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At least 343 records · Page 19Linked to original sources

PubMed2000

Virtual reality for dermatologic surgery: virtually a reality in the 21st century.

In the 20th century, virtual reality has predominantly played a role in training pilots and in the entertainment industry. Despite much publicity, virtual reality did not live up to its perceived potential. During the past decade, it has also been applied for medical uses, particularly as training simulators, for minimally invasive surgery. Because of advances in computer technology, virtual reality is on the cusp of becoming an effective medical educational tool. At the University of Washington, we are developing a virtual reality soft tissue surgery simulator. Based on fast finite element modeling and using a personal computer, this device can simulate three-dimensional human skin deformations with real-time tactile feedback. Although there are many cutaneous biomechanical challenges to solve, it will eventually provide more realistic dermatologic surgery training for medical students and residents than the currently used models.

Computer Simulation↗

PubMedDate not supplied

Implementation of advanced laparoscopy into daily gynecologic practice: difficulties and solutions.

BACKGROUND: The implementation of laparoscopy into Dutch gynecologic practice is slow. This study was conducted to assess the current state of laparoscopy, to identify factors influencing the implementation and to find solutions toward a better implementation. METHODS: In 2003 a questionnaire was sent to all 151 gynecologists who finished residency within the previous 5 years. The questionnaire addressed practice demographics, performance of laparoscopy, factors influencing use of laparoscopy in practice and means of obtaining laparoscopic skills after residency. RESULTS: Of 151 gynecologists, 124 (82%) responded, 46 (37%) male and 78 (63%) female. Mean age was 39 years (range 32-47 years). Respondents (73%) believed they were adequately trained during residency for basic laparoscopic procedures, but not for the more advanced procedures (82%). Lack of caseload, lack of being a primary surgeon, and lack of simulator training caused the deficiency of laparoscopic skills at the end of the residency. Causes of the slow implementation were long operating time, lack of attention for laparoscopy during residency, and budgetary problems, but not the financial compensation for gynecologists. In current practice, only 9% believed they reached their preferred level of competence. Hiring an advanced laparoscopic gynecologist was believed to be the best opportunity to reach the preferred level of competence. A minority of respondents supported a referral system or fellowship program. CONCLUSIONS: Basic laparoscopy is sufficiently mastered during residency training; however, advanced laparoscopy is not. More emphasis should be placed on laparoscopic training of advanced procedures during residency and for gynecologists in practice. Hiring a gynecologist with advanced laparoscopic skills is expected to be the solution for this problem. However, a referral system or fellowship program is not.

Adult↗

PubMed2002

Using mixed reality, force feedback and tactile augmentation to improve the realism of medical simulation.

This paper describes an application of a display approach which uses chromakey techniques to composite real and computer-generated images allowing a user to see his hands and medical instruments collocated with the display of virtual objects during a medical training simulation. Haptic feedback is provided through the use of a PHANTOM force feedback device in addition to tactile augmentation, which allows the user to touch virtual objects by introducing corresponding real objects in the workspace. A simplified catheter introducer insertion simulation was developed to demonstrate the capabilities of this approach.

Biomechanical Phenomena↗

PubMed2004

Implementation of team training in medical education in Denmark.

In the field of medicine, team training aiming at improving team skills such as leadership, communication, co-operation, and followership at the individual and the team level seems to reduce risk of serious events and therefore increase patient safety. The preferred educational method for this type of training is simulation. Team training is not, however, used routinely in the hospital. In this paper, we describe a framework for the development of a team training course based on need assessment, learning objectives, educational methods including full-scale simulation and evaluations strategies. The use of this framework is illustrated by the present multiprofessional team training in advanced cardiac life support, trauma team training and neonatal resuscitation in Denmark. The challenges of addressing all aspects of team skills, the education of the facilitators, and establishment of evaluation strategies to document the effect of the different types of training on patient safety are discussed.

Curriculum↗

PubMed2006

The impact of experiential learning on NUS medical students: our experience with task trainers and human-patient simulation.

INTRODUCTION: Experiential learning is one of the key methods for effective teaching of medical students. The use of simulation is ideal to achieve this goal. Simulation training allows the learner to be actively involved, and provides realism, self-direction, feedback and practice. We present 2 pilot projects in which the efficacy of experiential learning with simulation is demonstrated. MATERIALS AND METHODS: In the first project, groups of 4 to 6 fourth-year medical students were exposed to common crisis scenarios. Each student took turns to individually handle the situation (in the hot seat), while the rest of the group watched "live" via video-link. A group debrief was done after the completion of all scenarios and learning points were emphasized. A test was conducted shortly after, and the student who managed the same scenario in the hot seat earlier was compared to the rest of the group with respect to crisis recognition, management and diagnosis. In the second project, 36 fourth-year medical students were assigned to learn endotracheal intubation through a directed or experiential method. Students were recalled after 3 months and tested on 4 major categories: preparation, technique, success and ventilation. RESULTS: Students in the hot seat tended to perform better (72% vs. 64%), and were more likely to be the highest scoring student within their group; although this did not reach statistical significance. For the intubation study, students in the experiential group had a higher success rate at 3 months (78% vs. 41%). CONCLUSIONS: Experiential teaching methods with simulation result in better learning of crisis management and endotracheal intubation.

Clinical Competence↗

PubMed2005

Timing of praying mantis evasive responses during simulated bat attack sequences.

Praying mantids perform evasive maneuvers that vary with the level of danger posed by their bat predators. The vocalization pattern of attacking bats provides cues that mantids can potentially use to decide how and when to respond. Using pulse trains simulating bat attack echolocation sequences, this study determines when in the attack sequence the mantis power dive (its response to high-level threat) occurs and predicts the parameters within the echolocation sequence that are important for eliciting the response. For sequences with a rapid transition from low to high pulse repetition rates (PRRs), the evasive response occurred close to the point during the simulated sequence when the bat would have contacted the mantis. However, the evasive response occurred earlier if the transition was gradual. Regardless of the transition type, the prediction data show that sequences trigger the response when PRRs reach 20-40 pulses s(-1). These results suggest that a bat gradually increasing its PRR could 'tip off' the mantis, enabling it to escape. Attack sequences contain gradual transitions when bats engage in strobing behavior, an echolocation phenomenon that may help the bat perceive the auditory scene. Conversely, bat attack sequences that contain rapid increases in PRR close to the point of capture could circumvent the mantid's auditory defense. Based on these findings, mantids as well as other insects could benefit from having a back-up defense response to offset any advantage the bat gains by rapidly switching from low to high PRRs.

Acoustic Stimulation↗

PubMed2001

Effects of image scale and system time delay on simulator sickness within head-coupled virtual environments.

Novel patterns of visual-vestibular intersensory stimulation often result in symptoms of simulator sickness, raising health and safety concerns regarding virtual environment exposure. Two experiments investigated the effect of conflicting visual-vestibular cues on subjective reports of simulator sickness during and after a 50-min exposure to a head-coupled virtual interface. Virtual image scale factors (0.5. 1.0, 2.0 magnification, generated by varying geometric field of view angle) were investigated in Experiment 1, and additional system time delays (125, 250 ms) were investigated in Experiment 2. Simulator sickness metrics included spoken self-reports during exposure and simulator sickness questionnaires (pre-exposure, immediate postexposure, and 20 min postexposure). Head yaw angular position data were also recorded. Reports of simulator sickness symptoms were significantly greater in the minification (0.5) and magnification (2.0) image scale factor conditions than in the neutral condition (1.0). Simulator sickness did not vary with changes in time delay, however. Furthermore, a comparison across experiments suggests no appreciable increase in simulator sickness with increasing time delays above the nominal value (48 ms). Head angular position data exhibited certain systematic variations across conditions. Actual or potential applications of this research include virtual environment training, simulation, and entertainment systems.

Adult↗

PubMed1995

Acquisition of control skill with delayed and compensated displays.

The difficulty of mastering a two-axis, compensatory, manual control task was manipulated by introducing transport delays into the feedback loop of the controlled element. Realistic aircraft dynamics were used. Subjects' display was a simulation of an "inside-out" artificial horizon instrument perturbed by atmospheric turbulence. The task was to maintain straight and level flight, and delays tested were representative of those found in current training simulators. Delay compensations in the form of first-order lead and first-order lead/lag transfer functions, along with an uncompensated condition, were factorially combined with added delays. Subjects were required to meet a relatively strict criterion for performance. Control activity showed no differences during criterion performance, but the trials needed to achieve the criterion were linearly related to the magnitude of the delay and the compensation condition. These data were collected in the context of aircraft attitude control, but the results can be applied to the simulation of other vehicles, to remote manipulation, and to maneuvering in graphical environments.

Adaptation, Psychological↗

PubMed2005

Clinical simulation: measuring the efficacy of training.

PURPOSE OF REVIEW: Simulation is frequently cited as the ideal method to improve the training of health care professionals. Studies from specialties such as anesthesia and intensive care report that life-sized mannequins reliably measure acute care skills. Task trainers, such as laparoscopic simulators, effectively improve participants' ability to perform minimally invasive surgery. This review will chart the progress made in defining the role of simulation training in medical education. RECENT FINDINGS: Trainees who use high-fidelity task trainers (such as the laparoscopic simulators) avoided complications and errors associated with inexperience when compared with peers. Residents' skill in managing acute events can be objectively and reliably measured in a simulation laboratory. SUMMARY: Task trainers are recommended for training physicians for a number of minimally invasive procedures. Life-sized mannequins can be used to train residents to manage a range of critical events in a simulated setting. These exercises train residents to conduct a sequential, logical examination, perform various tasks, interpret clinical findings and use clinical reasoning to resolve the simulated crisis.

Journal Article↗

PubMedDate not supplied

Core competency in laparoendoscopic surgery.

BACKGROUND: Concern about patient safety and physician competence was highlighted by the Institute of Medicine report, revealing the prevalence of fatal medical errors. There is also awareness that technical difficulties specific to laparoendoscopic surgery can cause medical errors. Reported herein is a review of the evidence pertaining to objective assessment of core competency components in laparoendoscopic surgery: cognitive skills, technical skills, surgical performance, and judgment. METHODS: PubMed and MedLine searches were performed to identify articles with combinations of the following key words: core competency, competency, laparoscopy, training, assessment, and curriculum. Further articles were obtained by searching reference lists of identified papers and through personal communication. CONCLUSIONS: The available evidence suggests that it is currently possible to objectively assess core competency components in laparoendoscopic surgery: knowledge and clinical judgment with well-established tests and innate technical abilities with computer-based simulators with embedded metrics. Simulation training is conducted to a proficiency criterion regardless of the number of repetitions or practice hours. Reports indicate that skills learned on a simulator transfer to the operating room. However, to date, objective assessment of surgical performance can be obtained only through review of unedited video tapes of surgical procedures by disinterested experts as recently demonstrated by our Japanese colleagues in urology.

Clinical Competence↗

PubMed1990

Joint service training for medical readiness.

Medical Readiness Training is of major importance in preparing to meet the challenge of medical care during wartime and national emergencies or disasters. As an alternative to simulated casualty training, the U.S. Public Health Service and the U.S. Army joined forces to provide "real world" medical care for troops during training. Although simulated training provides insight into casualty and trauma medicine, it is felt that many aspects of real medical care are often ignored or taken for granted. Providing medical care under austere field conditions provides a realistic environment and presents situations that can not be evaluated by simulated training.

Disaster Planning↗

PubMed2005

Mismatch negativity evoked by stationary and moving auditory images of different azimuthal positions.

The present study has been designed to evaluate the pre-attentive detection of the location changes for stationary and moving sound sources. Auditory event-related potentials to the click trains simulating stationary and moving fused auditory images were recorded from healthy subjects using an oddball paradigm. The spatial characteristics of stimuli were created by introducing constant or variable interaural time delay (ITD) into the click trains. Repetitive standard auditory images (0 or 800 micros ITD, p=0.9) were interspersed by infrequent deviants (p = 0.1) of three types: stationary and moving to or from standards. The deviants moving to standards elicited similar mismatch negativities (MMNs) as compared to the stationary ones. The deviants moving from standards evoked the lowest and latest MMNs depending on standard location. Results suggest that pre-attentive ITD discrimination is essentially dependent on the pattern of ITD changes at the moment of the deviant onset.

Acoustic Stimulation↗

PubMedDate not supplied

Formidable challenges to teaching advanced laparoscopic skills.

Despite the acceptance of laparoscopy for performing routine operations, a need still exists for experienced surgeons and surgical residents to maintain and refine essential surgical skills. Unless used on a frequent basis, laparoscopic skills are not easily maintained. In addition, when new laparoscopic instruments are introduced, surgeons need a way to practice using them that does not involve immediate patient contact. Novice surgeons need the most training of all and ideally would be best served using a standardized teaching curriculum that would cover as many of the basic laparoscopic parameters as possible. This article discusses how best to set up a laparoscopic simulation training program that covers as much ground as necessary, while respecting the restraints of time limitations and monetary concerns.

Clinical Competence↗

PubMedDate not supplied

Speech acts, communication problems, and fighter pilot team performance.

Two aspects of team communication, speech acts and communication problems, and their relation to team performance in a team air combat simulator were studied. The purpose was to enhance the understanding of how team performance is related to team communication. Ten Swedish fighter pilots and four fighter controllers of varying experience participated. Data were collected during fighter simulator training involving four pilots and one fighter controller in each of two teams. Speech acts were collapsed over seven categories and communication problems over five categories. Communication was studied from two perspectives: critical situation outcome and mission outcome. Some problems were closely related to particular speech acts. Speech act frequency, especially meta-communications and tactics, was highest when winning. However, the timing of tactics in critical situations needs further research. Communication problem frequency was highest for runs which ended equally. The most common problem was simultaneous speech, possibly because of the simulator radio system. The number of speech acts was related to enhanced performance but in a complex manner. Thus in order to work efficiently team members need to communicate, but to communicate sufficiently and at appropriate times. This work has applications for fighter pilot and controller team training and the development of communication standards.

Aerospace Medicine↗

PubMed2004

Preliminary report on the use of high-fidelity simulation in the training of study coordinators conducting a clinical research protocol.

Training of health care research personnel is a critical component of quality assurance in clinical trials. Interactivity (such as simulation) is desirable compared with traditional methods of teaching. We hypothesized that the addition of an interactive simulation exercise to standard training methods would increase the confidence of study coordinators. A simulation exercise was developed to replicate a complex clinical trial. Eighteen study coordinators completed pre- and postexercise confidence questionnaires. Questions were targeted at key trial components using a 0-10 scale (not confident to confident) and were categorized using Bloom's Taxonomy. The primary analysis compared overall mean pre- and postexercise responses. Secondary analyses assessed affective, psychomotor, and cognitive confidence. Significance was at P < 0.05. A significant increase in overall confidence (8.64 versus 5.77; P < 0.0001) was reproduced in the subcategory analyses (affective, 8.24 versus 4.89; P < 0.0001; cognitive, 8.75 versus 6.42; P = 0.0003; psychomotor, 8.63 versus 5.26; P < 0.0001). A high level of internal consistency and reliability in question responses within domains was observed, validating the questionnaire tool. In this preliminary report, we confirmed that addition of a simulation exercise to the training of study coordinators resulted in increased confidence. Simulation exercises should be considered when training study coordinators for clinical research trials.

Adult↗

PubMed1996

[Training with a simulator--experiences in space flight].

High technology and automation have not been able to significantly improve flight safety within the last two decades. The main cause of aviation accidents was and is human error. Therefore, the most powerful tools to reduce risks in aviation deal with the human operator on the flight deck. Pilot selection, training and teamwork are of the utmost importance. The simulator is a valuable training aid. Simulation provides realistic scenarios that can be used to train optimal pilot behavior in emergency situations. Many complex abnormal situations can be only managed in teamwork. That is the reason why training programmes for improved team behavior (crew resource management) are becoming more and more important.

Accidents, Aviation↗

PubMed2003

Guidelines for assessing postnatal problems: introducing evidence-based guidelines in Australian general practice.

BACKGROUND: Postnatal morbidity is high, and many GPs lack the confidence and knowledge to deal with common postnatal problems. There is a high consultation rate, but few women disclose common health problems. OBJECTIVE: The aim of the present study was to increase the knowledge and skills of GPs to enable them to identify and manage common health problems experienced by women in the year following childbirth. METHODS: An educational programme [Guidelines for Assessing Postnatal Problems (GAPP)] embedded within a large randomized community intervention trial [Program of Resources, Information and Support for Mothers (PRISM)] with a before/after evaluation was undergone by Australian GPs working in four metropolitan and four rural communities. The programme comprised audit, interactive workshops, role-play and evidence-based guidelines, and was evaluated at baseline and 6 months through written questionnaires and a surgery consultation with a trained simulated patient evaluator. RESULTS: A total of 68 (86%) GPs took part in the full GAPP programme. The odds of a GP improving on the knowledge items ranged from 1.0 to 16, with the greatest change occurring in knowledge about the effectiveness of cognitive behavioural therapy for maternal depression. Of the GPs with an incorrect response at baseline, the percentage demonstrating improved knowledge at follow-up ranged from 22 to 100%. Around half of the GPs demonstrated excellent communication skills at baseline. Of the remaining GPs, more than half demonstrated greatly improved skills to detect common postnatal problems at follow-up. At baseline simulated patient visit, 70% of GPs inquired about sexual problems yet none inquired about the possibility of abuse, whereas at follow-up 94% inquired about sexual problems and 51.5% facilitated the disclosure of physical and emotional abuse. Anonymous feedback on the programme by participating GPs showed that 89% believed the programme positively influenced their actual practice. Interestingly, GPs demonstrated greater knowledge and skills in the simulated setting than on the written questionnaire. CONCLUSIONS: This relatively brief multifaceted educational programme assisted many participants in improving their knowledge and the skills required to improve both physical and emotional health after birth. Despite being experienced clinicians and participating actively in a programme on interviewing skills, half of the GPs did not facilitate disclosure of the underlying sensitive issue (abuse) during the follow-up consultation and could benefit from further in-depth training in effective communication skills.

Australia↗

PubMedDate not supplied

Simulated versus actual patients in teaching medical interviewing.

This research project investigates the value of using simulated v. real patients in teaching interviewing skills to third- and fourth-year medical students on a clerkship in family and community medicine. Sixty-four medical students (38 males, 28 females) were asked to make a videotaped patient interview at the beginning of the clerkship. Forty-one of the students interviewed trained, simulated patients and 22 interviewed real patients at their clerkship site. Students received feedback and faculty teaching of interviewing skills after the first interview. All students made another videotaped interview with a simulated patient at the conclusion of the clerkship. All interviews, pre- and post-clerkship, were scored for interviewing skills, focal areas, and nonverbal language. Multivariate and univariate analyses of pre- and post-interviews found simulated patients to be of most value in teaching medical students verbal interviewing skills and real patients to be of most value in teaching the focal content areas of the interview. Recommendations were made to include use of both simulated and real patients in the teaching of medical interviewing.

Analysis of Variance↗