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At least 1,081 records · Page 60Linked to original sources
PubMed2000

Time for a new paradigm in pediatric medical education: teaching neonatal resuscitation in a simulated delivery room environment.

OBJECTIVES: Acquisition and maintenance of the skills necessary for successful resuscitation of the neonate are typically accomplished by a combination of completion of standardized training courses using textbooks, videotape, and manikins together with active participation in the resuscitation of human neonates in the real delivery room. We developed a simulation-based training program in neonatal resuscitation (NeoSim) to bridge the gap between textbook and real life and to assess trainee satisfaction with the elements of this program. METHODS: Thirty-eight subjects (physicians and nurses) participated in 1 of 9 full-day NeoSim programs combining didactic instruction with active, hands-on participation in intensive scenarios involving life-like neonatal and maternal manikins and real medical equipment. Subjects were asked to complete an extensive evaluation of all elements of the program on its conclusion. RESULTS: The subjects expressed high levels of satisfaction with nearly all aspects of this novel program. Responses to open-ended questions were especially enthusiastic in describing the realistic nature of simulation-based training. The major limitation of the program was the lack of fidelity of the neonatal manikin to a human neonate. CONCLUSION: Realistic simulation-based training in neonatal resuscitation is possible using current technology, is well received by trainees, and offers benefits not inherent in traditional paradigms of medical education.

Delivery Rooms↗
PubMed2006

A randomized, controlled, prospective study validating the acquisition of percutaneous renal collecting system access skills using a computer based hybrid virtual reality surgical simulator: phase I.

PURPOSE: The need to develop new methods of surgical training combined with advances in computing has led to the development of sophisticated virtual reality surgical simulators. The PERC Mentortrade mark is designed to train the user in percutaneous renal collecting system access puncture. We evaluated and established face, content and construct validation of the simulator in this task. MATERIALS AND METHODS: A total of 63 trainees underwent baseline testing on the simulator, consisting of percutaneous renal puncture followed by the introduction of a guidewire into the collecting system. Subjects were then randomized to an intervention arm, in which they underwent 2, 30-minute training sessions on the simulator, and a control arm, in which no further training was given, followed by repeat testing. Performance was assessed using a global rating scale and by virtual reality derived parameters. RESULTS: There were no significant differences between the 2 groups with respect to baseline measures. Subjects who underwent training with the simulator demonstrated significant improvement in objective and subjective parameters compared to their baseline performance and compared to the untrained control group. Spearman rank correlations demonstrated a significant relationship between multiple parameters of the objective and subjective data. CONCLUSIONS: Training on the simulator improves virtual reality skills. It may allow trainees to develop the basic skills necessary to perform percutaneous renal collecting system access. Face and content validity were demonstrated and construct validity was supported by establishing convergent validity.

Computer Simulation↗
PubMed1981

Evaluation and training of medication adherence counselors in a clinical trial: application of a skill inventory to video-recorded interviews.

This report describes the procedures and feasibility of an integrated evaluation and training program developed at the Baylor-Methodist Lipid Research Clinic to examine the skills used by the clinic's professional staff in conducting medication adherence interviews with participants in the Coronary Primary Prevention Trial (CPPT). The specific aims of this project were to evaluate the staff's interviewing and counseling skills, identify strengths and deficits, provide needed training, and reexamine the staff's skills following this training. Each of five staff members conducted two 20-minute video-recorded interviews with two different simulated CPPT participants. A trained observer reviewed the video-recordings and evaluated, by an Inventory for Interviewing and Counseling Skills for Adherence to Medication (IICS-AM), each staff member's possession and frequency of use of 17 interviewing skills and 10 counseling skills. The 27 skills on the IICS-AM were selected from the literature as being most frequently recommended for effective interviewing and counseling for medication adherence. These rating data were used to design a 14-week training program to acquire and promote the use of these skills. Following training, the video-recorded interview procedure was repeated and the data analyzed to identify the effects of the training program. The integrated evaluation and training procedures used in this project offer a practical, objective method for examining, improving, and monitoring the skills of the adherence counseling staff in a clinic participating in a multicenter clinical trial.

Audiovisual Aids↗
PubMed1988

Programs and prospects in aircrew performance measurement.

This article provides a historical perspective on research in the area of aircrew performance measurement within AFHRL. The development efforts within the Division are traced, beginning with some of the early work using the T-37 Advanced Simulator for Undergraduate Pilot Training and its later transition to the A-10 and F-16. The attempt to develop a C-5 performance measurement capability for use in operational training is also presented. Current efforts include the development of a measurement test bed facility for the Simulator for Air-to-Air Combat and the Air Combat Maneuvering instrumentation and the extension of such work into the low-level surface attack domain. Future development of the Air Combat Assessment and the Debriefing System is presented.

Aviation↗
PubMed2002

Evaluation of the educational effectiveness of a virtual reality intravenous insertion simulator.

OBJECTIVE: To evaluate construct and content validity as well as learners' perceptions of CathSim, a virtual reality intravenous (IV) insertion simulator. METHODS: A prospective cohort study design was employed to determine construct validity, and a participant survey was used to ascertain content validity as well as user perceptions of CathSim. Forty-one attendings, residents, and medical students in emergency medicine and anesthesia attempted five simulated IV insertions on CathSim. Subject performances were scored by the computer, and subject perceptions of the simulator were measured using a Likert scale questionnaire (1 = worst rating; 5 = best rating). The subjects were divided into three groups (novices, intermediates, and experts) based on previous IV experience. To determine construct validity, performances of the three groups were compared using one-way analysis of variance (ANOVA). To determine content validity, the experts' perceptions of the simulator's realism and usefulness were assessed. Study subjects' perceptions of the simulator's ease of use and overall appeal were analyzed. RESULTS: The experts scored better than the others in five of nine scoring parameters (p < 0.05). The experts rated the realism of CathSim's four major simulation components at 3.85, 3.46, 3.69, and 3.46; the overall realism of CathSim at 2.93; and its utility for medical student training at 4.57. The simulator's ease of use was rated at 2.34 by all subjects. Novices reported a score of 4.59 regarding their likelihood to use the simulator. CONCLUSIONS: CathSim demonstrated construct validity in five of nine internal scoring parameters and was judged to be adequately realistic and highly useful for medical student training. Despite being difficult to learn to use, it remained appealing to the users, especially the novices.

Adult↗
PubMed2002

[Effects of simulated weightlessness on EEG frequency fluctuation characteristics].

Objective. To develop a method of EEG monitoring under special environment, which is of value for astronauts selection and training. Method. Weightlessness was simulated by means of -6 degrees head down bed rest (HDBR). Rest EEG was recorded in 12 male subjects (aged 18-22) with eyes-closed and then analyzed by means of EEG frequency-fluctuation analysis system. Result. Before HDBR, the dominant order at parietal and occiput was 10, 9, 11 Hz; At frontal and temporal regions 9 Hz competed with 10 Hz for the main dominant component, while the third was 7 Hz. During HDBR, reversible changes of position and interrelation between 7, 8, 9, 10, 11 and 12 Hz appeared, and the frequency components and their regions involved spread gradually. The probability of 7 Hz and 8 Hz dominance increased, while 10 Hz and 11 Hz dominance decreased. At parietal, occiput and post-temporal regions, 9 Hz competed with 10 Hz for the main dominant component, the third was 7 Hz. At frontal and pre-temporal regions, 9 Hz occupied the main dominant position, while the second was 7 Hz (at right-frontal regions, it even occupied the main dominant position), the third was 10 Hz. Conclusion. Simulated weightlessness cause change of EEG dominant-frequency fluctuation competitive structure significantly. Brain adaptation function decrease, and headache can be easily induced. There exists a potential influence on brain function.

Adolescent↗
PubMed2006

Validation of a computer-based bronchoscopy simulator developed in Taiwan.

BACKGROUND/PURPOSE: Conventional training in bronchoscopy may increase patient's discomfort and procedure-related morbidity. Computer-based bronchoscopy simulator (CBBS) permits the acquisition and evaluation of the necessary skills through a realistic bronchoscopic experience. This study was conducted to validate the use of a CBBS system developed in Taiwan as a learning and assessment tool. METHODS: Twenty novice bronchoscopists and 10 expert bronchoscopists were enrolled as subjects in this prospective study. The 20 novice bronchoscopists were randomized into two groups, which received conventional bronchoscopic training or CBBS training and then completed a satisfaction survey. Subsequently, the novices who received CBBS training underwent an observational performance trial and the results were compared with those of expert bronchoscopists. All 10 expert bronchoscopists completed a realism survey and observational trial after CBBS performance. RESULTS: The satisfaction survey showed that the CBBS training program significantly increased participants' satisfaction (p = 0.002) and interest in learning (p < 0.001). The realism survey by the 10 expert bronchoscopists indicated that CBBS provides a favorable degree of realism with regard to the mechanical and visual parameters examined. Analysis of the performance results showed that the following parameters were capable of differentiating the participants by level of expertise: total procedure time (p = 0.002), percentage of bronchial segments entered (p = 0.012), percentage of bronchial segments identified (p < 0.001), percentage of repeated bronchial segments entered (p = 0.004), percentage of pathologies identified (p < 0.001), number of times that the bronchoscope tip collided with airway walls (p = 0.013), and number of times oral instruction was needed (p = 0.01). CONCLUSION: CBBS is a valid training method that increases interest in learning and provides a favorable degree of virtual realism. It can also distinguish various levels of competence at actual bronchoscopy and may have a useful role in the bronchoscopic training curriculum.

Bronchoscopy↗
PubMed2002

Colonoscopy curriculum development and performance-based assessment criteria on a computer-based endoscopy simulator.

OBJECTIVE: Computer-based colonoscopy simulators (CBCS) have been developed and are being introduced into the training environment. The ability of these simulators to replicate the dimensions of patient-based diagnostic colonoscopy is good. However, the benefit of simulators to either learners or their patients has not yet been established. We describe a process by which a CBCS curriculum and CBCS-based performance criteria were established for first-year gastroenterology fellows at the Mayo Clinic in Rochester, Minnesota. DESCRIPTION: We used a commercially available CBCS (AccuTouch Endoscopy Simulator, Immersion Medical, Gaithersburg, MD), which consists of a specialized colonoscope that is inserted into a computer-based module with a screen showing the colonic lumen of a virtual patient. A tutorial and six cases of varying complexity are available on the CBCS. Performance variables that are measured by the simulator include the time to complete the procedure, the distance that the scope was advanced, the degree to which the mucosa was adequately visualized, the possible complications such as colonic perforation, and the level of pain experienced by the simulated patient. To begin, we established ideal performance standards by measuring the above variables for ten "expert" faculty colonscopists who completed two cases on the CBCS. Next, we measured CBCS performance standards for five partially trained colonoscopists. Finally, two non-physician gastrointestinal assistants, without prior endoscopic training, were asked to practice on the simulator to determine the time and procedure frequency required to improve their CBCS proficiency. By calculating average performance standards within each of these three groups, we were able to estimate the number of CBCS cases and minimal performance standards for new trainees. Based on the learning curves for novice colonoscopists as well as the performances of partially trained and expert colonoscopists, we speculated that if CBCS training were to be beneficial, the benefit would most likely occur at the early stages of training. The curriculum we developed consists of viewing a one-hour, multimedia tutorial, which describes the procedure and various colonoscopy techniques. This is followed by nine hours of hands-on CBCS experience, during which time the trainee will complete approximately 25 CBCS colonoscopies. Before advancing to live-patient colonoscopies, the trainee must meet certain performance standards on specific CBCS cases. These standards include the ability to view the entire colon in less than 15 minutes with minimal pain and no complications. DISCUSSION: If effective, this new colonoscopy training curriculum should result in improved competency at patient-based colonoscopy, particularly in the early stages of training. To address this question, first-year gastroenterology fellows at Mayo Clinic have been randomized into two groups: (1) a group that experiences a tutorial with hands-on CBCS curriculum and (2) a group that experiences a tutorial only. Their performances at patient-based colonoscopy as well as surveys of patient satisfaction will be measured and analyzed to determine what, if any, benefit is provided by CBCS.

Clinical Competence↗
PubMed2006

Virtual reality techniques. Application to anatomic visualization and orthopaedics training.

Surgical training systems using virtual reality simulation techniques offer a cost-effective alternative to traditional training methods. In this sense, techniques for interactive visualization and virtual reality surgery have been one of the very important research areas. We describe various techniques we have used in developing a virtual reality system for anatomic visualization and training arthroscopic knee surgeons. Virtual models used in our systems are constructed from the Visible Human Project and Chinese Visible Human data sets. We present our various developments in segmentation, personal-computer-based real-time volume visualization, soft tissue deformation with topological change in real-time using finite element analysis, and soft tissue cutting with tactile feedback.

Arthroscopy↗
PubMed2005

Improving model robustness with bootstrapping -- application to optimal discriminant analysis for ordinal responses (ODAO).

OBJECTIVE: Recent results published by Coste et al. in discriminant analysis with ordinal responses showed the superiority of optimal discriminating analysis for ordinal responses (ODAO) both in terms of classification and simplicity of implementation compared to classic methods (Fisher's discrimination, logistic regression) applied to medical data (prognostics of burns) and to simulated data. Nevertheless, the solutions obtained by ODAO may be sensitive to re-sampling (i.e the estimated coefficients by ODAO may show excessive sensitivity to the training sample). This study proposes some solutions to control the fluctuations of sampling and to ensure model stability. METHODS: We used intensive computational methods and bootstrapping, at the outset of model building in order to reduce the sampling variability of estimated coefficients. Thus, the estimation of the coefficients was not based on the minimization of a classification criterion of the training sample, but on the minimization of an aggregate criterion of bootstrapped replications of a classification criterion. Five aggregate criteria were studied. RESULTS: The improvement in terms of robustness appeared in 30% of the test cases with moderate training sample size and 55% of those with small training sample size. CONCLUSION: Simulated test cases showed that bootstrapping can help construct more robust models in difficult classification situations and small training samples which are particularly frequent.

Burns↗
PubMed1998

Conditioned visual flight orientation in Drosophila melanogaster abolished by benzaldehyde.

To study learning and memory of Drosophila melanogaster in the flight simulator, single flies are trained in an operant conditioning paradigm to avoid a course towards visual objects that are associated with heat. The results demonstrate that normal flies (wild-type "Berlin") can quickly learn to avoid the heat-associated objects and retain the memory. This allows us to further explore a recently communicated long-term effect of preimaginal benzaldehyde (BAL) influence on the association of visual objects with the aversive odor of BAL. Here we show that flies, exposed to BAL in the embryonic, larval or adult stage, do not accompany by a similar indifference to heat shocks. The flies are successfully trained to avoid the heat-associated visual patterns. It shows that the learning acquisition is not affected during the operant conditioning in the flight simulator. Neither object perception nor object discrimination is altered after exposure to BAL, as is shown by Fourier analysis. However, the test results after training show that exposure to BAL interferes directly with memory formation in Drosophila. It takes at least two generations of growth on the noncontaminated medium that the strain recovers fully from BAL-induced amnesia. The BAL treatment seems not only to affect the associative memory formation, but in addition the flies' development in general, as is indicated by prolonged developmental time. However, the impaired memory after BAL treatment in different stages seems to have nothing to do with an influence of BAL on the cAMP-level.

Adaptation, Physiological↗
PubMed2007

Physicians are different when they learn communication skills: influence of the locus of control.

PURPOSE: Although it is widely recognised that educational interventions may be more effective for people with an 'internal' Locus of Control (who believe that life outcomes are controlled by their own characteristics or actions) compared to people with an 'external' Locus of Control (who believe that life outcomes are controlled by external forces such as luck, fate or others), no study has yet assessed the influence of physicians' Locus of Control (LOC) on communication skills learning. This study aims to test the hypothesis that, in a communication skills training program, physicians with an 'internal' LOC would demonstrate communication skills acquisition to a greater degree than those with an 'external' LOC. METHODS: A non-randomised longitudinal intervention study was conducted between January 1999 and April 2001. Sixty-seven volunteer physicians from private and institutional practice in Belgium participated in a learner-centred, skills-focused, practice-oriented communication skills training program. Communication skills changes were assessed in 2 standardised simulated interviews before and after training (one two-person and one three-person interview). Communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills changes of the upper and lower third of physicians in respect of their scores on this scale were compared using group by time repeated measures of variance. RESULTS: In the two-person and three-person interviews, changes in the use of open directive questions were more important among physicians with an "internal" LOC compared with changes observed among physicians with an 'external' LOC (P=0.066 and P=0.004, respectively). In the three-person interview, changes in the use of directive questions, assessing functions and moderate feelings stated explicitly were more important among physicians with an 'internal' LOC compared with changes observed among physicians with an 'external' LOC (P= 0.001; P=0.002 and P=0.011 respectively). CONCLUSION: This study shows that physicians' LOC is a psychological characteristic that could influence the efficacy of a communication skills training program. This evidence supports the idea that a psychological characteristic such as 'internal' LOC may facilitate communication skills acquisition through physicians' belief that communication with patients may be controlled by physicians themselves.

Adult↗
PubMed2001

An analysis of neural receptive field plasticity by point process adaptive filtering.

Neural receptive fields are plastic: with experience, neurons in many brain regions change their spiking responses to relevant stimuli. Analysis of receptive field plasticity from experimental measurements is crucial for understanding how neural systems adapt their representations of relevant biological information. Current analysis methods using histogram estimates of spike rate functions in nonoverlapping temporal windows do not track the evolution of receptive field plasticity on a fine time scale. Adaptive signal processing is an established engineering paradigm for estimating time-varying system parameters from experimental measurements. We present an adaptive filter algorithm for tracking neural receptive field plasticity based on point process models of spike train activity. We derive an instantaneous steepest descent algorithm by using as the criterion function the instantaneous log likelihood of a point process spike train model. We apply the point process adaptive filter algorithm in a study of spatial (place) receptive field properties of simulated and actual spike train data from rat CA1 hippocampal neurons. A stability analysis of the algorithm is sketched in the. The adaptive algorithm can update the place field parameter estimates on a millisecond time scale. It reliably tracked the migration, changes in scale, and changes in maximum firing rate characteristic of hippocampal place fields in a rat running on a linear track. Point process adaptive filtering offers an analytic method for studying the dynamics of neural receptive fields.

Adaptation, Physiological↗
PubMed2003

Learning together: use of simulated patients with nursing and medical students for breaking bad news.

This article reports a small research study on the use of simulated patients for teaching medical and nursing students how to break bad news. A total of 34 nursing and medical students undertook the activity in mixed groups. Data obtained from free response questionnaires and a focus group were analysed and independently coded to identify recurrent themes across the data and the two student groups. Students reported that simulated patients gave instant feedback about their performance which they found useful. Students felt that working in doctor-nurse pairs helped them formulate strategies for imparting the bad news and that this made them feel better prepared and less isolated. The article outlines why the use of simulated patients may be valuable and suggests that this form of teaching could be used in other types of communications training. The use of simulated patients appears to have the potential to enhance patient-practitioner and practitioner-practitioner interactions.

Attitude of Health Personnel↗
PubMed2005

Emphatic, interactive volume rendering to support variance in user expertise.

Various levels of representation, from abstract to schematic to realistic, have been exploited for millennia to facilitate the transfer of information from one individual to another. Learning complex information, such as that found in biomedicine, proves specifically problematic to many, and requires incremental, step-wise depictions of the information to clarify structural, functional, and procedural relationships.Emerging volume-rendering technique, such as non-photorealistic representation, coupled with advances in computational speeds, especially new graphical processing units, provide unique capabilities to explore the use of various levels of representation in interactive sessions. We have developed a system that produces images that simulate pictorial representations for both scientific and biomedical visualization. The system combines traditional and novel volume illustration techniques. We present examples from our efforts to distill representational techniques for both creative exploration and emphatic presentation for clarity. More specifically, we present our efforts to adapt these techniques for interactive simulation sessions being developed in a concurrent project for resident training in temporal bone dissection simulation. The goal of this effort is to evaluate the use of emphatic rendering to guide the user in an interactive session and to facilitate the learning of complex biomedical information, including structural, functional, and procedural information.

Computational Biology↗
PubMed1998

Training students in education of the hypertensive patient: enhanced performance after a simulated patient instructor (SPI)-based exercise.

The process whereby a physician explains to the ill patient what has gone wrong and what can be done about it can be taught and evaluated by simulated patients (SPIs). This study was designed to determine whether a training experience in educating a diabetic SPI improves subsequent performance with a hypertensive SPI. Competence in educating a hypertensive SPI by students who had no prior training experience (n = 26) was compared to that of an experimental group (n = 20) that had a prior training session. Performance was assessed with a counseling skills scale and a case-specific content checklist (1 = poor to 5 = excellent). Students in the experimental group performed better than controls in both counseling skills (4.46 v 3.86, P < .01) and completeness of coverage of content (3.28 v 2.65, P < .01). Students in both groups focused more on clinical features and treatment than on laboratory testing and follow-up. The ability to counsel "patients" with hypertension can be enhanced by a prior learning experience with a diabetic SPI. Clinical application of knowledge about hypertension can be assessed by SPIs.

Adult↗
PubMed2006

A competency-based virtual reality training curriculum for the acquisition of laparoscopic psychomotor skill.

BACKGROUND: Studies have demonstrated the beneficial effect of training novice laparoscopic surgeons using virtual reality (VR) simulators, although there is still no consensus regarding an optimal VR training curriculum. This study aims to establish and validate a structured VR curriculum to provide an evidence-based approach for laparoscopic training programmes. METHODS: The minimally invasive VR simulator (MIST-VR) has 12 abstract laparoscopic tasks, each at 3 graduated levels of difficulty (easy, medium, and hard). Twenty medical students completed 2 sessions of all tasks at the easy level, 10 sessions at the medium level, and finally 5 sessions of the 2 most complex tasks at the hard level. At the medium level, subjects were randomized into 2 equal groups performing either all 12 tasks (group A) or the 2 most complex tasks (group B). Performance was measured by time taken, path length, and errors for each hand. The results were compared between groups, and to those of 10 experienced laparoscopic surgeons. RESULTS: Baseline performance of both groups was similar at the easy level. At the medium level, learning curves for all 3 parameters reached plateau at the second (group A, P < .05) and sixth (group B, P < .05) repetitions. Performance at the hard level was similar between the 2 groups, and all achieved the pre-set expert criteria. CONCLUSION: A graduated laparoscopic training curriculum enables trainees to familiarise, train and be assessed on laparoscopic VR simulators. This study can aid the incorporation of VR simulation into established surgical training programmes.

Adolescent↗