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PubMed2003

[Laparoscopic cholecystectomy. Training on a bio-simulation model with learning success documented using score-cards].

The possibilities of gaining theoretical knowledge in surgery are virtually unlimited. To acquire practical skills,however, the availability and willingness of the patient are the limiting factors. With the development of training tools and structured courses, experience can be gained independently of the clinical situation. To objectify and record individual performance and improvement, and to define further potential, a scoring system is necessary. Using the example of laparoscopic cholecystectomy, a training program was combined with an evaluation system and the beginners' learning curves were recorded during the course of a training week. The present study shows that first experiences and measurable improvements can be reliably assessed within one week's structured training on a simulation model.

Animals↗

PubMed1987

In vitro associative conditioning of Hermissenda: cumulative depolarization of type B photoreceptors and short-term associative behavioral changes.

Cumulative depolarization of Hermissenda type B photoreceptors, a short-term neural correlate of associative learning, was produced by simulating associative training in the isolated nervous system (in vitro conditioning). This simulation entailed stimulation and recording from three classes of neurons normally affected by the associative training procedure: a type B photoreceptor, the silent/excitatory (S/E) optic ganglion cell, and a statocyst caudal hair cell. Exposure of the isolated nervous system to five simultaneous pairings of light and current-induced impulse activity of the caudal hair cell resulted in an average 10-mV depolarization of type B cells. Cumulative depolarization was found to be pairing specific, to occur with a minimal number of training trials, and was paralleled by short-term pairing-specific changes in phototactic behavior for the intact animal. Two important determinants of cumulative depolarization were found to be the magnitude and duration of the long-lasting depolarization (LLD) response of type B cells to light, and a pairing-specific synaptic facilitation of the LLD response. The synaptic facilitation arose from two distinct sources: increased excitatory postsynaptic potential (EPSP) feedback on B cells following light and caudal hair cell stimulation pairings, and disinhibition of the type B photoreceptor following pairings. The S/E optic ganglion cell was found to be a potent regulator of B cell EPSPs. Cumulative depolarization was substantially reduced when the S/E cell was hyperpolarized throughout the course of pairings. Conversely, pairings of light with depolarizing current stimulation of the S/E cell were sufficient to produce cumulative depolarization of B cells. Precluding disinhibition of the B cell from the caudal hair cell was also found to attenuate cumulative depolarization. Additional constraints, inherent to the neural organization of the visual and statocyst neural systems were found to further limit the degree of cumulative depolarization. Among the most important of these were the interpairing interval and light intensity. Exposure of intact animals of five pairings of light and rotation resulted in short-term suppression of phototactic behavior. Like the cumulative depolarization of B cells with in vitro conditioning procedures, these changes were relatively pairing specific and persisted for comparable durations of time. Cumulative depolarization of B cells appears to be an important initial step in the production of long-term associative neural and behavioral changes in Hermissenda.

Animals↗

PubMed2000

LAHYSTOTRAIN intelligent training system for laparoscopy and hysteroscopy.

Rapid developments in the medical field, as an expanding knowledge base and emerging new technologies require continuing medical education to achieve life long learning and to keep the surgeons up to date. Consequently, specific training is necessary to guarantee qualification of the surgeons. The goal of LAHYSTOTRAIN is to overcome the current drawbacks of traditional training methods for laparoscopic/hysteroscopic procedures. A computer-assisted simulator for training and quality control in laparoscopy and hysteroscopy is developed using Virtual Reality (VR), Multimedia (MM) technology, and Intelligent Tutoring Systems (ITS).

Artificial Intelligence↗

PubMed2003

Changing learning with new interactive and media-rich instruction environments: virtual labs case study report.

Technology has created a new dimension for visual teaching and learning with web-delivered interactive media. The Virtual Labs Project has embraced this technology with instructional design and evaluation methodologies behind the simPHYSIO suite of simulation-based, online interactive teaching modules in physiology for the Stanford students. In addition, simPHYSIO provides the convenience of anytime web-access and a modular structure that allows for personalization and customization of the learning material. This innovative tool provides a solid delivery and pedagogical backbone that can be applied to developing an interactive simulation-based training tool for the use and management of the Picture Archiving and Communication System (PACS) image information system. The disparity in the knowledge between health and IT professionals can be bridged by providing convenient modular teaching tools to fill the gaps in knowledge. An innovative teaching method in the whole PACS is deemed necessary for its successful implementation and operation since it has become widely distributed with many interfaces, components, and customizations. This paper will discuss the techniques for developing an interactive-based teaching tool, a case study of its implementation, and a perspective for applying this approach to an online PACS training tool.

California↗

PubMed2006

Defining the technical skills of teamwork in surgery.

Developments in surgical technology and procedure have accelerated and altered the work carried out in the operating theatre/room, but team modelling and training have not co-evolved. Evidence suggests that team structure and role allocation are sometimes unclear and contentious, and coordination and communication are not fully effective. To improve teamwork, clinicians need models that specify team resources, structure, process and tasks. They also need measures to assess performance and methods to train teamwork strategically. An effective training strategy might be to incorporate teamwork with other technical skills training in simulation. However, the measures employed for enhancing teamwork in training and practice will need to vary in their object of analysis, level of technical specificity, and system scope.

Clinical Competence↗

PubMed2001

Virtual reality bronchoscopy simulation: a revolution in procedural training.

BACKGROUND: In the airline industry, training is costly and operator error must be avoided. Therefore, virtual reality (VR) is routinely used to learn manual and technical skills through simulation before pilots assume flight responsibilities. In the field of medicine, manual and technical skills must also be acquired to competently perform invasive procedures such as flexible fiberoptic bronchoscopy (FFB). Until recently, training in FFB and other endoscopic procedures has occurred on the job in real patients. We hypothesized that novice trainees using a VR skill center could rapidly acquire basic skills, and that results would compare favorably with those of senior trainees trained in the conventional manner. METHODS: We prospectively studied five novice bronchoscopists entering a pulmonary and critical care medicine training program. They were taught to perform inspection flexible bronchoscopy using a VR bronchoscopy skill center; dexterity, speed, and accuracy were tested using the skill center and an inanimate airway model before and after 4 h of group instruction and 4 h of individual unsupervised practice. Results were compared to those of a control group of four skilled physicians who had performed at least 200 bronchoscopies during 2 years of training. Student's t tests were used to compare mean scores of study and control groups for the inanimate model and VR bronchoscopy simulator. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired two-sample t tests were used. RESULTS: Novices significantly improved their dexterity and accuracy in both models. They missed fewer segments after training than before training, and had fewer contacts with the bronchial wall. There was no statistically significant improvement in speed or total time spent not visualizing airway anatomy. After training, novice performance equaled or surpassed that of the skilled physicians. Novices performed more thorough examinations and missed significantly fewer segments in both the inanimate and virtual simulation models. CONCLUSION: A short, focused course of instruction and unsupervised practice using a virtual bronchoscopy simulator enabled novice trainees to attain a level of manual and technical skill at performing diagnostic bronchoscopic inspection similar to those of colleagues with several years of experience. These skills were readily reproducible in a conventional inanimate airway-training model, suggesting they would also be translatable to direct patient care.

Bronchoscopy↗

PubMed2006

Implementation of the laparoscopic simulator in a gynecological residency curriculum.

BACKGROUND: In view of the current emphasis on increasing patient safety and quality control in laparoscopic surgery, there is a growing need to improve laparoscopic training. This study was conducted to investigate if and when residents reached performance standards for basic laparoscopic skills on a boxtrainer and to analyze the current state of implementation of laparoscopic simulators in a gynecological residency curriculum. METHODS: Residents across all 6 years of residency (postgraduate year [PGY] 1-6) were tested once on our boxtrainer by performing five inanimate tasks (pipe cleaner, rubber band, beads, cutting circle, intracorporeal knot tying). A sumscore for the five tasks was calculated for each participant (sum of all scores). Scores were calculated by adding completion time and penalty points, thus rewarding both speed and precision. These data were compared with scores of laparoscopic experts, which were set as performance standards. RESULTS: Of the participants, 111 were residents (7 PGY1, 27 PGY2, 29 PGY3, 28 PGY4, 14 PGY5, 6 PGY6) and 8 were experts. At the end of residency, PGY6 residents reached the performance standard for all tasks except intracorporeal knot tying. It was not until PGY5 that residents reached the performance standard for the pipe cleaner task; PGY1, for rubber band; PGY5, for beads; PGY4, for circle cutting; and PGY6, for sumscore. Throughout residency PGY6 had a mean total of only 3.6 h of simulator training experience. No correlation was found between this previous voluntary simulator training experience and performance on our boxtrainer during this study (sumscore), and between previous voluntary simulator training and total laparoscopic procedures performed. In a combined multivariate analysis, sumscore performance remained significantly associated with the number of laparoscopic procedures performed by residents when they were working as as a primary surgeon (p = 0.002), and not with the cumulative hours of simulator training during residency prior to participating in this study (p = 0.15). CONCLUSIONS: In a current Dutch gynecological residency curriculum, residents do not reach all performance standards for basic laparoscopic skills on the boxtrainer. We conclude that the voluntary simulator training program has a substantial risk to fail and that the implementation of the laparoscopic skills simulator in the current residency curriculum is in its infancy.

Female↗

PubMed1988

Respiratory and cardiac responses to exercise-simulating peripheral perfusion in endurance trained and untrained rats. I. Reflex responses and changes in perfusion outflow.

Ventilatory and circulatory drives elicited by exercise-simulating perfusion of the circulatory isolated hindleg were examined in 10 trained (TR) and untrained (UTR) rats. TR were submitted to endurance training on a motordriven treadmill (30.min-1 at a grade of 10%, 5 days a week for 30 min). Exercise was simulated by perfusion with modified tyrode solutions: I.) hypoxic, enriched with lactic acid (15 mmol.l-1), II.) normoxic, enriched with lactic acid. III.) hypoxic without lactic acid. Perfusion was performed in anaesthetized animals through cannulae in the femoral artery and vein; the hindled was connected to the rest of the body only by nerve and bone. 10 min of control perfusion (normoxic tyrode solution) was followed by a 20 min test period and another 10 min control perfusion. Apart from heart rate (HR), respiratory rate (RR) and several outflow parameters were measured ([K+], [Na+], [lactate], pH, PO2, PCO2). During control period HR was slightly higher in UTR than in TR (375.5 +/- 3.9 (SE) vs. 364.1 +/- 5.5 beats/min-1, p less than 0.6 n.s.), and RR in UTR was significantly higher than those in TR (61.5 +/- 0.4 bpm vs. 55.5 +/- 3.9 breaths.min-1, p less than 0.001). During the test periods both HR and RR in UTR increased significantly while in TR they did not (e.g. in series I mean HR and RR in UTR increased by 8.9 +/- 1.2 beats.min-1 and 1.4 +/- 0.1 breaths.min-1 respectively, whereas in TR the changes were - 2.9 +/- 1.5 beats/min-1 and -0.8 +/- 0.2 breaths.min-1.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2003

Training in tasks with different visual-spatial components does not improve virtual arthroscopy performance.

BACKGROUND: We earlier showed that training in the Procedicus KSA Simulator improves the performance of tasks done later in the same simulator. However, it is still unclear how performance in a specific visual-spatial simulator context may change after training in other simulators with different visual-spatial components. In particular, the aim of this study was to test whether performance in the Procedicus Virtual Arthroscopy (VA) Knee Simulator would remain unchanged after a training session in three other simulators with different visual-spatial components. METHODS: Twenty-eight medical students participated in a quasi-transfer study. They were randomly allocated to an experimental group ( n = 14) and a control group ( n = 14). RESULTS: Performance in the Procedicus VA Knee Simulator did not improve after training in other simulators with different visual-spatial components ( t-test p = NS). No significant correlation was found between the Procedicus VA Knee and the Minimally Invasive Surgical Trainer (MIST) simulators. CONCLUSION: One hour of training in different visual-spatial contexts was not enough to improve the performance in virtual arthroscopy tasks. It cannot be excluded, however, that experienced trainees could improve their performance, because perceived similarity between different situations is influenced by many psychological factors, such as the knowledge or expertise of the person performing the transfer task.

Adult↗

PubMed1995

Use of the Remote Access Virtual Environment Network (RAVEN) for coordinated IVA-EVA astronaut training and evaluation.

This paper presents a unique virtual reality training and assessment tool developed under a NASA grant, "Research in Human Factors Aspects of Enhanced Virtual Environments for Extravehicular Activity (EVA) Training and Simulation." The Remote Access Virtual Environment Network (RAVEN) was created to train and evaluate the verbal, mental and physical coordination required between the intravehicular (IVA) astronaut operating the Remote Manipulator System (RMS) arm and the EVA astronaut standing in foot restraints on the end of the RMS. The RAVEN system currently allows the EVA astronaut to approach the Hubble Space Telescope (HST) under control of the IVA astronaut and grasp, remove, and replace the Wide Field Planetary Camera drawer from its location in the HST. Two viewpoints, one stereoscopic and one monoscopic, were created all linked by Ethernet, that provided the two trainees with the appropriate training environments.

Astronauts↗

PubMedDate not supplied

[New ultrasound simulation system: a method for training and improved quality management in ultrasound examination].

PURPOSE: Although ultrasound examination became almost indispensable in prenatal diagnosis as well as in gynecological examination, there are still a lot of deficits in the quality management of medical education. We present a "ultrasound simulation system", that makes it possible to simulate a complete ultrasound examination. The system is able to simulate all imaginable kinds of ultrasound examination. MATERIAL AND METHODS: At the Department of Gynecology and Obstetrics of the "Medizinische Hochschule Hannover" 115 banks of normal and 29 banks of pathologic volumes were scanned and stored into our newly developed "ultrasound simulation system". 7 physicians had to examine 10 "virtual" cases each; we evaluated the incidence of positive and negative results. Furthermore, the physicians had to evaluate the quality of visualization with a score. RESULTS: 12 of 14 malformations were identified as "fetal anomalies", whereas 2 fetal anomalies could not be identified correctly. All 56 healthy fetuses could be identified to be normal. The quality of visualization was regarded to be good in 62 cases, sufficient in 6 cases and poor in 2 cases. CONCLUSION: The "ultrasound simulation system" enables users to test and improve their levels of skill to detect pathologic findings in gynecological and obstetrical examinations. At the same time the system gives the instructor the possibility to test the quality of medical examinations. The integration of ultrasound training with an ultrasound simulation system into medical education should be discussed to improve the general level of skill in gynecological ultrasound.

Computer Simulation↗

PubMed2003

Training medical students to communicate with a linguistic minority group.

Effective communication is central to a successful physician-patient relationship. Communication is usually enhanced when the linguistic and cultural attributes of patients are incorporated in health care delivery. With this purpose in mind, the Faculty of Medicine at the University of Ottawa has developed a French-language stream to train future physicians for the francophone minority population of Ontario. As part of this project, a communication skills laboratory was created for francophone students in 1996, since all three tertiary care teaching hospitals operated in English only. The laboratory consists of a controlled environment where francophone students conduct interviews in French while being observed by clinicians trained in observation and feedback techniques. It makes use of simulated patients trained to play specific roles and to give feedback to students. Laboratory sessions take place throughout the first and second years and expose students to 15 scenarios covering different themes in each year. Each scenario includes a communication problem. Facilities are in place for filming the encounters for review by students. The project has had favorable outcomes. Both students and clinician-supervisors find that the laboratory offers an excellent learning environment and describe the cases as realistic and instructive. Clerkship preceptors are pleased with the students' communication skills. Because of the success of the laboratory, faculty authorities plan to translate the scenarios and offer similar sessions to students in the English-language stream. The teaching methods used in the communication skills laboratory may be of interest to other medical schools that serve linguistic minority populations.

Communication↗

PubMed1987

Relations between physicians' behaviors and analogue patients' satisfaction, recall, and impressions.

This paper investigates associations between physicians' task-oriented and socioemotional behaviors, on the one hand, and analogue patients' satisfaction, recall of information, and global impressions. The study is based on role-playing subjects' responses to interactions between physicians and simulated patients. Audiotapes of two standardized patient cases presented by trained patient simulators to 43 primary care physicians were rated by role-playing patients (N = 258), and electronically filtered excerpts from the encounters were rated for vocal affect by 37 independent judges. Content analysis was made of the visits' transcripts to assess interaction process and to identify all medical information communicated. Finally, speech error rate was calculated from a combination of audiotape and transcript. Findings revealed that role-playing patients clearly distinguished task from socioemotional behaviors of the physicians, and a consistent pattern of association emerged between physicians' task behaviors and role-playing patients' satisfaction, recall, and impressions. Within the task domain, patient-centered skills (i.e., giving information and counseling) were consistently related to patient effects in a positive direction, but physician-centered behaviors (i.e., giving directions and asking questions) demonstrated the opposite relationship. A negative pattern of association was also evident between physicians' socioemotional behaviors and patient effects.

Affect↗

PubMed2006

Accident and emergency training perspectives in Scotland.

OBJECTIVE: To determine the perspectives of Scottish accident and emergency (A&E) trainees and trainers on current training in the speciality, in order to help develop a simulator based training programme to complement existing training. METHODS: Questionnaires were sent to all Scottish A&E trainees and consultants responsible for training. They were presented with various clinical challenges. Trainees were asked to rate their confidence, experience, knowledge, and training on a Likert scale of 1 to 5. Trainers were asked to identify those areas where they felt trainees' performance consistently failed to meet a desired standard, and whether this was the result of lack of training, lack of exposure, or both. RESULTS: Trainees' response rate was 75%; consultants' was 59.4%. Overall trainees gave scores of 4/5 for confidence and knowledge, 3/5 for experience, and 2/5 for training. The highest scores were for medical, anaesthetics, and interpersonal skills. Consultants attributed lack of exposure to underperformance more frequently than lack of training. CONCLUSIONS: Trainees and trainers agree on the level of exposure to various clinical challenges, but disagree on training. Trainees' levels of confidence and knowledge outweigh their experience and training, suggesting that trainees associate knowledge with clinical competence.

Attitude of Health Personnel↗

PubMed2004

Simulation in critical care and trauma education and training.

PURPOSE OF REVIEW: To review theory and practice of simulation technology in critical care and trauma training. RECENT FINDINGS: Simulators provide a safe and realistic environment in which active learning, enhanced by repetition and feedback, can take place. Simulation and computer-based education address the needs of knowledge and skill acquisition across a continuum of professional development. SUMMARY: Simulation appears poised to revolutionize education, training, and credentialing in critical care, surgery, and anesthesiology. However, advances in computing and technology have outpaced the evaluative and validation studies of simulation-based education.

Computer Simulation↗

PubMed1998

Technique training: endoscopic percutaneous tracheostomy.

Percutaneous tracheostomy is being used increasingly in the intensive care unit and endoscopic control of this procedure affords an improved level of safety. Training in such new minimal access techniques can be a significant risk factor in patient outcome. Surgical simulation provides training which minimizes this risk. We present a method of training in percutaneous endoscopic tracheostomy using a simulation model based on animal tissue. Our experience with this model is reported.

Animals↗

PubMed2004

Phantom-based multimodal interactions for medical education and training: the Munich Knee Joint Simulator.

Simulation environments based on virtual reality technologies can support medical education and training. In this paper, the novel approach of an "interactive phantom" is presented that allows a realistic display of haptic contact information typically generated when touching and moving human organs or segments. The key idea of the haptic interface is to attach passive phantom objects to a mechanical actuator. The phantoms look and feel as real anatomical objects. Additional visualization of internal anatomical and physiological information and sound generated during the interaction with the phantom yield a multimodal approach that can increase performance, didactic value, and immersion into the virtual environment. Compared to classical approaches, this multimodal display is convenient to use, provides realistic tactile properties, and can be partly adjusted to different, e.g., pathological properties. The interactive phantom is exemplified by a virtual human knee joint that can support orthopedic education, especially for the training of clinical knee joint evaluation. It is suggested that the technical principle can be transferred to many other fields of medical education and training such as obstetrics and dentistry.

Computer Graphics↗

PubMed1999

Single-trial estimation of neuronal firing rates: from single-neuron spike trains to population activity.

We present a method to estimate the neuronal firing rate from single-trial spike trains. The method, based on convolution of the spike train with a fixed kernel function, is calibrated by means of simulated spike trains for a representative selection of realistic dynamic rate functions. We derive rules for the optimized use and performance of the kernel method, specifically with respect to an effective choice of the shape and width of the kernel functions. An application of our technique to the on-line, single-trial reconstruction of arm movement trajectories from multiple single-unit spike trains using dynamic population vectors illustrates a possible use of the proposed method.

Action Potentials↗