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Results for “Simulation Training”

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PubMed2002

An acute care skills evaluation for graduating medical students: a pilot study using clinical simulation.

PURPOSE: This investigation aimed to explore the measurement properties of scores from a patient simulator exercise. METHODS: Analytic and holistic scores were obtained for groups of medical students and residents. Item analysis techniques were used to explore the nature of specific examinee actions. Interrater reliability was calculated. Scores were contrasted for third year medical students, fourth year medical students and emergency department residents. RESULTS: Interrater reliabilities for analytic and holistic scores were 0.92 and 0.81, respectively. Based on item analysis, proper timing and sequencing of actions discriminated between low- and high-ability examinees. In general, examinees with more advanced training obtained higher scores on the simulation exercise. CONCLUSION: Reliable and valid measures of clinical performance can be obtained from a trauma simulation provided that care is taken in the development and scoring of the scenario.

Analysis of Variance↗

PubMed1996

A haptic interface for virtual simulation of endoscopic surgery.

Virtual reality can be described as a convincingly realistic and naturally interactive simulation in which the user is given a first person illusion of being immersed within a computer generated environment While virtual reality systems offer great potential to reduce the cost and increase the quality of medical training, many technical challenges must be overcome before such simulation platforms offer effective alternatives to more traditional training means. A primary challenge in developing effective virtual reality systems is designing the human interface hardware which allows rich sensory information to be presented to users in natural ways. When simulating a given manual procedure, task specific human interface requirements dictate task specific human interface hardware. The following paper explores the design of human interface hardware that satisfies the task specific requirements of virtual reality simulation of Endoscopic surgical procedures. Design parameters were derived through direct cadaver studies and interviews with surgeons. Final hardware design is presented.

Computer Simulation↗

PubMed2004

Visuospatial skills and computer game experience influence the performance of virtual endoscopy.

Advanced medical simulators have been introduced to facilitate surgical and endoscopic training and thereby improve patient safety. Residents trained in the Procedicus Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) laparoscopic simulator perform laparoscopic cholecystectomy safer and faster than a control group. Little has been reported regarding whether factors like gender, computer experience, and visuospatial tests can predict the performance with a medical simulator. Our aim was to investigate whether such factors influence the performance of simulated gastroscopy. Seventeen medical students were asked about computer gaming experiences. Before virtual endoscopy, they performed the visuospatial test PicCOr, which discriminates the ability of the tested person to create a three-dimensional image from a two-dimensional presentation. Each student performed one gastroscopy (level 1, case 1) in the GI Mentor II, Simbionix, and several variables related to performance were registered. Percentage of time spent with a clear view in the endoscope correlated well with the performance on the PicSOr test (r = 0.56, P < 0.001). Efficiency of screening also correlated with PicSOr (r = 0.23, P < 0.05). In students with computer gaming experience, the efficiency of screening increased (33.6% +/- 3.1% versus 22.6% +/- 2.8%, P < 0.05) and the duration of the examination decreased by 1.5 minutes (P < 0.05). A similar trend was seen in men compared with women. The visuospatial test PicSOr predicts the results with the endoscopic simulator GI Mentor II. Two-dimensional image experience, as in computer games, also seems to affect the outcome.

Case-Control Studies↗

PubMed2000

The knowledge acquired during artificial grammar learning: testing the predictions of two connectionist models.

An artificial grammar learning experiment is reported which investigated whether three types of information are learned during this kind of task: information about the positions of single letters, about fragments of training strings, and about entire training strings. Results indicate that participants primarily learned information about string fragments and, to a lesser extent, information about positions of letters. Two connectionist models, an autoassociator and a simple recurrent network (SRN), were tested on their ability to account for these results. In the autoassociator simulations, similarity of test items to entire training items had a large effect, which was at variance with the experimental results. The results of the SRN simulations almost perfectly matched the experimental ones.

Adult↗

PubMed1996

Integration time for short broad band clicks in echolocating FM-bats (Eptesicus fuscus).

Vespertilionid FM-bats (four Eptesicus fuscus and one Vespertilio murinus) were trained in an electronic phantom target simulator to detect synthetic echoes consisting of either one or two clicks. The threshold sound pressure for single clicks was around 47 dB peSPL for all five bats corresponding to a threshold energy of -95 dB re 1 Pa2*s. By varying the interclick interval, delta T, for double clicks it was shown that the threshold intensity was around -3 dB relative to the threshold for single clicks at delta T up to 2.4 ms, indicating perfect power summation of both clicks. A threshold shift of -13.5 dB for a 1 ms train of 20 clicks (0.05 ms interclick interval) confirmed that the bats integrated the power of the stimuli. At delta T longer than around 2.5 ms the threshold for double clicks was the same as for single clicks. Thus, the bats performed like perfect energy detectors with an integration time of approximately 2.4 ms. This integration time is an order of magnitude shorter than that reported for bats listening passively for pure tones. In our setup the bats emitted sonar signals with durations of 2-3 ms. Hence, the results may indicate that while echolocating the bats integration time is adapted to the duration of the sonar emissions.

Animals↗

PubMed1999

View dependence in scene recognition after active learning.

Human spatial encoding of three-dimensional navigable space was studied, using a virtual environment simulation. This allowed subjects to become familiar with a realistic scene by making simulated rotational and translational movements during training. Subsequent tests determined whether subjects could generalize their recognition ability by identifying novel-perspective views and topographic floor plans of the scene. Results from picture recognition tests showed that familiar direction views were most easily recognized, although significant generalization to novel views was observed. Topographic floor plans were also easily identified. In further experiments, novel-view performance diminished when active training was replaced by passive viewing of static images of the scene. However, the ability to make self-initiated movements, as opposed to watching dynamic movie sequences, had no effect on performance. These results suggest that representation of navigable space is view dependent and highlight the importance of spatial-temporal continuity during learning.

Adult↗

PubMed2000

Skill acquisition in the implementation of functional analysis methodology.

Functional analysis methodology is a powerful assessment tool for identifying contingencies that maintain a wide range of behavior disorders and for developing effective treatment programs. Nevertheless, concerns have been raised about the feasibility of conducting functional analyses in typical service settings. In this study, we examined the issue of skill acquisition in implementing functional analyses by evaluating an instructional program designed to establish a basic set of competencies. Eleven undergraduate students enrolled in a laboratory course in applied behavior analysis served as participants. Their performance was assessed during scripted simulations in which they played the roles of "therapists" who conducted functional analyses and trained graduate students played the roles of "clients" who emitted self-injurious and destructive behaviors. To approximate conditions under which an individual might conduct an assessment with limited prior training, participants read a brief set of materials prior to conducting baseline sessions. A multiple baseline design was used to assess the effects of training, which consisted of reading additional materials, watching a videotaped simulation demonstrating correct procedural implementation, passing a written quiz, and receiving feedback on performance during sessions. Results showed that participants scored a relatively high percentage of correct therapist responses during baseline, and that all achieved an accuracy level of 95% or higher following training that lasted about 2 hr. These results suggest that basic skills for conducting functional analyses can be acquired quickly by individuals who have relatively little clinical experience.

Feasibility Studies↗

PubMed2000

Effects of physical and apnea training on apneic time and the diving response in humans.

The aim of this investigation was to study separately the effects of physical training and apnea training on the diving response and apneic time in humans. Both types of training have been suggested to lead to prolonged apneic time and an increased "diving response" (i.e., regional vasoconstriction and bradycardia). The study was also designed to examine the effects of these two types of training on the characteristics of the increase in apneic time with repeated apneas. Simulated diving tests were performed before and after the different training programs. The test format was one apnea and five apneas with facial immersion in cold water at 2-min intervals. An increase in apneic time was observed after physical training (n = 24), and this was attributable to an increased time beyond the physiological breaking point. The other parameters that were measured remained unaffected. After apnea training (n = 9), however, apneic time was increased by a delay in the physiological breaking point, which is mainly determined by the arterial tension of CO2. The diving response had increased, and the effect of repeated apneas on apneic time tended to be larger after apnea training. These results may explain the pronounced diving responses and long apneas observed in trained apneic divers.

Adult↗

PubMed1993

Analyses of cognitive processes in train traffic control.

The study of complex information processing and problem-solving situations in practice is discussed, in particular the methods of analysing the cognitive aspects in train dispatcher's work. Some parallels are drawn with related work in processing industries. A prerequisite for the approach to the issue was that the results would have to yield very concrete starting-points for the design of technical aids. The research started from the assumption that it would be extremely difficult to derive design indications from apparently observable actions of the train dispatchers. This led to the choice of a combination of a preliminary simulation study followed by analysis of cognitive processes in the train dispatcher's behaviour in every day practice. It turned out to be helpful for the analysis to draw parallels between the cognitive processes in the behaviour of the train dispatchers and the way of working/thinking shown by test subjects in complex problem-solving experiments.

Cognition↗

PubMed2000

Cardiovascular response to hypoxia after endurance training at altitude and sea level and after detraining.

The purpose of this study was to elucidate 1) the effects of endurance exercise training during hypoxia or normoxia and of detraining on ventilatory and cardiovascular responses to progressive isocapnic hypoxia and 2) whether the change in the cardiovascular response to hypoxia is correlated to changes in the hypoxic ventilatory response (HVR) after training and detraining. Seven men (altitude group) performed endurance training using a cycle ergometer in a hypobaric chamber of simulated 4,500 m, whereas the other seven men (sea-level group) trained at sea level (K. Katayama, Y. Sato, Y. Morotome, N. Shima, K. Ishida, S. Mori, and M. Miyamura. J. Appl. Physiol. 86: 1805-1811, 1999). The HVR, systolic and diastolic blood pressure responses (DeltaSBP/DeltaSa(O(2)), DeltaDBP/DeltaSa(O(2))), and heart rate response (DeltaHR/DeltaSa(O(2)); Sa(O(2)) is arterial oxygen saturation) to progressive isocapnic hypoxia were measured before and after training and during detraining. DeltaSBP/DeltaSa(O(2)) increased significantly in the altitude group and decreased significantly in the sea-level group after training. The changed DeltaSBP/DeltaSa(O(2)) in both groups was restored during 2 wk of detraining, as were the changes in HVR, whereas there were no changes in the DeltaDBP/DeltaSa(O(2)) and DeltaHR/DeltaSa(O(2)) throughout the experimental period. The changes in DeltaSBP/DeltaSa(O(2)) after training and detraining were significantly correlated with those in HVR. These results suggest that DeltaSBP/DeltaSa(O(2)) to progressive isocapnic hypoxia is variable after endurance training during hypoxia and normoxia and after detraining, as is HVR, but DeltaDBP/DeltaSa(O(2)) and DeltaHR/DeltaSa(O(2)) are not. It also suggests that there is an interaction between the changes in DeltaSBP/DeltaSa(O(2)) and HVR after endurance training or detraining.

Altitude↗

PubMed1982

Increase in jammed word intelligibility due to training of listeners.

Data are presented on the effect of training on naive subjects' ability to listen to voice communications under conditions of simulated cockpit noise and active jamming. The results indicate that training improved the performance of listeners under all conditions tested. Suggestions are made for further research to quantify increases in performance of communicators in jammed environments due to training.

Aerospace Medicine↗

PubMed1997

Telepresence in neurosurgery: the integrated remote neurosurgical system.

This paper describes the Integrated Remote Neurosurgical System (IRNS), a remotely-operated neurosurgical microscope with high-speed communications and a surgeon-accessible user interface. The IRNS will allow high quality bidirectional mentoring in the neurosurgical suite. The research goals of this effort are twofold: to develop a clinical system allowing a remote neurosurgeon to lend expertise to the OR-based neurosurgical team and to provide an integrated training environment. The IRNS incorporates a generic microscope/transport model, Called SuMIT (Surgical Manipulator Interface Translator). Our system is currently under test using the Zeiss MKM surgical transport. A SuMIT interface is also being constructed for the Robotics Research 1607. The IRNS Remote Planning and Navigation Workstation incorporates surgical planning capabilities, real-time, 30 fps video from the microscope and overhead video camera. The remote workstation includes a force reflecting handcontroller which gives the remote surgeon an intuitive way to position the microscope head. Bidirectional audio, video whiteboarding, and image archiving are also supported by the remote workstation. A simulation mode permits pre-surgical simulation, post-surgical critique, and training for surgeons without access to an actual microscope transport system. The components of the IRNS are integrated using ATM switching to provide low latency data transfer. The research, along with the more sophisticated systems that will follow, will serve as a foundation and test-bed for extending the surgeon's skills without regard to time zone or geographic boundaries.

Humans↗

PubMed1999

Training theory and taper: validation in triathlon athletes.

This paper defines a training theory with which to predict the effectiveness of various formats of taper in optimizing physical performance from a standardized period of training and taper. Four different taper profiles: step reduction vs exponential (exp) decay and fast vs slow exp decay tapers, were simulated in a systems model to predict performance p(t) resulting from a standard square-wave quantity of training for 28 days. The relative effectiveness of each of the profiles in producing optimal physical improvement above pre-taper criterion physical test standards (running and cycle ergometry) was determined. Simulation showed that an exp taper was better than a step-reduction taper, and a fast exp decay taper was superior to a slow exp decay taper. The results of the simulation were tested experimentally in field trials to assess the correspondence between simulation and real-training criterion physical tests in triathlon athletes. The results showed that the exp taper (tau = 5 days) group made a significantly greater improvement above a pre-taper standard (P < or = 0.05) than the step-reduction taper group in cycle ergometry, and was better, but not significantly so, in a 5-km run. A fast exp taper group B (tau = 4 days) performed significantly better (P < or = 0.05) in maximal, cycle ergometry above a pre-taper training standard than a slow exp taper group A (tau = 8 days) and was improved more, but not significantly so, than group A in a 5-km criterion run. The mean improvement on both physical tests by exp decay taper groups all increased significantly (P < or = 0.05) above their pre-taper training standard. Maximum oxygen uptake increased significantly in a group of eight remaining athletes during 2 weeks of final taper after three athletes left early for final preparations at the race site.

Adult↗

PubMed1995

New model for microsurgical training and skills maintenance.

PracticeRat (Sharpoint, Reading PA) is a system containing a simulation vein, artery and nerve, designed as an alternative to live animal use in microsurgical training. We find PracticeRat to be more expensive than living models. However, it does decrease animal usage and provides a very convenient opportunity to practice microsurgical techniques and procedures in a fairly realistic manner. Trainees can practice anytime, for any length of time, wherever microscopes are available. In this regard we find PracticeRat+ to be a useful addition to microsurgical training programs and an excellent tool for skills maintenance.

Animal Testing Alternatives↗

PubMed2004

Influences of variation in force application on tibial displacement and strain in the anterior cruciate ligament during the Lachman test.

OBJECTIVE: The purpose of this study was to examine the influence of Lachman test performance technique on tibial displacement and strain in the anterior cruciate ligament. DESIGN: Model simulation of experimental Lachman test performance by trained clinicians. BACKGROUND: Differences in clinician hand placement during Lachman test performance have been observed. METHODS: A two-dimensional computer sagittal plane model of the knee was designed to simulate experimentally observed Lachman test performance, and determine anterior cruciate ligament strain and tibial translation that occurred during variation in clinician hand placement and force magnitude. RESULTS: Anterior cruciate ligament strain and tibial translation were greater under conditions mimicking clinician hand placement utilizing a more proximal force application on the tibia. CONCLUSIONS: Tibial translation and strain behavior of the anterior cruciate ligament during the Lachman test appear to be influenced by clinician hand position used in the application of force to the tibia.

Adult↗

PubMed2005

Challenges in the transition to model-based development.

Practitioners of the art and science of pharmacometrics are well aware of the considerable effort required to successfully complete modeling and simulation activities for drug development programs. This is particularly true because of the current, ad hoc implementation wherein modeling and simulation activities are piggybacked onto traditional development programs. This effort, coupled with the failure to explicitly design development programs around modeling and simulation, will continue to be an important obstacle to the successful transition to model-based drug development. Challenges with timely data availability, high data discard rates, delays in completing modeling and simulation activities, and resistance of development teams to the use of modeling and simulation in decision making are all symptoms of an immature process capability for performing modeling and simulation. A process that will fulfill the promise of model-based development will require the development and deployment of three critical elements. The first is the infrastructure--the data definitions and assembly processes that will allow efficient pooling of data across trials and development programs. The second is the process itself--developing guidelines for deciding when and where modeling and simulation should be applied and the criteria for assessing performance and impact. The third element concerns the organization and culture--the establishment of truly integrated, multidisciplinary, and multiorganizational development teams trained in the use of modeling and simulation in decision-making. Creating these capabilities, infrastructure, and incentivizations are critical to realizing the full value of modeling and simulation in drug development.

Animals↗

PubMed2005

Teaching intravenous cannulation to medical students: comparative analysis of two simulators and two traditional educational approaches.

This study examines the effectiveness of two virtual reality simulators when compared with traditional methods of teaching intravenous (IV) cannulation to third year medical students. Thirty-four third year medical students were divided into four groups and then trained to perform an IV cannulation using either CathSim, Virtual I.V., a plastic simulated arm or by practicing IV placement on each other. All subjects watched a five minute training video and completed a cannulation pretest and posttest on the simulated arm. The results showed significant improvement from pretest to posttest in each of the four groups. Students trained on the Virtual I.V. showed significantly greater improvement over baseline when compared with the simulated arm group (p<.026). Both simulators provided at least equal training to traditional methods of teaching, a finding with implications for future training of this procedure to novices.

Catheterization↗

PubMed1990

Space Station Freedom crew training.

The nature of the Space Station Freedom Program presents an array of new and enhanced challenges which need to be addressed en route to developing an effective and affordable infrastructure for crew training. Such an infrastructure is essential for the safety and success of the program. The three major challenges that affect crew training are the long lifetime of the program (thirty years), the interdependence of successive increments, and the participation of the three International Partners (Canada, European Space Agency, and Japan) and a myriad of experimenters. This paper addresses these major challenges as they drive the development of a crew training capability and the actual conduct of crew training.

Astronauts↗