Live Labs Research Articles

Impact of Online Education on Anatomy Test Results

Introduction Anatomy is a fundamental science essential to the practice and understanding of medicine. As the COVID-19 pandemic has put a halt to live teaching, specifically, Anatomy classes and Lab Practical examination at Baylor College Medicine (BCM), the opportunity was presented to compare test scores of students who matriculated into the Physician Assistant (PA), Doctor of Nursing Practice-Anesthesia (DNP), and Medical School (MS) programs in 2020 with those of the same programs from previous cohorts. Students who matriculated in August of 2019 and before were able to have live Anatomy lectures, live Lab Practical examinations, and live cadaver labs. Whereas those who matriculated in the year 2020 had to watch online lectures, have online Lab Practical examinations, but still have live cadaver labs with COVID-19 rules i.e., social distancing implemented. Materials & Methods Lab Practical examination scores from classes who matriculated in the years of 2016 through 2019 were compared with those who matriculated in 2020 for the PA, DNP, and MS programs. Independent Measures Two-tailed T-test and One-Way Anova Analyses were used to determine whether there were any statistically significant differences of exam scores compared within the PA, DNP, and MS programs. The DNP and PA programs must also take a cumulative multiple-choice (MC) exam at the end of each term. These scores were also compared using the same measures. Results Independent Measures T-test revealed statistical significance (p < 0.05) when comparing the MS 2017 Lab Practical scores with the 2020 MS cohort with the 2020 cohort scoring significantly lower. For the DNP program, statistical significance was found between Lab Practical test scores from every cohort when compared to the 2020 cohort with the 2020 cohort scoring significantly higher in each comparison. Only when comparing the DNP 2016 to the 2020 cohort (MC) exam results was a statistical significance found for the MC exam with the 2020 cohort scoring significantly higher. One-Way Anova Analyses revealed there were no statistically significant findings within any of the cohorts from any of the programs other than the DNP 2016/2020 cohort comparison and 2019/2020 cohort comparison which yielded statistically significant differences with the 2020 cohort scoring significantly higher in each comparison. Conclusions While the current situation of the COVID-19 Pandemic may not be permanent, it has had a profound impact on the delivery of education in the year of 2020. As the delivery of education has shifted, one should acknowledge that test results may be impacted as well. This analysis reveals that students test scores, while varying more so than previous cohorts, were not significantly impacted in every cohort comparison with the shift to online learning. Significance Online learning in Anatomy has not been attempted before at BCM and evaluating student performance was vital this year. Anatomy at BCM continues for 2 more terms, and while the exam scores do not show significant differences for one term, the long term-term influences from COVID-19 on learning Anatomy still remains to be investigated.

Back in the saddle: student response to remote online equine science classes.

The COVID-19 pandemic has challenged professors and students of all disciplines to adjust quickly to remote online teaching and education platforms. In this new era of remote teaching, a greater challenge has been presented in the field of equine science; how to effectively share knowledge that is most often demonstrated by providing students access to live, in-person animal examples. Historically, students and teachers believed skill sets, which are vital for future careers in the industry (e.g., veterinarian) must be learned through hands-on experience. However, in-person methods were not available, so students were taught through the Zoom platform. Students enrolled in various levels of equine science classes were invited to complete a short voluntary questionnaire measuring their response and perception to equine courses taught in an entirely online remote setting by the same professor. One group was comprised of undergraduates majoring in the field (n = 44) in upper level equine science courses, Advanced Equine Reproduction Physiology and/or Equine Enterprise. These students, 41 females and 3 males, ranged in age from 20 to 25 yr, were provided a voluntary questionnaire seeking responses related to the perceived effectiveness and individual preferences of in-class lectures and in-person labs vs. remote online teaching practices. A similar questionnaire was offered on a volunteer basis to precollege students (n = 17). These students, female, high-school students from freshman to senior status (14–18 yr of age), were interested in equine science as a major at UC Davis in the future. This questionnaire evaluated their response to a 2-week remote synchronous online equine science course, which included multiple teaching methods, including lectures, mini labs, and full labs. Responses from both populations suggested that equine courses were perceived as effective when offered as online, remote courses. Live (synchronous) classes and labs offered on Zoom increased engagement and interaction, but students also appreciated the opportunity to access recorded materials. Students responded positively to online remote teaching and found courses to be effective for increasing their knowledge about equine science in an engaging manner, despite their continued preference for in-person instruction.

Preferences versus Performances in a Hybrid Histology Course

Due to advancements and availability of technology, quality virtual histology slides are now readily accessible on‐line. While many studies have looked at the efficacy of using online technology to teach histology, to our knowledge, no one has done a hybrid course of both on‐line and live sessions. Thus it was our goal to directly assess the effect of learning from virtual versus live histology lecture and labs within single students and compare their performances to self‐reported learning preferences.A graduate histology class was designed in which every other session was taught either completely on‐line or live (both lecture and lab). At the beginning of the course, students were surveyed on their experience and bias with learning histology and technology. Questions from two exams were categorized based on their delivery (live and virtual) and performance on each was analyzed for each student who served as their own control. Overall feedback of the course was also collected.While 82% of students surveyed felt that a microscope was required to learn histology, and 75% felt like live sessions would be more conducive to learning, there was no significant difference on exam performance of questions despite the delivery. Students averaged 71% on questions related to material taught live compared to 78% on virtually taught material (p=0.33). The average difference of individual performance between live and virtual questions was 0.08. There was no difference between males and females.Despite initial hesitation about the efficacy of teaching a traditionally laboratory course virtually, the data equivocally shows that there is no hindrance to learning histology when the material is presented virtually. Further, individual students are able to adapt to both delivery styles within a single course.Support or Funding InformationnoneThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Worksheets: What Are They Good for? Perspectives on Worksheet‐Based Ultrasound Curriculum in Gross Anatomy Education

Ultrasound (US) has been implemented within gross anatomy courses in many medical school curricula, though no standardized US curriculum currently exists. However, facilitator led, small group, hands‐on formats are common. At CUSOM, large medical class sizes require numerous facilitators and concurrent sessions to achieve small group, hands‐on live scanning labs suitable for novice learners. Obtaining facilitators and ensuring equivalent experiences across groups remains challenging in the smaller graduate course. The US worksheets were designed to alleviate demand on facilitators and standardize gross anatomy and clinical review in smallgroup scanning labs. The aim of this study was to evaluate student and facilitator perceptions of worksheets created for ultrasound labs integrated in two gross anatomy courses.Worksheets were created for each of six existing US labs integrated into the Spring 2018 (N=37 students) graduate gross anatomy course. Each worksheet contained step‐by‐step scanning instructions, questions reviewing gross anatomy and US terminology, and clinical correlates. In Fall 2018, these worksheets were reorganized to align with five existing US labs for Human Body Block, the medical gross anatomy course (N=184).Graduate (N=35) and medical students (N=152) were recruited to complete a COMIRB exempt‐survey about their perceptions of the US worksheets. The voluntary and anonymous paper survey contained six Likert‐type items regarding worksheet structure and effectiveness. The US facilitators are currently being recruited to complete a survey regarding their perceptions of the worksheets. This COMIRB exempt‐survey is also voluntary and anonymous, however, it is electronic and contains ten Likert items to evaluate facilitator perceptions, plus three forced response items for demographic data.Descriptive statistical analysis of US student survey results showed the majority of graduate (91–100%) and medical (65–92%) students agreed or strongly agreed with four statements regarding the appropriateness of the worksheet structure. Similarly, graduate (91% &amp; 97%) and medical (84% &amp; 85%) students agreed or strongly agreed with both statements regarding worksheet effectiveness for improving understanding of gross anatomy and anatomical relationships. Wilcoxon Rank Sum analysis showed no significant difference between responses from the two student populations (p&gt;0.05). US facilitator data collection is underway.The survey results demonstrated positive student perceptions of the US worksheets. These worksheets, a relatively simple educational innovation, have larger implications as nationwide medical education reform calls for more active learning sessions, which presents challenges for large classes. The results of this study offer important lessons for design and development of US curricula and resources integrated within gross anatomy coursework, and the implementation of large‐scale active learning modalities within the context of gross anatomy education.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Climate Change Impacts on Livelihood Vulnerability Assessment-Adaptation and Mitigation Options in Marine Hot Spots in Kerala, India

Climate change, a global challenge facing mankind necessitates governments to develop mitigation and adaptation plans. The climate change has multidimensional impacts on environment, fishery, social, economic and development drivers. Climate change hot spots –can be defined as the ‘live labs’ where the manifestation of the climate change impacts is observed “first”. The South west India has been recognised as one among the twenty four hot spot regions identified globally. The present paper assessed the climate change vulnerability of over 800 fisher households in two major fishing villages of Kerala from the south west hotspot regions of India. Exposure (E), Sensitivity (S) and Adaptive Capacity (AC) are the pertinent factors that determine the vulnerability of households which were captured using a structured household questionnaire. One ninety eight indicators were identified in the construction of vulnerability indices of which 37 related to sensitivity, 36 related to exposure and the other 125 indicators dealt with adaptive capacity. The overall vulnerability of the regions was assessed and the analysis revealed that the Poonthura village of Kerala was more vulnerable when compared to Elamkunnapuzha. The coastal population on their vulnerability scores were categorised into low, moderate, high and very high based on score values and geo-spatial analysis was attempted. The results revealed that majority of fisher households in both villages were highly vulnerable to climate change, which is a major cause of concern. The study advocates the need for a bottom up approach with the proactive participation of the fishers in developing location specific adaptation and mitigation plans to ensure the livelihood of the fishers and the sustainable development of the fisheries sector in the climate change regime.

Online class teaching tips

Without a doubt, online classes are popular with students. In 2013, over 7.1 million higher education students took at least one online class. As online learning becomes more prevalent, educators have to ask themselves: What are the best strategies for teaching a successful online class? How do we keep students engaged and create an inclusive atmosphere in a virtual space? Live classroom instruction, simulation labs, and clinical experiences can't be replaced by online sessions, but they can be enhanced with synchronous online classes or asynchronous video instruction. Here are six quick tips for educators to consider when planning a live online class. 1. Provide clear directions Students in classrooms are used to having face-to-face time with faculty before and after a class. In person, students can easily ask questions and get clarification; this opportunity isn't as easy to come by within the online classroom environment. Providing clear directions for participation helps students become engaged in the online learning process. Be sure to include assignment rubrics, detailed expectations, and due dates. Questions or confusion can frustrate students, so be concise and avoid ambiguity. 2. Engage students In the classroom, inattention is easy to spot; online, it's more difficult. To help engage students, show your passion for the topic—and for nursing. Learn your students' names, be friendly, and, if your online learning management system offers this functionality, chat with them before class starts. Use interactive questions throughout the online lecture to promote involvement. Online instructors can foster helping-trusting-caring relationships and address individual learning needs. Take time to interact with students and address their different learning styles in your presentation. Don't forget that cultural competency is important in all learning environments. The online environment may make it difficult to be aware of cultural clues, so using sensitive and inclusive language is a must. 3. Encourage participation Many online classroom formats have features such as polls, breakout rooms, and whiteboards. Familiarize yourself with these tools and use them frequently. Your online dashboard may reflect usage data, allowing you to see how many students are actually participating, as well as gauge student understanding of presented concepts. Giving homework is essential in an online environment. Keep learners engaged during the week with assignments, such as journals, readings, projects, discussions, ungraded practice quizzes, document downloads, or short papers. As discussed in the first tip, be clear about homework and talk about it during class. Homework also gives students a shared experience outside of class. Work hard to ensure that assignments and classroom content align with course objectives and goals. Include various activities that challenge knowledge and impart critical-thinking skills. Be thoughtful when developing assignments and give timely, effective feedback. 4. Give them a break Although it's tempting to finish class early by skipping breaks, this isn't an effective strategy. If too much information is imparted at one time, students will lose interest, walk away from the screen, and become disengaged. Students need to stand up and move around occasionally, so give them frequent breaks. Getting a drink or even stepping outside makes a world of difference to engagement. These breaks can be a good time to encourage peer-to-peer interaction through a group chat feature, which positively contributes to student learning. 5. Stress organization Succeeding in online coursework requires self-motivation and organization. This is important not only for the student, but also for the instructor. Studies reveal that the average time spent preparing for online lectures is similar to the average time it takes to prepare for a traditional lecture, so make time to be ready for your online session. Remind students that online classes aren't quicker or easier than traditional courses; they may actually require more discipline and focus than students expect. Offer course orientation (either before the class begins or during the first session), calendar reminders, frequent assignments, and occasional e-mails to keep students organized. 6. Offer technology support Whether the server isn't responding or the computer has a glitch, technology challenges frustrate students and instructors alike, taking the focus off learning. Be sure that students know what level of technology is necessary to participate in and complete the online course, including specific browsers or computer programs. Enlist your campus technology office to help students get online and stay online for your course. All together now! Following these six simple tips can increase online student retention and ultimately encourage passion and engagement in the dynamic field of nursing.

Transnational Connected Learning and Experimentation - Using live online classes and remote labs for preparing international engineering students for an international working world

Students, who are leaving their home country for taking part in an international study program, face several challenges. Not only the new course of studies can be very challenging but also their whole living conditions may change significantly. This can be a severe clash especially for students who are moving to a country with a totally different cultural background in comparison to their home countries. Moreover, it can profoundly complicate the first weeks at the new university. Knowing about the difficulties the Institute of Forming Technology and Lightweight Construction (IUL) at TU Dortmund University in Germany developed a preparational online course for those international students, who are coming to the IUL for their Master of Science program in Manufacturing Technology (MMT; a special international master program). In context of this course the use of the IUL’s remote laboratory equipment was a key aspect. The course itself was implemented and delivered for the first time in 2014. By now a second updated edition was delivered in 2015. It was designed to prepare the students as best as possible for their new studies at a German university and at the same time prepare them for transnational collaboration. Hence, this course is a good example for a meaningful integration of remote laboratories into an innovative online course concept. On the one hand making use of remote laboratories and its practical integration in online courses helps to connect the international students and on the other hand it brings them into the situation to interact in context of a typical engineering situation, the experiment. The paper presents the course itself and experiences from its first and second implementation.

Innovation in engineering education through computer assisted learning and virtual university model

The paper presents the most important aspects of innovation in Engineering Education using Computer Assisted Learning. The authors propose to increase the quality of Engineering Education programs of study at European standards. The use of computer assisted learning methodologies in all studies is becoming an important resource in Higher Education. We intend to improve the concept of e-Learning using virtual terminals, online support and assisting special training through live seminars and interactive labs to develop a virtual university model. We intend to encourage computer assisted learning and innovation as sources of competitive advantage, to permit vision and learning analysis, identifies new sources of technology and ideas. Our work is based on our university datasets collected during last fifteen years using several e-Learning systems. In Constanta Maritime University (CMU), using eLearning and Knowledge Management Services (KMS) is very important and we apply it effectively to achieve strategic objectives, such as collaboration, sharing and good practice. We have experience in this field since 2000 year using Moodle as KMS in our university. The term KMS can be associated to Open Source Software, Open Standards, Open Protocols and Open Knowledge licenses, initiatives and policies. In CMU Virtual Campus we have today over 12500 active users. Another experience of the authors is the implementation of MariTrainer Wiki educational platform based on Dokeos and DekiWiki under MARICOMP and MEP Leonardo da Vinci Project. We'll also present in this paper a case study under EU funded project POSDRU, where the authors implemented other educational platform in Technological High Schools from Romania used over 1000 teachers. Based on large datasets the study tries to improve the concept of e-Learning teaching using the revolutionary technologies. The new concept present in this paper is that the teaching and learning will be interactive and live. The new and modern techniques are the flexible learning courses, the production of learning demonstrators and testing. All the information from the virtual educational platform remain open space, communication between participants and continued after graduation, so we can talk about creating and maintaining a community of graduates, a partnership with them. Every European University must have a department which aims to provide computer assisted learning using knowledge creation through learning, capture and explication, sharing and collaborative communication, access, use and reuse and knowledge archiving.

Use of a Chicken Thigh Model To Teach Laparoscopic Electrosurgery

Electrosurgery is an important component of laparoscopy that requires care to avoid inadvertent injury. It is difficult to teach these skills to trainees as many of the current models for resident education such as virtual training systems, inanimate simulators and even live tissue labs do not have the capability to simulate electrosurgery. We sought to develop a model for teaching use of monopolar surgical skills to residents utilizing a chicken thigh. We present 4 exercises on this model that include ureterolysis, excision of pelvic sidewall endometriosis, creation of a colpotomy and lysis of adhesions. We compare and contrast these exercises to live surgical scenarios to create realistic exercises in the video. This is an innovative, inexpensive and reproducible tissue simulation for use of monopolar energy in resident education.

About Our Authors

About Our Authors

Automated generation of massive image knowledge collections using Microsoft Live Labs Pivot to promote neuroimaging and translational research.

BackgroundMassive datasets comprising high-resolution images, generated in neuro-imaging studies and in clinical imaging research, are increasingly challenging our ability to analyze, share, and filter such images in clinical and basic translational research. Pivot collection exploratory analysis provides each user the ability to fully interact with the massive amounts of visual data to fully facilitate sufficient sorting, flexibility and speed to fluidly access, explore or analyze the massive image data sets of high-resolution images and their associated meta information, such as neuro-imaging databases from the Allen Brain Atlas. It is used in clustering, filtering, data sharing and classifying of the visual data into various deep zoom levels and meta information categories to detect the underlying hidden pattern within the data set that has been used.MethodWe deployed prototype Pivot collections using the Linux CentOS running on the Apache web server. We also tested the prototype Pivot collections on other operating systems like Windows (the most common variants) and UNIX, etc. It is demonstrated that the approach yields very good results when compared with other approaches used by some researchers for generation, creation, and clustering of massive image collections such as the coronal and horizontal sections of the mouse brain from the Allen Brain Atlas.ResultsPivot visual analytics was used to analyze a prototype of dataset Dab2 co-expressed genes from the Allen Brain Atlas. The metadata along with high-resolution images were automatically extracted using the Allen Brain Atlas API. It is then used to identify the hidden information based on the various categories and conditions applied by using options generated from automated collection. A metadata category like chromosome, as well as data for individual cases like sex, age, and plan attributes of a particular gene, is used to filter, sort and to determine if there exist other genes with a similar characteristics to Dab2. And online access to the mouse brain pivot collection can be viewed using the link http://edtech-dev.uthsc.edu/CTSI/teeDev1/unittest/PaPa/collection.html (user name: tviangte and password: demome)ConclusionsOur proposed algorithm has automated the creation of large image Pivot collections; this will enable investigators of clinical research projects to easily and quickly analyse the image collections through a perspective that is useful for making critical decisions about the image patterns discovered.

Web GIS in practice IX: a demonstration of geospatial visual analytics using Microsoft Live Labs Pivot technology and WHO mortality data

The goal of visual analytics is to facilitate the discourse between the user and the data by providing dynamic displays and versatile visual interaction opportunities with the data that can support analytical reasoning and the exploration of data from multiple user-customisable aspects. This paper introduces geospatial visual analytics, a specialised subtype of visual analytics, and provides pointers to a number of learning resources about the subject, as well as some examples of human health, surveillance, emergency management and epidemiology-related geospatial visual analytics applications and examples of free software tools that readers can experiment with, such as Google Public Data Explorer. The authors also present a practical demonstration of geospatial visual analytics using partial data for 35 countries from a publicly available World Health Organization (WHO) mortality dataset and Microsoft Live Labs Pivot technology, a free, general purpose visual analytics tool that offers a fresh way to visually browse and arrange massive amounts of data and images online and also supports geographic and temporal classifications of datasets featuring geospatial and temporal components. Interested readers can download a Zip archive (included with the manuscript as an additional file) containing all files, modules and library functions used to deploy the WHO mortality data Pivot collection described in this paper.

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Focus on Authors

Global Exploratory Analysis of Massive Neuroimaging Collections using Microsoft Live Labs Pivot and Silverlight

Event Abstract Back to Event Global Exploratory Analysis of Massive Neuroimaging Collections using Microsoft Live Labs Pivot and Silverlight Robert W. Williams1*, Lei Yan1, Xiaodong Zhou1, Lu Lu1, Arthur Centeno1, Leonard Kuan2, Michael Hawrylycz2 and Glenn D. Rosen3 1 University of Tennessee Health Science Center, Department of Anatomy and Neurobiology, Center for Integrative and Translational Genomics, United States 2 The Allen Institute for Brain Science, United States 3 Beth Israel Deaconess Medical Center/Harvard Medical School, Department of Neurology, United States Introduction: The Mouse Brain Library (www.mbl.org) consists of high resolution images generated for 200 genetically well defined strains of mice, 2200 cases, 8800 Nissl-stained slides, and ~120,000 coronal and horizontal sections of the brain. The MBL includes representatives for most sets of recombinant inbred strains, (BXD, LXS, AXB, BXH, CXB). This collection provides a solid foundation for studies of the genetic control of brain structure, function, and behavior (Lu et al. 2001; Yang et al., 2008; Rosen et al., 2009). A key challenge is how to deliver massive image collections such as the MBL, Allen Brain Atlas projects, and BrainMaps using modern web services. In this work we tested Microsoft Live Labs Pivot (www.getpivot.com ) as an image distribution portal. Pivot provides a unique method for delivering and exploring very large collections of high-resolution images. Methods and Results: Large slides of 30-µm celloidin sections were imaged using a 20x objective (NA 0.75) and an Aperio Scanscope CS scanner at an in-plane resolution of 1-µm/pixel and at 150-µm steps along the cutting axis. Images were segmented to extract single sections. SVS format image were converted into Advanced Forensic format (AFF), JPEG2000, and Silverlight deep zoom (DZI) pyramids. A DVI is 2x larger than its JPEG parent. DZIs were assembled into a set of Pivot image collections. Metadata for sorting and display were extracted from MBL and GeneNetwork.org data tables. Metadata types include thousands of genotypes and phenotypes for all strains, as well as data for individual cases (sex, age, body weight, brain weight, litter size). Spatial coordinate tags for each section using INCF Waxholm space and BIRNLex neuroanatomical terms are being added. A Pivot server was installed on a Linux CentOS 5 8-core system (Dell R610) running Tomcat and MySQL. The system was tested on Vista and Windows 7 using a Pivot browser (www.getpivot.com) and runs well on Mac OS X 10.6 using the VMWARE Fusion 3 virtual machine. Link to http://mbl.pivotcollections.org to view the MBL. The MBL collection is large and unwieldy and our current interface (www.mbl.org) does not provide sufficient sorting flexibility and speed to effectively explore or analyze the collection. A good exploratory interface would provide both forest and tree views and a way to effectively scan the entire collection for variation in traits such as ventricular volume, callosal architecture, cortical lamination, and differences in the cytology in specific nuclei in a matter of minutes, not hours or days. Pivot is optimal for these types of rapid review and exploratory tasks. The collection can be filtered, sorted, and viewed at a wide range of magnifications—from thumbnails of whole slide to full zooms of subnuclei—almost instantly. The collection can be split, filtered, and sorted using a range of continuous and discrete metadata variables (sex, age, strain, genotype, behavior) Limitations with the current Pivot implementation can be divided into two categories: those associated with the interface itself (no nested displays, a limit of 15 displayed categories, no graphic overlay for marking or annotation), and those associated with secondary analytic and statistical functions that would typically be used to test hypotheses (no dynamic output of group statistics nor tests for differences among groups using ANOVA or t tests) Discussion: Pivot is a superb web service architecture that provides very fluid access to massive neuroimaging databases. It is extremely well suited for both the dissemination of massive 2D collections and direct exploratory analysis as part of a web service. Pivot has also been extremely helpful as part of quality control workflow and has enabled us to search for neuroanatomical differences and patterns of variation among strains of mice in ways that far surpass any other web interface.

Computerized Dog Lab for Teaching Cardiovascular Physiology to First Year Medical Students

PurposeTo provide the students with an experience similar to that provided through animal labs but without using animals.MethodsDogs were chronically instrumented to demonstrate cardiovascular function and reflexes. This included aortic, left atrial and left ventricular catheters (LV), aortic and coronary flow probes, inferior vena cava, coronary artery and aortic occluders and in some instances LV dimension crystals. This allowed demonstration of the cardiac cycle and the direct and reflex responses to various interventions in conscious animals. The interventions included increasing and decreasing preload and afterload with drugs or vascular occluders, injecting an alpha or beta agonist, nitroglycerine or veratradine into the left atria. Reactive hyperemia was demonstrated with coronary occlusion.ResultsData were obtained over a period of years, negating the need for animals in student labs. The data were organized in a html format allowing the playback of avi files or figures showing the response to the intervention. For more advanced analysis the Chart 5 program (ADInstruments) was used.ConclusionThis lab has repeatedly been very highly evaluated by the students. They appreciate observing the integration of the cardiovascular system without using animals for their "educational use." This lab has replace much of the experience previously obtained with live animal labs.

P REHOSPITAL R APID-SEQUENCE I NTUBATION : A P ILOT T RAINING P ROGRAM

Objective. To develop a training program enabling paramedics to use sedation and paralytic medications to facilitate endotracheal intubation in patients who otherwise could not be successfully intubated. Methods. Paramedics underwent a training program consisting of six hours of didactic education, two four-hour mannequin labs, one four-hour animal intubation lab, and operating room experience. Rapid-sequence intubation (RSI) runs were reviewed for appropriateness in patient selection and medication use. Non-RSI runs were reviewed to determine whether appropriate patients were being missed. Intubation success rates continue to be followed. Long-term quality assurance includes monthly run reviews, periodic quizzes, and unannounced on-site practical tests. Results. 101 patients have been intubated using RSI, including medical, trauma, pediatric, and adult cases. Of all patients receiving RSI drugs, 100 of 101 were successfully intubated. There were no undetected esophageal intubations. Paramedics were able to demonstrate proper patient selection and appropriately administer RSI medications. The use of sheep labs was a critical component of this training because it permitted multiple intubations in a live model possessing an airway quite similar to that of the human. The gum elastic bougie was felt to be critical in the intubation of three patients. Conclusion. This RSI training model can serve as a template for other agencies seeking to implement RSI. Limitations of this model include the availability of live animal labs and the expense of conducting the training. Intense medical director involvement has been key to the success of this prehospital RSI program.