skill before ACLS training comprising 1-hr lecture and handout, and 1-hr simulation training. Concepts included ABCD, primary and secondary survey, management, medications, and algorithms for common problems. Skill practice comprised airway management, chest compression and practice with equipment. After the training, the nurse anesthetists were immediately tested and again three months later. RESULTS: Age of participants averaged 39.33 + or - 3.14 years and working experience 10.04 +/- 3.23 years. The knowledge and skill scores pre- vs post-training vs three-months-later was 50.32 +/- 15.24 vs 75.40 +/- 10.29 (p < 0.001) vs 60.48 +/- 11.80 (p < 0.001) and 65.00 + 16.07 vs 79.67 +/- 10.80 (p < 0.001) vs 75.67 +/- 14.53 (p < 0.001), respectively. The pre-training vs three-months-post-training skill scores was not statistically different (p = 0.255). CONCLUSION: After the briefACLS training knowledge and skills were significantly improved, but knowledge was not retained at the post-training test levels until the 3-month check, albeit skills had persisted. More frequent ACLS education is necessary.

Adult↗

PubMed2002

[Innovative training for enhancing patient safety. Safety culture and integrated concepts].

INTRODUCTION: Patient safety is determined by the performance safety of the medical team. Errors in medicine are amongst the leading causes of death of hospitalized patients. These numbers call for action. Backgrounds, methods and new forms of training are introduced in this article. METHOD: Concepts from safety research are transformed to the field of emergency medical treatment. Strategies from realistic patient simulator training sessions and innovative training concepts are discussed. RESULTS: The reasons for the high numbers of errors in medicine are not due to a lack of medical knowledge, but due to human factors and organisational circumstances. A first step towards an improved patient safety is to accept this. We always need to be prepared that errors will occur. A next step would be to separate "error" from guilt (culture of blame) allowing for a real analysis of accidents and establishment of meaningful incident reporting systems. Concepts with a good success record from aviation like "crew resource management" (CRM) training have been adapted my medicine and are ready to use. These concepts require theoretical education as well as practical training. Innovative team training sessions using realistic patient simulator systems with video taping (for self reflexion) and interactive debriefing following the sessions are very promising. CONCLUSION: As the need to reduce error rates in medicine is very high and the reasons, methods and training concepts are known, we are urged to implement these new training concepts widely and consequently. To err is human - not to counteract it is not.

Clinical Competence↗

PubMed2000

A prototype haptic lumbar puncture simulator.

Lumbar punctures (LP) are complex, precise procedures done to obtain cerebro-spinal fluid from a patient for diagnostic purposes. Incorrect techniques resulting from inadequate training or supervision can result in sub-optimal outcomes. As tactile feedback is crucial for a successful lumbar puncture, this procedure serves as an ideal candidate for the development of a haptic training simulator. The intent of this project is to engineer a force feedback LP simulator that provides a safe method of training students (medical students, residents, or trained physicians) for an actual LP procedure on a patient.

Computer Graphics↗

PubMed2006

Enhancing job-site training of supported workers with autism: a reemphasis on simulation.

Currently recommended practice in supported work emphasizes training job skills to workers with severe disabilities while on the job. Early behavioral research indicated that skills needed in natural environments could also be trained in simulated settings. We compared job-site plus simulation training for teaching job skills to supported workers with autism to provision of training exclusively on the job. Job-site training occurred in a small publishing company during the regular work routine, and simulation training occurred in an adult education site for people with severe disabilities. Two pairs of workers received training on two job skills; one skill was trained at the job site and the other was trained using job-site plus simulation training. Results indicated that for 3 of the 4 comparisons, job-site plus simulation training resulted in a higher level of skill or more rapid skill acquisition than did job-site-only training. Results suggested that job-site training, the assumed best practice for teaching vocational skills, is likely to be more effective if supplemented with simulation training. Directions for future research include expanding applications of behavioral technologies to other aspects of the current support paradigm.

Adult↗

PubMed1984

Identification and estimation algorithm for stochastic neural system.

An algorithm for the estimation of stochastic processes in a neural system is presented. This process is defined here as the continuous stochastic process reflecting the dynamics of the neural system which has some inputs and generates output spike trains. The algorithm proposed here is to identify the system parameters and then estimate the stochastic process called neural system process here. These procedures carried out on the basis of the output spike trains which are supposed to be the data observed in the randomly missing way by the threshold time function in the neural system. The algorithm is constructed with the well-known Kalman filters and realizes the estimation of the neural system process by cooperating with the algorithm for the parameter estimation of the threshold time function presented previously (Nakao et al., 1983). The performance of the algorithm is examined by applying it to the various spike trains simulated by some artificial models and also to the neural spike trains recorded in cat's optic tract fibers. The results in these applications are thought to prove the effectiveness of the algorithm proposed here to some extent. Such attempts, we think, will serve to improve the characterizing and modelling techniques of the stochastic neural systems.

Animals↗

PubMed2001

Virtual reality training leads to faster adaptation to the novel psychomotor restrictions encountered by laparoscopic surgeons.

BACKGROUND: The fulcrum effect of the body wall on instrument handling poses a major obstacle to the mastery of instrument coordination for junior laparoscopic surgeons. This study evaluated three types of laparoscopic simulator training to assess their ability to promote the user's adaptation to the fulcrum effect. METHODS: Thirty-two participants with no previous experience in laparoscopic surgery were randomly assigned to one of four groups representing different training conditions. One group was assigned to use a virtual reality simulator (MIST VR); two others were given a laparoscopic Z or U maze-tracking task. The control group received no training. Subjects were asked to perform a 2-min laparoscopic cutting task under normal laparoscopic imaging conditions first before and then after training. RESULTS: In the test trial, subjects who trained on MIST VR made significantly more correct incisions (p < 0.0001) and fewer incorrect incisions (p < 0.0001). CONCLUSION: Training on a virtual reality simulator such as MIST VR helps laparoscopic novices adapt to the fulcrum effect faster.

Clinical Competence↗

PubMed2003

The use of advanced simulation in the training of anesthesiologists to treat chemical warfare casualties.

UNLABELLED: Training anesthesiologists to treat nerve gas intoxication in a mass casualty scenario is a complicated task. The scenario is an unfamiliar medical situation involving the need to decontaminate patients before providing definitive medical treatment, and the need for physical protection to the medical team before decontamination. We describe the development of a simulation-based training program. In one site of a virtual hospital, anesthesiologists were trained in initial airway and breathing resuscitation before decontamination while wearing full protective gear. In another site, they were trained in the treatment of critically-ill patients with combined conventional and chemical injuries or severe intoxication. Intubation simulators of newborn, pediatric, and adult patients, advanced full-scale simulators, and actors simulating patients were used. Initial airway, breathing, and antidotal treatment were performed successfully, with or without full protective gear. The gas mask did not interfere with orotracheal intubation, but limited effective communication within the medical team. Chemical protective gloves were the limiting factor in the performance of medical tasks such as fixing the orotracheal tube. Twenty-two participants (88%) pointed out that the simulated cases represented realistic problems in this scenario, and all 25 participants found the simulated-based training superior to previous traditional training they had in this field. Using advanced simulation, we were able to train anesthesiologists to treat nerve gas intoxication casualties and to learn about the limitations of providing medical care in this setting. IMPLICATIONS: Advanced medical simulation can be used to train anesthesiologists to treat nonconventional warfare casualties. The limitations of medical performance in full protective gear can be learned from this training.

Anesthesiology↗

PubMed1998

Virtual reality versus conventional training in retinal photocoagulation: a first clinical assessment.

Virtual reality can provide a new method for apprenticeship in surgery. We have developed a training simulator for retinal photocoagulation. This paper describes a comparison between this new training tool and the conventional teaching method. Residents were divided into two groups, each group being trained exclusively with one of the methods. A final evaluation was made by a single expert, who did not know which training mode the residents had undergone. The results show that this new training mode is at least as efficient as the current one and may reduce training duration. While experts remain in control of the contents of training and assessment of skill, this study outlines new prospects for apprenticeship and evaluation in the field of medicosurgical techniques. In addition, this preliminary study emphasizes the difficulties in introducing a new modality in a traditional teaching environment.

Humans↗

PubMed2006

Providing support to families considering the option of organ donation: an innovative training method.

Families must make decisions about organ donation for a loved one during intensely emotional circumstances in the hospital, where support from others is crucial to their coping. Research about families' experiences during the decision-making process regarding donating their loved ones' organs has shown that quality of hospital care and receiving psychosocial support are important factors influencing their decision. Typically, a donation coordinator from the local organ procurement organization approaches the family about the option of donation, whereas the role of medical and nursing staff is to convey diagnostic and prognostic information to the family. Currently, no requirement is in place for training of professional staff in communication skills for approaching and interacting with families about organ donation. This article discusses a simulated training method in empathic communication used for supporting families who are approached about organ donation. This innovative method can be adapted to and should be tested with professional audiences.

Attitude to Health↗

PubMed2006

Haptic device for a ventricular shunt insertion simulator.

In this paper we propose a new one-degree-of-freedom haptic device that can be used to simulate ventricular shunt insertion procedures. The device is used together with the BRAINTRAIN training simulator developed for neuroscience education, neurological data visualization and surgical planning. The design of the haptic device is based on a push-pull cable concept. The rendered forces produced by a linear motor connected at one end of the cable are transferred to the user via a sliding mechanism at the end-effector located at the other end of the cable. The end-effector provides the range of movement up to 12 cm. The force is controlled by an open-loop impedance algorithm and can become up to 15 N.

Computer Simulation↗

PubMed2006

Learning curves and reliability measures for virtual reality simulation in the performance assessment of carotid angiography.

OBJECTIVES: Improvement in performance as measured by metric-based procedural errors must be demonstrated if virtual reality (VR) simulation is to be used as a valid means of proficiency assessment and improvement in procedural-based medical skills. BACKGROUND: The Food and Drug Administration requires completion of VR simulation training for physicians learning to perform carotid stenting. METHODS: Interventional cardiologists (n = 20) participating in the Emory NeuroAnatomy Carotid Training program underwent an instructional course on carotid angiography and then performed five serial simulated carotid angiograms on the Vascular Interventional System Trainer (VIST) VR simulator (Mentice AB, Gothenburg, Sweden). Of the subjects, 90% completed the full assessment. Procedure time (PT), fluoroscopy time (FT), contrast volume, and composite catheter handling errors (CE) were recorded by the simulator. RESULTS: An improvement was noted in PT, contrast volume, FT, and CE when comparing the subjects' first and last simulations (all p < 0.05). The internal consistency of the VIST VR simulator as assessed with standardized coefficient alpha was high (range 0.81 to 0.93), except for FT (alpha = 0.36). Test-retest reliability was high for CE (r = 0.9, p = 0.0001). CONCLUSIONS: A learning curve with improved performance was demonstrated on the VIST simulator. This study represents the largest collection of such data to date in carotid VR simulation and is the first report to establish the internal consistency of the VIST simulator and its test-retest reliability across several metrics. These metrics are fundamental benchmarks in the validation of any measurement device. Composite catheter handling errors represent measurable dynamic metrics with high test-retest reliability that are required for the high-stakes assessment of procedural skills.

Cardiology↗

PubMed2005

Fundamental aspects of learning minimally invasive surgical skills.

With the introduction of minimally invasive surgery (MIS) the necessity to develop training methods to learn skills outside the operating room (OR) became clear. Several training simulators have become commercially available. However, fundamental research into the requirements for effective and efficient training in MIS is still lacking. Yet in the literature several learning models have been described that may be used when designing the structure of a training program. While learning skills, three stages can be observed: cognitive, associative and autonomous. The learning cycle also includes different learning styles and, moreover, every trainee has his/her preferred learning style. Furthermore, training should be adapted to the level of behaviour: skill-based, rule-based or knowledge-based. Training of complex skills should include multiple performance objectives, such as just-in-time supportive information and part-task practice. Finally, motivation for training can be created by assessment. In conclusion, several theories on learning can be found in the literature. These theories may help in the development of effective training programs for training MIS skills outside the OR.

Journal Article↗

PubMed1987

Simulator sickness: a problem for Army aviation.

"Simulator Sickness" describes a symptom complex frequently reported by pilots during or after flight simulator training. There were 112 helicopter pilots at a U.S. Army AH-1 Cobra Flight Weapons Simulator (FWS) who completed a symptom-oriented subjective questionnaire. Of these, 40% reported symptoms of dysequilibrium; pilots developing simulator sickness had significantly more total and AH-1 flight time. Adaptation to the syndrome occurred with increasing FWS experience. The history and aeromedical significance of simulator sickness are briefly reviewed, and a case report presented. A mandatory grounding policy in use locally is described. Potential treatment strategies are briefly discussed.

Adult↗

PubMed1985

The effectiveness of specific weight training regimens on simulated aerial combat maneuvering G tolerance.

To assess the effectiveness of muscle-strength (weight training) on simulated aerial combat maneuvering (SACM) G tolerance, seven young men were exposed to a 12-week program of whole-body weight training in which were measured, strengths of various muscle groups, body circumferences, body mass, and the percentage of body fat. The magnitudes of the weights used in training were used to measure muscle strength and were compared and correlated with each subject's SACM tolerance--defined as the total time that a subject could withstand continuous exposure to a 4.5 and 7.0 + Gz centrifuge profile using fatigue as his voluntary endpoint. Chest and biceps circumferences increased 4.2% and 3.1%, respectively; abdomen and thigh circumferences did not significantly change; body fat decreased 16.8%; and body mass increased 2.3%. Abdominal (sit ups) and biceps (arm curl) strengths increased 99% and 26.2%, respectively, and were highly correlated with SACM tolerance time (p less than 0.01); leg (leg press) and chest strengths (bench press) made less significant contributions to the SACM tolerance time. A net increase in SACM tolerance times of 53% resulted from weight-training. Multiple regression analysis of all four muscle groups between weeks 1 and 12 with the SACM tolerance had a correlation of determination of 0.61.

Acceleration↗

PubMed2004

Virtual vitreoretinal surgical simulator as a training tool.

OBJECTIVE: To demonstrate the feasibility and potential applicability of a virtual reality simulator for vitreoretinal surgery as a training and/or assessment tool. METHODS: The subjects of this study included medical students, ophthalmologic residents, and trained vitreoretinal surgeons. There were three study groups. Group I comprised 22 subjects who performed a navigation task. The time to complete the task was recorded. The relationship between the completion time, experience, and stereopsis was evaluated. Group II included 6 subjects who consecutively performed the navigation task to evaluate their learning curve. Group III included 16 subjects who performed the membrane peeling task. The number of retinal contacts and the completion time were recorded. The relationship between experience and stereopsis with the number of contacts and the completion time were evaluated. RESULTS: The average completion time in Group I for students, residents, and trained surgeons was 121.6, 92.5, and 70.6 seconds. There was a significant difference between students and trained surgeons (P = 0.004). In Group II, there was a significant decrease in the completion time with training (P = 0.001). In Group III, the average completion time for students, residents, and trained surgeons was 197, 144, and 118.2 seconds; the respective number of retinal contacts was 14, 8, and 3. There was a significant difference between students and residents (P = 0.05) and between residents and trained surgeons (P = 0.003) for the average completion time in Group III. There was a significant difference between students and trained surgeons (P = 0.003) for the number of contacts per average time and between students and residents (P = 0.05). There was a significant inverse correlation between stereopsis vision score and completion time in Group I and number of contacts per average time (P = 0.0004 and P = 0.01, respectively). CONCLUSIONS: This study demonstrates potential applications of a vitreoretinal surgical simulator as a training and skills assessment tool for novice, inexperienced, and trained surgeons. A simulator can be used to teach specific techniques and train surgeons.

Adult↗