Learning kinematic mappings in laparoscopic surgery.

Learning kinematic mappings in laparoscopic surgery.

Huang FC, Pugh CM, Patton JL, Mussa-Ivaldi FA

Conf Proc IEEE Eng Med Biol Soc. 2010;1:2097-102

Authors: Huang FC, Pugh CM, Patton JL, Mussa-Ivaldi FA

We devised an interactive environment in which subjects could perform simulated laparoscopic maneuvers, using either unconstrained movements or standard mechanical contact typical of a box-trainer. During training the virtual tool responded to the absolute position in space (Position-Based) or the orientation (Orientation-Based) of a hand-held sensor. Volunteers were further assigned to different sequences of target distances (Near-Far-Near or Far-Near-Far). Orientation-Based control produced much lower error and task times during training, which suggests that the motor system more easily accommodates tool use with degrees of freedom that match joint angles. When evaluated in constrained (physical box-trainer) conditions, each group exhibited improved performance from training. However, Position-Based training enabled greater reductions in movement error relative to Orientation-Based (mean -13.7%, CI:-27.1, -0.4). Furthermore, the Near-Far-Near schedule allowed a greater decrease in task time relative to the Far-Near-Far sequence (mean -13.5%, CI:-19.5, -7.5). Training at shallow insertion in virtual laparoscopy might promote more efficient movement strategies by emphasizing the curvature of tool motion. In addition, our findings suggest that an understanding of absolute tool position is critical to coping with mechanical interactions between the tool and trochar.

PMID: 21095685 [PubMed - in process]

Are United States Medical Licensing Exam Step 1 and 2 Scores Valid Measures for Postgraduate Medical Residency Selection Decisions?

Are United States Medical Licensing Exam Step 1 and 2 Scores Valid Measures for Postgraduate Medical Residency Selection Decisions?

Authors: McGaghie WC, Cohen ER, Wayne DB

PURPOSE: United States Medical Licensing Examination (USMLE) scores are frequently used by residency program directors when evaluating applicants. The objectives of this report are to study the chain of reasoning and evidence that underlies the use of USMLE Step 1 and 2 scores for postgraduate medical resident selection decisions and to evaluate the validity argument about the utility of USMLE scores for this purpose.
METHOD: This is a research synthesis using the critical review approach. The study first describes the chain of reasoning that underlies a validity argument about using test scores for a specific purpose. It continues by summarizing correlations of USMLE Step 1 and 2 scores and reliable measures of clinical skill acquisition drawn from nine studies involving 393 medical learners from 2005 to 2010. The integrity of the validity argument about using USMLE Step 1 and 2 scores for postgraduate residency selection decisions is tested.
RESULTS: The research synthesis shows that USMLE Step 1 and 2 scores are not correlated with reliable measures of medical students', residents', and fellows' clinical skill acquisition.
CONCLUSIONS: The validity argument about using USMLE Step 1 and 2 scores for postgraduate residency selection decisions is neither structured, coherent, nor evidence based. The USMLE score validity argument breaks down on grounds of extrapolation and decision/interpretation because the scores are not associated with measures of clinical skill acquisition among advanced medical students, residents, and subspecialty fellows. Continued use of USMLE Step 1 and 2 scores for postgraduate medical residency selection decisions is discouraged.
PMID: 21099388 [PubMed - as supplied by publisher]

Long-term retention of central venous catheter insertion skills after simulation-based mastery learning.

Acad Med. 2010 Oct;85(10 Suppl):S9-12.

20881713

Barsuk JH, Cohen ER, McGaghie WC, Wayne DB.
Northwestern University Feinberg School of Medicine, Division of HospitalMedicine, Chicago, IL 60611, USA. jbarsuk@nmh.org


BACKGROUND: Simulation-based mastery learning (SBML) of central venous catheter(CVC) insertion improves trainee skill and patient care. How long skills areretained is unknown.

METHOD: This is a prospective cohort study. Subjects completed SBML and wererequired to meet or exceed a minimum passing score (MPS) for CVC insertion on aposttest. Skills were retested 6 and 12 months later and compared with posttestresults to assess skill retention.

RESULTS: Forty-nine of 61 (80.3%) subjects completed follow-up testing. Although performance declined from posttest where 100% met the MPS for CVC insertion,82.4% to 87.1% of trainees passed the exam and maintained their high performance up to one year after training.

CONCLUSIONS: Skills acquired from SBML were substantially retained during oneyear. Individual performance cannot be predicted, so programs should use periodictesting and refresher training to ensure competence.PMID: 20881713 [PubMed - indexed for MEDLINE]

Advancing the Science of Team Science.

1. Transl Sci. 2010 Oct;3(5):263-266. doi: 10.1111/j.1752-8062.2010.00223.x.

Advancing the Science of Team Science.

Falk-Krzesinski HJ, Börner K, Contractor N, Fiore SM, Hall KL, Keyton J, SpringB, Stokols D, Trochim W, Uzzi B.

Research Team Support, Northwestern University Clinical and TranslationalSciences (NUCATS) Institute, Northwestern University, Chicago, Illinois, USACyberinfrastructure for Network Science Center, SLIS, Indiana University,Bloomington, Illinois, USA Department of Industrial Engineering & ManagementSciences, Northwestern University, Evanston, Illinois, USA Department ofPhilosophy and Institute for Simulation and Training, University of CentralFlorida, Orlando, Florida, USA Division of Cancer Control and PopulationSciences, National Cancer Institute, Bethesda, Maryland, USA Department ofCommunication, North Carolina State University, Raleigh, North Carolina, USADepartment of Preventive Medicine, Northwestern University, Chicago, Illinois,USA Department of Planning, Policy and Design and Department of Psychology andSocial Behavior, University of California Irvine, Irvine, California, USADepartment of Policy Analysis and Management, Cornell University, Ithaca, NewYork, USA Department of Management & Organizations, Kellogg School of Management,Northwestern University, Evanston, Illinois, USA.

The First Annual International Science of Team Science (SciTS) Conference washeld in Chicago, IL April 22-24, 2010. This article presents a summary of theConference proceedings. Clin Trans Sci 2010; Volume 3: 263-266.

PMCID: PMC2965626 [Available on 2011/10/1]
PMID: 20973925 [PubMed - as supplied by publisher]

Simulation center accreditation and programmatic benchmarks: a review for emergency medicine.

Simulation center accreditation and programmatic benchmarks: a review for emergency medicine.

Fernandez R, Wang E, Vozenilek JA, Hayden E, McLaughlin S, Godwin SA, Griswold-Theodorson S, Davenport M, Gordon JA,

Simulation center accreditation and programmatic benchmarks: a review for emergency medicine.

Acad Emerg Med. 2010 Oct;17(10):1093-103

Authors: Fernandez R, Wang E, Vozenilek JA, Hayden E, McLaughlin S, Godwin SA, Griswold-Theodorson S, Davenport M, Gordon JA,

Simulation-based education has grown significantly over the past 10 years. As a result, more professional organizations are developing or implementing accreditation processes to help define minimum standards and best practices in simulation-based training. However, the benefits and potential pitfalls of sponsoring and implementing such programs have yet to be fully evaluated across specialties. The board of directors of the Society for Academic Emergency Medicine (SAEM) requested an evaluation of the potential to create an emergency medicine (EM)-based Simulation Consultation and Accreditation Service. In response to this request, the Simulation Accreditation and Consultation Work Group, a subgroup of the Committee on Technology in Medical Education (now Simulation Academy), was created. The work group was charged with: 1) reviewing current benchmarks and standards set by existing simulation accreditation programs; 2) analyzing current EM simulation program structures, including leadership, administrative, and financial components; and 3) proposing a potential model for EM-based simulation accreditation. This article outlines currently existing and proposed accreditation models and identifies components that support best practices. It then goes on to describe three general programmatic models to better understand how simulation training can be operationalized in EM. Finally, the work group uses this collective information to propose how an accreditation process, in concert with the SAEM Simulation Consultation Service, can enhance and advance EM simulation training.
PMID: 21040111 [PubMed - in process]

Pediatric residents' ability to perform a lumbar puncture: evaluation of an educational intervention.

Pediatric residents' ability to perform a lumbar puncture: evaluation of an educational intervention.

Kilbane BJ, Adler MD, Trainor JL

Pediatr Emerg Care. 2010 Aug;26(8):558-62

Authors: Kilbane BJ, Adler MD, Trainor JL


Abstract

OBJECTIVE: To assess the baseline ability of pediatric residents to successfully perform a lumbar puncture (LP) and to evaluate the impact of an educational intervention on this skill in both a simulated and clinical environment.

METHODS: An experimental group of first-year residents and a control group of second-year residents were enrolled in a prospective nonrandomized intervention study. Knowledge and skill at performing LPs were assessed using a written and a simulated LP test. The experimental group was tested at the start of their residency and then received the educational intervention. They were retested 6 months later. The control group did not receive the educational intervention and were tested at the start of their second year. The outcomes of clinical LPs performed by the 2 groups were also recorded.

RESULTS: The experimental group showed significant improvement on both the written and the simulated LP test after the educational intervention. When compared with the control group, they performed the simulated LP significantly better as measured by the number of correctly performed steps. Both groups performed a low number of clinical LPs.

CONCLUSIONS: After an educational intervention, pediatric first-year residents performed a simulated LP better than a group of second-year residents who had greater clinical LP experience. The low number of clinical LPs performed limits our ability to determine the educational intervention's impact in the clinical setting and reinforces the concern that recent changes to pediatric residencies may negatively impact residents' procedural experience.

PMID: 20657337 [PubMed - indexed for MEDLINE]

Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

Cost savings from reduced catheter-related bloodstream infection after simulation-based education for residents in a medical intensive care unit.

Cohen ER, Feinglass J, Barsuk JH, Barnard C, O'Donnell A, McGaghie WC, Wayne DB

Simul Healthc. 2010 Apr;5(2):98-102

Authors: Cohen ER, Feinglass J, Barsuk JH, Barnard C, O'Donnell A, McGaghie WC, Wayne DB

Interventions to reduce preventable complications such as catheter-related bloodstream infections (CRBSI) can also decrease hospital costs. However, little is known about the cost-effectiveness of simulation-based education. The aim of this study was to estimate hospital cost savings related to a reduction in CRBSI after simulation training for residents.

PMID: 20389233 [PubMed - in process]

Acquisition of critical intraoperative event management skills in novice anesthesiology residents by using high-fidelity simulation-based training.

Acquisition of critical intraoperative event management skills in novice anesthesiology residents by using high-fidelity simulation-based training.

Park CS, Rochlen LR, Yaghmour E, Higgins N, Bauchat JR, Wojciechowski KG, Sullivan JT, McCarthy RJ

Anesthesiology. 2010 Jan;112(1):202-11

Authors: Park CS, Rochlen LR, Yaghmour E, Higgins N, Bauchat JR, Wojciechowski KG, Sullivan JT, McCarthy RJ


Abstract

BACKGROUND: Early acquisition of critical competencies by novice anesthesiology residents is essential for patient safety, but traditional training methods may be insufficient. The purpose of this study was to determine the effectiveness of high-fidelity simulation training of novice residents in the initial management of critical intraoperative events.

METHODS: Twenty-one novice residents participated in this 6-week study. Three hypoxemia and three hypotension scenarios were developed and corresponding checklists were validated. Residents were tested in all scenarios at baseline (0 weeks) and divided into two groups, using a randomized crossover study design. Group 1 received simulation-based training in hypoxemic events, whereas Group 2 was trained in hypotensive events. After intermediate (3 weeks) testing in all scenarios, the groups switched to receive training in the other critical event. Final testing occurred at 6 weeks. Raters blinded to subject identity, group assignment, and test date scored videotaped performances by using checklists. The primary outcome measure was composite scores for hypoxemia and hypotension scenarios, which were compared within and between groups.

RESULTS: Baseline performance between groups was similar. At the intermediate evaluation, the mean hypoxemia score was higher in Group 1 compared with Group 2 (65.5% vs. 52.4%, 95% CI of difference 6.3-19.9, P < 0.003). Conversely, Group 2 had a higher mean hypotension score (67.4% vs. 45.5%, 95% CI of difference 14.6-29.2, P < 0.003). At Week 6, the scores between groups did not differ.

CONCLUSIONS: Event-specific, simulation-based training resulted in superior performance in scenarios compared with traditional training and simulation-based training in an alternate event.
PMID: 20010420 [PubMed - indexed for MEDLINE]

Internal medicine residency graduates' perceptions of the systems-based practice and practice-based learning and improvement competencies.

Internal medicine residency graduates' perceptions of the systems-based practice and practice-based learning and improvement competencies.

Didwania A, McGaghie WC, Cohen E, Wayne DB
Teach Learn Med. 2010 Jan;22(1):33-6

Authors: Didwania A, McGaghie WC, Cohen E, Wayne DB

Resident education in Systems-Based Practice (SBP) and Practice-Based Learning and Improvement (PBLI) is required but underemphasized.

PMID: 20391281 [PubMed - indexed for MEDLINE]