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At least 469 records · Page 26Linked to original sources
PubMed2007

The current role of medical simulation in american urological residency training programs: an assessment by program directors.

PURPOSE: Although medical simulation opportunities are increasingly available, resident training to date has involved primarily hands-on, subjective assessments. The role of simulation and computer based training for urology residents remains unknown. We evaluated the current status of medical simulation among urological training programs in the United States. MATERIALS AND METHODS: An anonymous questionnaire was developed and mailed to the program director at the 119 Accreditation Council for Graduate Medical Education accredited United States urology training programs, and consisted of 17 questions documenting the prior experience of the responder to medical simulation as well as the current status of simulation at their institution. An additional 14 questions sought the responders' opinion of medical simulation in urology training programs. RESULTS: The questionnaire was returned by 41 program directors (35%). Among respondents, access to a laparoscopy simulator was 76%. In comparison, reported access to cystoscopy, ureteroscopy, transurethral resection and percutaneous access simulators was 16%, 21%, 8% and 12%, respectively. Respondents indicated that these simulators were good educational tools, realistic and easy to use. Unanimous agreement was reported for simulation training in residency and that simulators allow practice in a controlled environment. Disagreement was reported about the cost effectiveness, validity and ability of simulators to replace hands-on instruction in the operating room. CONCLUSIONS: Among responders a high level of access to laparoscopic simulators for urology residents is coupled with low levels of access to other endoscopic trainers. Urology residency program directors unanimously recognize a role for simulation training in residency, although the extent to which they may be incorporated remains to be resolved.

Computer Simulation↗
PubMedDate not supplied

Prehospital and hospital-based health care providers' experience with a human patient simulator.

OBJECTIVES: To ascertain the level of acceptance of a human patient simulator as a training tool among a diverse group of health care providers. Secondary objectives were to elucidate its most useful aspects for training and find ways to improve upon the simulation experience. METHODS: A satisfaction survey was conducted regarding the use of a human patient simulator from July 1999 to February 2000. The survey consisted of five questions with a five-point Likert scale (5 being the most favorable score) and three questions that asked for qualitative written feedback on the simulator experience. The survey was handed to 78 consecutive participants immediately after their experiences and collected immediately after it was filled out to ensure a 100% response rate to the overall survey. Qualitative responses were placed into categories by theme, and a sum was calculated for each category. RESULTS: There was a high level of acceptance for simulation training among this diverse group, with Likert scores for the first two questions regarding general satisfaction of 4.74 +/- 0.126 (n = 77) and 4.77 +/- 0.126 (n = 78). Regarding the usefulness of each specific area of simulator training, the scores were 4.53 +/- 0.153 (n = 78) for patient assessment, 4.55 +/- 0.182 (n = 47) for treatment options, and 4.70 +/- 0.125 (n = 63) for response to treatment. There were 49 positive comments and nine negative comments. Realism (n = 26) and the ability to see response to treatment (n = 12) were the two most common positive comments. Negative comments focused on logistics of the simulator lab (n = 4) rather than the simulator itself. CONCLUSIONS: In this sample, prehospital and hospital-based health professionals were accepting of human patient simulation as a new teaching tool with multiple useful applications.

Consumer Behavior↗
PubMed2000

A new endoscopic simulator.

Trainees need to perform a certain number of endoscopic procedures to achieve competence. Training on simulators is advantageous because it reduces the number of potentially life-threatening critical mistakes. The change in medical practice that limits education time and patient availability, and the increase in medical legal awareness, have contributed to the greater use of simulators in medical training and education. Simulators are of three types: mechanical, animal, and computer based. Progress in computer technology is expected to promote computer-based simulators. At present, the computer-based simulator is helpful in teaching upper and lower gastrointestinal endoscopy, for diagnostic and some therapeutic procedures. It has been used at workshops and live demonstrations performed during endoscopic meetings. It is predicted that with further technological improvement, training on simulators will become obligatory before performing on humans.

Computer Simulation↗
PubMed2001

The simulation effects of mountain climbing training on selected endocrine responses.

The simulation effects of mountain climbing exercise training on plasma testosterone, cortisol and luteinizing hormone (LH) levels were examined in ten recreational mountain male climbers. Subjects underwent a simulating mountain climbing exercise training 3 times a week for a total of eight weeks before an expedition to Mount Muztag Ata (7546 m, Xingian, China). During training, each subject carried a 40 kg back pack while walking on a treadmill at a speed of 1.9 mph for 60 min at sea level. Subjects completed an incremental treadmill test to exhaustion prior to training, after training, and one week after returning from Mount Muztag Ata. Blood samples were collected from antecubital vein at rest and at 5, 60, and 120 min post testing to determine the plasma testosterone, cortisol and LH levels. The basal plasma testosterone and cortisol concentrations were lower in both post-training and after-climbing conditions compared with that in the pre-training condition (p<0.01). The basal plasma LH concentration was remained unchanged after training and after the mountain climbing compared with levels measured in the pre-training phase. No correlation could be established between plasma LH and testosterone level. These results suggest that an eight-week period of mountain climbing training protocol may be beneficial in maintaining normal endocrine function during and after high altitude mountain expedition. Our results also indicate the decrease of plasma testosterone was LH independent.

Adult↗
PubMed2001

Design principles for the use of simulation as an aid in interventional cardiology training.

Learning complex skills through simulation is a goal for training physicians in specialties such as interventional cardiology, where traditional training puts patients at risk. Intuitively, interactive simulation of anatomy, pathology and therapeutic actions should lead to shortening of the learning curve for novice or inexperienced physicians. An accurate recreation of the interactions among anatomy, pathology and therapeutic actions is a necessary, but not sufficient, condition for the development of a simulation-based training system. In addition to real-time graphic interactivity coupled with haptic response, a successful training tool will require features of a 'learning system' such as: an embedded curriculum, functionality that allows rehearsal and practice, hypertext links to educational information, personal archiving, and instructor review and testing capabilities. We describe how such a system might look for the field of interventional cardiology, and suggest that designing a simulation with both technical and pedagogical fidelity is essential in developing simulation-based training systems in any field of medicine.

Journal Article↗
PubMed2006

Gene knockout experiments to quantify a G2/M genetic network simulation for mammary cancer susceptibility.

A G2/M genetic network simulation is trained with tumor incidence data from knockout experiments. The genetic network is implemented using a neural network; knockout genotypes are simulated by removing nodes in the neural network. Two analyses are used to interpret the resulting network weights. We use a novel approach of fixing the network topology that allows knockout TSG (tumor suppressor gene) data from multiple studies to overlap and indirectly inform one another. The trained simulation is validated by reproducing qualitative mammary cancer susceptibilities of ATM, BRCA1, and p53 TSGs. The work described is valuable because it allows TSG mammary cancer susceptibility to be quantified using genetic network topology and in vivo knockout data.

Animals↗
PubMed2006

The influence of different training schedules on the learning of psychomotor skills for endoscopic surgery.

BACKGROUND: Psychomotor skills for endoscopic surgery can be trained with virtual reality simulators. Distributed training is more effective than massed training, but it is unclear whether distributed training over several days is more effective than distributed training within 1 day. This study aimed to determine which of these two options is the most effective for training endoscopic psychomotor skills. METHODS: Students with no endoscopic experience were randomly assigned either to distributed training on 3 consecutive days (group A, n = 10) or distributed training within 1 day (group B, n = 10). For this study the SIMENDO virtual reality simulator for endoscopic skills was used. The training involved 12 repetitions of three different exercises (drop balls, needle manipulation, 30 degree endoscope) in differently distributed training schedules. All the participants performed a posttraining test (posttest) for the trained tasks 7 days after the training. The parameters measured were time, nontarget environment collisions, and instrument path length. RESULTS: There were no significant differences between the groups in the first training session for all the parameters. In the posttest, group A (training over several days) performed 18.7% faster than group B (training on 1 day) (p = 0.013). The collision and path length scores for group A did not differ significantly from the scores for group B. CONCLUSION: The distributed group trained over several days was faster, with the same number of errors and the same instrument path length used. Psychomotor skill training for endoscopic surgery distributed over several days is superior to training on 1 day.

Adult↗
PubMed2006

Development of an objective scoring system for measurement of resident performance on the human patient simulator.

BACKGROUND: The decrease in the percentage of patients having cesarean delivery during general anesthesia has led some educators to advocate the increased use of simulation-based training for this anesthetic. The authors developed a scoring system to measure resident performance of this anesthetic on the human patient simulator and subjected the system to tests of validity and reliability. METHODS: A modified Delphi technique was used to achieve a consensus among several experts regarding a standardized scoring system for evaluating resident performance of general anesthesia for emergency cesarean delivery on the human patient simulator. Eight third-year and eight first-year anesthesiology residents performed the scenario and were videotaped and scored by four attending obstetric anesthesiologists. RESULTS: Third-year residents scored an average of 150.5 points, whereas first-year residents scored an average of 128 points (P = 0.004). The scoring instrument demonstrated high interrater reliability with an intraclass correlation coefficient of 0.97 (95% confidence interval, 0.94-0.99) compared with the average score. CONCLUSIONS: The developed scoring tool to measure resident performance of general anesthesia for emergency cesarean delivery on the patient simulator seems both valid and reliable in the context in which it was tested. This scoring system may prove useful for future studies such as those investigating the effect of simulator training on objective assessment of resident performance.

Adult↗
PubMed2003

Simulators for intimate examination training in the developing world.

CONTEXT: Family planning clinic in urban India. OBJECTIVE: To assess the usefulness of a pelvic simulator for intimate examination and intrauterine device insertion training, and for enhancing reproductive education for women. DESIGN: Observational study using evaluation forms completed by staff, and focus group interviews with women and girls participating in sexual health education. Content analysis of interview material. RESULTS: Staff being trained in intimate examination found the simulator to be useful in increasing their level of skill. Participants in sexual health education reported an improved range and depth of knowledge following demonstrations with the simulator. CONCLUSION: Where working and training conditions are crowded and lacking in privacy, inappropriate examination practices are likely to be propagated. Training for intimate examinations can be enhanced by the use of pelvic simulators.

Adolescent↗
PubMedDate not supplied

Visuohaptic simulation of bone surgery for training and evaluation.

Visual and haptic simulation of bone surgery can support and extend current surgical training techniques. The authors present a system for simulating surgeries involving bone manipulation, such as temporal bone surgery and mandibular surgery, and discuss the automatic computation of surgical performance metrics. Experimental results confirm the system's construct validity.

Bone and Bones↗
PubMed2026

Impact of real-time respiratory function monitoring on neonatal mask ventilation training: a multicentre simulation-based crossover study.

OBJECTIVE: To evaluate whether visibility of respiratory function monitor (RFM) feedback improves mask ventilation performance and influences subsequent ventilation performance during neonatal resuscitation training. DESIGN: multicentre randomised crossover simulation study. PARTICIPANTS: Healthcare professionals involved in neonatal resuscitation training across participating centres. INTERVENTION: Participants performed positive pressure ventilation (PPV) on both term and premature manikins under two conditions: with visible RFM feedback and with the display masked. The order of feedback visibility was randomised. Each participant completed ventilation assessments in both conditions. MAIN OUTCOME MEASURES: Primary outcomes were expired tidal volume (Vte) and mask leak (%). The proportion of breaths within the target Vte range (4-8&#x2009;mL/kg) was calculated as a performance indicator. Secondary outcomes included variability in Vte and mask leak to assess ventilation stability between conditions. RESULTS: Visible RFM feedback was associated with lower mask leak and improved ventilation stability in the preterm manikin and with tidal volumes entering the target range in the term manikin. Participants initially ventilated with visible feedback maintained performance after feedback removal, suggesting a carry-over learning effect. CONCLUSION: In this multicentre crossover simulation study, visible RFM feedback was associated with changes in mask ventilation performance and evidence of a carry-over learning effect following feedback removal. Real-time visibility of respiratory parameters may strengthen neonatal resuscitation training.

Humans↗
PubMed2004

The simulated operating theatre: comprehensive training for surgical teams.

Surgical excellence is traditionally defined in terms of technical performance, with little regard for the importance of interpersonal communication and leadership skills. Studies in the aviation industry have stressed the role of human factors in causing error and, in an attempt to reduce the occurrence of adverse events, led to the organisation of simulation based training scenarios. Similar strategies have recently been employed for the surgical team with the development of a simulated operating theatre project. This enables technical and non-technical performance of the surgeon and circulating staff to be assessed by experts situated in an adjacent control room, and provides an opportunity for constructive feedback. The scenarios have good face validity and junior surgeons can benefit from the process of learning new technical skills in a realistic environment. The effect of external influences such as distractions, new technology, or a crisis scenario can also be defined, with the ultimate aim of reducing the number of adverse events arising in the real operating room.

Clinical Competence↗
PubMed1998

It is not how much you have but how you use it: toward a rational use of simulation to support aviation training.

One of the most remarkable changes in aviation training over the past few decades is the use of simulation. The capabilities now offered by simulation have created unlimited opportunities for aviation training. In fact, aviation training is now more realistic, safe, cost-effective, and flexible than ever before. However, we believe that a number of misconceptions--or invalid assumptions--exist in the simulation community that prevent us from fully exploiting and utilizing recent scientific advances in a number of related fields in order to further enhance aviation training. These assumptions relate to the overreliance on high-fidelity simulation and to the misuse of simulation to enhance learning of complex skills. The purpose of this article is to discuss these assumptions in the hope of initiating a dialogue between behavioral scientists and engineers.

Aviation↗
PubMed2005

Witness preparation training with real and simulated criminal defendants.

Two studies examined the impact of witness preparation training with criminal defendants. In the first study, mock criminal defendants testified twice on videotape about minor crimes they were accused of but had not committed. Approximately half underwent witness preparation between their first and second testimony simulations. In the second study, eight public defender clients were videotaped during testimony simulations both before and after being prepared to testify. In both studies, ratings by trained evaluators indicated that witness preparation was associated with increases in the use of several testimony delivery skills, improvements in overall testimony quality, and reductions in apparent guilt. Training was also associated in both studies with an unintended decrease in expressiveness. Ratings from the mock defendant study further suggested that prepared defendants were seen as more credible than unprepared defendants because they used more effective testimony delivery skills, and as less likely to be guilty than unprepared defendants because they were perceived as being more credible.

Criminal Law↗
PubMed2004

Cranial suture simulator for ultrasound diagnosis of craniosynostosis.

BACKGROUND: In evaluating the effectiveness of ultrasound as a screening tool for craniosynostosis it was discovered that sonologists and sonographers needed more experience scanning and visualizing cranial sutures on ultrasound. OBJECTIVE: To create an ultrasound simulator to train radiologists and technologists to locate and recognize patent and fused cranial sutures in children. MATERIALS AND METHODS: The hypoechoic appearance of patent sutures was simulated by cutting lines into life-sized plastic doll heads and filling them with a commercial hypoechogenic material. Fused hyperechoic sutures were simulated by not cutting into the hard plastic region of a suture. The simulator's teaching value was evaluated on three radiology residents and three fellows. Subjects performed pre-training scans on unknown simulators, received feedback and an opportunity to scan a training simulator, and then performed post-training scans on random unknown simulators. Accuracy was recorded as percentage of correctly demonstrated sutures. RESULTS: The suture simulator reproduces the sonographic appearance of patent and fused cranial sutures. Accuracy of acquisition, interpretation, and overall diagnosis increased from 64 to 91%, 79 to 91%, 61 to 97%, respectively, between pre and post training scans. CONCLUSION: An ultrasound simulator can reproduce the appearance of patent and fused cranial sutures in children and can be used to train radiologists and technologists in the performance of a screening protocol.

Cranial Sutures↗
PubMed1982

Determining the training effectiveness of flight simulators: some basic issues and practical developments.

This paper seeks to examine some of the assumptions that can confuse attempts to determine the training effectiveness of flight simulators. It sets out the arguments in favour of using measures of training effectiveness derived from the concept of transfer of training and examines ways in which information may be used to present more detailed specification for training device requirements. It also draws attention to a number of interacting factors (eg, cost and utilisation) which must be taken into account when arriving at an assessment of training effectiveness.

Journal Article↗
PubMed2004

Computer-simulated phacoemulsification.

OBJECTIVE: To develop a simulator for training in phacoemulsification to be used as a learning device for both beginners and experienced surgeons to shorten the learning curve. DESIGN: Experimental study. METHODS: The system consists of a personal computer, a 3-dimensional visual interface, a phacoemulsification handpiece, and a nucleus manipulator and foot pedals for control of the phacoemulsification procedure and microscope adjustments. The simulation is based on generalized simulation software that can be also used for the development of other medical simulations. MAIN OUTCOME MEASURES: Qualitative statements given in a questionnaire. Medical students and ophthalmic surgeons with varying experience of phacoemulsification were tested. RESULTS: A simulator for training in phacoemulsification has been developed. The surgical procedures can be practiced any number of times, and there is no risk to patients. The efforts of the surgeon can be evaluated objectively. CONCLUSIONS: Studies have shown that the number of complications for an ophthalmic surgeon learning phacoemulsification decreases exponentially, reaching close to the asymptote only after several hundred procedures. Simulator training might shorten the learning period, reduce expensive supervision by an experienced surgeon, and maintain and improve the skills of experienced surgeons.

Computer Simulation↗