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PubMedDate not supplied

An evaluation of residency training in interviewing skills and the psychosocial domain of medical practice.

Competent use of interviewing skills is important for the care of all patients but is especially critical, and frequently deficient, in meeting the needs of patients experiencing emotional distress. This study presents an evaluation of a curriculum in communication and psychosocial skills taught to first-year medical residents. A randomized experimental design compared trained and untrained residents' (n = 48) performances with a simulated patient presenting with atypical chest pain and psychosocial distress. Evaluation was based on analysis of videotapes, simulated patient report of residents' behaviors, and chart notation. Trained compared with untrained residents asked more open-ended questions and fewer leading questions, summarized main points more frequently, did more psychosocial counseling, and were rated as having better communication skills by the simulated patient. The use of more focused and psychosocially directed questions, and fewer leading and grab-bag questions, was associated with more accurate diagnoses and management recorded in the medical chart. However, no significant difference was found in the charting practices of trained versus untrained residents.

Chest Pain↗

PubMed2001

Training the assessors for the General Medical Council's Performance Procedures.

From July 1997, the General Medical Council (GMC) has had the power to investigate doctors whose performance is considered to be seriously deficient. Assessment procedures have been developed for all medical specialties to include peer review of performance in practice and tests of competence. Peer review is conducted by teams of at least two medical assessors and one lay assessor. A comprehensive training programme for assessors has been developed that simulates the context of a typical practice-based assessment and has been tailored for 12 medical specialties. The training includes the principles of assessment, familiarization with the assessment instruments and supervised practice in assessment methods used during the peer review visit. High fidelity is achieved through the use of actors who simulate third party interviewees and trained doctors who role play the assessee. A subgroup of assessors, selected to lead the assessment teams, undergo training in handling group dynamics, report writing and in defending the assessment report against legal challenge. Debriefing of assessors following real assessments has been strongly positive with regard to their preparedness and confidence in undertaking the assessment.

Competency-Based Education↗

PubMed2004

Safety investigation of team performance in accidents.

The paper presents the capacities of the performance evaluation of teamwork (PET) method. Its practicability and efficiency are illustrated by retrospective human reliability analyse of the famous nuclear and maritime accidents. A quantitative assessment of operators' performance on the base of thermo-hydraulic (T/H) calculations and full-scope simulator data for set of NPP design basic accidents with WWER is demonstrated. The last data are obtained on the 'WWER-1000' full-scope simulator of Kozloduy NPP during the regular practical training of the operators' teams. An outlook on the "evaluation system of main control room (MCR) operators' reliability" project, based on simulator data of operators' training is given.

Disaster Planning↗

PubMed1999

"Live high, train low" does not change the total haemoglobin mass of male endurance athletes sleeping at a simulated altitude of 3000 m for 23 nights.

The purpose of this study was to document the effect of 23 days of "live high, train low" on the haemoglobin mass of endurance athletes. Thirteen male subjects from either cycling, triathlon or cross-country skiing backgrounds participated in the study. Six subjects (HIGH) spent 8-10 h per night in a "nitrogen house" at a simulated altitude of 3000 m in normobaric hypoxia, whilst control subjects slept at near sea level (CONTROL, n = 7). Athletes logged their daily training sessions, which were conducted at 600 m. Total haemoglobin mass (as measured using the CO-rebreathing technique) did not change when measured before (D1 or D2) and after (D28) 23 nights of hypoxic exposure [HIGH 990 (127) vs 972 (97) g and CONTROL 1042 (133) vs 1033 (138) g, before and after simulated altitude exposure, respectively]. Nor was there any difference in the substantial array of reticulocyte parameters measured using automated flow cytometry prior to commencing the study (D1), after 6 (D10) and 15 (D19) nights of simulated altitude, or 1 day after leaving the nitrogen house (D28) when HIGH and CONTROL groups were compared. We conclude that red blood cell production is not stimulated in male endurance athletes who spend 23 nights at a simulated altitude of 3000 m.

Adult↗

PubMed2006

Study of physiological responses to acute carbon monoxide exposure with a human patient simulator.

Human patient simulators are widely used to train health professionals and students in a clinical setting, but they also can be used to enhance physiology education in a laboratory setting. Our course incorporates the human patient simulator for experiential learning in which undergraduate university juniors and seniors are instructed to design, conduct, and present (orally and in written form) their project testing physiological adaptation to an extreme environment. This article is a student report on the physiological response to acute carbon monoxide exposure in a simulated healthy adult male and a coal miner and represents how 1) human patient simulators can be used in a nonclinical way for experiential hypothesis testing; 2) students can transition from traditional textbook learning to practical application of their knowledge; and 3) student-initiated group investigation drives critical thought. While the course instructors remain available for consultation throughout the project, the relatively unstructured framework of the assignment drives the students to create an experiment independently, troubleshoot problems, and interpret the results. The only stipulation of the project is that the students must generate an experiment that is physiologically realistic and that requires them to search out and incorporate appropriate data from primary scientific literature. In this context, the human patient simulator is a viable educational tool for teaching integrative physiology in a laboratory environment by bridging textual information with experiential investigation.

Adaptation, Physiological↗

PubMed2005

Physiologic and chemical simulation of cyanide and sarin toxicity and therapy.

The possibility of mass terrorism has become increasingly apparent. Accurate and relevant teaching tools are needed for healthcare givers and emergency personnel of all experience. We describe one of these tools, BODY Simulation, and its use in training caregivers to respond to chemical terrorism. We have implemented two chemical agents--cyanide and sarin, the latter a nerve agent--in a detailed whole-body model and simulation. In the simulation, each agent was administered to a healthy young adult, first without therapy, then with therapy, for a total of four runs. We recorded several variables, each appropriate to the agent used. The recorded variables included physiological variables in addition to the blood and brain concentrations of each agent and its antidotes. In addition, for cyanide, the compounds that resulted as the byproducts of therapy (methemoglobin, for example) were plotted. The results were consistent with those described in the literature, including agent concentrations and pathophysiologic changes.

Computer Simulation↗

PubMedDate not supplied

A simulator for teaching electrical safety procedures in the hospital.

The dangers of accidental electrocution in the hospital, especially in the intensive care and coronary care units, have recently received much attention. The most important step in reducing such dangers is the proper training of hospital personnel in appropriate safety procedures. As a teaching aid for the training of V.A. personnel, a Simulator of Assorted Hazardous Malfunctions in Electrical Equipment (SAHMEE) was developed. With this simulator, safety hazards that might exist in a hospital environment can be shown, as well as the effects of electrical shock on a patient, and the effectiveness of various safety measures.

Accident Prevention↗

PubMed2005

The effects of previously acquired skills on sinus surgery simulator performance.

OBJECTIVE: The Endoscopic Sinus Surgery Simulator is currently being studied as a tool for otolaryngology resident training. While examining performance patterns on the simulator, we sought to define any relationships that may exist between students' previously acquired skills and their performance on the simulator. METHODS: Twenty-six medical students were enrolled in our study. After completing their trials, they were asked to complete a 28-item questionnaire. This questionnaire included yes/no questions as well as 10-point Likert scale instruments. RESULTS: Only 4 students did not respond to the questionnaire. Significant contributions to simulator performance were elucidated for a number of previously learned skills, but most were short-lived. For example, experienced video gamers were significantly better at hazard avoidance in the simulator's novice mode (P = .03), but their advantage dissipated as they advanced to intermediate mode trials. In addition, students' handedness contributed to simulator performance for only the first 3 trials (P = .04), but this relationship, too, was no longer statistically significant in later trials. CONCLUSIONS: Some study students had skills and characteristics that significantly aided them in their ability to perform surgery on the simulator. However, these benefits were short-lived, and these results suggest that practicing plays a more important and long-standing role than other factors in surgical simulator performance. It follows that surgical simulation should play a more prominent role in surgical education because residents who practice on simulators such as this are, in turn, practicing for the reality of the operating room.

Adult↗

PubMed1979

Generalization by autistic-type children of verbal responses across settings.

Generalization of verbal behavior by autistic-type children across physically different settings was assessed. Four boys learned responses to common questions in two settings at school and were probed to determine transfer of learning to home. Three of the children demonstrated little generalization to home when trained in a cubicle. Greater generalization was indicated when they received training at varied locations. The fourth child generalized most responses to his home regardless of training setting. Simple manipulations of the school environment to more closely simulate home conditions may facilitate transfer of training to the natural environment.

Autistic Disorder↗

PubMed1998

A neural network approach to the rapid computation of rotational correlation times from slow motional ESR spectra.

We explore the use of feed forward artificial neural networks for determining rotational correlation times from slow motional nitroxide electron spin resonance spectra. This approach is rapid and potentially eliminates the need for traditional iterative fitting procedures. Two networks are examined: the radial basis network and the multilayer perceptron. Although the radial basis network trains rapidly and performs well on simulated spectra, it is less satisfactory when applied to experimental spectra. In contrast, the multilayer perceptron trains slowly but is excellent at extracting correlation times from experimental spectra. In addition, the multilayer perceptron operates well in the presence of noise as long as the signal-to-noise ratio is greater than approximately 200/1. These findings suggest neural networks offer a promising approach for rapidly extracting correlation times without the need for iterative simulations.

Electron Spin Resonance Spectroscopy↗

PubMed2003

The quality of a simulation examination using a high-fidelity child manikin.

PURPOSE: Developing quality examinations that measure physicians' clinical performance in simulations is difficult. The goal of this study was to develop a quality simulation examination using a high-fidelity child manikin in evaluating paediatric residents' competence about managing critical cases in a simulated emergency room. Quality was determined by evidence of the reliability, validity and feasibility of the examination. In addition, the participants' responses regarding its realism, effectiveness and value are presented. METHOD: Scenario scripts and rating instruments were carefully developed in this study. Experts were used to validate the case scenarios and provide evidence of construct validity. Eighteen paediatric residents, 'working' as pairs, participated in a manikin-based simulation pre-test, a training session and a post-test. Three independent raters rated the participants' performance on task-specific technical skills, medications used and behaviours displayed. At the end of the simulation, the participants completed an evaluation questionnaire. RESULTS: The manikin-based simulation examination was found to be a realistic, valid and reliable tool. Validity (i.e. face, content and construct) of the test instrument was evident. The level of inter-rater concordance of participants' clinical performance was good to excellent. The item analysis showed good to excellent internal consistency on all the performance scores except the post-test technical score. CONCLUSIONS: With a carefully designed rating instrument and simulation operation, the manikin-based simulation examination was shown to be reliable and valid. However, a further refinement of the test instrument will be required for higher stake examinations.

Adult↗

PubMed2005

Physicians and lay people are unable to apply pressure immobilization properly in a simulated snakebite scenario.

OBJECTIVE: To determine whether volunteers (with or without prior medical training) can correctly apply pressure immobilization (PI) in a simulated snakebite scenario after receiving standard instructions describing the technique. METHODS: Twenty emergency medicine physicians (residents and attendings) and 20 lay volunteers without prior formal medical training were given standard printed instructions describing the application of PI for field management of snakebite. They were then supplied with appropriate materials and asked to apply the technique five separate times (twice to another individual [one upper and one lower extremity] and three times to themselves [nondominant upper extremity, dominant upper extremity, and one lower extremity]). Successful application was defined a priori by four criteria previously published in the literature: wrap begins at the bite site, entire extremity is wrapped, splint or sling is applied, and pressures under the dressing are between 40 and 70 mm Hg in upper-extremity application and between 55 and 70 mm Hg in lower-extremity use. Pressures were determined using a specially designed skin interface pressure-measuring device placed at the simulated bite site. RESULTS: The technique was correctly applied as judged by the preset criteria in only 13 out of 100 applications by emergency medicine physicians and in only 5 out of 100 applications by lay people. There was no significant difference in success rates between physicians and lay volunteers. Likewise, there was no significant difference in success based on which extremity was being wrapped. More detailed analysis revealed that the major contributor to failure was inability to achieve recommended target pressures. CONCLUSIONS: Volunteers in a simulated snakebite scenario have difficulty applying PI correctly, as defined in the literature. The major source of failure is an inability to achieve recommended pressure levels under the dressing. New methods of instructing people in the proper use of PI or new technologies to guide or automate application are needed if this technique is to be used consistently in an effective manner for field management of bites by venomous snakes not known to cause significant local wound necrosis.

Animals↗

PubMed2001

[Simulators in anesthesiology].

The work of an anesthesiologist and that of a flight pilot share certain attributes. As pilots use simulators to obtain risk-free practice in recognizing and controlling situations that might lead to disaster, simulation programs are now emerging as a new way to learn and train anesthesiology is being conceived as a new task that integrates scientific knowledge and human factors. Simulators have been introduced into teaching and training programs as a powerful tools that allow anesthesiologists to learn, practice and train in a multitude of situations without putting human life at risk. Experience is limited so far, but acceptance has been high and simulators seem to accelerate the acquisition of skills and knowledge, although their effect on performance in critical situations has not been proven yet. Two types have been applied in anesthesiology: computer screen and mannequin. The usefulness of simulators ranges from training for situations that require the systematic application of protocols and the understanding of new drugs being introduced into clinical practice to the practice of how to use resources for managing anesthetic emergencies. It is still too early to use simulators for certifying and evaluating clinical performance, as further studies are needed to identify the type of events that reflect typical situations and to determine which procedures should be evaluated.

Anesthesiology↗

PubMed2003

The assessment of stability and reliability of a virtual reality-based laparoscopic gynecology simulation system.

PURPOSE OF INVESTIGATION: Surgeons require practiced skills in laparoscopic surgery. A virtual reality-based simulator system was developed for extensive training. The purpose of this study was to assess the feasibility of a virtual reality-based laparoscopic gynecology simulation system. METHODS: Laparoscopic tools and three-dimensional virtual environments were included in the simulation system. Ten healthy, non-disabled volunteers were recruited. The surgical procedure is a process of tubal sterilization by cauterization. Volunteers followed the training procedure, 15 trials in the first test and retest, respectively. RESULTS: Stable performances were obtained after about seven trials for all subjects. The intraclass correlation coefficients were 0.935 and 0.425 for task time and error frequency, respectively. CONCLUSION: The results of this study indicate that the system is stable and has a fair high test-retest reliability. Therefore, the VR-based laparoscopic gynecology system is feasible.

Adult↗

PubMed2000

ICTS, an interventional cardiology training system.

In this article, we present an Interventional Cardiology Training System developed by the Medical Application Group at Mitsubishi Electric in collaboration with the Center for Innovative Minimally Invasive Therapy. The core of the ICTS is a computer simulation of interventional cardiology catheterization. This simulation integrates clinical expertise, research in learning, and technical innovations to create a realistic simulated environment. The goal of this training system is to augment the training of new cardiology fellows as well as to introduce cardiologists to new devices and procedures. To achieve this goal, both the technical components and the educational content of the ICTS bring new and unique features: a simulated fluoroscope, a physics model of a catheter, a haptic interface, a fluid flow simulation combined with a hemodynamic model and a learning system integrated in a user interface. The simulator is currently able to generate--in real-time--high quality x-ray images from a 3D anatomical model of the thorax, including a beating heart and animated lungs. The heart and lung motion is controlled by the hemodynamic model, which also computes blood pressure and EKG. The blood flow is then calculated according to the blood pressure and blood vessel characteristics. Any vascular tool, such as a catheter, guide wire or angioplasty balloon can be represented and accurately deformed by the flexible tool physics model. The haptics device controls the tool and provides appropriate feedback when contact with a vessel wall is detected. When the catheter is in place, a contrast agent can be injected into the coronary arteries; blood and contrast mixing is computed and a visual representation of the angiogram is displayed by the x-ray renderer. By bringing key advances in the area of medical simulation--with the real-time x-ray renderer for instance--and by integrating in a single system both high quality simulation and learning tools, the ICTS opens new perspectives for computer based training systems.

Angioplasty, Balloon, Coronary↗

PubMed2001

Virtual reality based surgical assistance and training system for long duration space missions.

Access to medical care during long duration space missions is extremely important. Numerous unanticipated medical problems will need to be addressed promptly and efficiently. Although telemedicine provides a convenient tool for remote diagnosis and treatment, it is impractical due to the long delay between data transmission and reception to Earth. While a well-trained surgeon-internist-astronaut would be an essential addition to the crew, the vast number of potential medical problems necessitate instant access to computerized, skill-enhancing and diagnostic tools. A functional prototype of a virtual reality based surgical training and assistance tool was created at our center, using low-power, small, lightweight components that would be easy to transport on a space mission. The system consists of a tracked, head-mounted display, a computer system, and a number of tracked surgical instruments. The software provides a real-time surgical simulation system with integrated monitoring and information retrieval and a voice input/output subsystem. Initial medical content for the system has been created, comprising craniofacial, hand, inner ear, and general anatomy, as well as information on a number of surgical procedures and techniques. One surgical specialty in particular, microsurgery, was provided as a full simulation due to its long training requirements, significant impact on result due to experience, and likelihood for need. However, the system is easily adapted to realistically simulate a large number of other surgical procedures. By providing a general system for surgical simulation and assistance, the astronaut-surgeon can maintain their skills, acquire new specialty skills, and use tools for computer-based surgical planning and assistance to minimize overall crew and mission risk.

Aerospace Medicine↗

PubMed2006

Comparison of a personalized parent voice smoke alarm with a conventional residential tone smoke alarm for awakening children.

BACKGROUND: Conventional residential tone smoke alarms fail to awaken the majority of children during slow wave sleep. With the objective of identifying a more effective smoke alarm for children, we compared a personalized parent voice smoke alarm with a conventional residential tone smoke alarm, both presented at 100 dB, with respect to their ability to awaken children 6- to 12-years-old from stage 4 sleep and prompt their performance of a simulated self-rescue escape procedure. METHODS: Using a randomized, nonblinded, clinical research design, a volunteer sample of healthy children 6- to 12-years-old was enrolled in the study. Children were trained how to perform a simulated self-rescue escape procedure when they heard a smoke alarm. Each child's mother recorded a voice alarm message, "First name! First name! Wake up! Get out of bed! Leave the room!" For each child, either the voice or tone smoke alarm was randomly selected and triggered during the first cycle of stage 4 sleep, and then the other alarm was triggered during the second cycle of stage 4 sleep. Children's sleep stage was monitored by electroencephalography, electro-oculography, and chin electromyography. The 4 main outcome measures included the number of children who awakened, the number of children who escaped, the time to awakening, and the time to escape. RESULTS: Twenty-four children were enrolled. The median age was 9 years, and 11 (46%) were boys. One half of the children received the parent voice alarm first, and one half received the tone alarm first; however, the order that the alarm stimuli were presented was not statistically associated with awakening or escaping. Twenty-three (96%) of the 24 subjects awakened to the parent voice alarm compared with 14 (58%) to the tone alarm. One child did not awaken to either stimulus. Nine children awakened to their parent's voice but not to the tone, whereas none awakened to only the tone and not the voice. Twenty (83%) of the subjects in the parent voice alarm group successfully performed the escape procedure within 5 minutes of alarm onset compared with 9 (38%) in the tone alarm group. The median time to awaken was 20 seconds in the voice alarm group compared with 3 minutes in the tone alarm group. The median time to escape was 38 seconds in the voice alarm group compared with the maximum allowed 5 minutes in the tone alarm group. When exposed to the tone alarm, older children were more likely to awaken and were more likely to escape than younger children. There was no association between child's age and awakening or escaping for children exposed to the parent voice alarm. There was no association between child's gender and awakening or escaping for either alarm type. CONCLUSIONS: To our knowledge, this study is the first to compare the ability of different types of smoke alarms to awaken children while monitoring sleep stage. The personalized parent voice smoke alarm at 100 dB successfully awakened 96% of children 6- to 12-years-old from stage 4 sleep with 83% successfully performing a simulated self-rescue escape procedure, significantly outperforming the 100-dB conventional residential tone smoke alarm. These findings suggest a clear direction for future research, as well as important fundamental changes in smoke alarm design, that address the unique developmental needs of children. The development of a more effective smoke alarm for use in homes and other locations where children sleep provides an opportunity to reduce fire-related morbidity and mortality among children.

Accident Prevention↗

PubMed1997

Exploring clinical study design by computer simulation based on pharmacokinetic/pharmacodynamic modelling.

Computer simulations have been successfully applied in various industries (e.g. automobile, aerospace) to make product development more efficient. Just recently, it was suggested to use simulations in support of clinical drug development for predicting clinical outcomes of planned trials. The methodological basis for this approach is provided by pharmacokinetic and pharmacodynamic mathematical models together with Monte Carlo techniques. In the present paper, the basic notions of clinical trial simulation are introduced and illustrated with the example of an oral anticancer drug. It is shown that computer simulation helps to evaluate consequences of design features on safety and efficacy assessment of the drug which are not easily obtained otherwise. An overview of existing simulation resources with respect to training and software is provided.

Administration, Oral↗