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PubMed1995

Effects of auditory radio interference on a fine, continuous, open motor skill.

The effects of human speech on a fine, continuous, and open motor skill were examined. A tape of auditory human radio traffic was injected into a tank gunnery simulator during each training session for 4 wk. of training for 3 hr. a week. The dependent variables were identification time, fire time, kill time, systems errors, and acquisition errors. These were measured by the Unit Conduct Of Fire Trainer (UCOFT). The interference was interjected into the UCOFT Tank Table VIII gunnery test. A Solomon four-group design was used. A 2 x 2 analysis of variance was used to assess whether interference gunnery training resulted in improvements in interference posttest scores. During the first three weeks of training, the interference group committed 106% more systems errors and 75% more acquisition errors than the standard group. The interference training condition was associated with a significant improvement from pre- to posttest of 44% in over-all UCOFT scores; however, when examined on the posttest the standard training did not improve performance significantly over the same period. It was concluded that auditory radio interference degrades performance of this fine, continuous, open motor skill, and interference training appears to abate the effects of this degradation.

Attention↗

PubMed1993

Artificial neural networks as adjuncts for assessing medical students' problem solving performances on computer-based simulations.

Artificial neural networks were trained by supervised learning to recognize the test selection patterns associated with students' successful solutions to seven immunology computer-based simulations. New test selection patterns evaluated by the trained neural network were correctly classified as successful or unsuccessful solutions to the problem > 90% of the time. The examination of the neural networks output weights after each test selection revealed a progressive and selective increase for the relevant problem suggesting that a successful solution is represented by the neural network as the accumulation of relevant tests. Unsuccessful problem solutions were classified by the neural network software into two patterns of students performance. The first pattern was characterized by low neural network output weights for all seven problems reflecting extensive searching and lack of recognition of relevant information. In the second pattern, the output weights from the neural network were biased toward one of the remaining six incorrect problems suggesting that the student misrepresented the current problem as an instance of a previous problem. Finally, neural network analysis could detect cases where the students switched hypotheses during the problem solving exercises.

California↗

PubMed2003

Quantifying expert vs. novice skill in vivo for development of a laryngoscopy simulator.

Many medical procedures require fine motor skills, and these skills are developed over years of practice and through performing hundreds to thousands of procedures. However medical training that is based upon gaining this expertise by performing procedures on patients results in unnecessary risk to the patient. In this project expert medical skill is quantified, so that advanced medical simulators can be created to provide a realistic training environment. This approach is applied to airway intubation with a rigid laryngoscope; a procedure that is performed prior to general anesthesia and during emergency situations. A laryngoscope has been instrumented with a 3 dimensional force/torque sensor, and magnetic position sensors have been placed on the laryngoscope and the patient. Measurements are made in the operating room of both experts and novices as they perform laryngoscopy on consenting patients undergoing general anesthesia. The skill of the laryngoscopist is represented by the motion and force trajectories applied to the laryngoscope during the procedure. Preliminary results show that novices often err in the placement of the tip of the laryngoscope blade. However, when two experts perform laryngoscopy on the same patient, both experts perform key elements of the task consistently. The measured consistency among experts indicates that it will be possible to apply algorithms developed for Human Skill Acquisition, and thereby define regions of expert motion relative to patient anatomy. This is the first step in developing advanced training simulators that will simulate the procedure accurately, provide guidance to the trainee, and can be used for assessment of medical skill.

Clinical Competence↗

PubMed2001

Communication between nurses and simulated patients with cancer: evaluation of a communication training programme.

In this paper the effect of a communication training programme on the instrumental and affective communication skills employed by ward nurses during the admittance interview with recently diagnosed cancer patients was investigated. The training focused on teaching nurses skills to discuss and handle patient emotions. For this purpose, 46 nurses participated in 92 videotaped admittance interviews with simulated patients. The study had a randomized pre-test-post-test design. Multi-level analysis was used to measure the effects of the training. The results revealed that the trained nurses significantly increased asking open-ended psychosocial questions, which indicates that they were actively exploring patients' feelings. Furthermore, the patients showed a significant increase in affective communication. In conclusion, the results of this study demonstrate that, although limited, training can induce favourable changes in the communication skills of nurses, and can even affect patient communication. Future studies should focus on the further evaluation of educational programmes to enhance communication skills.

Journal Article↗

PubMed1995

AANA journal course: update for nurse anesthetists--anesthesia simulation: a tool for learning and research.

High fidelity simulators are a new technology for training and research in anesthesiology. The simulators accurately replicate the anesthetist's entire work environment, including the patient, anesthesia machine, monitors, and drugs. The trainee is allowed to develop and refine his skills in anesthesia management in a safe and realistic environment. By tailoring the scenario, both basic and advanced management skills can be taught. Learners can be exposed to serious or uncommon anesthetic events which they may not otherwise see during their training. Videotaping and case logs provide unbiased recording of the session. Simulators also allow the use of new instructional techniques that are untenable in a real operating room, such as allowing critical incidents to develop fully to teach management skills or redoing cases that were poorly handled. Allowing the student to make critical errors, pausing the simulation to discuss management, or replaying the case with different management techniques are valuable teaching tools. Research studies in human performance, learning and cognition, and anesthesia crisis management training are currently underway and may produce improved training methods for novice and expert anesthesia practitioners alike.

Education, Nursing↗

PubMed2004

Simulators and difficult airway management skills.

Although difficult airway management remains one of the leading factors in anaesthetic deaths, there have been tremendous advances in the field in the last few decades. The question is, are advanced airway management skills being taught and used? Of the numerous training tools available, simulators have the advantages of providing whole-task learning with the potential to change behaviour and, when applied to large groups of trainees, the possibility of achieving standardized application of the safest practices for a range of scenarios limited only by the creativity of the program designers. Partial-task trainers include computer-based software programs and simulators. Full-scale simulators include a variety of products from several manufacturers. To take full advantage of simulators as educational tools, curricula should be designed around a set of educational objectives that address the objectives of learning in all three skill domains (cognitive, psychomotor, and affective). Simulation experiences using partial-task or whole-task trainers should be coupled whenever feasible with a structured clinical experience in airway management. This can best be achieved through a dedicated airway management rotation. Monitored procedure logs may also be used. Whether using a simulator or in a clinical rotation, experiences should be graded, for example, gaining experience in an adult population before gaining experience in paediatrics and in each population mastering airway management skills for common scenarios before advancing to more complicated techniques such as fibreoptic bronchoscopy.

Anesthesiology↗

PubMed1996

An artificial neural network for sound localization using binaural cues.

A three-layer neural network is used to estimate the direction of a sound source from the signals detected by two directional, spatially separate receivers. Although the implemented system does not require any specific knowledge about acoustical parameters or propagation properties, a model of the acoustical environment is used to generate simulated data for training the network. The neural network is trained according to the multiple extended Kalman algorithm (MEKA), which provides fast convergence and does not require intervention for adjustment of the learning parameters. Lower bounds on estimation are computed and compared with simulations using the neural network.

Acoustics↗

PubMed2002

Reliability and validity of Endotower, a virtual reality trainer for angled endoscope navigation.

We hypothesized that a simulator designed to train surgical novices angled laparoscopic navigation would show an improvement in subjects' performance, a high test re-test reliability and high internal validity as measured by standardized coefficient alpha. It was also predicted that simulator performance would be strongly related to objectively assess perceptual and visuospatial ability. EndoTower has good face validity in that it mimics precisely the performance of an angled laparoscope and previous studies suggest construct validity. In this study, EndoTower is shown to be a trainer intended for laparoscopic skill than can test for inherent perceptual and visuospatial ability.

Computer Simulation↗

PubMed2004

Developing a virtual reality application for training nuclear power plant operators: setting up a database containing dose rates in the refuelling plant.

Operators in Nuclear Power Plants can receive high doses during refuelling operations. A training programme for simulating refuelling operations will be useful in reducing the doses received by workers as well as minimising operation time. With this goal in mind, a virtual reality application is developed within the framework of the CIPRES project. The application requires doses, both instantaneous and accumulated, to be displayed at all times during operator training. Therefore, it is necessary to set up a database containing dose rates at every point in the refuelling plant. This database is based on radiological protection surveillance data measured in the plant during refuelling operations. Some interpolation routines have been used to estimate doses through the refuelling plant. Different assumptions have been adopted in order to perform the interpolation and obtain consistent data. In this paper, the procedures developed to set up the dose database for the virtual reality application are presented and analysed.

Computer Simulation↗

PubMed2006

Laparoscopic skills laboratories: current assessment and a call for resident training standards.

BACKGROUND: Numerous protocols for laparoscopic skills training using simulator-based laboratories have proven effective. However, little is known about the availability and uniformity of such facilities. The purpose of this study was to evaluate the prevalence, utilization, and costs of skills laboratories currently in use. METHODS: A survey was mailed to 253 general surgery program directors to determine the perceived value, prevalence, equipment, types of training, supervision, and costs of the labs. RESULTS: One hundred sixty-two (64%) programs completed the survey. Eighty-eight percent of responders consider skills labs effective in improving operating room performance; however, only 55% have skills labs. Of 89 programs with skills labs, 99% have videotrainer equipment (mean 3.8 trainers per lab, range 1 to 15); 46% have virtual reality trainer equipment (mean 1.7 trainers per lab, range 1 to 7). Eighty-two percent of programs teach basic skills using a variety of tasks (Rosser/Southwestern stations, MIST-VR, MISTELS, department-created); 96% teach suturing (intracorporeal, extracorporeal, suture devices). On average, residents train 0.8 hours per week (range 0 to 6). Training is mandatory in 55% and supervised in 73% of the programs. The mean development cost was 133,000 dollars (range 300 dollars to 1,000,000 dollars). CONCLUSIONS: While a large majority of program directors consider skills labs important, 45% of programs have no such facilities. Moreover, significant variability of equipment and training practices exist in currently available labs. Strategies are needed for more widespread implementation of skills labs, and standards should be developed to facilitate uniform adoption of validated curricula that reliably maximize training efficiency and educational benefit.

Clinical Competence↗

PubMed2005

Blood lactate and metabolic responses to controlled frequency breathing during graded swimming.

Controlled frequency breathing (CFB) is a training technique used by swimmers in an effort to simulate high-intensity workloads by limiting oxygen availability to the body and stimulating anaerobic metabolism. During CFB, a swimmer voluntarily restricts breathing, which, theoretically, limits oxygen availability and stimulates anaerobic metabolism. The purpose of this study was to determine the influence of CFB on blood lactate and metabolic responses during graded increases in swimming intensity. A free swimming (FS) protocol was used to determine blood lactate and heart rate (HR) responses to CFB, while a tethered swimming (TS) protocol was used to determine blood lactate, HR, and ventilatory responses to CFB. The subjects swam four 3-minute trials at workloads of 55, 65, 75, and 85% of peak intensity during both protocols. A total of 46 competitive collegiate swimmers participated in the study. Thirty-four subjects (14 men and 20 women) completed the FS protocol, and 12 subjects (7 men and 5 women) completed the TS protocol. CFB reduced ventilation and Vo(2) (p < 0.05) during the TS protocol and reduced HR (p < 0.05) during the FS protocol when compared to normal breathing. However, CFB did not alter blood lactate concentrations for either protocol (p > 0.05). Our findings demonstrate that although CFB does not alter the blood lactate response to graded increases in swimming intensity, it appears to reduce the ventilatory and HR responses to exercise. Thus, swim coaches can use CFB at moderate intensities to simulate high-intensity training but should consider adjusting HR training zones to reflect the reduction in HR associated with reduced ventilation.

Female↗

PubMed2006

A haptics based simulator for laparoscopic pyeloplasty.

We present a methodology for modeling the surgical procedures involved in robotics-assisted Pyeloplasty, which is a minimally invasive surgical procedure for correcting a kidney ureteropelvic junction obstruction. The simulator facilitates surgical training of laparoscopic pyeloplasty by providing both visual and haptic feedback to the trainee.

Canada↗

PubMed2000

The virtual standardized patient. Simulated patient-practitioner dialog for patient interview training.

We describe the Virtual Standardized Patient (VSP) application, having a computerized virtual person who interacts with medical practitioners in much the same way as actors hired to teach and evaluate patient assessment, diagnosis, and interviewing skills. The VSP integrates technologies from two successful research projects conducted at Research Triangle Institute. AVATALK provides natural language processing, emotion and behavior modeling, and composite facial expression and lip-shape modeling for a natural patient-practitioner dialog. Trauma Patient Simulator provides case-based patient history and trauma casualty data, real-time physiological modeling, interactive patient assessment, 3-D scenario simulation, and instructional record-keeping capabilities. The VSP offers training benefits that include enhanced adaptability, availability, and assessment.

Communication↗

PubMed1981

A comparison of behaviour on simulated patients and patient management problems.

This paper describes a study in which students were faced with a series of problems presented as patient management problems and as simulated patients (individuals trained to accurately portray a clinical problem). The subjects were sixty-five final-year medical students in a clinical clerkship in family medicine. Four clinical problems were used--each was developed in the PMP and simulated patient format. Each student completed one PMP and one simulated patient encounter (SPE) during the 2nd week of the 8-week clerkship, and a second PMP and SPE in the 7th week of the clerkship. Performance on the two formats was compared by determining the number of options, and the number of critical options (weighted +1 or +2 by a criterion panel) elicited in each section of the problem--history, physical examination, investigations and management. Students were found to elicit significantly more options in the PMP in all sections of the problem, an increase of from 20 to 150%. This difference due to format was of similar magnitude to the difference between problems and the proportion of observed variance in response due to the differences between formats and cases was consistently greater than the variance due to systematic differences between students. The findings of this study are consistent with previous studies comparing performance on PMPs to oral examinations and medical records, and raise some concern about the use of PMPs as a measure of competence in certification and licensure decisions.

Clinical Competence↗

PubMed2004

[Present and future developments of the virtual surgery and tele-virtual surgery system].

One of the applications available now in the medical field is the virtual surgery system. This system allows surgeons a safe place to master surgical techniques and to plan surgical procedures before the operation. To provide the system for use in a clinical situation, a soft tissue model and a force feedback device suited for the surgery is required. In this paper, we would like to introduce our virtual surgery system, which possesses a soft tissue model that can show accurate, real-time deformation and is equipped with a force feedback device that allows the user to experience the tactile sensations. In addition, we will introduce our tele-virtual surgery simulation system for training in the procedures used in robotic surgery.

Computer Graphics↗

PubMed2005

Simulation of endovascular neurointervention using silicone models: imaging and manipulation.

Silicone models of cerebral aneurysm and stroke pathology were produced by copying the images of clinical cases to evaluate the simulation of endovascular procedures. Conventional silicone models, silicone suture models made from separate aneurysm sac and parent artery sutured together, and animal vascular models made from vessels obtained from pigs were made. The models were incorporated in the training system for simulation of endovascular procedures under digital subtraction angiography control using a portable angiography system. The conventional silicone models provided very close reproduction of the aneurysm and vessels, even the fine branches. However, greater resistance or impact was felt, especially when passing the device through curved vessels. Stroke models were insufficiently dilated by percutaneous transluminal angioplasty or stenting. The silicone suture model was useful to avoid damage to models of giant aneurysm or models with small orifices during the lost wax procedure, whereas the projection of domes was somewhat inaccurate. The animal vascular model could not provide accurate aneurysm shape and vessel diameter, although the feel during manipulation was much more realistic.

Angiography↗

PubMedDate not supplied

[The use of LapSim virtual reality simulator in the evaluation of laparoscopic surgery skill. Preliminary results].

The aim of this study is to establish if the results obtained in the evaluation of the candidates for the laparoscopic surgery competence using the LapSim virtual reality simulator are comparable with intraoperative evaluation. For this study has been evaluated in front of the LapSim and in the operating room a number of 12 surgeons who have achieved the criteria for laparoscopic surgery competence evaluation. The results of any one of the candidates have been evaluated, on Lapsim and by the exam committee in the operation room relating to four criteria: (1) utilization of 300 camera; (2) manipulation and coordination of laparoscopic instruments, suturing; (3) grasping and cutting; (4) clip applying. The evaluation has been made relating to the time need for every candidate to perform the asked task, and the subjective evaluation of the examining committee with marks from 1 to 10. The LapSim evaluation, in concordance with intraoperative evaluation managed to establish 2 candidates with deficiency in manipulation and coordination of laparoscopic instruments, and difficulty in the laparoscopic bidimensional field orientation. We consider this experiment only the beginning in the evaluation of the utility of virtual reality simulator in the training and examination of the results in laparoscopic surgery. We consider that large series of subjects with different levels of knowledge in laparoscopic surgery have to be evaluated to conclude if the benefit of laparoscopic surgery virtual reality simulator is the same as in airplane pilots.

Clinical Competence↗

PubMed2003

Incidence of decompression sickness in hypoxia training with and without 30-min O2 prebreathe.

BACKGROUND: All naval aviators, navigators, and aircrewmen are required to participate in hypoxia familiarization training. This training is performed in a hypobaric chamber and is considered high risk due to the potential for barotrauma and/or decompression sickness (DCS). Prior analysis of the DCS in U.S. Navy hypobaric chambers revealed a significantly higher incidence among inside observers (IOs) compared with students. In response to these reports, all IOs are required to denitrogenate by breathing 100% oxygen for 30 min prior to altitude exposure (prebreathing). Although the Army, Navy, and Air Force prebreathe for 30 min prior to most hypobaric training exposures, there have been no reports validating the efficacy of this measure. This study examined the incidence of altitude DCS during training exposures to simulated altitudes of 25,000 ft (25k) and 35,000 ft (35k) in IOs and students, some of whom prebreathed and some of whom did not. METHODS: Exposures and DCS cases for a period of 9 yr were tabulated from training reports maintained at the Naval Operational Medicine Institute in Pensacola, FL. Chi-square or Fisher's Exact test was used to compare the data sets and p < or = 0.05 was considered significant. RESULTS: The overall DCS incidence for students and IOs for all chamber profiles was 0.25%. The incidence for 25k was 0.29% for students who did not prebreathe and 0.15% for IOs who did (p = 0.10). Within the student group there was a 0.44% DCS incidence for 25k with no prebreathe and a 0.17% DCS incidence for 35k with prebreathe (p = 0.004). CONCLUSIONS: A 30-min prebreathe prior to altitude exposure appears to contribute to a reduction in the risk of DCS during hypobaric chamber training.

Adaptation, Physiological↗