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At least 883 records · Page 49Linked to original sources

PubMed2000

Learning from errors in a driving simulation: effects on driving skill and self-confidence.

Two experiments investigated the effect of making errors during training (error training) on a driving simulator versus learning from examples of errors (guided error training) on driving skill and confidence. Experiment 1 indicated that compared with errorless learning (where participants drove through a training run not designed to elicit errors), error training led to significantly better transfer to driving tests that were analogous to those situations encountered in training and more effective use of strategies for coping with a novel driving situation. Error training also reduced self-confidence in driving skill at the end of training relative to errorless learning. Experiment 2 provided weak evidence of the superiority of guided error training over errorless learning (where the driver in the video did not make any errors) on analogous tests, and no evidence of transfer to a novel test. Furthermore, guided error training did not influence self-confidence in driving skill. The potential value of driving simulators in providing active processing during driver training is discussed, along with the effects of passive and active exposure to errors on driver confidence.

Adult↗

PubMed1987

Intrinsic features contributing to spike train patterning in proprioceptive cuneate neurons.

The intrinsic processes contributing to the three discharge patterns of proprioceptive cuneate neurons described by Surmeier and Towe were studied experimentally and with computer simulation. Examination of the alterations in excitability produced by antidromic activation suggested that a prolonged inhibition was a concomitant of discharge in proprioceptive cuneate neurons. Computer simulation was performed to test the possible roles of inhibitory hyperpolarizing processes in governing the observed discharge patterns. These simulations used two constant threshold models. The simplest model linearly integrated synaptic potentials until the spike threshold was reached. After the discharge, synaptic potentials that preceded the spike were ignored (i.e., the model was "reset"). The second model was similar to the first except that following a spike two hyperpolarizing processes were activated and preceding events continued to play a role in membrane potential. Simulation of class A spike trains that possessed positive correlations between nearby intervals was successful only with a resetting model. This suggested that class A neurons have fast, no-memory postspike conductance changes, which effectively shunt synaptic charge. Simulation of class B spike trains was possible with the nonresetting model. At least two periodic inputs, which evoked brief, relatively large EPSPs, were required. In addition, a prominent, fast, spike-dependent hyperpolarization and a small-amplitude, slow hyperpolarization were required. Simulation of class C spike trains was also possible with the nonresetting model. Several periodic inputs were required; one input had to evoke a slow suprathreshold EPSP. In contrast to class B simulations, class C spike train simulation required that a large-amplitude, slow hyperpolarization, as well as a brief hyperpolarization, following spike initiation. The results of class B and C simulations suggested that these two groups differed primarily in the amplitude of a slow, hyperpolarizing, postspike conductance. Some role may also be played by the time course of the driving EPSPs.

Animals↗

PubMed1998

VIRGY: a virtual reality and force feedback based endoscopic surgery simulator.

This paper describes the VIRGY project at the VRAI Group (Virtual Reality and Active Interface), Swiss Federal Institute of Technology (Lausanne, Switzerland). Since 1994, we have been investigating a variety of virtual-reality based methods for simulating laparoscopic surgery procedures. Our goal is to develop an endoscopic surgical training tool which realistically simulates the interactions between one or more surgical instruments and gastrointestinal organs. To support real-time interaction and manipulation between instruments and organs, we have developed several novel graphic simulation techniques. In particular, we are using live video texturing to achieve dynamic effects such as bleeding or vaporization of fatty tissues. Special texture manipulations allows us to generate pulsing objects while minimizing processor load. Additionally, we have created a new surface deformation algorithm which enables real-time deformations under external constraints. Lastly, we have developed a new 3D object definition which allows us to perform operations such as total or partial object cuttings, as well as to selectively render objects with different levels of detail. To provide realistic physical simulation of the forces and torques on surgical instruments encountered during an operation, we have also designed a new haptic device dedicated to endososcopic surgery constraints. We are using special interpolation and extrapolation techniques to integrate our 25 Hz visual simulation with the 300 Hz feedback required for realistic tactile interaction. The fully VIRGY simulator has been tested by surgeons and the quality of both our visual and haptic simulation has been judged sufficient for training basic surgery gestures.

Algorithms↗

PubMed1994

Colposcopy and cervical biopsy educational training models.

BACKGROUND: Realistic simulation models serve meaningful educational purposes. The intent of this article is to review the physical and educational features of three instructional colposcopy models, and to discuss the advantages and implications of the use of models in teaching colposcopic skills. METHODS: Models made from latex, steak, and the bovine cervix were assessed as instructional devices to simulate the uterine cervix and cervical disease. Model construction, preparation, and unique features were critiqued. The models were also evaluated for their potential use in the preclinical teaching of important colposcopic skills. RESULTS: The latex model required minimal assembly but was costly. It was limited in design, which would exclude the training of most colposcopic techniques. The steak model used readily available materials, facilitated colposcopic skill acquisition, and was the least expensive model. The bovine model best simulated human cervical tissue, was intermediate in cost, and enabled teaching a variety of colposcopic procedures. The optional silicone inserts realistically demonstrated the spectrum of cervical disease. CONCLUSIONS: Various cervical biopsy models have different strengths and weaknesses for teaching colposcopic procedural skills. Available models each possess unique features designed to reproduce anatomy, pathology, tissue texture, and technical spatial limitations. The models permit assessment of gynecologic knowledge and psychomotor abilities.

Animals↗

PubMed1984

Three approaches to marital enrichment: toward optimal matching of participants and interventions.

Three approaches to marital enrichment were examined to determine if predictors of client gains could be identified empirically. Direct training of spousal communication skills by one of two male-female co-trainer teams, observation of videotaped simulations of direct training, and bibliotherapy with telephone contacts were the three approaches, and a wait-list control group was also evaluated. Clear predictive relationships emerged between initial indices of marital and family adjustment and prior experience with therapy, and client changes on self-report measures of marital and family adjustment. Different predictors and predictive relationships characterized each of the three different enrichment approaches, and prediction of outcome was more robust for these three trained groups than for the wait-list group. Changes in clients' communication behaviors were not well predicted, leading to the conclusion that attitudinal changes in marital enrichment programs may be facilitated by optimal matching of different clients with the appropriate type of intervention, but that behavior changes are more a function of systematic skills training for all clients.

Adult↗

PubMed2007

[A new model for training in tympanoplasty].

BACKGROUND: Functional simulation of middle ear reconstruction is a valuable tools for training in otosurgery. We introduce a new experimental model which provides a direct acoustic feedback of the functional quality of ossicular chain reconstruction. METHOD: In this model the tympanic membrane and the ossicular chain have to be reconstructed for proper sound transmission to an artificial inner ear receptor. The received signal is converted into acoustic information and consecutively provided via headphone. RESULTS: Any changes in the reconstruction (e. g. tilting the prosthesis) can be experienced online and immediately optimized by the surgeon or a trainee. CONCLUSION: The experimental model can be used for demonstration and training in otosurgery. This model is also suitable for comparing measurements of transfer functions in a calibrated version and can be applied to development and critical evaluation of middle ear prostheses.

Acoustic Stimulation↗

PubMed2005

Dynamic generation of surgery specific simulators -- a feasibility study.

Most of the current surgical simulators rely on preset anatomical virtual environments (VE). The functionality of a simulator is typically fixed to anatomy-based specific tasks. This rigid design principle makes it difficult to reuse an existing simulator for different surgeries. It also makes it difficult to simulate procedures for specific patients, since their anatomical features or anomalies cannot be easily replaced in the VE. In this paper, we demonstrate the reusability of a modular skill-based simulator, LapSkills, which allows dynamic generation of surgery-specific simulations. Task and instrument modules are easily reused from LapSkills and the three-dimensional VE can be replaced with other anatomical models. We build a nephrectomy simulation by reusing the simulated vessels and the clipping and cutting task modules from LapSkills. The VE of the kidney is generated with our anatomical model generation tools and then inserted into the simulation (while preserving the established tasks and evaluation metrics). An important benefit for the created surgery and patient-specific simulations is that reused components remain validated. We plan to use this faster development process to generate a simulation library containing a wide variety of laparoscopic surgical simulations. Incorporating the simulations into surgical training programs will help collect data for validating them.

Computer Simulation↗

PubMed2005

Immersive visualization training of radiotherapy treatment.

External radiation beam treatment of cancer tumours involves delivery of invisible radiation beams through the body where internal structures can not be seen. Beam targeting of patient anatomy has to very accurate to achieve the desired therapeutic result. Good understanding of radiotherapy treatment (RT) concepts is essential to training. This paper presents a virtual environment simulator developed by the authors for training and education of intensity modulated radiotherapy (IMRT) treatment of cancer. This simulator employs immersive visualization to provide a high fidelity spatial awareness of the complex relationships between tumour, organs at risk, treatment beam and radiation dose. All these visualization are provided by a 3D virtual environment based on the patient in a RT treatment room. Immersive visualization using this simulator is being used to train radiation oncologist and radiation physicists about radiotherapy treatment.

Computer Simulation↗

PubMed2003

[Development of a robotic walking simulator for gait rehabilitation].

Restoration of gait is a major concern of rehabilitation after stroke or spinal cord injury. Modern concepts of motor learning favour a task-specific repetitive approach, i.e. "whoever wants to learn to walk again must walk." However, the physical demands this places on the therapist, is a limiting factor in the clinical routine setting. This article describes a robotic walking simulator for gait training that enables wheelchair-bound subjects to freely carry out repetitive practicing of an individually adapted gait pattern under simulation of the manual guidance of an experienced therapist. The technical principle applied makes use of programmable footplates with permanent foot/machine contact in combination with compliance control. The solution chosen comprises a planar parallel-serial hybrid kinematic system with three degrees of freedom that moves the feet in the sagittal plane. Gait analysis while floor walking and stair climbing, clinical practicability and safety aspects were the basis for the design. A variable compliance control enables man-machine interaction, ranging from purely position controlled movement to full compliance during swing phase above a virtual ground profile. In full compliance mode the robotic walking simulator behaves like a haptic device. The concept presented offers new prospects for individualized gait rehabilitation.

Artificial Intelligence↗

PubMed1996

PatSim--simulator for practising anaesthesia and intensive care. Development and observations.

Simulators may be used in training personnel for the situations when consequences of inappropriate action could be dangerous or expensive. Mishaps and accidents in connection with the use of biomedical instrumentation are frequently a result of technical malfunction and improper use of the equipment. In the medical field, however, use of simulators is not very common. This paper reports our experiences of a development project to design the "PatSim' hands-on simulator for training anaesthesia and intensive care personnel. The simulator consists of a manikin positioned on an operation table or in a typical critical care bed. The manikin, which is controlled by a standard personal computer (PC), can be ventilated by an anaesthesia machine or a ventilator, intravenous pumps can also be connected. Any standard electrodes and transducers can be used to pick up parameters, like ECG, invasive and non-invasive blood pressure, airway pressure and CO2. Data can be displayed on any monitor or workstation. There is no need for modification or special adaptation of the medical equipment used in the simulation scenario. The manikin is capable of spontaneous breathing. Controlled from the PC, different clinical signs can be developed. In addition, typical clinical symptoms can be created during the simulated treatment period. They include laryngospasm, change of lung compliance or airway resistance, pneumothorax, leakage of the intubation tube cuff, blocking of the breathing sounds from one lung, secretion, gastric regurgitation and diuresis. During a simulation session, the trainee should be exposed to a lifelike situation. Hence, we place the manikin in a room that resembles either intensive care or operating room environment.

Algorithms↗

PubMed2005

Simulators in surgery.

The introduction of minimally invasive surgery has demonstrated the need for training surgical skills outside the operating room using animal models or simulators. As laparoscopic surgery involves displaying images on a screen, virtual reality simulation of the surgical tasks is feasible. Different types of simulators have become available. The existing trainers can be divided into three groups: mechanical, hybrid, and virtual reality. This article aims at giving an overview of the different simulators available and the potential of simulators in the education of surgeons with focus on virtual reality simulators. All simulators aim at training psychomotoric skills and some simulators also allow training in decision-making and anatomical orientation. In the future virtual reality simulators may become a tool for training and validation of surgical skills and monitoring the training progress.

Journal Article↗

PubMed2003

Design and testing of a virtual environment to train stroke patients with unilateral spatial neglect to cross a street safely.

Virtual reality (VR) entails the use of advanced technologies, including computers and various multimedia peripherals, to produce a simulated (that is, virtual) environment that users perceive as comparable to real world objects and events. In recent years, virtual reality technologies have begun to be used as an assessment and treatment tool in occupational therapy, in part because of the ability to create environments that provide patients with opportunities to engage in meaningful, purposeful tasks that are related to real-life interests and activities. The objective of this study was to determine the suitability and feasibility of using a PC-based, non-immersive, VR system (that is, a system in which the user has a reduced sense of actual presence in and control over the simulated environment) for training individuals with unilateral spatial neglect to cross streets in a safe and vigilant manner. A virtual environment, consisting of a typical city street, was programmed using Superscape's 3D-Webmaster, a 3D web-authoring tool. Twelve subjects, aged 55 to 75 years, participated in the initial feasibility study and, to date, a further eight subjects have participated in the intervention study. Six of the initial subjects and all eight of the intervention subjects had sustained a right hemispheric stroke at least 6 weeks prior to the study. The remaining subjects were healthy age-matched adults who were independently mobile and had no difficulty in crossing streets. The results show that this virtual environment was suitable in both its cognitive and motor demands for the targeted population and indicate that the virtual reality training is likely to prove beneficial to people who have difficulty with crossing streets. The generalizability of these results, and recommendations regarding the use of virtual reality as an occupational therapy intervention, must be substantiated by further studies using a range of VR platforms with people with different cognitive and motor disabilities.

Accidents, Traffic↗

PubMed2006

The Israel Center for Medical Simulation: a paradigm for cultural change in medical education.

Simulation-based medical education (SBME) is a rapidly growing field, as is illustrated by the increased development of simulation centers worldwide. SBME is becoming a powerful force in addressing the need to increase patient safety through quality-care training. Recognizing the benefits of SBME, increasing numbers of bodies involved in medical and health care education and training are establishing simulation centers worldwide. The general model of most facilities focuses on a single simulation modality or a specific branch of medicine or health care, limiting their overall impact on patient safety and quality of care across the health care systems. MSR, the Israel Center for Medical Simulation, is a comprehensive, national, multimodality, multidisciplinary medical simulation center dedicated to enhancing hands-on medical education, performance assessment, patient safety, and quality of care by improving clinical and communication skills. The center uses an "error-driven" educational approach, which recognizes that errors provide an opportunity to create a unique beneficial learning experience. The authors present the Israeli experience as an alternative model, and describe the impact of the MSR model on the Israeli medical community during four years of activity. They also describe the opportunities this model has opened towards changing the culture of medical education and patient safety within Israel Although this model may require modification when implemented in other medical systems, it highlights important lessons regarding the power of SBME in triggering and bringing about cultural changes in traditional medical education.

Computer Simulation↗

PubMed1985

Beyond lecture and laboratory in the physical therapy classroom.

The purpose of this paper is to describe how two teaching models, the Inquiry Training Model and the Simulation Model, have been adapted for use in the physical therapy classroom. To help students synthesize the various physical therapy skills they were learning, variations of the Inquiry Training Model and the Simulation Model were used in addition to standard lectures and laboratories to teach the Evaluation Unit to junior level physical therapy students. The feedback obtained at the end of each class from both students and faculty members indicated that the learning experiences were considered both helpful and fun. This article summarizes the important components of the Inquiry Training Model and the Simulation Model. I recommend learning experiences based on these models to augment lecture and laboratory classes.

Feedback↗

PubMed2006

Construct validation of a novel hybrid surgical simulator.

BACKGROUND: Simulated minimal access surgery has improved recently as both a learning and assessment tool. The construct validation of a novel simulator, ProMis, is described for use by residents in training. METHODS: ProMis is a surgical simulator that can design tasks in both virtual and actual reality. A pilot group of surgical residents ranging from novice to expert completed three standardized tasks: orientation, dissection, and basic suturing. The tasks were tested for construct validity. Two experienced surgeons examined the recorded tasks in a blinded fashion using an objective structured assessment of technical skills format (OSATS: task-specific checklist and global rating score) as well as metrics delivered by the simulator. RESULTS: The findings showed excellent interrater reliability (Cronbach's alpha of 0.88 for the checklist and 0.93 for the global rating). The median scores in the experience groups were statistically different in both the global rating and the task-specific checklists (p < 0.05). The scores for the orientation task alone did not reach significance (p = 0.1), suggesting that modification is required before ProMis could be used in isolation as an assessment tool. CONCLUSIONS: The three simulated tasks in combination are construct valid for differentiating experience levels among surgeons in training. This hybrid simulator has potential added benefits of marrying the virtual with actual, and of combining simple box traits and advanced virtual reality simulation.

Computer Simulation↗

PubMed2004

Intraosseous vascular access in the treatment of chemical warfare casualties assessed by advanced simulation: proposed alteration of treatment protocol.

UNLABELLED: Current treatment protocols for chemical warfare casualties assume no IV access during the early treatment stages. Time constraints in mass casualty scenarios, impaired manual dexterity of medical personnel wearing protective gear, and victims' complex clinical presentations render standard IV access techniques impractical. A newly developed spring-driven, trigger-operated intraosseous infusion device may offer an effective solution. Sophisticated simulators were developed and used to mimic scenarios of chemical warfare casualties for assessing the feasibility of intraosseous infusion delivery. We evaluated the clinical performance of medical teams in full protective gear. The success rate in intraosseous insertion, time to completion of treatment goals, and outcome were measured in a simulated setting. Medical teams from major hospitals in Israel, designated for emergency response in a real chemical warfare mass casualty scenario, were trained in a simulated setting. All 94 participating physicians were supplied with conventional treatment modalities: only the 64 study group physicians received intraosseous devices. The simulated survival rate was 73.4% for the study group and 3.3% for the controls (P < 0.001). Treatment goals were achieved within 3.5 min (range, 1-9 min) in the study group and within >10 min for controls (P < 0.001), and the complication rate for intraosseous use was 13.8%. Personnel satisfaction with the intraosseous device was unanimous and high. New-generation intraosseous infusions have great potential value in the early treatment stages of chemical warfare casualties. IMPLICATIONS: In a chemical warfare mass casualty scenario, the protective gear worn by medical personnel, the time constraints, and the casualties' medical condition impose limitations on the establishment of IV access during early treatment of the victims. A spring-driven, trigger-operated intraosseous infusion delivery system may offer an effective solution.

Chemical Warfare↗

PubMed2005

A theoretical study of taper characteristics to optimize performance.

PURPOSE: The aim of this study was to examine the training factors that could affect taper efficiency. The analysis was done using simulations from a nonlinear model of the training effects on performance giving an individual optimal daily training (ODT). METHODS: Training responses were simulated using data from six subjects obtained in a previous training experiment (15-wk program including 3 wk without training). Assuming first a steady state with training equal to ODT, the taper was simulated with various step training reductions up to 100% of previous training. Overload period (OT) was then featured by a 20% step increase in training during 28 d before the taper. Finally, a taper with step reduction was compared with progressive reduction. RESULTS: The taper allowed performance gains if training was higher than a minimal level. The best performance without OT preceding the taper was reached with a load reduction of 30.8 +/- 11.8% and a duration of 19.3 +/- 2.3 d. The best performance with OT preceding the taper was significantly higher than without OT (P < 0.02) and was obtained with a significantly greater load reduction and duration, 39.3 +/- 9.9% and 28.0 +/- 5.1 d respectively. The best performance with a progressive load reduction was significantly higher than with a step reduction only with OT before the taper (102.2 +/- 1.7 vs 101.8 +/- 1.5% of performance with ODT, P < 0.005). CONCLUSION: Greater training volume and/or intensity before the taper would allow higher performance gains, but would demand a greater reduction of the training load over a longer period. The results also pointed out the importance of training adaptations during the taper, in addition to fatigue dissipation.

Adaptation, Physiological↗

PubMed2003

A direct comparison of ERCP teaching models.

BACKGROUND: Several teaching models for ERCP are now available. Live, anesthetized porcine models have been used for many years, but harvested porcine organ preparations have recently been developed, and computer-based endoscopy simulators now incorporate ERCP modules. Each has proven to be a useful educational modality, but there is no direct comparison among these models. This study compared the performance of these 3 ERCP teaching models. METHODS: Twenty endoscopists used each ERCP training model (computer simulator, harvested porcine organ, live anesthetized pig) and then completed a survey grading the realism and performance of each model compared with performance of ERCP in patients. A rank order was established for the models relative to their realism, educational utility, ease of use, and ease of incorporation into a training program. RESULTS: The harvested porcine organ model scored highest on indices of realism, usefulness, and performance, although this reached statistical significance only for "ease of use" (p < 0.05). Conversely, the computer simulator scored significantly lower in most realism scores, although it was felt to be the one model most easily incorporated into a training program. CONCLUSIONS: Although each ERCP teaching model has proven to be a useful training modality, the harvested porcine organ model was felt to be the most realistic as well as the most favorable model for instruction in both basic and advanced ERCP.

Adult↗