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PubMedDate not supplied

[Measurement of the development of psychomotor abilities in surgical endoscopy training with the use of a simulator and biological pieces].

INTRODUCTION: Learning laparoscopic surgery skills using a simulator board is one of the new acquired teaching methods. This work seeks an evaluation method to assess, by objective means, the development of psychometric skills during a simulated workshop with biological pieces. MATERIAL AND METHODS: During a 2-month period, 15 students from an endoscopic surgery seminar were evaluated using a simulator board with the objective to assess four specific skills: object mobilization, cutting pattern, sutures and intracorporeal knots. Eight practice procedures with biological pieces were performed in the simulator. Time and precision were measured in the four assignments. RESULTS: Students improved significantly in object mobilization (p = 0.02), precision in cutting pattern (p < 0.01) and suture (p = 0.02), and time and precision to realize intracorporeal knots (p < 0.01). CONCLUSIONS: This method allows the objective evaluation of the degree of development of surgical skills using a simulator board. It is inexpensive and easy to perform, which makes it useful for other institutions.

Computer Simulation↗
PubMed1989

[Simulation with a pre-clinical training system. 1. Practice in operative dentistry using an experimental manequin articulator, jaw model, and artificial teeth].

Clinical practice with patients is the most important part of education for dental students. However there are considerable difference between lecture, basic practice, and clinical practice. Therefore it is difficult to go from basic practice to clinical practice. To overcome this, we developed and introduced a Pre-Clinical Training system using a newly designed manequin, articulater, jaw model, and artificial teeth. This manequin is very similar to patients in appearance. The mandibular part used a semi-adjustable arcon type articulator. The artificial teeth were made of two types of synthetic resins with different hardness for use in operative dentistry. The teeth also have caries areas made of soft black resin. Using this system, the students practiced oral examination, cavity preparation and restoration in operative dentistry.

Dental Articulators↗
PubMed1989

[Simulation with a pre-clinical training system. 2. Evaluation of the pre-clinical training system].

This study evaluated usefulness of the Pre-Clinical Training System. Undergraduate students and instructors at Higashi-Nippon-Gakuen University practiced class I composite resin restoration of the lower right first molar using the system. After the practice, they filled out questionnaires to evaluate the system. According to the results, this system proved useful for pre-clinical education though there is room for improvement.

Dental Restoration, Permanent↗
PubMed1994

A method for training surgeons in laparoscopic ultrasound.

With the increased use of laparoscopic surgery and the obligatory loss of palpation of solid organs, laparoscopic ultrasound will be an invaluable tool for the location and evaluation of solid or fluid-filled masses and retroperitoneal organs. Surgeons have heretofore had limited experience with ultrasound but are increasingly using other minimally invasive techniques to perform major operations. A graduated learning experience has been developed for surgeons, including a didactic introduction to ultrasound, inanimate and ex vivo training models, and finally, a live large animal model. Hepatic metastases were simulated and surgeons trained to locate and biopsy these lesions within the liver parenchyma under laparoscopic ultrasound guidance. The devised training session has allowed the participating surgeons to feel confident that they could identify and then biopsy intrahepatic lesions using minimally invasive techniques.

Animals↗
PubMed1997

Influence of frame rate and image delay on virtual driving performance.

The control and navigation of unmanned ground vehicles (UGVs) by humans requires a thorough understanding of the limitations in human perception and performance. Images of the external world recorded by cameras mounted on the UGV are presented as a video display to the operator, who then remotely manipulates the vehicle using a standard control. Operator performance is directly proportional to the computational complexity associated with the processing of video data. This work studies the effects of frame rate and image delay (lag) on remote driving performance. Experiments were conducted with five subjects using a driving simulator with a 1 dof force feedback steering wheel control. After sufficient training on the simulator, subjects drove a virtual car on a standard track under varying settings of frame rate and lag. Performance was measured by the duration to complete the course. Comparison of performance both within and between subjects showed characteristic driving patterns at different settings. Implications of the findings are discussed in relation to video data presentation for remote driving applications.

Automobile Driving↗
PubMed1999

Virtual cutting of anatomical structures.

In the context of medicine cutting is one of the most important operations. Many surgical tasks start with an incision, allowing the surgeon to access the region of interest, using either conventional or minimal invasive surgery techniques. The work presented herein should be seen in the context of surgical training and preoperative planning using computer assisted medical simulation systems. The main result of this work is the proposed cutting algorithm based on predefined templates. To integrate this approach in the existing surgical training simulator and to handle additional tasks like soft tissue deformation, needed by the medical environment, a generic simulation framework was developed. This framework is able to utilize given multiprocessor- and network-environments to achieve the desired realtime interactivity.

Algorithms↗
PubMed1998

In-house development of test equipment for quality control and training. Case study: a prototype ECG simulator-tester.

The support services for biomedical technology address a variety of technical and administrative issues, concerning the safe and efficient operation of medical equipment over the period of its intended use and the training of hospital personnel in issues concerning safety and quality. Clinical Engineering Departments undertake the responsibility of developing and operating training programs in medical equipment utilisation apart from the traditional role of training and supervising technicians involved in testing, calibration and preventive/corrective maintenance of electromedical equipment. In view of the above, the Institute of Biomedical Technology and the Centre of Biomedical Engineering collaborated for the design and development of a prototype digital ECG and arrhythmia simulator. In the absence of internationally accepted inspection protocols for ECG simulators, the verification phase of the project involved mainly the inspection of the device's conformity to its initial technical specifications. The results demonstrated that this tester. due to simplicity in construction and easiness of use could be a practical, reliable and economical solution for electrocardiograph and ECG monitor testing and waveform recognition training.

Arrhythmias, Cardiac↗
PubMed2001

Management of anaphylactic shock evaluated using a full-scale anaesthesia simulator.

BACKGROUND: The diagnosis of an anaphylactic reaction during anaesthesia is not the first consideration for the anaesthetist and might be missed. The aim of this study was to describe anaesthetists' management of an anaphylactic reaction concerning diagnosing, treatment and application of anaesthesia crisis resource management (ACRM) in a full-scale anaesthesia simulator. METHODS: Forty-two anaesthetists in teams of two attended training sessions with a critical incident of anaphylactic shock in a full-scale simulator. Trained observers from the study group evaluated the medical treatment according to a treatment sequence developed from the literature and graded the ACRM performance on a five-point scale where 1 is bad and 5 is best. RESULTS: None of the teams made the correct diagnosis within 10 min and treatment according to the treatment sequence was not initiated. Only 6/21 teams considered the right diagnosis but first after hints from the instructor 15 min after the start of the incident. Evaluation of the use of the total ACRM concept (that is the use of all of the ACRM expressions seen in a total connection: called general impression) gave a median value of 2.0 with a range of (1-3). CONCLUSION: Anaphylactic shock was difficult to diagnose and no structured plans were used for the treatment in the simulated incident in this study.

Anaphylaxis↗
PubMed1999

Simulation technology for health care professional skills training and assessment.

Changes in medical practice that limit instruction time and patient availability, the expanding options for diagnosis and management, and advances in technology are contributing to greater use of simulation technology in medical education. Four areas of high-technology simulations currently being used are laparoscopic techniques, which provide surgeons with an opportunity to enhance their motor skills without risk to patients; a cardiovascular disease simulator, which can be used to simulate cardiac conditions; multimedia computer systems, which includes patient-centered, case-based programs that constitute a generalist curriculum in cardiology; and anesthesia simulators, which have controlled responses that vary according to numerous possible scenarios. Some benefits of simulation technology include improvements in certain surgical technical skills, in cardiovascular examination skills, and in acquisition and retention of knowledge compared with traditional lectures. These systems help to address the problem of poor skills training and proficiency and may provide a method for physicians to become self-directed lifelong learners.

Anesthesiology↗
PubMed1990

The transfer effect of leadup activities.

Previous literature shows that operative laboratory performance can be significantly improved through leadup training where students complete simulated preparations in plastic blocks. Since the task requirements of most fixed prosthodontic preparations seem similar to those of operative dentistry, it may be hypothesized that leadup training utilizing operative-like preparations would facilitate performance in the projects of both courses. The objective of this study was to test that hypothesis. The performance of students who had completed the leadup training nine months earlier was compared with that of randomly selected control groups, with replacement, in a subsequent operative and fixed prosthodontics course. Calibrated raters were unaware of group affiliation of products. Analyses of variance showed that students in the experimental group statistically significantly outperformed those in the control group on the two operative preparations which were most like products completed during the leadup training. There was no such difference for any of the three fixed prosthodontics products. It is concluded that transfer of training is highly specific and that leadup training must simulate the criterion in both its cognitive and motor components, if it is to have a facilitating effect.

Analysis of Variance↗
PubMedDate not supplied

Results and recommendations from the helicopter EMS pilot safety survey 2005.

INTRODUCTION: In 2005, the Pilot Safety Study Group (PSSG), consisting of members of the Association of Air Medical Services Research Committee, wrote, distributed, and analyzed a survey of helicopter pilots regarding their knowledge, attitude, and perspectives on safety in the field of air medical transport. METHODS: The Pilot Safety Survey 2005 (PSS2005) was based on another survey--one that was sponsored by Helicopter Association International (HAI) and National EMS Pilots Association (NEMSPA) and administered to pilots in 2001. The PSS2005 pared questions down so that the survey could be completed in 15 minutes on the internet, and the answers were organized in a manner to simplify analysis. An electronic link to the survey was distributed in a non-randomized fashion to HEMS pilots using the mailing lists of various operators and HEMS programs. Questions were clustered into eight groupings of safety, with a majority of responses being categorical, lending themselves to cross-tabulations. RESULTS: The information gathered indicated that Helicopter EMS (HEMS) pilots are very experienced, with the average pilot logging 6,625 flight hours. Collectively, they took responsibility for HEMS accidents; with 92% of total respondents citing "pushing weather minimums" and 82% citing "pilot decision making" as the main reasons for crashes. Crew resource management (CRM) was well appreciated by the pilots; there appeared to be a positive correlation with programs that offer their employees CRM and the pilots' general perspective on safety. The survey was also clear that amongst 40% of the respondents, mission-oriented training needs improvement, and 74% responded that more realistic training in flight simulators would improve safety overall. Finally, 57% of the pilots both desired night vision goggles or devices (NVG/NVD) and believed that their usage would improve safety in the field of air medical transport (55% vs 45%, P = .0025). CONCLUSIONS: Although the recommendations from the PSS2005 are lacking in definite evidence for a decrease in HEMS crashes, we consider the direct input from pilots as critical in the absolute elimination of crashes in Helicopter EMS (Vision Zero). Pilots are, after all, the very ones held responsible for HEMS crashes. Based on these findings, the PSSG hopes that the HEMS community will incorporate the following recommendations into their standard practices. We recommend that all HEMS operators have annual and regular CRM training. We recommend that all HEMS pilots have annual and regular training in realistic flight simulators. Finally, we recommend that all HEMS aircraft be in possession of NVGs, and if this is not possible (eg, light pollution from a highly urbanized region or cost-benefit issues), then to have annual and regular mission-oriented nighttime training.

Adult↗
PubMed1984

Teaching interviewing skills to paediatric junior clerks using simulated mothers.

In this article a training programme is described for improving interviewing skills of students in the fifth year (junior clerkship) of the medical curriculum. Two interviews with a 'simulated mother' form the core of the programme. The interviews are immediately followed by a feedback session in which the simulated mother discusses the strong and the weak points of the interview. In the feedback she makes use of a checklist with relevant points concerning the content and the process of the interview. Where required the comments are substantiated with fragments of the videotaped interview. In a 2-hour theoretical session, students are told how to prepare themselves for the interview. The learning effects of the training programme using simulated mothers were evaluated in order to determine: (1) the subsequent improvement in interviewing skills; and (2) the effect of the feedback session. It was found that students' interviewing skills improved significantly on the content and the process aspects after one or two interviews. In addition the feedback sessions proved very helpful, although no significant differences were revealed, when comparing the mean group scores for students who had had feedback sessions with the scores for those who had not. The results also revealed that two interviews were insufficient and that the training should include at least three interviews. This was borne out by the large number of students who asked for more interviews with simulated mothers. In the training programme the simulated mothers perform two functions: (1) playing the role of the mother of a sick child; and (2) giving feedback to students regarding their interviewing skills.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Clerkship↗
PubMed1997

Detection, classification, and superposition resolution of action potentials in multiunit single-channel recordings by an on-line real-time neural network.

Determination of single-unit spike trains from multiunit recordings obtained during extracellular recording has been the focus of many studies over the last two decades. In multiunit recordings, superpositions can occur with high frequency if the firing rates of the neurons are high or correlated, making superposition resolution imperative for accurate spike train determination. In this work, a connectionist neural network (NN) was applied to the spike sorting challenge. A novel training scheme was developed which enabled the NN to resolve some superpositions using single-channel recordings. Simulated multiunit spike trains were constructed from templates and noise segments that were extracted from real extracellular recordings. The simulations were used to determine the performances of the NN and a simple matched template filter (MTF), which was used as a basis for comparison. The network performed as well as the MTF in identifying nonoverlapping spikes, and was significantly better in resolving superpositions and rejecting noise. An on-line, real-time implementation of the NN discriminator, using a high-speed digital signal processor mounted inside an IBM-PC, is now in use in six laboratories.

Action Potentials↗
PubMed2002

The transfer of basic skills learned in a laparoscopic simulator to the operating room.

BACKGROUND: The aim of the study was to evaluate whether basic surgical skills achieved by training in LapSim, a computerbased laparoscopic simulator, could be transferred to the operating room. METHODS: For this study, 24 medical students undergoing courses in surgery were randomly assigned to train with LapSim or to serve as control subjects. After they had undergone simulator training 2 h per week for 5 weeks, their basic skills in laparoscopic surgery were assessed in a porcine model. The time to perform each task was measured, and four senior surgeons independently graded the overall performance on a 9-step differential rating scale. RESULTS: The participants randomized to train with LapSim showed significantly better results for all tasks in both parts of the study than the untrained participants, according to the expert evaluation. Time consumption was accordingly lower in the training group in the control group. CONCLUSIONS: The results show that basic skills achieved by systematic training with a laparoscopic simulator such as LapSim can be transferred to the operating room.

Animals↗
PubMed2000

[Augmented reality in echocardiography. A new method of computer-assisted training and image processing using virtual and real three-dimensional data sets].

Augmented reality (AR) applications link real with virtual image data, in order to increase their information content. In medicine they are especially useful for education and for supporting the interpretation of three-dimensional (3D) image data. Simulators are used to train risky or expensive procedures. In the AR application EchoCom2 a 3D surface model of the human heart is linked with echocardiographic volume data sets. The 3D echocardiographic data sets are registered with the heart model to synchronize it's temporal and spatial orientation. The heart model together with an animated ultrasound sector represents a reference scenario, which displays the currently selected cutting plane within the echocardiographic volume data set. Modifications of the cutting plane within the echocardiographic data are transferred simultaneously and in real time to the reference scenario. The AR application is used as a simulator to train two-dimensional echocardiographic examinations and as an orientation and navigation aid for the exploration of 3D echocardiographic data sets. Beginners in echocardiography have only a rudimentary conception of the spatial relationship between the actual ultrasound image and the 3D anatomy of the heart. They are unable to translate multiple two-dimensional slices into a coherent 3D mental image of the heart. In EchoCom2 the trainee can interactively explore the 3D heart model and the registered 3D echocardiographic data sets by the animated ultrasound sector, whose position is controlled by an electromagnetic orientation and position system (EPOS). The data from the EPOS are used to calculate the echocardiographic images that are analogue to the position of the animated ultrasound sector. EchoCom2 is also used to support the interpretation of 3D echocardiographic data sets. The analysis of 3D echocardiographic data has to be done during a post processing. Defining the exact position of a cutting plane within the volume is difficult due to the lack of a standardized representation, the independence of the cutting plane of any transducer position and the possibility to calculate an indefinite number of views. The simultaneous representation of the current cutting plane both in the volume data, and in the heart model enables the examiner ad hoc to recognize it's position and the visualized structures.

Computer Simulation↗
PubMed2002

A score card for upper GI endoscopy: Evaluation of interobserver variability in examiners with various levels of experience.

BACKGROUND: In most European countries, training in GI endoscopy has largely been based on hands-on acquisition of experience in patients rather than on a structured training programme. With the development of training models systematic hands-on training in a variety of diagnostic and therapeutic endoscopy techniques was achieved. Little, however, is known about methods of objectively assessing trainees' performance. We therefore developed an assessment 'score card' for upper GI endoscopy and tested it in endoscopists with various levels of experience. The aim of the study was therefore to assess interobserver variations in the evaluation of trainees. METHODS: On the basis of textbook and expert opinions a consensus group of eight experienced endoscopists developed a score card for diagnostic upper GI endoscopy with biopsy. The score card includes an assessment of the single steps of the procedure as well as of the times needed to complete each step. This score card was then evaluated in a further conference including ten experts who blindly assessed videotapes of 15 endoscopists performing upper GI endoscopy in a training bio-simulation model (the 'Erlangen Endo-Trainer'). On the basis of their previous experience (i. e. the number of endoscopies performed) these 15 endoscopists were classified into four groups: very experienced, experienced, having some experience and inexperienced. Interobserver variability (IOV) was tested for the various score card parameters (Kendall's rank-correlation coefficient 0.0-0.5 poor, 0.5-1.0 good agreement). In addition, the correlation between the score card assessment and the examiners' experience levels was analysed. RESULTS: Despite poor IOV results for all the parameters tested (Kendall coefficient < 0.3), the assessment parameters correlated well when the examiners' different experience levels were taken into account (correlation coefficient 0.59-0.89, p < 0.05). The score card parameters were suitable for differentiating between the four groups of examiners with different levels of endoscopic experience. CONCLUSIONS: As expected with scores involving subjective assessment of performance, the variability between reviewers was substantial. Nevertheless, the assessment score was capable of distinguishing reliably between different experience levels in terms of a good individual observer consistency. The score card can therefore be used to document both training status and progress during endoscopy training courses using bio-simulation models, and this might be able to provide improved quality assurance in GI endoscopy training.

Animals↗