By Tate Skinner and Dr. Adam Dubrowski
1.J R Soc Med. 2016 Oct;109(10):372-380.
A review of
wearable technology in medicine.
Iqbal MH1, Aydin A1, Brunckhorst O1, Dasgupta P1, Ahmed K2.
Author information:
1MRC Centre for Transplantation, Guy's Hospital, King's College
London, London, UK.
2MRC Centre for Transplantation, Guy's Hospital, King's College
London, London, UK kamran.ahmed@kcl.ac.uk.
Abstract
With rapid advances in technology, wearable devices have evolved
and been adopted for various uses, ranging from simple devices used in aiding
fitness to more complex devices used in assisting surgery. Wearable technology
is broadly divided into head-mounted displays and body sensors. A broad search
of the current literature revealed a total of 13 different body sensors and 11
head-mounted display devices. The latter have been reported for use in surgery
(n = 7), imaging (n = 3), simulation and education (n = 2) and as navigation
tools (n = 1). Body sensors have been used as vital signs monitors (n = 9) and
for posture-related devices for posture and fitness (n = 4). Body sensors were
found to have excellent functionality in aiding patient posture and
rehabilitation while head-mounted displays can provide information to surgeons
to while maintaining sterility during operative procedures. There is a
potential role for head-mounted wearable technology and body sensors in
medicine and patient care. However, there is little scientific evidence
available proving that the application of such technologies improves patient
satisfaction or care. Further studies need to be conducted prior to a clear
conclusion.
© The Royal Society of Medicine.
PMID: 27729595 [PubMed - in process]
2.N Z Med J. 2016 Oct 14;129(1443):9-17.
Can team training
make surgery safer? Lessons for national implementation of a simulation-based
programme.
Weller J1, Civil I2, Torrie J3, Cumin D4, Garden A5, Corter A6,
Merry A4.
Author information:
1Centre for Medical and Health Sciences Education and Department
of Anaesthesia, University of Auckland, Auckland City Hospital, Auckland.
2Department of Trauma, Auckland City Hospital, Auckland.
3Department of Anaesthesiology, University of Auckland, Auckland
City Hospital, Auckland.
4Department of Anaesthesiology, University of Auckland, Auckland.
5 Department of Anaesthesia, Capital and Coast District Health
Board, New Zealand.
6Department of Psychological Medicine, University of Auckland,
Auckland.
Abstract
AIM:
Unintended patient harm is a major contributor to poor outcomes
for surgical patients and often reflects failures in teamwork. To address this
we developed a Multidisciplinary Operating Room Simulation (MORSim)
intervention to improve teamwork in the operating room (OR) and piloted it with
20 OR teams in two of the 20 District Health Boards in New Zealand prior to
national implementation. In this study, we describe the experience of those
exposed to the intervention, challenges to implementing changes in clinical
practice and suggestions for successful implementation of the programme at a regional
or national level.
METHODS:
We undertook semi-structured interviews of a stratified random
sample of MORSim participants 3-6 months after they attended the course. We
explored their experiences of changes in clinical practice following MORSim.
Interviews were recorded, transcribed and analysed using a general inductive
approach to develop themes into which interview data were coded. Interviews
continued to the point of thematic saturation.
RESULTS:
Interviewees described adopting into practice many of the elements
of the MORSim intervention and reported positive experiences of change in
communication, culture and collaboration. They described sharing MORSim
concepts with colleagues and using them in teaching and orientation of new
staff. Reported barriers to uptake included uninterested colleagues, limited
team orientation, communication hierarchies, insufficient numbers of staff
exposed to MORSim and failure to prioritise time for team information sharing
such as pre-case briefings.
CONCLUSION:
MORSim appears to have had lasting effects on reported attitudes
and behaviours in clinical practice consistent with more effective teamwork and
communication. This study adds to the accumulating body of evidence on the
value of simulation-based team training and offers suggestions for implementing
widespread, regular team training for OR teams.
PMID: 27736848 [PubMed - in process]
3.Simul Healthc. 2016 Oct;11(5):316-322.
Preparation With
Web-Based Observational Practice Improves Efficiency of Simulation-Based Mastery
Learning.
Cheung JJ1, Koh J, Brett C, Bägli DJ, Kapralos B, Dubrowski A.
Author information:
1From the Wilson Centre (J.J.H.C.), Faculty of Medicine,
University of Toronto; SickKids Learning Institute (J.J.H.C.), The Hospital for
Sick Children, Toronto, ON, Canada; Changi Simulation Institute (J.K.), Changi
General Hospital, Singapore, Singapore; Department of Curriculum (C.B.),
Teaching and Learning, Ontario Institute for Studies in Education, University
of Toronto; Department of Surgery (D.J.B.), University of Toronto, Toronto;
Faculty of Business and Information Technology (B.K.), University of Ontario
Institute of Technology, Oshawa; and Discipline of Emergency Medicine (A.D.),
Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL,
Canada.
Abstract
INTRODUCTION:
Our current understanding of what results in effective
simulation-based training is restricted to the physical practice and debriefing
stages, with little attention paid to the earliest stage: how learners are
prepared for these experiences. This study explored the utility of Web-based
observational practice (OP) -featuring combinations of reading materials (RMs),
OP, and collaboration- to prepare novice medical students for a
simulation-based mastery learning (SBML) workshop in central venous
catheterization.
METHODS:
Thirty medical students were randomized into the following 3
groups differing in their preparatory materials for a SBML workshop in central
venous catheterization: a control group with RMs only, a group with Web-based
groups including individual OP, and collaborative OP (COP) groups in addition
to RM. Preparation occurred 1 week before the SBML workshop, followed by a
retention test 1-week afterward. The impact on the learning efficiency was
measured by time to completion (TTC) of the SBML workshop. Web site preparation
behavior data were also collected.
RESULTS:
Web-based groups demonstrated significantly lower TTC when
compared with the RM group, (P = 0.038, d = 0.74). Although no differences were
found between any group performances at retention, the COP group spent
significantly more time and produced more elaborate answers, than the OP group
on an OP activity during preparation.
DISCUSSION:
When preparing for SBML, Web-based OP is superior to reading
materials alone; however, COP may be an important motivational factor to
increase learner engagement with instructional materials. Taken together,
Web-based preparation and, specifically, OP may be an important consideration
in optimizing simulation instructional design.
PMID: 27388862 [PubMed - in process]
4.Pediatr Emerg Care. 2016 Oct 18. [Epub
ahead of print]
Can Residents
Assess Other Providers' Infant Lumbar Puncture Skills?: Validity Evidence for a
Global Rating Scale and Subcomponent Skills Checklist.
Braun C1, Kessler DO, Auerbach M, Mehta R, Scalzo AJ, Gerard JM.
Author information:
1From the *Department of Pediatrics, Saint Louis University School
of Medicine, St Louis, MO; †Department of Pediatrics, Columbia University
Medical Center, New York, NY; ‡Department of Pediatrics, Yale University School
of Medicine, New Haven, CT; and §Department of Pediatrics, Medical College of
Georgia at Georgia Regents University, Augusta, GA.
Abstract
OBJECTIVES:
The aims of this study were to provide validity evidence for
infant lumbar puncture (ILP) checklist and global rating scale (GRS)
instruments when used by residents to assess simulated ILP performances and to
compare these metrics to previously obtained attending rater data.
METHODS:
In 2009, the International Network for Simulation-based Pediatric
Innovation, Research, and Education (INSPIRE) developed checklist and GRS
scoring instruments, which were previously validated among attending raters
when used to assess simulated ILP performances. Video recordings of 60 subjects
performing an LP on an infant simulator were collected; 20 performed by
subjects in 3 categories (beginner, intermediate, and expert). Six blinded
pediatric residents independently scored each performance (3 via the GRS, 3 via
the checklist). Four of the 5 domains of validity evidence were collected:
content, response process, internal structure (reliability and discriminant
validity), and relations to other variables.
RESULTS:
Evidence for content and response process validity is presented.
When used by residents, the checklist performed similarly to what was found for
attending raters demonstrating good internal consistency (Cronbach α = 0.77)
and moderate interrater agreement (intraclass correlation coefficient = 0.47).
Residents successfully discerned beginners (P < 0.01, effect size = 2.1) but
failed to discriminate between expert and intermediate subjects (P = 0.68,
effect size = 0.34). Residents, however, gave significantly higher GRS scores
than attending raters across all subject groups (P < 0.001). Moderate
correlation was found between GRS and total checklist scores (P = 0.49, P <
0.01).
CONCLUSIONS:
This study provides validity evidence for the checklist instrument
when used by pediatric residents to assess ILP performances. Compared with
attending raters, residents appeared to over-score subjects on the GRS
instrument.
PMID: 27763954 [PubMed - as supplied by publisher]
5.Int J Surg. 2016 Oct 11;36(Pt
A):26-29. doi: 10.1016/j.ijsu.2016.10.008. [Epub ahead of print]
Can specialized
surgical simulation influence resident career choice?
Kaban JM1, Dayama A2, Reddy SH3, Teperman S4, Stone ME Jr5.
Author information:
1Jacobi Medical Center, 1400 Pelham Pkwy S., Bronx, NY 10461, USA.
Electronic address: jody.kaban@nbhn.net.
2Jacobi Medical Center, 1400 Pelham Pkwy S., Bronx, NY 10461, USA.
Electronic address: anand.dayama@nbhn.net.
3Jacobi Medical Center, 1400 Pelham Pkwy S., Bronx, NY 10461, USA.
Electronic address: srinivas.h.reddy@nbhn.net.
4Jacobi Medical Center, 1400 Pelham Pkwy S., Bronx, NY 10461, USA.
Electronic address: sheldon.teperman@nbhn.net.
5Jacobi Medical Center, 1400 Pelham Pkwy S., Bronx, NY 10461, USA.
Electronic address: melvin.stone@nbhn.net.
Abstract
OBJECTIVE:
Our institution began Advanced Trauma Operative Management (ATOM)
simulation course in 2007 for senior residents with the aim of increasing
opportunities for surgical trainees to gain operative trauma experience. The
aim of our study was to evaluate the effect of the ATOM simulation course on
residents' choice of trauma as a career as demonstrated by entrance into
surgical critical care (SCC) fellowships.
DESIGN:
Retrospective study of institutional data on graduating residents
from 2002 to 2015. Residents were divided into pre-ATOM (2002-08) and post-
(institution of) ATOM (2009-15) cohorts. The percentage of residents entering
SCC fellowships was then compared among cohorts as well as to national trends.
RESULTS:
Nationally the pre-ATOM group had 7057 graduating general surgery
(GS) residents (847 SCC) and post-ATOM had 7581 graduating GS residents (1268
SCC). Locally the pre-ATOM group consisted of 40 graduating GS residents (1
SCC) and while the post-ATOM cohort had 51 graduating GS residents (9 SCC). The
number of SCC fellows increased by 4.7% nationally and 15.7% institutionally
between the two study groups. The increased interest in SCC was more than could
be accounted for by national trends.
CONCLUSIONS:
Interest in a career in trauma was increased among residents
graduating from this single institution after instituting ATOM as part of the
educational curriculum.
6.Surg Endosc. 2016
Nov;30(11):4871-4879. Epub 2016 Feb 23.
Design and
validation of a cost-effective physical endoscopic simulator for fundamentals
of endoscopic surgery training.
King N1, Kunac A2, Johnsen E3, Gallina G4, Merchant AM5,6.
Author information:
1Division of General Surgery, Rutgers-New Jersey Medical School,
Newark, NJ, 07103, USA.
2Division of Trauma and Critical Care, Rutgers-New Jersey Medical
School, Newark, NJ, 07103, USA.
3Department of Surgery, Rutgers-New Jersey Medical School, 185 So.
Orange Ave., MSB G-506, Newark, NJ, 07103, USA.
4Division of Surgery, Hackensack University Medical Center,
Hackensack, NJ, 07601, USA.
5Division of General Surgery, Rutgers-New Jersey Medical School,
Newark, NJ, 07103, USA. Aziz.Merchant@rutgers.edu.
6Department of Surgery, Rutgers-New Jersey Medical School, 185 So.
Orange Ave., MSB G-506, Newark, NJ, 07103, USA. Aziz.Merchant@rutgers.edu.
Abstract
BACKGROUND:
The American Board of Surgery will require graduating surgical
residents to achieve proficiency in endoscopy. Surgical simulation can help
residents to prepare for this proficiency test, accelerate skill acquisition,
shorten the learning, and improve patient safety. Currently, endoscopic
simulators are extremely cost-prohibitive. We therefore designed an inexpensive
physical endoscopic simulator to (1) facilitate Fundamentals of Endoscopic Surgery
skills training and (2) teach basic colonoscopy skills, for <$200.00.
METHODS:
We constructed the Rutgers Open Source Colonoscopy Simulator
(ROSCO) from easily acquired commercial materials. For construct validation, we
compared novices to experts in a two-arm non-randomized study. Each participant
performed the five tasks and a full cecal intubation on the simulator. Face and
content validity surveys were taken by the experts, after the construct
validity study to determine the simulator's ability to achieve the intended
task with "realism." Data were collected on (1) cost and construction,
(2) time to completion of individual tasks, (3) percentage of task completion,
and (4) survey statistics.
RESULTS:
Our simulator requires no advanced expertise, costs $62.77 US, and
weighs 8.5 pounds. The ROSCO simulator was clearly able to distinguish expert
from novice. Expert task times for completing all five tasks, performing the
loop reduction, and reaching the splenic and hepatic flexures on the simulator
were significantly better than novice times (p < 0.05). All participants
were able to complete all five tasks on the simulator 100 % of the time. Three
out of five experts "Agreed" or "Strongly Agreed" with five
out of the six statements regarding the simulator's teaching ability. Four out
of five experts rated each of the five specific aspects of the simulator as
"Realistic" or "Very Realistic."
CONCLUSIONS:
We have designed a low-cost colonoscopy simulator with easily
available materials and which requires very little advanced construction
expertise and have demonstrated construct, face, and content validity. We
believe this will have broad impact for endoscopic simulation, surgical
education, and health education cost.
7.Med Health Care Philos. 2016 Oct 28.
[Epub ahead of print]
Empathizing with
patients: the role of interaction and narratives in providing better patient
care.
Hardy C1.
Author information:
1Department of Philosophy, University of South Florida, 4202 E.
Fowler Ave., FAO 280, Tampa, FL, 33620, USA. carterhardy@mail.usf.edu.
Abstract
Recent studies have revealed a drop in the ability of physicians
to empathize with their patients. It is argued that empathy training needs to
be provided to both medical students and physicians in order to improve patient
care. While it may be true that empathy would lead to better patient care, it
is important that the right theory of empathy is being encouraged. This paper
examines and critiques the prominent explanation of empathy being used in
medicine. Focusing on the component of empathy that allows us to understand
others, it is argued that this understanding is accomplished through a
simulation. However, simulation theory is not the best explanation of empathy
for medicine, since it involves a limited perspective in which to understand
the patient. In response to the limitations and objections to simulation
theory, interaction theory is presented as a promising alternative. This theory
explains the physicians understanding of patients from diverse backgrounds as
an ability to learn and apply narratives. By explaining how we understand
others, without limiting our ability to understand various others, interaction
theory is more likely than simulation theory to provide better patient care,
and therefore is a better theory of empathy for the medical field.
8.J Surg Educ. 2016 Nov 4. pii:
S1931-7204(16)30193-3. doi: 10.1016/j.jsurg.2016.09.009. [Epub ahead of print]
Talk the Talk:
Implementing a Communication Curriculum for Surgical Residents.
Newcomb AB1, Trickey AW2, Porrey M3, Wright J2, Piscitani F2,
Graling P2, Dort J2.
Author information:
1Division of Trauma, Department of Surgery, Inova Fairfax Medical
Campus, Falls Church, Virginia. Electronic address: Anna.Newcomb@inova.org.
2Department of Surgery, Advanced Surgical Technology and Education
Center, Inova Fairfax Medical Campus, Falls Church, Virginia.
3Division of Trauma, Department of Surgery, Inova Fairfax Medical
Campus, Falls Church, Virginia.
Abstract
OBJECTIVES:
The Accreditation Council for Graduate Medical Education
milestones provide a framework of specific interpersonal and communication
skills that surgical trainees should aim to master. However, training and
assessment of resident nontechnical skills remains challenging. We aimed to
develop and implement a curriculum incorporating interactive learning principles
such as group discussion and simulation-based scenarios to formalize
instruction in patient-centered communication skills, and to identify best
practices when building such a program.
DESIGN:
The curriculum is presented in quarterly modules over a 2-year
cycle. Using our surgical simulation center for the training, we focused on
proven strategies for interacting with patients and other providers. We trained
and used former patients as standardized participants (SPs) in communication
scenarios.
SETTING:
Surgical simulation center in a 900-bed tertiary care hospital.
PARTICIPANTS:
Program learners were general surgery residents (postgraduate year
1-5). Trauma Survivors Network volunteers served as SPs in simulation
scenarios.
RESULTS:
We identified several important lessons: (1) designing and
implementing a new curriculum is a challenging process with multiple barriers
and complexities; (2) several readily available facilitators can ease the
implementation process; (3) with the right approach, learners, faculty, and
colleagues are enthusiastic and engaged participants; (4) learners increasingly
agree that communication skills can be improved with practice and appreciate
the curriculum value; (5) patient SPs can be valuable members of the team; and
importantly (6) the culture of patient-physician communication appears to shift
with the implementation of such a curriculum.
CONCLUSIONS:
Our approach using Trauma Survivors Network volunteers as SPs
could be reproduced in other institutions with similar programs. Faculty
enthusiasm and support is strong, and learner participation is active.
Continued focus on patient and family communication skills would enhance
patient care for institutions providing such education as well as for institutions
where residents continue on in fellowships or begin their surgical practice.
Copyright © 2016 Association of Program Directors in Surgery.
Published by Elsevier Inc. All rights reserved.
PMID: 27825662 [PubMed - as supplied by publisher]
9.J Ultrasound Med. 2016 Nov 7. pii:
16.01050. [Epub ahead of print]
Early Innovative
Immersion: A Course for Pre-Medical Professions Students Using Point-of-Care
Ultrasound.
Smalley CM1, Browne V2, Kaplan B2, Russ B3, Wilson J2, Lewiss RE2.
Author information:
1Emergency Services Institute, Cleveland Clinic, Cleveland, Ohio,
USA courtney.smalley@gmail.com.
2Department of Emergency Medicine, University of Colorado School
of Medicine, Aurora, Colorado USA.
3Department of Emergency Medicine, The University of Arkansas for
Medical Sciences, Little Rock, Arkansas USA.
Abstract
In preparing for medical school admissions, premedical students
seek opportunities to expand their medical knowledge. Knowing what students
seek and what point-of-care ultrasound offers, we created a novel educational
experience using point-of-care ultrasound. The innovation has 3 goals: (1) to
use point-of-care ultrasound to highlight educational concepts such as the
flipped classroom, simulation, hands-on interaction, and medical exposure; (2)
to work collaboratively with peers; and (3) to expose premedical students to
mentoring for the medical school application process. We believe that this
course could be used to encourage immersive innovation with point-of-care
ultrasound, progressive education concepts, and preparation for medical
admissions.
© 2016 by the American Institute of Ultrasound in Medicine.
PMID: 27821654 [PubMed - as supplied by publisher]
10.J Surg Educ. 2016 Nov 8. pii:
S1931-7204(16)30211-2. doi: 10.1016/j.jsurg.2016.10.007. [Epub ahead of print]
Systematic Review
of Voluntary Participation in Simulation-Based Laparoscopic Skills Training:
Motivators and Barriers for Surgical Trainee Attendance.
Gostlow H1, Marlow N2, Babidge W1, Maddern G3.
Author information:
1Division of Surgery, University of Adelaide, The Queen Elizabeth
Hospital, Woodville South, South Australia, Australia; Australian Safety and
Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal
Australasian College of Surgeons, North Adelaide, South Australia, Australia.
2Australian Safety and Efficacy Register of New Interventional
Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, North
Adelaide, South Australia, Australia.
3Division of Surgery, University of Adelaide, The Queen Elizabeth
Hospital, Woodville South, South Australia, Australia; Australian Safety and
Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal
Australasian College of Surgeons, North Adelaide, South Australia, Australia.
Electronic address: guy.maddern@adelaide.edu.au.
Abstract
OBJECTIVE:
To examine and report on evidence relating to surgical trainees'
voluntary participation in simulation-based laparoscopic skills training.
Specifically, the underlying motivators, enablers, and barriers faced by
surgical trainees with regard to attending training sessions on a regular
basis.
DESIGN:
A systematic search of the literature (PubMed; CINAHL; EMBASE;
Cochrane Collaboration) was conducted between May and July 2015. Studies were
included on whether they reported on surgical trainee attendance at voluntary,
simulation-based laparoscopic skills training sessions, in addition to
qualitative data regarding participant's perceived barriers and motivators
influencing their decision to attend such training. Factors affecting a
trainee's motivation were categorized as either intrinsic (internal) or
extrinsic (external).
RESULTS:
Two randomised control trials and 7 case series' met our inclusion
criteria. Included studies were small and generally poor quality. Overall,
voluntary simulation-based laparoscopic skills training was not well attended.
Intrinsic motivators included clearly defined personal performance goals and
relevance to clinical practice. Extrinsic motivators included clinical
responsibilities and available free time, simulator location close to clinical
training, and setting obligatory assessments or mandated training sessions. The
effect of each of these factors was variable, and largely dependent on the
individual trainee. The greatest reported barrier to attending voluntary
training was the lack of available free time.
CONCLUSION:
Although data quality is limited, it can be seen that providing
unrestricted access to simulator equipment is not effective in motivating
surgical trainees to voluntarily participate in simulation-based laparoscopic
skills training. To successfully encourage participation, consideration needs
to be given to the factors influencing motivation to attend training. Further
research, including better designed randomised control trials and large-scale
surveys, is required to provide more definitive answers to the degree in which
various incentives influence trainees' motivations and actual attendance rates.
Copyright © 2016 Association of Program Directors in Surgery.
Published by Elsevier Inc. All rights reserved.
PMID: 27836238 [PubMed - as supplied by publisher]
11.J Asthma. 2016 Nov 11:0. [Epub ahead
of print]
Improving
Childcare Staff Management of Acute Asthma Exacerbation - An Australian Pilot
Study.
Soo YY1, FitzGerald KH2, Saini B3, Kritikos V4, Brannan JD5, Moles
RJ6.
Author information:
1a National Prescribing Service, Learning Specialist Program &
Product Development , Level 7 / 418a Elizabeth St Surry Hills NSW 2010, Surry
Hills , 2010 Australia.
2b The University of Sydney, Faculty of Pharmacy, Room N517,
Building A15, Faculty of Pharmacy, Science Road, University of Sydney ,
Camperdown Campus,, 2006 Australia.
3c University of Sydney Faculty of Pharmacy, Dept of Pharmacy ,
Pharmacy and Bank Building, A15 The University of Sydney , Sydney , 2006
Australia.
4d The University of Sydney, Woolcock Institute of Medical
Research , Australia.
5e John Hunter Hospital , Department of Respiratory and Sleep
Medicine , Hunter , 2310 Australia.
6f University of Sydney Faculty of Pharmacy, Department of
Pharmacy , Pharmacy and Bank Building, A15 The University of Sydney Camperdown
Campus , Sydney , 2006 Australia.
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of an
asthma first-aid training tool for childcare staff in Australia. The effects of
training on both asthma knowledge and skills were assessed. METHODS A pre/post
study design was utilised to assess changes in asthma knowledge and asthma
first-aid skills in childcare staff before and after an educational
intervention. Asthma first-aid skills were assessed from the participant's
response to two scenarios in which a child was having a severe exacerbation of
asthma. Asthma knowledge and asthma skills scores were collected at base-line
and three weeks post the education session which involved feedback on each
individual's skills and a brief lecture on asthma delivered via PowerPoint
presentation. RESULTS There was a significant improvement after intervention in
asthma knowledge (Z = -3.638, p<0.001) and asthma first-aid skills for both
scenario 1 (Z = -6.012, p<0.001) and scenario 2 (Z = -6.018, p<0.001). In
scenario 1 and 2, first-aid skills improved by 65% (p<0.001) and 57%
(p<0.001) respectively. Asthma knowledge was high at baseline (79%) and
increased by 7% (p<0.001) after the educational intervention. These asthma
knowledge results were not significant when adjusted for prior knowledge.
Results suggest that knowledge assessment alone may not predict the practical
skills needed for asthma first-aid. CONCLUSIONS Skills assessment is a useful
adjunct to knowledge assessment when gauging the ability of childcare staff to
manage acute asthma exacerbation. Skills assessment could be considered for
incorporation into future educational interventions to improve management of
acute asthma exacerbation.
PMID: 27834496 [PubMed - as supplied by publisher]
Similar articles
12.Am J Perinatol. 2016 Nov 10. [Epub
ahead of print]
Simulation-Based
Patient-Specific Multidisciplinary Team Training in Preparation for the
Resuscitation and Stabilization of Conjoined Twins.
Yamada NK1, Fuerch JH1, Halamek LP1.
Author information:
1Division of Neonatal and Developmental Medicine, Department of
Pediatrics, Stanford University, Stanford, Palo Alto, California.
Abstract
The resuscitation of conjoined twins is a rare and complex
clinical challenge. We detail how patient-specific, in situ simulation can be
used to prepare a large, multidisciplinary team of health care professionals
(HCPs) to deliver safe, efficient, and effective care to such patients. In this
case, in situ simulation allowed an 18-person team to address the clinical and
ergonomic challenges anticipated for this neonatal resuscitation. The HCPs
trained together as an intact team in the actual delivery room environment to
probe for human and system weaknesses prior to this unique delivery, and
optimized communication, teamwork, and other behavioral skills as they prepared
for the simultaneous resuscitation of two patients who were physically joined to
one another.
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001,
USA.
PMID: 27832667 [PubMed - as supplied by publisher]
Similar articles
13.J Am Acad Orthop Surg. 2016 Nov 2.
[Epub ahead of print]
Construct
Validity for a Cost-effective Arthroscopic Surgery Simulator for Resident
Education.
Lopez G1, Martin DF, Wright R, Jung J, Hahn P, Jain N, Bracey DN,
Gupta R.
Author information:
1From Rush University, Chicago, IL (Dr. Lopez), Wake Forest University
School of Medicine, Winston-Salem, NC (Dr. Martin and Dr. Bracey), the
Department of Orthopaedic Surgery, Washington University School of Medicine,
St. Louis, MO (Dr. Wright), and the Department of Orthopaedics, University of
California Irvine, Irvine, CA (Dr. Jung, Dr. Hahn, Dr. Jain, and Dr. Gupta).
Abstract
INTRODUCTION:
Arthroscopy is one of the most challenging surgical skills to
assess and teach. Although basic psychomotor arthroscopic skills, such as
triangulation and object manipulation, are incorporated into many simulation
exercises, they are not always individually taught or objectively evaluated. In
addition, arthroscopic instruments, arthroscopy cameras, and the cadaver or
joint models necessary for practice are costly.
METHODS:
A low-cost arthroscopic simulator was created to practice
triangulation, probing, horizon changes, suture management, and object
manipulation. The simulator materials were purchased exclusively from national
hardware stores with a total cost averaging $79. The universal serial bus (USB)
camera is included in the total cost. Three residency programs accredited by
the Accreditation Council for Graduate Medical Education were tested on the
simulator. Replica boards were created at each institution. Participants included
medical students (20), residents (46), and attending physicians (9).
RESULTS:
Construct validity-the ability to differentiate between novice,
intermediate, and senior level participants-was obtained. On all tasks, junior
residents scored at a statistically significant lower rate than senior
residents and attending physicians.
CONCLUSIONS:
This cost-effective arthroscopic surgical simulator objectively
demonstrated that attending physicians and senior residents performed at a
higher level than junior residents and novice medical students. The results of
this study demonstrate that this simulator could be an important training tool
for resident education.
PMID: 27832043 [PubMed - as supplied by publisher]
Similar articles
14.Ann Biomed Eng. 2016 Nov 9. [Epub
ahead of print]
Soft 3D-Printed
Phantom of the Human Kidney with Collecting System.
Adams F1,2, Qiu T3,4, Mark A3, Fritz B5, Kramer L6, Schlager D7,
Wetterauer U7, Miernik A7, Fischer P3,4.
Author information:
1Micro Nano and Molecular Systems Lab, Max Planck Institute for
Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany.
adams@is.mpg.de.
2Department of Urology, University Medical Center Freiburg,
Hugstetterstr. 55, 79106, Freiburg, Germany. adams@is.mpg.de.
3Micro Nano and Molecular Systems Lab, Max Planck Institute for
Intelligent Systems, Heisenbergstr. 3, 70569, Stuttgart, Germany.
4Institute of Physical Chemistry, University of Stuttgart,
Pfaffenwaldring 55, 70569, Stuttgart, Germany.
5Department of Radiology, University Medical Centre Freiburg,
Hugstetterstr. 55, 79106, Freiburg, Germany.
6Institute of Forensic Medicine, University Medical Centre
Freiburg, Albertstr. 9, 79106, Freiburg, Germany.
7Department of Urology, University Medical Center Freiburg,
Hugstetterstr. 55, 79106, Freiburg, Germany.
Abstract
Organ models are used for planning and simulation of operations,
developing new surgical instruments, and training purposes. There is a
substantial demand for in vitro organ phantoms, especially in urological
surgery. Animal models and existing simulator systems poorly mimic the detailed
morphology and the physical properties of human organs. In this paper, we
report a novel fabrication process to make a human kidney phantom with realistic
anatomical structures and physical properties. The detailed anatomical
structure was directly acquired from high resolution CT data sets of human
cadaveric kidneys. The soft phantoms were constructed using a novel technique
that combines 3D wax printing and polymer molding. Anatomical details and
material properties of the phantoms were validated in detail by CT scan,
ultrasound, and endoscopy. CT reconstruction, ultrasound examination, and
endoscopy showed that the designed phantom mimics a real kidney's detailed
anatomy and correctly corresponds to the targeted human cadaver's upper urinary
tract. Soft materials with a tensile modulus of 0.8-1.5 MPa as well as
biocompatible hydrogels were used to mimic human kidney tissues. We developed a
method of constructing 3D organ models from medical imaging data using a 3D wax
printing and molding process. This method is cost-effective means for obtaining
a reproducible and robust model suitable for surgical simulation and training
purposes.
PMID: 27830490 [PubMed - as supplied by publisher]
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15.Surg Endosc. 2016 Nov 8. [Epub ahead
of print]
Development of a
novel simulation model for assessment of laparoscopic camera navigation.
Brackmann MW1, Andreatta P2, McLean K3, Reynolds RK3.
Author information:
1University of Michigan, 1500 E. Medical Center Drive, Ann Arbor,
MI, 48109-5276, USA. mkwylie@med.umich.edu.
2University of Central Florida College of Medicine, Orlando, FL,
USA.
3Gynecologic Oncology, University of Michigan Medical Center, Ann
Arbor, MI, USA.
Abstract
BACKGROUND:
Laparoscopic camera navigation is vital to laparoscopic surgery,
yet often falls to the most junior member of the surgical team who has limited
laparoscopic operating experience. Previously published reports on simulation
models fail to address qualitative scoring of movement, method of communication
and correct physician location with respect to patient position. The purpose of
this study was to develop and evaluate a novel laparoscopic camera navigation
simulation model that addresses these deficiencies.
METHODS:
A novel, low-cost laparoscopic camera navigational maze was
constructed from pliable foam for use in a standard laparoscopic surgery box
trainer. Participants (n = 37) completed a camera navigation exercise by
following a pre-recorded set of verbal instructions using correct anatomic
terminology that is used in the operating room, to simulate an actual operating
room experience of receiving verbal cues from senior surgeons. The sample group
consisted of participants at various levels of Obstetrics and Gynecology
training, representing novice to expert laparoscopists. Each trial was recorded
with a multi-channel video camera. Performances were scored by a blinded
evaluator for excess gross and fine camera movements as well as overt errors,
including camera collisions and failure to follow directions.
RESULTS:
Our model demonstrated evidence of validity by discriminating
performance by level of laparoscopic experience with a statistically
significant decrease in number of movements and errors in experts compared to
novices. A trend emerged toward improvement with each additional year of
training, with reduced variability among performances in more experienced
participants.
CONCLUSIONS:
This novel, low-cost box-trainer simulation model for laparoscopic
camera navigation offers a mechanism for assessment of laparoscopic camera
operation skills. Moreover, this model closely replicates operating room
logistics and communication. Given the necessity for improved laparoscopic
camera operation education, our model represents a unique, complementary tool
to other laparoscopic simulation curricula.
PMID: 27826776 [PubMed - as supplied by publisher]
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