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PubMed2000

Performance implications of leader briefings and team-interaction training for team adaptation to novel environments.

The authors examined how leader briefings and team-interaction training influence team members' knowledge structures concerning processes related to effective performance in both routine and novel environments. Two-hundred thirty-seven undergraduates from a large mid-Atlantic university formed 79 three-member tank platoon teams and participated in a low-fidelity tank simulation. Team-interaction training, leader briefings, and novelty of performance environment were manipulated. Findings indicated that both leader briefings and team-interaction training affected the development of mental models, which in turn positively influenced team communication processes and team performance. Mental models and communication processes predicted performance more strongly in novel than in routine environments. Implications for the role of team-interaction training, leader briefings, and mental models as mechanisms for team adaptation are discussed.

Adult↗

PubMed1996

Effect of breast-tissue characteristics on the outcome of clinical breast examination training.

PURPOSE: To compare the effects of clinical breast examination (CBE) training on lump-detection rates in simulated premenopausal and postmenopausal breast tissue. METHOD: Two sets of six silicone models were made with background breast tissue simulating premenopausal tissue (most nodular, least soft) and postmenopausal breast tissue (least nodular, most soft) respectively. Eighteen lumps were located in each set of models. In September 1994, 82 housestaff and attending physicians with outpatient practices in the Division of General Internal Medicine at Northwestern University Medical School were randomized to a CBE-teaching intervention or a control group. Lump-detection rates for the two sets of models were measured before and after the teaching intervention. Analysis of covariance was used to analyze the effect of CBE training on examination sensitivity and specificity, controlling for baseline rates. RESULTS: CBE training increased lump-detection rates similarly and significantly in models simulating premenopausal and postmenopausal tissue, respectively. Specificity declined after training in models simulating postmenopausal tissue (p = 0.02) but was unchanged in models simulating premenopausal tissue (p = 0.54). CBE training had greater influence on sensitivity among house-staff than among attending physicians (p = 0.02). CONCLUSION: CBE training similarly affects lump detection in simulated premenopausal and postmenopausal breast tissue, but adversely affects specificity in simulated postmenopausal tissue only.

Analysis of Variance↗

PubMed2000

Simulated moderate altitude elevates serum erythropoietin but does not increase reticulocyte production in well-trained runners.

The purpose of this study was to investigate whether the modest increases in serum erythropoietin (sEpo) experienced after brief sojourns at simulated altitude are sufficient to stimulate reticulocyte production. Six well-trained middle-distance runners (HIGH, mean maximum oxygen uptake, VO2max = 70.2 ml x kg(-1) x min(-1) spent 8-11 h per night for 5 nights in a nitrogen house that simulated an altitude of 2650 m. Five squad members (CONTROL, mean VO2max= 68.9 ml x kg(-1) x min(-1) undertook the same training, which was conducted under near-sea-level conditions (600 m altitude), and slept in dormitory-style accommodation also at 600 m altitude. For both groups, this 5-night protocol was undertaken on three occasions, with a 3-night interim between successive exposures. Venous blood samples were measured for sEpo after 1 and 5 nights of hypoxia on each occasion. The percentage of reticulocytes was measured, along with a range of reticulocyte parameters that are sensitive to changes in erythropoiesis. Mean serum erythropoietin levels increased significantly (P < 0.01) above baseline values [mean (SD) 7.9 (2.4) mU x ml(-1)] in the HIGH group after the 1st night [11.8 (1.9) mU x ml(-1), 57%], and were also higher on the 5th night [10.7 (2.2) mU x ml(-1), 42%] compared with the CONTROL group, whose erythropoietin levels did not change. After athletes spent 3 nights at near sea level, the change in sEpo during subsequent hypoxic exposures was markedly attenuated (13% and -4% change during the second exposure; 26% and 14% change during the third exposure; 1st and 5th nights of each block, respectively). The increase in sEpo was insufficient to stimulate reticulocyte production at any time point. We conclude that when daily training loads are controlled, the modest increases in sEpo known to occur following brief exposure to a simulated altitude of 2650 m are insufficient to stimulate reticulocyte production.

Adult↗

PubMed1981

Acute effects of a single exercise session on serum lipids in untrained men.

Acute reductions in triglycerides and calculated low density lipoprotein cholesterol with little change in high density lipoprotein cholesterol have been reported in trained men after a single exercise session. To examine if a similar acute exercise effect occurs in sedentary subjects, wer measured triglycerides, total cholesterol, and high density lipoprotein cholesterol in eight sedentary men before and for 66 hours after a single 30-minute exercise session. The exercise was designed to simulate a typical exercise training session for untrained subjects. An isolated reduction in estimated low density lipoprotein cholesterol was observed 66 hours after the exercise. All other serum lipid measurements at 5 minutes and 1, 4, 18, 42, and 66 hours after exercise did not differ from pre-race concentrations. Consequently, the reductions in triglycerides and low density lipoprotein cholesterol and increase in high density lipoprotein cholesterol reported in previously sedentary subjects after exercise training are a chronic rather than an acute exercise effect.

Adult↗

PubMed1999

British Isles symposium on the future of dental clinical skills training.

A symposium on the future of dental clinical skills training is reported. Abstracts of the symposium presentations review the current and future use of simulation in dental education, future skills training in the creation of new dentists, equipment and methods for simulation, the transition from simulation to clinical practice and recent developments in simulation employing new technologies. The report concludes that simulation will continue to have an important, probably increasing role in dental education, and that further developments in clinical skills training should be sensitive to changing patterns of dental disease and opportunities of provide clinical instruction.

Clinical Competence↗

PubMed2005

Eighth-order rational harmonic mode-locked fiber laser with amplitude-equalized output operating at 80 Gbits/s.

We report the generation of an 80 Gbit/s pulse train by an eighth-order rational harmonic mode-locking technique. Equalized pulse-train amplitude is achieved by proper adjustment of the dc bias point and the 10 GHz modulation strength applied to the cavity-loss modulator. A numerical model is developed to simulate the properties of the generated 80 Gbit/s pulse train. The simulated results are well supported by the experimental measurements.

Journal Article↗

PubMed1982

Use of the interview in admissions.

A description of one method of dealing with nonacademic information from applicants seeking acceptance into a physical therapy curriculum is presented. The strengths of this admission process are interviewer training sessions, use of simulated interviews presented by videotape, subsequent discussion of ratings, specific criteria to support interview ratings, and an arbitration procedure. Attempts were made to increase the objectivity of the interview through frequent meetings of the admission committee to decide on the areas of the interview and specific criteria on which to rate each area. In the areas of weighting factors, training of interviewers, development of specific interview criteria, arbitration procedure, and the use of the computer printout, this admission process could be easily adapted to other allied health programs. Details of the interview are discussed.

Educational Measurement↗

PubMed1971

Simulation of clinical diagnosis: a comparative study.

This paper presents a comparison between three different modes of simulation of the diagnostic process-a computer-based system, a verbal mode, and a further mode in which cards were selected from a large board. A total of 34 subjects worked through a series of 444 diagnostic simulations.The verbal mode was found to be most enjoyable and realistic. At the board, considerable amounts of extra irrelevant data were selected. At the computer, the users asked the same questions every time, whether or not they were relevant to the particular diagnosis. They also found the teletype distracting, noisy, and slow.The need for an acceptable simulation system remains, and at present our Minisim and verbal modes are proving useful in training junior clinical students. Future simulators should be flexible, economical, and acceptably realistic-and to us this latter criterion implies the two-way use of speech. We are currently developing and testing such a system.

Appendicitis↗

PubMed2002

Inspiratory muscle fatigue in trained cyclists: effects of inspiratory muscle training.

PURPOSE: This study evaluated the influence of simulated 20- and 40-km time trials upon postexercise inspiratory muscle function of trained competitive cyclists. In addition, we examined the influence of specific inspiratory muscle training (IMT) upon the responses observed. METHODS: Using a double-blind placebo-controlled design, 16 male cyclists (mean +/- SEM VO2max 64 +/- 2 mL.kg-1.min-1) were assigned randomly to either an experimental (IMT) or sham-training control (placebo) group. Maximum static and dynamic inspiratory muscle function was assessed immediately pre- and <2, 10, and 30 min post-simulated 20- and 40-km time trials before and after 6-wk of IMT or sham-IMT. RESULTS: Maximum inspiratory mouth pressure (P0) measured within 2 min of completing the 20- and 40-km time trial rides was reduced by 18% and 13%, respectively, and remained below preexercise values at 30 min. The 20- and 40-km time trials induced a reduction in inspiratory flow rate at 30% P0 by 14% and 6% in the IMT group versus 13% and 7% for the placebo group, and also remained below preexercise values at 30 min. There was also a significant slowing of inspiratory muscle relaxation rate postexercise; these trends were almost completely reversed by 30 min postexercise. Significant improvements in 20- and 40-km time trial performance were seen (3.8 +/- 1.7% and 4.6 +/- 1.9%, respectively; P < 0.05) and postexercise reductions in muscle function were attenuated with IMT. CONCLUSION: These data support existing evidence that there is significant global inspiratory muscle fatigue after sustained heavy endurance exercise. Furthermore, the present study provides new evidence that performance enhancements observed after IMT are accompanied by a decrease in inspiratory muscle fatigue.

Adult↗

PubMed2000

The Erlangen Endo-Trainer: life-like simulation for diagnostic and interventional endoscopic retrograde cholangiography.

The Erlanger Endo-Trainer offers a large spectrum of training possibilities in endoscopic techniques using life-like biological specimens. We organised the first pilot study of interventions at the papilla and the bile duct under x-ray control. Specially prepared upper visceral porcine organ packages including the esophagus, stomach, duodenum, liver, gallbladder and bile ducts were implanted into the Endo-Trainer. Furthermore, small stones were introduced into the bile duct. The test study was carried out by a senior endoscopist assisted by his endoscopy nurse. The following steps could therefore be carried out as a structured team-training scheme: Introduction of the side-viewing endoscope and passage into the duodenum; identification and adjustment at the papilla; cannulation of the papilla; selective bile duct imaging with contrast application under x-ray vision; placement of a guidewire; papillotomy; stone extraction and finally placement of a plastic stent. The special value of this type of simulation is the fact that endoscopic techniques can be trained in the usual manner with real tissue-feeling using regular commercial instruments. Although there is general consent that individual practice on the patient cannot be completely replaced by simulator training, a suitable and realistic simulation model can be of great value, for initial steps prior to "real" patient contact as well as for refining techniques and tactics.

Animals↗

PubMed2007

Teaching and assessing competence in cataract surgery.

PURPOSE OF REVIEW: To review recent literature regarding innovative techniques, methods of teaching and assessing competence and skill in cataract surgery. RECENT FINDINGS: The need for assessment of surgical competency and the requirement of wet lab facilities in ophthalmic training programs are being increasingly emphasized. Authors have proposed the use of standardized forms to collect objective and subjective data regarding the residents' surgical performance. Investigators have reported methods to improve visualization of cadaver and animal eyes for the wet lab, including the use of capsular dyes. The discussion of virtual reality as a teaching tool for surgical programs continues. Studies have proven that residents trained on a laparoscopic simulator outperformed nontrained residents during actual surgery for both surgical times and numbers of errors. Besides virtual reality systems, a program is being developed to separate the cognitive portion from the physical aspects of surgery. Another program couples surgical videos with three-dimensional animation to enhance the trainees' topographical understanding. SUMMARY: Proper assessment of surgical competency is becoming an important focus of training programs. The use of surgical data forms may assist in standardizing objective assessments. Virtual reality, cognitive curriculum and animation video programs can be helpful in improving residents' surgical performance.

Cataract Extraction↗

PubMed2000

Proposed design modifications to reduce risk of operating rotary field mowers.

The primary objective of this project was to reduce risk of injury associated with operating a rotary mower driven by a tractor power take-off (PTO) by developing and evaluating design improvements and determining their economic feasibility. Researchers have concluded that alteration of machinery design has a greater impact on the reduction of accidents than safety training. Implementation of an Operator Presence Sensing System (OPSS) and removal of the PTO are the two injury-reducing, engineering modifications evaluated by this research. Hydraulic power allows this to occur by providing dynamic braking, few moving parts (removal of the PTO), and controllable power. A hydraulic circuit was developed to power the mower and to enable an OPSS. Tractor hydraulics were simulated using a hydraulic training bench. Two mower configurations were tested: 6.55 cm3 rev(-1) (0.4 in.3 rev(-1)) displacement motor with a 0.748 kg blade and 47.5 cm3 rev(-1) (2.9 in.3 rev(-1)) displacement motor with a 9.4 kg blade. A PTO-driven rotary mower was not used to test the circuit due to spatial and safety limitations of the hydraulic training bench. Results from the first mower configuration verified the concepts behind the hydraulic circuit. The second configuration verified the OPSS and indicated the applicability of the circuit to a rotary mower.

Accidents, Occupational↗

PubMedDate not supplied

[Role of the right brain hemisphere in training for the operator work].

Functional state of the human right brain hemisphere was studied during simulation of 4-hour operator's training work with a computer in novel conditions. Participants of the experiments differed in the degree of extraversion and baseline level of cortical activity. The obtained results suggest that the role of the right hemisphere in the process of simulated activity consists in reception and primary processing of information. This hemisphere is not involved in the correction of cortical activation to the optimal level of activity, which is necessary for the efficient performance of a task.

Adult↗

PubMed2000

The 'HysteroTrainer'--an in vitro simulator for hysteroscopy and falloposcopy. Experimental and clinical background and technical realisation including the development of organ modules for electrothermal treatment.

Hysteroscopy and falloposcopy are routine procedures in gynecological endoscopy. Injuries to the cervix or uterine perforations due to blind manipulation or wrong use of instruments are the most common complications associated with these procedures. In vitro simulators have been shown to be valuable tools in the laparoscopic training of physicians. Therefore we developed a simulator for hysteroscopy offering realistic anatomical and physiological training conditions. Additionally, we examined different polymer substances as basic materials for organ modules that allow the realistic application of electric instruments, e.g. resector blades and rollerball.

Equipment and Supplies↗

PubMed2005

Event-related potential measures of the disruptive effects of trains of auditory stimuli during waking and sleeping states.

Acoustic backup alarms have been reported to particularly disrupt sleep. The present study simulated backup alarms by presenting trains of five consecutive 500 ms duration audible tones, with the time between the onset of each tone being 1 s and the time between trains (offset to onset) between 15 and 20 s. In different conditions, the tones were set at either 80 or 60 dB sound pressure level (SPL). Twelve young adults spent two consecutive nights in the laboratory. Stimuli were presented only on the second night. Measures of traditional sleep architecture (sleep stages) were not affected by the acoustic trains. Event-related potentials were also measured following presentation of the stimuli. In the waking state, the initial 80 dB stimulus elicited a large amplitude N1, peaking at about 100 ms, followed by a positive peak, P3, peaking at about 325 ms. N1 was attenuated following presentation of the 60 dB stimulus. The amplitude of N1 was much reduced following presentation of the subsequent second to fifth stimuli in the train. During non-rapid eye movement (NREM) sleep, the initial 80 dB stimulus elicited a large and later negativity (N350) that was reduced in amplitude for the 60 dB stimulus. A K-Complex (a composite N350 and a much larger N550) was elicited following 35% of the initial 80 dB tones and 12% of the initial 60 dB tones. The amplitude of N550 did not, however, significantly vary as a function of stimulus SPL. During REM sleep, N1 continued to be elicited by the initial louder stimulus, but the later positive wave was not apparent. A late negativity peaking at about 350 ms was, however, apparent. When queried the next morning, subjects rarely indicated that the stimulus presentations disturbed their sleep. This might be because of the absence of the late positivity. The presence of the long latency negativities (N350 and N550) might serve to protect sleep from obtrusive sound during sleep.

Acoustic Stimulation↗

PubMed1997

Use of the Stroop phenomenon as a diagnostic tool for malingering.

AIMS: To assess a computerised version of the Stroop test for detection of malingering of cognitive deficit. METHODS: Sixty subjects were assessed using this test. Twenty had cognitive deficits due to brain damage of miscellaneous aetiologies. Ten were healthy, not acquainted with the test, and were asked to simulate cognitive impairment. Another 10 simulators were psychology students trained in the use of the test. Twenty healthy subjects served as controls. Results were analysed for reaction time, error percentage, and the Stroop effect. RESULTS: There was a significant difference in reaction time among groups, showing a direct relation of age among control subjects, and also longer reaction time in patients with brain damage than in controls. Controls and patients with brain damage showed a clear Stroop effect. Simulators had a significantly prolonged reaction time, increased error percentage, and inverted or absent Stroop effect. This alteration of the Stroop effect is never present in organic cognitive deficits and seems to be a characteristic pattern of feigning, independently of knowledge of the test. CONCLUSION: This technique is recommended as a valuable tool to detect feigned cognitive impairment.

Adult↗

PubMed2005

Renal and iliac artery stenting by interventional cardiologists and vascular surgeons: the Foundation to Advance Medical Education (FAME) initiative.

The American College of Cardiology, in concert with the Society for Coronary Angiography and Interventions and the Society for Vascular Surgery, planned and implemented an initiative to teach stenting of renal and iliac arteries to their peers in practice. Supported by the Foundation to advance medical Education (FAME), the initiative involved 25 preceptees and 6 preceptors and included a didactic portion (a remote learning exercise), an animal practicum, a procedural simulation, and a preceptor/preceptee training segment, all of which was followed by evaluations by the participants. Assessments of the success of the initiative differed between preceptees, who were positive about the experience, and preceptors, who were more critical of the endeavor (with surgeons more critical than cardiologists). Technical problems, such as obtaining temporary licensure to practice medicine in another state, interfered with the hands-on experiences of several preceptees. Programs such as the FAME initiative will grow in importance as new technologies continue to be introduced into medical practice and the need to train physicians in practice in their use expands.

Animals↗

PubMed1989

Exercise training in patients with chronic airways obstruction.

Some studies concerning the effects of specific and non-specific techniques of respiratory muscle training and new strategies in exercise training of both skeletal and respiratory muscles, are reviewed. Breathing and exercise training show some evidence of improved gas exchange. Breathing through an inspiratory resistance has some advantages but also disadvantages. This technique has caused immediate hypoxaemia and pulmonary arterial hypertension in one third of the subjects studied. High intensity exercise with correspondingly high levels of ventilation may induce improvements in ventilatory muscle function. Two new techniques are described: the "above anaerobic threshold 40 min constant exercise" and the "45 min square-wave endurance exercise test" (SWEET), simulating an interval-training session. The effects on the cardiorespiratory, metabolic, arterial blood gases and acid base balance responses, were measured in normal subjects and in patients with chronic airway obstruction (CAO). After training, the magnitude of ventilation (VE) reduction was correlated with the reduction in end-exercise lactate. In addition, maximal ventilation and maximal oxygen consumption (VO2max) can increase after training. Finally, an interesting hypothesis is proposed about the use of arm-training.

Aged↗