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PubMed2005

Physicians' communication with a cancer patient and a relative: a randomized study assessing the efficacy of consolidation workshops.

BACKGROUND: Although patients with cancer are often accompanied by a relative during medical interviews, to the authors' knowledge little is known regarding the efficacy of communication skills training programs on physicians' communication skills in this context. The objective of the current study was to assess the efficacy of 6 consolidation workshops, 3 hours in length, that were conducted after a 2.5-day basic training program. METHODS: After attending the basic training program, physicians were assigned randomly to consolidation workshops or to a waiting list. Training efficacy was assessed through simulated and actual interviews that were recorded on an audio tape at baseline, after consolidation workshops for the consolidation-workshops group, and 5 months after the end of basic training for the waiting-list group. Communication skills were assessed according to the Cancer Research Campaign Workshop Evaluation Manual. Patients' and relatives' perceptions of and satisfaction with physicians' communication performance were assessed using a 15-item questionnaire. RESULTS: Sixty-two physicians completed the training program. Compared with physicians who participated to the basic training program, when addressing the patient, physicians who were randomized to the consolidation workshops used more open, open directive, and screening questions (P = 0.011 in simulated patient interviews and P = 0.005 in actual patient interviews) and elicited and clarified psychologic concerns more often (P = 0.006 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the relative, physicians who were randomized to the consolidation workshops gave less premature information (P = 0.032 in simulated patient interviews and P < 0.001 in actual patient interviews). When they addressed the patient and the relative simultaneously, physicians who were randomized to the consolidation workshops used more empathy, educated guesses, alerting to reality, confronting, negotiating, and summarizing (P = 0.003 in simulated patient interviews and P = 0.024 in actual patient interviews). Patients, but not relatives, who interacted with physicians in the consolidation-workshops group were more satisfied globally with the interviews (P = 0.022). CONCLUSIONS: Six 3-hour consolidation workshops resulted in improved communication skills addressed to patients and to relatives. The current results showed that the transfer of skills addressing relatives' concerns remained limited and that consolidation workshops should focus even more systematically on the practice of three-person interviews.

Communication↗

PubMed1990

Auditory basis of maternal attachment in ducklings (Anas platyrhynchos) under simulated naturalistic imprinting conditions.

The presence of broodmates during the imprinting process results in peer imprinting that interrupts a visually mediated maternal attachment. We sought to determine the conditions in which group-trained mallard ducklings (Anas platyrhynchos) acquire a maternal attachment. At 48 hr of age, ducklings were allowed to follow a vocal, stuffed mallard hen individually or in groups of 4. Individual ducklings showed a preference for the silent, familiar mallard over an unfamiliar pintail. Ducklings trained in groups did not show a preference. When the mallard maternal call was present during testing, group-trained ducklings overwhelmingly responded to it regardless of whether it came from the familiar mallard or an unfamiliar pintail. Training ducklings in groups, which simulates the natural social context of imprinting, results in peer imprinting. Thus, early in development the young become visually imprinted to each other, and the maternal call mediates attachment to the mother.

Animals↗

PubMed2005

Optimal training strategies for carotid stenting.

Future participation in the treatment of carotid occlusive disease is dependent on training to perform carotid stent placement. Reviewed herein are strategies for training in carotid stenting. Included in this discussion are; the skills required for carotid stenting, the carotid stent learning curve, a comparison of training and credentialing, and the roles of simulators, courses, and hands-on experience in carotid stent training.

Angioplasty↗

PubMed1998

Virtual reality: preparation and execution of sinus surgery.

Endonasal sinus surgery requires a great deal of training before it can be performed adequately. Due to the complex and variable anatomy and the proximity of important structures, severe complications are possible, even for experienced surgeons. The nasal endoscopy simulator (NES) is an interactive training system for nasal endoscopy and endonasal sinus surgery that combines computer graphics and virtual reality (VR) techniques. This system consists of a graphics workstation, a tracking system for measuring the position of the endoscope and surgical instruments in space, a head model, image data sets of the nasal cavity and paranasal sinus area, and complementary software. The current NES is a visual and auditory VR system that provides both educational and planning options for sinus surgery. The usual resistance when touching relevant anatomical structures is not provided by this release. Therefore, a "force feedback system" is implemented that allows for such a response. VR simulation will become an important part of surgical education and planning for individual sinus surgery procedures. The ongoing development of the NES will lead to an improved educational environment for residents in training and practitioners.

Computer Graphics↗

PubMed2005

Emergency preparedness volunteer training program.

The Vermont Department of Health (VDH) does not have sufficient personnel to fully staff a mass prophylaxis or vaccination clinic in response to a natural or man-made disease outbreak. Therefore, the VDH developed an emergency preparedness volunteer training program with three primary goals: to include both background information about public health and emergency preparedness and a hands-on training for clinic volunteers; to be adaptable for both community and healthcare professional volunteers; and to examine local emergencies and the VDH public health response to these events. Major components of the training program include basic public health goals and capacities; an introduction to emergency preparedness; a role-playing exercise using Job Action Sheets to simulate "just-in-time" training; and guidance for personal and family preparedness. The VDH has experienced difficulty finding and recruiting volunteers. To increase the potential volunteer pool, it will be implementing a multifaceted training program (on-line, through the mail, in person) to most effectively engage volunteers with varying interests and learning styles. The VDH must also develop a system to maintain regular contact with volunteers and clarify regulations regarding their scope of practice and liability.

Disaster Planning↗

PubMed1994

The integration of laparoscopy into a surgical residency and implications for the training environment.

Although laparoscopic cholecystectomy is now an accepted part of resident training, the impact of operative laparoscopy (OL) upon the residency environment has not been examined in detail. We reviewed the first 3 years' experience with OL and the process by which it was introduced into our residency program. Data were obtained from our prospective computerized surgical laparoscopic registry as well as from a survey conducted midway in this experience. At that time, a questionnaire was sent to current residents in the program and residents who graduated after the inception of the OL program were interviewed by telephone. OL cases increased each year and comprised a progressively greater percentage of total cases. Residents performed over 97% of cases, with attending surgeons as first assistants. Initially, only senior-level residents participated as surgeons; however, after the first year we noted a significant tendency for cases to filter down the ranks. Junior-level residents have already participated in more laparoscopic than open cholecystectomies and expressed considerable concern about training in open procedures. Graduated residents without exception were able to obtain privileges to perform OL without additional training. They did not feel that resident education was compromised by the advent of laparoscopy. Both current and graduated residents considered didactic sessions including animal laboratories and simulators an important part of training.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2006

High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost.

BACKGROUND: This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. METHODS: Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMantrade mark to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, subjects completed visual analog scales and a semi-structured interview to measure their self-efficacy, i.e. comfort with their ability to treat patients in the helicopter, and recognition of obstacles to care in the helicopter environment. After all 12 residents had completed their first non-simulated flight as the flight physician; they were surveyed about self-assessed comfort and perceived value of the simulation. Continuous data were compared between pre- and post-simulation using a paired samples t-test, and between residents participating in the simulation and those who did not using an independent samples t-test. Categorical data were compared using Fisher's exact test. Cost data for the simulation experience were estimated by the investigators. RESULTS: The simulations functioned correctly 5 out of 7 times; suggesting some refinement is necessary. Cost data indicated a monetary cost of 440 dollars and a time cost of 22 hours of skilled instructor time. The simulation and non-simulation groups were similar in their demographics and pre-hospital experiences. The simulation did not improve residents' self-assessed comfort prior to their first flight (p > 0.234), but did improve understanding of the obstacles to patient care in the helicopter (p = 0.029). Every resident undertaking the simulation agreed it was educational and it should be included in their training. Qualitative data suggested residents would benefit from high fidelity simulation in other environments, including ground transport and for running codes in hospital. CONCLUSION: It is feasible to provide a high fidelity medical simulation experience in the difficult environment of the air ambulance helicopter, although further experience is necessary to eliminate practical problems. Simulation improves recognition of the challenges present and provides an important opportunity for training in challenging environments. However, use of simulation technology is expensive both in terms of monetary outlay and of personnel involvement. The benefits of this technology must be weighed against the cost for each institution.

Adult↗

PubMed1998

Automated neural network detection of wavelet preprocessed electrocardiogram late potentials.

The aim of the study is to investigate the potential of a feedforward neural network for detecting wavelet preprocessed late potentials. The terminal parts of a simulated QRS complex are processed with a continuous wavelet transform, which leads to a time-frequency representation of the QRS complex. Then, diagnostic feature vectors are obtained by subdividing the representations into several regions and by processing the sum of the decomposition coefficients belonging to each region. The neural network is trained with these feature vectors. Simulated ECGs with varying signal-to-noise ratios are used to train and test the classifier. Results show that correct classification ranges from 79% (high-level noise) to 99% (no noise). The study shows the potential of neural networks for the classification of late potentials that have been preprocessed by a wavelet transform. However, clinical use of this method still requires further investigation.

Arrhythmias, Cardiac↗

PubMed2006

Building a motor simulation de novo: observation of dance by dancers.

Research on action simulation identifies brain areas that are active while imagining or performing simple overlearned actions. Are areas engaged during imagined movement sensitive to the amount of actual physical practice? In the present study, participants were expert dancers who learned and rehearsed novel, complex whole-body dance sequences 5 h a week across 5 weeks. Brain activity was recorded weekly by fMRI as dancers observed and imagined performing different movement sequences. Half these sequences were rehearsed and half were unpracticed control movements. After each trial, participants rated how well they could perform the movement. We hypothesized that activity in premotor areas would increase as participants observed and simulated movements that they had learnt outside the scanner. Dancers' ratings of their ability to perform rehearsed sequences, but not the control sequences, increased with training. When dancers observed and simulated another dancer's movements, brain regions classically associated with both action simulation and action observation were active, including inferior parietal lobule, cingulate and supplementary motor areas, ventral premotor cortex, superior temporal sulcus and primary motor cortex. Critically, inferior parietal lobule and ventral premotor activity was modulated as a function of dancers' ratings of their own ability to perform the observed movements and their motor experience. These data demonstrate that a complex motor resonance can be built de novo over 5 weeks of rehearsal. Furthermore, activity in premotor and parietal areas during action simulation is enhanced by the ability to execute a learned action irrespective of stimulus familiarity or semantic label.

Adolescent↗

PubMed2003

Input prediction and autonomous movement analysis in recurrent circuits of spiking neurons.

Temporal integration of information and prediction of future sensory inputs are assumed to be important computational tasks of generic cortical microcircuits. It has remained open how cortical microcircuits could possibly achieve this, especially since they consist--in contrast to most neural network models--of neurons and synapses with heterogeneous dynamic responses. It turns out, however, that the diversity of computational units increases the capability of microcircuit models for temporal integration. Furthermore the prediction of future input may be rather easy for such circuits since it suffices to train the readouts from such microcircuits. In this article we show that very simple readouts from a generic recurrently connected circuit of integrate-and-fire neurons with diverse dynamic synapses can be trained in an unsupervised manner to predict movements of different objects, that move within an unlimited number of combinations of speed, angle, and offset over a simulated sensory field. The autonomously trained microcircuit model is also able to compute the direction of motion, which is a computationally difficult problem ('aperture problem') since it requires disambiguation of local sensory readings through the context of other sensory readings at the current and preceding moments. Furthermore the same circuit can be trained simultaneously in a supervised manner to also report the shape and velocity of the moving object. Finally it is shown that the trained neural circuit supports novelty detection and the generation of 'imagined movements'. Altogether the results of this article suggest that it is not necessary to construct specific and biologically unrealistic neural circuit models for specific sensory processing tasks, since 'found' generic cortical microcircuit models in combination with very simple perceptron-like readouts can easily be trained to solve such computational tasks.

Action Potentials↗

PubMed1997

Carbohydrate ingestion improves endurance performance during a 1 h simulated cycling time trial.

This study examined the effect of carbohydrate ingestion on metabolic and performance-related responses during and after a simulated 1 h cycling time trial. Eight trained male cyclists (VO2 peak = 66.5 ml kg-1 min-1) rode their own bicycles mounted on a windload simulator to imitate real riding conditions. At a self-selected maximal pace, the cyclists performed two 1 h rides (separated by 7 days) and were fed either an 8% carbohydrate or placebo solution. The beverages were administered 25 min before (4.5 ml kg-1) and at the end (4.5 ml kg-1) of the ride. With carbohydrate feeding, plasma glucose tended (P = 0.21) to rise before the time trial. Compared with rest, the plasma glucose concentration decreased significantly (P < 0.05) at the end of both rides, with no statistically significant difference being observed between treatments. Thereafter, plasma glucose increased significantly (P < 0.05) at 15 and 30 min into recovery and was significantly higher at 30 min during the carbohydrate trial compared with the placebo trial. No significant changes in plasma free fatty acids were observed during the ride. However, a significant increase (P < 0.05) in free fatty acids was found at 15 and 30 min into recovery, with no difference between trials. Mean power output was significantly (P < 0.05) greater during the carbohydrate compared with the placebo trial (mean +/- S.E.: 277 +/- 3 and 269 +/- 3 W, respectively). The greater distance covered in the carbohydrate compared with the placebo trial (41.5 +/- 1.06 and 41.0 +/- 1.06 km, respectively; P < 0.05) was equivalent to a 44 s improvement. We conclude that pre-exercise carbohydrate ingestion significantly increases endurance performance in trained cyclists during a 1 h simulated time trial. Although the mechanism for this enhancement in performance with carbohydrate ingestion cannot be surmised from the present results, it could be related to a higher rate of carbohydrate oxidation, or to favourable effects of carbohydrate ingestion on the central component of fatigue.

Adult↗

PubMed2005

Transfer of communication skills training from workshop to workplace: the impact of clinical supervision.

OBJECTIVE: Recent studies have recognised that the communication skills learned in the training environment are not always transferred back into the clinical setting. This paper reports a study which investigated the potential of clinical supervision in enhancing the transfer process. METHODS: A randomised controlled trial was conducted involving 61 clinical nurse specialists. All attended a 3-day communication skills training workshop. Twenty-nine were then randomised to 4 weeks of clinical supervision, aimed at facilitating transfer of newly acquired skills into practice. Assessments, using real and simulated patients, were carried out before the course, immediately after the supervision period and 3 months later. Interviews were rated objectively using the Medical Interview Aural Rating Scale (MIARS) to assess nurses' ability to use key skills, respond to patient cues and identify patient concerns. RESULTS: Assessments with simulated patients showed that the training programme was extremely effective in changing competence in all three key areas. However, only those who experienced supervision showed any evidence of transfer. Improvements were found in the supervised groups' use of open questions, negotiation and psychological exploration. Whilst neither group facilitated more disclosure of cues or concerns, those in the experimental group responded more effectively to the cues disclosed, reduced their distancing behaviour and increasing their exploration of cues. CONCLUSIONS: The study has shown that whilst training enhances skills, without intervention, it may have little effect on clinical practice. The potential role of clinical supervision as one way of enhancing the clinical effectiveness of communication skills training programmes has been demonstrated. PRACTISE IMPLICATIONS: This study raises questions about the effectiveness of training programmes which do not incorporate a transfer element, and provides evidence to support the need for clinical supervision for clinical nurse specialist.

Adult↗

PubMed2005

A multilevel examination of the relationships among training outcomes, mediating regulatory processes, and adaptive performance.

This study examined whether cognitive, affective-motivational, and behavioral training outcomes relate to posttraining regulatory processes and adaptive performance similarly at the individual and team levels of analysis. Longitudinal data were collected from 156 individuals composing 78 teams who were trained on and then performed a simulated flight task. Results showed that posttraining regulation processes related similarly to adaptive performance across levels. Also, regulation processes fully mediated the influences of self- and collective efficacy beliefs on individual and team adaptive performance. Finally, knowledge and skill more strongly and directly related to adaptive performance at the individual than the team level of analysis. Implications to theory and practice, limitations, and future directions are discussed.

Adaptation, Psychological↗

PubMed2004

Effect of chronic clenbuterol administration and exercise training on immune function in horses.

Effects of longitudinal exercise training and acute intensive exercise (simulated race test) on immune function have not been reported in horses. Clenbuterol, a beta2-adrenergic agonist, is used to manage inflammatory airway disease in horses. This study investigated the interaction of 8 wk of exercise training with or without 12 wk of clenbuterol administration in horses. Twenty-three untrained standardbred mares (10 +/- 3 yr, Mean +/- SE) were used and divided into four experimental groups. Horses given clenbuterol plus exercise (CLENEX; n = 6) and clenbuterol alone (CLEN; n = 6) received 2.4 microg/kg BW of clenbuterol twice daily (in an average volume of 20 mL) on a schedule of 5 d on and 2 d off for 12 wk. The CLENEX group was also aerobically trained 3 d/wk. Mares given exercise alone (EX; n = 5) were aerobically trained for 3 d/wk, and the control group (CON; n = 6) remained sedentary. Both EX and CON horses were administered similar volumes (approximately 20 mL) of molasses twice daily. A simulated race test (SRT) resulted in an elevation in lymphocyte number postexercise (P < 0.05). There was no significant difference after acute exercise in either monocyte or granulocyte number. Acute exercise resulted in a decrease (P < 0.05) in the percentage of CD4+ and an increase (P < 0.05) in the percentage of CD8+ cells. The SRT resulted in a decreased lymphoproliferative response to pokeweed mitogen (P < 0.05). A SRT had no effect on antibody production in response to equine influenza vaccine. The EX group demonstrated greater cortisol concentrations at rest and at all other time points postexercise after completing the training regimen compared with CLENEX horses (P < 0.05). Preexercise (SRT) peripheral blood monocyte number was lower in CLENEX horses than in other treatment groups (P < 0.05). Clenbuterol and exercise training did not significantly affect post-SRT changes in leukocyte numbers. Exercise training resulted in a decrease (P < 0.05) in the percentage of CD8+ cells post-SRT compared with other groups, but the percentage of CD4+ cells was not altered by either clenbuterol or exercise conditioning. Lymphocyte proliferative response was not affected by clenbuterol or exercise treatment. Horses demonstrated responses to bouts of acute exercise as noted with other species, namely humans and rodents.

Adrenergic beta-Agonists↗

PubMed2003

GeRTiSS: Generic Real Time Surgery Simulation.

Minimally invasive surgery is a technique that permits interventions through very small incisions. This minimises the patients' trauma and permits a faster recovery in comparison with classical surgery. The disadvantage of this surgery technique, though, is its complexity, requiring a high training effort of the surgeon. In this paper, we present a general surgery simulator for training surgeons in minimally invasive surgery. The application allows to create environments and interaction modes very similar to those encountered in real surgical interventions. The virtual environments are optionally composed of an actual patient's organs the intervention on which one desires to practice in a beforehand manner, or of synthetically generated organs with arbitrary pathologies. The intervention is carried out by means of haptic interfaces with force feedback, providing the surgeon with a sense of touch, a fundamental element of all types of surgery.

Computer Simulation↗

PubMed2005

LapSim virtual reality laparoscopic simulator reflects clinical experience in German surgeons.

BACKGROUND AND AIMS: The aim of this study was to analyze the ability of a training module on a virtual laparoscopic simulator to assess surgical experience in laparoscopy. METHODS: One hundred and fifteen participants at the 120th annual convent of the German surgical society took part in this study. All participants were stratified into two groups, one with laparoscopic experience of less than 50 operations (group 1, n=61) and one with laparoscopic experience of more than 50 laparoscopic operations (group 2, n=54). All subjects completed a laparoscopic training module consisting of five different exercises for navigation, coordination, grasping, cutting and clipping. The time to perform each task was measured, as were the path lengths of the instruments and their respective angles representing the economy of the movements. Results between groups were compared using chi(2) or Mann-Whitney U-test. RESULTS: Group 1 needed more time for completion of the exercises (median 424 s, range 99-1,376 s) than group 2 (median 315 s, range 168-625 s) (P<0.01). Instrument movements were less economic in group 1 with larger angular pathways, e.g. in the cutting exercise (median 352 degrees , range 104-1,628 degrees vs median 204 degrees , range 107-444 degrees , P<0.01), and longer path lengths (each instrument P<0.05). CONCLUSION: As time for completion of exercises, instrument path lengths and angular paths are indicators of clinical experience, it can be concluded that laparoscopic skills acquired in the operating room transfer into virtual reality. A laparoscopic simulator can serve as an instrument for the assessment of experience in laparoscopic surgery.

Chi-Square Distribution↗

PubMed2005

The impact of shortened training times on the discipline of vascular surgery in the United Kingdom.

Political initiatives and European health and safety working time regulations have combined to reduce the time available for surgical training in the United Kingdom in the future by a third. For the safety of patient care, surgeons must evolve strategies to cope with these reduced training times so that they preserve the current high level of competence exhibited by UK trainees when they attain the right to independent surgical practice recognized by appointment as a Consultant Surgeon. Such strategies include a focus on dedicated training time, the use of simulators, and a move towards progression based on satisfactory completion of a defined curriculum and competency assessment rather than the amount of time served. With insufficient time to train in every aspect of general surgery, a move towards fragmentation into its sub-specialty components seems unavoidable. Such a move offers an opportunity to re-evaluate conventional surgical training and to consider the evolution of a system-specific vascular specialist with patient-focused expertise in vascular surgery, endovascular radiology, and vascular medicine.

Clinical Competence↗

PubMed2004

Implementing a simulated client program: bridging the gap between theory and practice.

INTRODUCTION: This paper outlines the design and implementation of an innovative communication skills training program at the Ontario Veterinary College (OVC). Based upon the body of research in human medical education reporting effective results through the use of standardized patients (SPs) for this type of training, an experiential learning laboratory using simulated clients (SCs) and patients was introduced to first-year veterinary students. METHOD: One hundred and four first-year students were assigned to 12 groups of eight or nine students plus a facilitator. Each student interacted with a simulated client and a patient while being observed by peers and a facilitator. The Calgary-Cambridge Observation Guide (CCOG) was used to guide students and facilitators with performance standards and feedback. Assessment strategies were utilized. RESULTS: Implementation of this program required extensive resources, including funding, expertise, facilitator training, time allotment in an already overburdened curriculum, and administrative and faculty support. Preliminary assessment revealed high student and facilitator satisfaction. The potential of this program for student education and assessment was recognized, and it will be expanded in years 2 and 3 of the DVM (Doctor of Veterinary Medicine) curriculum. CONCLUSIONS: Medical educators have created resources, including skills checklists and experiential learning modalities, that are highly applicable to veterinary medical education. Ongoing evaluation of the program is essential to determine whether we are meeting expectations for communication competency in veterinary medicine.

Communication↗