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At least 541 records · Page 30Linked to original sources
PubMed2005

Use of a virtual reality, real-time, simulation model for the training of urologists in transurethral resection of the prostate.

OBJECTIVE: There is a growing need to develop surgical skills outside the operating theatre. In this study we describe the development of a virtual reality training system for practising transurethral resection of the prostate (TURP). MATERIAL AND METHODS: A face validity study was performed using a questionnaire sent to 28 experienced urologists to find out the ideal characteristics of a simulated TURP. Based on the comments a simulator was constructed and a content validity study was then performed in which nine experienced urologists tested the simulator and answered a second questionnaire. After corrections to the simulator, a basic construct validity test was performed. RESULTS: We have developed a computer-based simulator based on the requirements listed by 17 urologists. It consists of a modified resectoscope connected to a haptic device and supported by a frame. The software provides a virtual view of the prostatic lumen and resectoscope tip, a haptic rendering that generates force feedback and a simulation module that computes the information from the haptic device, resectoscope fluid tap and handle and the foot pedals. The software also simulates bleeding, absorption of irrigation fluid and pressure gradients. Variables are measured and presented in a result file after each "operation". Nine experienced urologists performed a content validity study and changes were made accordingly. A basic construct validity test performed by seven inexperienced students showed a significant improvement in performance after they each performed six simulated procedures. CONCLUSION: We have developed a simulator that may be used to practise TURP and which meets most of the demands raised in a face validity study. A basic construct validity test showed improved performance after repeated practice in the simulated environment.

Computer Simulation↗
PubMed2006

Evolution of surgical skills training.

Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients. Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced, virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations. The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent. Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery. An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training, ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

Clinical Competence↗
PubMed2005

Effect of augmented visual feedback from a virtual reality simulation system on manual dexterity training.

Little research has been published about the impact of simulation technology on the learning process of novel motor skills. Especially the role of augmented feedback (FB) on the quality of performance and the transfer of the acquired behaviour to a no-augmented FB condition require further investigation. Therefore, novice dental students were randomly assigned to one of three groups and given the task of drilling a geometrical class 1 cavity. The FB group trained under augmented visual FB conditions, provided by the virtual reality (VR) system (DentSim). The no-FB group practised under normal vision conditions, in the absence of augmented FB. A control group performed the test sessions without participating in any training programme. All preparations were evaluated by the VR grading system according to four traditional (outline shape, floor depth, floor smoothness and wall inclination), and two critical, criteria (pulp exposure and damage to adjacent teeth). Performance analyses revealed an overall trend towards significant improvement with training for the experimental groups. The FB group obtained the highest scores. It scored better for floor depth (P < 0.001), whilst the no-FB group was best for floor smoothness (P < 0.005). However, at the retention tests, the FB group demonstrated inferior performance in comparison with the no-FB group. The transfer test on a traditional unit revealed no significant differences between the training groups. Consequently, drilling experience on a VR system under the condition of frequently provided FB and lack of any tutorial input was considered to be not beneficial to learning. The present data are discussed in view of the guidance hypothesis of FB, which refers to the apprentice's dependence on FB.

Adolescent↗
PubMed2006

Integrating simulation into a surgical residency program: is voluntary participation effective?

OBJECTIVE: Surgical training programs nationwide are struggling with the integration of simulation training into their curriculum given the constraints of the 80-h work week. We examine the effectiveness of voluntary training in a simulation lab as part of the surgical curriculum. METHODS: The ProMIS simulator was introduced into the general surgery residency at Boston University Medical Center. All categorical residents (28) and non-categorical residents (23) were offered a 2-h training session and curriculum review. After the introductory session, time spent in the lab was encouraged, but voluntary. Use of the simulator was tracked for all residents. Participation in the simulation curriculum was defined as three or more uses of the simulator. After 3 months, all residents completed a survey regarding the simulation lab and their simulator usage. RESULTS: Twenty-six (93%) categorical residents and three (6%) non-categorical residents completed the introductory simulator training session. Over a 3 month period, use of the simulator at least once was 31% among all eligible residents; 80% of postgraduate year (PGY)1, 40% of PGY2, 60% of PGY3, and 0% of PGY4 and PGY5. Four residents (14%) participated in the simulation curriculum. Overall, 70% of simulator usage was during working hours, and 30% was completed post-call or when the resident was off duty. Most residents agreed that the simulator was easy to use and that its use improved their operative skills, but they did not think it was a good substitute for actual operative experience. Reported reasons for not using the simulator included off-site rotation (44%), no time (30%), and no interest (11%). CONCLUSIONS: Voluntary use of a surgical simulation lab leads to minimal participation in a training curriculum. Participation should be mandatory if it is to be an effective part of a residency curriculum.

Boston↗
PubMed2000

Designing a computer-based simulator for interventional cardiology training.

Interventional cardiology training traditionally involves one-on-one experience following a master-apprentice model, much as other procedural disciplines. Development of a realistic computer-based training system that includes hand-eye coordination, catheter and guide wire choices, three-dimensional anatomic representations, and an integrated learning system is desirable, in order to permit learning to occur safely, without putting patients at risk. Here we present the first report of a PC-based simulator that incorporates synthetic fluoroscopy, real-time three-dimensional interactive anatomic display, and selective right- and left-sided coronary catheterization and angiography using actual catheters. Significant learning components also are integrated into the simulator.

Cardiac Catheterization↗
PubMed2026

Educational interventions to improve medical students' bad news communication skills: A systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to both determine whether educational interventions improve medical students' ability and/or confidence in Bad News Communication (BNC), as well as assess the relative efficacy of instructional formats. METHODS: Performed according to the PRISMA guidelines, four databases were searched for articles describing education-based interventions to improve medical student's BNC ability and/or confidence, published in English between 2001 and 2024. Data on students' self-reported or observer-assessed level of competence/ability in BNC (primary outcome), and students' self-assessed confidence in BNC skills (secondary outcomes), were analysed. Meta regression explained the influence of several categorical moderators on heterogeneity in relation to intervention effects on competence/ability. RESULTS: 27 studies met the criteria for inclusion in the systematic review and 17 studies for the meta-analysis. Interventions described in controlled studies were associated with a moderate and significant increase in BNC ability (13 data sets; standardized mean difference [SMD] = 1.09, 95% CI = 0.52 - 1.66). Interventions detailed in pre-post design studies were associated with a significant increase in BNC ability (20 data sets; SMD = 0.92, 95% CI = 0.52 - 1.32), and student confidence/comfort in their BNC skills (12 data sets; SMD = 1.16, 95% CI = 0.57 - 1.75). Subgroup analysis demonstrated better skills/competence outcomes in studies that included simulation-based training (SBT). CONCLUSIONS: Educational interventions improve the BNC ability and confidence of medical students. Interventions should include an SBT element as this leads to greater improvements in BNC ability. Further research is needed to determine to what extent these interventions translate to positive patient outcomes. PRACTICE IMPLICATIONS: Diverse educational programme, especially those including simulation-based training, are effective in improving BNC skills, although the longetivity of these improvements is at present unclear. Therefore, we recommend that refresher courses or practice opportunities should be scheduled throughout students' medical education to ensure retention of BNC skills.

Humans↗
PubMed1984

Post-tetanic hyperpolarization evoked by depolarizing pulses in crayfish stretch receptor neurones in tetrodotoxin.

A post-tetanic hyperpolarization (p.t.h.) that is quantitatively identical to that evoked by a train of action potentials in stretch receptor neurones of crayfish Procambarus clarki and Pacifastacus leniculus is evoked when the normal Na+ influx is blocked with tetrodotoxin (TTX) and a train of depolarizing pulses is used to simulate a train of action potentials. The p.t.h. evoked by depolarizing pulses in the presence of TTX is attributable to an electrogenic Na-K pump, because it (a) is abolished by strophanthidin, (b) is abolished by removal of external K+, (c) depends in magnitude on internal Na+ concentration, (d) is not associated with a change in membrane conductance and (e) does not exhibit a reversal potential. When each action potential in the stimulus train is followed by a hyperpolarizing pulse, generation of the p.t.h. is prevented even though the action potentials are unchanged. The time constant for build-up of the p.t.h. is longer than the time constant of decay. Increasing the magnitude of depolarizing pulses increases the magnitude of the p.t.h. response in the presence of TTX and also increases the time constant for its build-up. The suppression of the p.t.h. occurring in low external Na+ appears to represent a response to a change in internal Na+ concentration, characterized by a time constant much longer than the decay of the p.t.h. The activity of the pump appears to be regulated by two mechanisms: a Na+-sensitive mechanism with a time constant of the order of a minute and an apparently voltage-sensitive mechanism with a time constant of about 5 s. The hypothesis is proposed that changes in the transmembrane electric field influence the enzymatic systems of the pump and disrupt the steady-state distribution of conformation states. The decay of the p.t.h. represents a relaxation back to the resting distribution.

Action Potentials↗
PubMedDate not supplied

Applied physiology of cycling.

Historically, the bicycle has evolved through the stages of a machine for efficient human transportation, a toy for children, a finely-tuned racing machine, and a tool for physical fitness development, maintenance and testing. Recently, major strides have been made in the aerodynamic design of the bicycle. These innovations have resulted in new land speed records for human powered machines. Performance in cycling is affected by a variety of factors, including aerobic and anaerobic capacity, muscular strength and endurance, and body composition. Bicycle races range from a 200m sprint to approximately 5000km. This vast range of competitive racing requires special attention to the principle of specificity of training. The physiological demands of cycling have been examined through the use of bicycle ergometers, rollers, cycling trainers, treadmill cycling, high speed photography, computer graphics, strain gauges, electromyography, wind tunnels, muscle biopsy, and body composition analysis. These techniques have been useful in providing definitive data for the development of a work/performance profile of the cyclist. Research evidence strongly suggests that when measuring the cyclist's aerobic or anaerobic capacity, a cycling protocol employing a high pedalling rpm should be used. The research bicycle should be modified to resemble a racing bicycle and the cyclist should wear cycling shoes. Prolonged cycling requires special nutritional considerations. Ingestion of carbohydrates, in solid form and carefully timed, influences performance. Caffeine appears to enhance lipid metabolism. Injuries, particularly knee problems which are prevalent among cyclists, may be avoided through the use of proper gearing and orthotics. Air pollution has been shown to impair physical performance. When pollution levels are high, training should be altered or curtailed. Effective training programmes simulate competitive conditions. Short and long interval training, blended with long distance tempo cycling, will exploit both the anaerobic and aerobic systems. Strength training, to be effective, must be performed with the specific muscle groups used in cycling, and at specific angles of involvement.

Air Pollution↗
PubMed1975

A comparison of pediatric interviewing skills using real and simulated mothers.

In order to allay concerns about using simulators as opposed to real mothers for teaching and evaluating interviewing skills, a study was designed to test for differences in students' approaches when interviewing simulated and real mothers. Three mothers were trained to give their own children's histories consistently and two mothers trained to simulate a history. Thirty third-year medical students conducted two interviews which were audiotaped. Students were told the nature of the study and whether the mother was real or simulated. One half of the time the mothers were presented as simulators and one half of the time the simulators were presented as mothers. The variable of order was controlled. An objective checklist containing 70 to 80 bits of organic and personal data per case and an interaction analysis (with an average of 285 interactions per interview) were utilized to measure the content material gathered and the approach used by the students. The data were analyzed using an analysis of variance (ANOVA) technique. All but 1 of the 55 null hypotheses were accepted, i.e., no significant differences were found. The Use of Simulation for Teaching and Evaluating Interviewing Skills Provides a Valid Experience.

Child↗
PubMed1991

Simulator sickness provoked by a human centrifuge.

Simulator sickness is now a well-recognized entity. It is recognized as a form of motion sickness, having a higher incidence in the more sophisticated simulators. Human centrifuges (dynamic simulators) are the newest innovation in aircrew training devices. Simulator sickness has never been reported in human centrifuges. We are reporting on a case of delayed simulator sickness in a pilot-subject after a centrifuge experience. A review of the "psycho-physiological" problems routinely experienced by subjects on human centrifuges indicates such problems are due to simulator sickness, although they are not reported as such. In this paper, we give a brief overview of simulator sickness and briefly discuss simulator sickness, as related to the human centrifuge experience.

Adult↗
PubMed2005

Comparison of training on two laparoscopic simulators and assessment of skills transfer to surgical performance.

BACKGROUND: Several studies have investigated the transfer of surgical trainees' skills acquired on surgical simulators to the operating room setting. The purpose of this study was to compare the effectiveness of two laparoscopic surgery simulators by assessing the transfer of skills learned on simulators to closely matched surgical tasks in the animal laboratory. STUDY DESIGN: In this post-test-only Control group study design, 46 surgically naive medical student volunteers were randomly assigned to one of three groups: Tower Trainer group (n = 16), LapSim group (n = 17), and Control group (n = 13). Outcomes measures included both time and accuracy scores on three laparoscopic tasks (Task 1: Grasp and Place; Task 2: Run the Bowel; Task 3: Clip and Cut) performed on live anesthetized pigs, and a global rating of overall performance as judged by four experienced surgeons. RESULTS: The Tower Trainer group performed significantly better than the Control group on 1 of 7 outcomes measures-Task 3: Time (p < 0.032), although the LapSim group performed significantly better than the Control group on 2 of 7 measures-Task 3: Time (p < 0.008) and Global score (p < 0.005). In comparing the two simulators, the LapSim group performed significantly better than the Tower Trainer group on 3 of 7 outcomes measures-Task 2: Time (p < 0.032), Task 2: Accuracy (p < 0.030) and Global score (p < 0.005), although the Tower Trainer group did not perform significantly better than the LapSim group on any measure. CONCLUSIONS: This study demonstrated that naive subjects trained on a virtual-reality part-task trainer performed better on live surgical tasks in a porcine model as compared with those trained with a traditional box trainer. These findings could aid in selection of appropriate training methodologies.

Adult↗
PubMed2004

Simulation of bilateral movement training through mirror reflection: a case report demonstrating an occupational therapy technique for hemiparesis.

In rehabilitation for hemiparesis, one of the goals of an occupational therapist is to practice upper extremity tasks with the recovering individual. The practice is intended to strengthen muscles and refine movements. It also provides examples for the recovering body and brain as they attempt to reestablish the now delicate cognitive and neural connections mediating voluntary behavior. However, the paresis significantly limits the movement sequence possibilities that may be physically practiced. We outline a method for using simulation of movement, which is intended to provide a means for experiencing a range of smooth and controlled movements completed by a paretic limb. The simulation provides a compelling perceptual experience of bilateral motion beyond the current capabilities of the affected limb. The benefits of this technique after a 3-week course of the simulation practice are exemplified by the presented case study that reveals improved function as demonstrated by increases in Fugl-Meyer scores and faster movement speeds as demonstrated by decreased movement times for the Jebsen test of hand function.

Arm↗
PubMed2005

Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator.

PROBLEM: Advance cardiac life support (ACLS) training does not address coordination of team resources to improve the ability of teams to deliver needed treatments reliably and rapidly. Our objective was to use a human simulation training educational environment to develop multidisciplinary team skills and improve medical emergency team (MET) performance. We report findings of a crisis team training course that is focused on organization. SETTING: Large center for human simulation training at a university affiliated tertiary care hospital. PARTICIPANTS: Ten courses were delivered and 138 clinically experienced individuals were trained (69 critical care nurses, 48 physicians, and 21 respiratory therapists). All participants were ACLS trained and experienced in responding to cardiac arrest situations. COURSE DESIGN: Each course had four components: (1) a web based presentation and pretest before the course; (2) a brief reinforcing didactic session on the day of the course; (3) three of five different simulated scenarios; each followed by (4) debriefing and analysis with the team. Three of five simulator scenarios were used; scenario selection and order was random. Trainees did not repeat any scenario or role during the training. Participants were video recorded to assist debriefing. Debriefing focused on reinforcing organizational aspects of team performance: assuming designated roles independently, completing goals (tasks) assigned to each role, and directed communication. MEASURES FOR IMPROVEMENT: Participants graded their performance of specific organizational and treatment tasks within specified time intervals by consensus. Simulator "survival" depended on supporting oxygenation, ventilation, circulation within 60 seconds, and delivering the definitive treatment within 3 minutes. EFFECTS OF CHANGE: Simulated survival (following predetermined criteria for death) increased from 0% to 89%. The initial team task completion rate was 10-45% and rose to 80-95% during the third session. LESSONS LEARNT: Training multidisciplinary teams to organize using simulation technology is feasible. This preliminary report warrants more detailed inquiry.

Computer Simulation↗
PubMedDate not supplied

Learning curves, acquisition, and retention of skills trained with the endoscopic sinus surgery simulator.

BACKGROUND: As an initial step in evaluating the effectiveness of training otolaryngology residents on an endoscopic sinus surgery simulator (ES3), we have assessed the ability of the ES3 to train persons inexperienced in sinus surgery (medical students) to perform certain simulated procedural tasks needed in endoscopic sinus surgery (ESS). METHODS: A total of 26 medical students were enrolled and trained on the ES3 following a preset protocol in the three levels of difficulty and complexity (novice, intermediate, and advanced modes). RESULTS: In the novice mode (three-dimensional abstract images are used to teach the use of endoscopic surgical equipment), medical students displayed a steep learning curve within three to five trials on the simulator and after an additional four to five trials, they reached a plateau in their learning curves to within 90% of that of experienced sinus surgeons. In the intermediate mode (ESS is performed on a simulated patient with teaching aids), medical students were able to reach a plateau in their learning curves to within 80% of that of experienced surgeons. This performance was sustained in the advanced mode (simulated sinus surgery without teaching aids). We observed that medical students, who had novice or intermediate mode training interrupted with an interval of 11-60 days, were able to resume their training without deviation from their prior learning curves. CONCLUSION: Intensive, proctored training on the ES3 can train inexperienced persons to perform simulated ESS within a reasonable approximation of the performance of experienced sinus surgeons on the ES3 and the training that an inexperienced person receives on the simulator is not short term but is retained over a period of at least 2 months.

Adult↗
PubMed2006

Using 3D computer simulations to enhance ophthalmic training.

PURPOSE: To develop more effective methods of demonstrating and teaching complex topics in ophthalmology with the use of computer aided three-dimensional (3D) animation and interactive multimedia technologies. METHODS: We created 3D animations and interactive computer programmes demonstrating the neuroophthalmological nature of the oculomotor system, including the anatomy, physiology and pathophysiology of the extra-ocular eye muscles and the oculomotor cranial nerves, as well as pupillary symptoms of neurological diseases. At the University of Vienna we compared their teaching effectiveness to conventional teaching methods in a comparative study involving 100 medical students, a multiple choice exam and a survey. RESULTS: The comparative study showed that our students achieved significantly better test results (80%) than the control group (63%) (diff. = 17 +/- 5%, p = 0.004). The survey showed a positive reaction to the software and a strong preference to have more subjects and techniques demonstrated in this fashion. CONCLUSION: Three-dimensional computer animation technology can significantly increase the quality and efficiency of the education and demonstration of complex topics in ophthalmology.

Computer Simulation↗
PubMed1999

Characteristic feature of oxygen cost at simulated laboratory triathlon test in trained triathletes.

BACKGROUND: The present study was carried out in order to investigate the respiratory and circulatory features during a simulated laboratory triathlon test in trained triathletes. METHODS EXPERIMENTAL DESIGN: Sixteen male triathletes were divided into superior (n = 8) and slower triathletes (n = 8) according to their race time. These subjects performed both maximal exercise tests and a simulated laboratory triathlon test (ST). The latter test consisted of flume-pool swimming for 30 min, ergometer cycling for 75 min and treadmill running for 45 min as a continuous task. The exercise intensity was 60% of VO2 max during swimming, cycling and running, respectively. RESULTS: In slower triathletes, VO2, minute ventilation (VE), heart rate (HR) and temperature of external auditory canal were increased from an earlier stage compared with those in superior athletes. The percent increase (delta) of VO2, VE and HR between the 10th and last min of cycling and running stages in superior triathletes were significantly smaller than those in slower athletes. The oxygen cost (oxygen uptake/running velocity) of running stage was significantly lower in superior triathletes (0.220 +/- 0.020 ml.kg-1.m-1) compared with slower athletes (0.264 +/- 0.014 ml.kg-1.m-1). CONCLUSIONS: These results suggest that superior triathletes performed ST more economically than slower athletes and had excellent thermoregulatory adaptation.

Analysis of Variance↗