Effectiveness of EYESI binocular indirect ophthalmoscope simulation training system as an assessment and training platform for ophthalmic residents

We evaluated the Resident Assessment Instrument-Mental Health (RAI-MH) assessment platform at a large psychiatric hospital in Ontario during the 3 years following its provincially mandated implementation in 2005. Our objectives were to document and consider changes over time in front-line coding practices and in indicators of data quality. Structured interviews with program staff were used for preliminary information-gathering on front-line coding practices. A retrospective data review of assessments conducted from 2005 to 2007 examined 5 quantitative indicators of data quality. There is evidence of improved data quality over time; however, low scores on the outcome scales highlight potential shortcomings in the assessment system's ability to support outcome monitoring. There was variability in implementation and performance across clinical programs. This evaluation suggests that the RAI-MH-based assessment platform may be better suited to longer-term services for severely impaired clients than to short-term, highly specialized services. In particular, the suitability of the RAI-MH for hospital-based addictions care should be re-examined. Issues of staff compliance and motivation and problems with assessment system performance would be highly entwined, making it inappropriate to attempt to allocate responsibility for areas of less than optimal performance to one or the other. The ability of the RAI-MH to perform well on clinical front lines is, in any case, essential for it to meet its objectives. Continued evaluation of this assessment platform should be a priority for future research.

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

BackgroundThe paper version of the training assessment was time-consuming and labor-consuming. It is an inevitable trend to change the appraisal method utilizing information technology. This study aimed to realize convenient and rapid management of the whole process of clinical nursing operation technology through information-based training and assessment platform.MethodsCombined with the operation mode of clinical nursing operation skills and set the basic functions of the information platform of clinical nursing operation training and assessment, the information-based training and evaluation platform for clinical nursing operation skills was established. The platform was officially operated in a tertiary level A general hospital in Shandong Province in 2018.ResultsThe information-based training and assessment platform is composed of Management Center (Computer Terminal) and a client terminal (APP terminal). The computer terminal contains 11 modules, and the APP terminal contains 8 modules. By December 2020, a total of 12,619 nurses had completed the training in nursing operation skills, and a total of 11,986 nurses had completed the examination. The examination results of nursing operation skills of the same nurses in 2018 were significantly higher than those in 2017(P < 0.05), and the error rate was significantly lower (P < 0.05). From 2016 to 2020, the scores of nasal feeding, CPR, and respiratory airbag of N1 level nurses significantly increased after using the information-based training and Assessment Platform (P < 0.05).ConclusionBased on the information terminal training assessment can realize the management of the whole process of clinical nursing operation technology training and assessment, which is better than the traditional method, and is a very practical and convenient clinical training and assessment method.

This study addresses the issues of poor interdisciplinary integration and misalignment between experimental content and industry demands in the construction of applied undergraduate laboratory facilities, based on the background of industry-academia collaboration. This paper presents the design and development of an intelligent connected access integrated training and assessment platform, utilizing a full-stack development approach that combines knowledge graph, sensor principles, communication protocol integration, microcontroller programming, networking, connected access, and cloud platform development. The platform adopts a topological hierarchical structure, facilitating layered instruction for teachers and helping students to understand the logical development of Internet of Things products. Furthermore, the platform utilizes equipment commonly used in enterprises to enhance students' technical application, practical, and innovative capabilities. Through teaching practice, students' engineering awareness and practical skills have significantly improved, effectively promoting the development of relevant courses and practical training.

BackgroundThe assessment system for standardized resident training is crucial for developing competent doctors. However, it is complex, making it difficult to manage. The COVID-19 pandemic has also aggravated the difficulty of assessment. We, therefore, integrated lean thinking with App-based e-training platform to improve the assessment process through Define–Measure–Analyze–Improve–Control (DMAIC) cycles. This was designed to avoid unnecessary activities that generate waste.MethodsPanels and online surveys were conducted in 2021–2022 to find the main issues that affect resident assessment and the root causes under the frame of waste. An online app was developed. Activities within the process were improved by brainstorming. Online surveys were used to improve the issues, satisfaction, and time spent on assessment using the app.ResultsA total of 290 clinical educators in 36 departments responded to the survey, and 153 clinical educators used the online app for assessment. Unplanned delay or cancellation was defined as the main issue. Eleven leading causes accounted for 87.5% of the issues. These were examiner time conflict, student time conflict, insufficient examiners, supervisor time conflict, grade statistics, insufficient exam assistants, reporting results, material archiving, unfamiliarity with the process, uncooperative patients, and feedback. The median rate of unplanned delay or cancellation was lower with use of the app (5% vs 0%, P < 0.001), and satisfaction increased (P < 0.001). The median time saved by the app across the whole assessment process was 60 (interquartile range 60–120) minutes.ConclusionsLean thinking integrated with an App-based e-training platform could optimize the process of resident assessment. This could reduce waste and promote teaching and learning in medical education.

Objective To observe the application value of RetCam Ⅲ in the diagnosis of retinoblastoma (RB). Methods The clinical data of 125 eyes from 94 patients with RB were retrospectively analyzed. According to the International Intraocular Retinoblastoma Classification, the results of binocular indirect ophthalmoscope and RetCam Ⅲ was compared. The consistency between RetCam Ⅲ and binocular indirect ophthalmoscope was analyzed by Kappa test. The detectable rates of tumor between binocular indirect ophthalmoscope, RetCam Ⅲand B scan ultrasound were comparatively analyzed. Results By binocular indirect ophthalmoscope, there were 18 eyes (14.4%) in stage A, 15 eyes (12.0%) in stage B, 10 eyes (8.0%) in stage C, 28 eyes (22.4%) in stage D, and 54 eyes (43.2%) in stage E. Using RetCam Ⅲ, the classification was 18 eyes (14.4%) in stage A, 16 eyes (12.8%) in stage B, 11 eyes (8.8%) in stage C, 27 eyes (21.6%) in stage D, and 53 eyes (42.4%) in stage E. The RB classification of RetCam Ⅲ was quite consistent with binocular indirect ophthalmoscope (Weighted Kappa Coefficient=0.979 8, 95% confidence interval=0.960 1 - 0.999 5). A total of 150 tumors from stage A - D were observed by binocular indirect ophthalmoscope. In which, 147 tumors (98.0%) were found by RetCam Ⅲ, 122 tumors (81.3%) were found by B scan ultrasound. No serious complication was found in these patients. Conclusions RetCam Ⅲ can detect RB of different stage in clinic. It is quite consistent with binocular indirect ophthalmoscope. Key words: Retinoblastoma/diagnosis; Ophthalmoscopy; Ultrasonography

The Accreditation Council for Graduate Medical Education (ACGME) and American Board of Orthopaedic Surgery (ABOS) recently mandated major changes to curricular requirements for the PGY-1 (intern) year for categorical orthopaedic surgery residents. Since July 1, 2013, PGY-1 residents are required to have 6 months of orthopaedic surgery rotations, 6 months of nonorthopaedic surgery rotations, and complete a mandatory surgical skills curriculum [1, 2]. The ACGME and ABOS executed these changes in an effort to improve the quality and breadth of education for interns, preparing them for more advanced orthopaedic education. These changes were prompted by shifts in general surgery procedures (from open to laparoscopic), which have reduced the operating room experience of suturing and knot tying for interns, as well as by duty hour requirements that further reduce the operating room experience for interns. Together, these shifts in first-year resident experience have resulted in less surgical training for the orthopaedic surgery intern. The new ABOS requirements, which commence on July 1, 2014, seek to offset those losses [1, 2]. This column describes the changes mandated by the ABOS and ACGME for the orthopaedic intern year, discusses some limitations associated with these changes, and offers program strategies for effective implementation.

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We describe a novel method of digital, virtual-reality based binocular indirect ophthalmoscopy which allows for simultaneous stereoscopic recording of the examination with the potential of real-time anatomic correction of the retinal view. A provisional prototype of the all-digital, binocular, indirect virtual stereo video ophthalmoscope was designed consisting of a generic LED light source and two synchronized closely spaced side-by-side minicameras which are connected to a processor, storage media (a Samsung note-9 android smartphone in the current provisional prototype), and a virtual reality set (VISIONHMD Bigeyes H1 3D Video Glasses, in the current prototype). A custom designed android application was developed to capture the examination media and allow optional real-time anatomical correction of the examination view. Binocular stereoscopic indirect ophthalmoscopy was attempted on 15 eyes of 15 patients without and with digital real-time anatomic correction of the examination view. Binocular, video, stereo ophthalmoscopic media could be successfully obtained in all 15 patients. Anatomic correction of the examination view as well as a collateral observer's view could be achieved in all 15 patients. An all-digital, binocular, stereo, video indirect ophthalmoscopy is a feasible alternative for conventional binocular indirect ophthalmoscopy and provides stereoscopic video documentation identical to what the examiner sees. The examination video can be streamed in the real-time of the examination for educational or telemedicine purposes.

Introduction: ESD is an endoscopic technique for the en bloc resection of gastrointestinal lesions. ESD is a widely-used technique in Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula has restricted its wide acceptance in the US. Thus, we aim to develop the VESS for ESD procedures. The VESS platform will aim to provide a training and assessment platform by highly realistic visualization and high fidelity of simulating the colorectal ESD procedure. The goal of the ESD simulation is to deliver realistic haptic (touch) feedback to provide a more immersive virtual experience. This abstract describes the design and task analysis study performed to date. Methods: Based on the ESD videos, we performed a detailed colorectal ESD task analysis to determine the critical procedural steps for the design of the VESS. Through the task analysis, the critical ESD steps including lesion identification, lesion marking, injection, circumferential cutting, dissection, intraprocedural complication management and post-procedure examination were detailed. Furthermore, endoscopic devices were allocated to each step of the task analysis. Results: Using our task analysis, we constructed a hierarchical task tree that elaborates the order of tasks in these steps (Figure 1). Furthermore, we developed quantitative ESD performance metrics for each phase in the task tree. For the VESS design, we generated three dimensional (3D) virtual models for various colorectal mucosal lesions (Figure 2), using the Paris and Japanese tumor classifications. 3D models of ESD devices were created. We developed realistic ESD instrument-lesion interactions with our custom-designed haptic device. We designed the electromechanical interface with 2-degrees of freedom to manipulate a dummy endoscope to provide the users with haptic feedback (Figure 3).Figure: Hierarchical task tree.Figure: (a) Paris type 0 + Is tumor and (b) Japanese type 0 + ls tumor.Figure. 3D: Design of the simulator.Conclusion: We describe the initial phases of the design of the VESS for colorectal ESD. Through a task analysis, simulation software and Hardware-software interface developments will allow for the manipulation of virtual colorectal lesions using 3D endoscopic accessories with haptic feedback. Our quantitative ESD metrics will be used in future validation studies of the VESS simulator for performance score computation of trainees.

ObjectiveTo explore the effectiveness, feasibility, and training effect of a highly simulated and adaptable laparoscopic training system in the advanced integrated two-stage laparoscopic simulation training course for surgical residents. MethodsThis study prospectively took the surgical residents who received the advanced integrated two-stage laparoscopic simulation training course in our hospital from December 2019 to December 2021 as the research objects. In the stage one course, the trainees are randomly distributed into the dry simulation system group and Darwin laparoscopic training system group. The subjective assessment results of the trainees from the two groups are collected by questionnaires, and the simulation assessment results of the two groups are evaluated in a unified, objective, and standardized assessment form. The pre-course and post-course questionnaires were used to evaluate the feasibility and effectiveness of the Darwin system in the stage two course. ResultsA total of 62 trainees completed the stage one and stage two courses. In the stage one course, the trainees were randomly distributed into the dry simulation trainer group (N = 19) and the Darwin group (N = 43). The results of the subjective assessment questionnaire showed that compared with the dry simulator group, the students in the Darwin group had higher subjective scores (P < 0.05). The objective assessment results for the 3 modules of "One Track Transfer", "One Tunnel Pass" and "High and Low Pillars" in the Darwin group were significantly better than those in the dry simulator group (P < 0.05). The trainees who received the stage two course completed the questionnaires before and after the course. The results showed that compared with pre-course evaluation, "basic theoretical knowledge of laparoscopy", "basic skills of laparoscopy", "laparoscopic suture technique" and "camera-holding technique" were significantly improved after training (P < 0.05). ConclusionThe highly simulated and adaptable laparoscopic training system is effective and feasible in the advanced integrated two-stage laparoscopic simulation training course for surgical residents.

Background: Binocular indirect ophthalmoscopy (BIO) is a challenging skill to learn and teach. Purpose: To evaluate the utility of video-guided BIO for training medical students without prior BIO experience using Scanoptix, a novel, wireless, ophthalmoscope-mounted camera. Methods: This was a mixed-methods study including a survey and prospective, double-armed intervention. Medical students at the University of Virginia School of Medicine without prior BIO experience were recruited via email and randomized into video-guided and non-video-guided indirect ophthalmoscopy training groups (VIO and nVIO, resp.). Both groups underwent a demonstration session led by a retina specialist followed by an instructional session with real-time feedback on examination technique by the retina specialist. During the VIO sessions, the retina specialist and students had access to live video recordings of the examination, whereas the nVIO group did not. All students were asked to perform BIO examination of a model eye pre- and post-intervention, and deidentified recordings were transmitted wirelessly from a novel ophthalmoscope-mounted camera to a smart tablet. Two independent retina specialists graded students’ examination videos for competency pre- and post-intervention. Students also completed a questionnaire regarding their confidence performing BIO before and after the intervention. Changes in confidence and competency were analyzed in Excel using paired and unpaired t tests. Main outcome measures were medical student confidence and competency performing BIO examination of the posterior pole. Results: A total of 38 medical students participated: 20 in the VIO group and 18 in the nVIO group. Students in both groups demonstrated significant improvement in examination skills and confidence following intervention (for skills, VIO p < 0.0001 and nVIO p = 0.0004; for confidence, VIO and nVIO p < 0.0001). Comparing post-intervention scores, VIO examination scores were not significantly greater than those for nVIO (7.95 vs 7.29, resp. [p = 0.441]); however, the VIO group achieved a greater degree of improvement from baseline compared with nVIO controls (Δ = 6.73 vs Δ = 4.49, resp.), with results approaching significance (p = 0.082). Conclusions: BIO-naive medical students benefitted from formal instruction with or without video guidance. Additional studies are required to determine whether an ophthalmoscope-mounted camera would enhance BIO education for naive learners.

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Air simulated firing training system design, is for a certain type of machine can't air simulated firing training and development of embedded weapon firing training simulation system for special purpose, and specially designed for the system to the infinite launches air simulation training, the training on the system design is consistent with the real platforms in the air to shot, effectively improve the effect of simulated firing training, after simulated firing training, firing live ammunition to start hitting the target, greatly reduce the training costs, and improve the training efficiency, for other aerial platform development similar simulated firing training system have great reference value.

There is an anticipated shortage of primary care providers trained to care for patients with HIV. The Yale School of Medicine developed and implemented a novel HIV training track within our Primary Care Internal Medicine Residency Program. A set of 12 Entrustable Professional Activities (EPAs) were developed to guide curriculum development and resident assessment. To describe the process of implementing a novel EPA-based curriculum for the HIV Primary Care Training Track including EPA-based trainee evaluation tools. Two to three residents were enrolled annually from 2012 to 2017 (total n = 11). Training sites included the outpatient academic center HIV clinic and inpatient HIV ward. An expert panel developed 12 HIV-specific EPAs. These were mapped to curricular and reporting internal medicine milestones. Curricular activities and evaluation tools were developed to guide EPA progress. Graduating residents were ready for unsupervised practice in 91% of EPAs at the end of the 3-year program. Development of HIV-specific training EPAs was effective for driving curricular development and resident evaluation, and served as an effective method to communicate expectations to resident participants. These HIV-specific EPAs could serve as a useful template to enhance HIV education in academic settings.