Simulated Medical Environments Research Articles

Validation of 3D printed MAYO tubes and stethoscope in simulated medical environment – Tools fabricated with additive manufacturing for emergency care

Emergency and disaster medical care often face resource or equipment shortages. 3D printing technology has been proven to be effective in cases with insufficient supply chains. MAYO tubes and stethoscopes are essential components of ABCDE patient examinations; however, 3D-printed variants have not been fully tested. These 3D-printed instruments were substituted and validated in a simulated pre-hospital environment.In total, 26 participants were included in this study. Fifteen clinicians or paramedics with at least 3 years of professional experience and 10 medical students. One student was excluded because he had relevant experience with emergency care. As basic tasks, the placement of MAYO tubes and auscultation with stethoscopes were performed using medical simulators. 3D printed instruments were compared with conventional clinical devices by measuring the time required for the intervention, success rate, and user satisfaction. In the study FFF (Fused Filament Fabrication (FFF), SLS (Selective Laser Sintering (SLS), and SLA (stereolithography) 3D printing were used in this study.The times required for implementation and auscultation were examined for each instrument. There was no significant difference between the MAYO tube (p = 0.798) and the stethoscope (p = 0.676). In the case of stethoscopy, the study investigated the correct diagnosis, and no significant difference was found (p = 0.239), although an interesting trend was observed. Regarding the MAYO tube, the study found no significant difference in correct position formation (p = 0.163). The experience levels of the groups did not influence these factors. However, significant differences in user satisfaction were found in both cases in favour of the conventional versions (p < 0.001).Overall, the results of this study suggest that 3D-printed devices could be suitable replacements for clinic-based devices in emergency situations. The 3D-printed devices did not perform inferiorly at any of the indicated points compared to their classical counterparts. However, the practical applicability of the devices used in this study requires further investigation.

Impact of using peer role-playing on the clinical skills performance of pediatric trainees

ObjectiveThe aim of this study was to evaluate the impact of peer role-playing on the clinical skills performance of pediatric trainees.MethodsSeventy-eight clinical medicine trainees were randomly divided into a role-playing group and a traditional teaching group, with 39 students in each group. The role-playing group alternated between the roles of clinicians and patients, while the traditional teaching group received the bedside teaching mode of verbal instruction. After two weeks traineeship, mini-Clinical Evaluation Exercise(Mini-CEX) was used to evaluate the trainees’ competence in physician-patient communication and clinical practice. A questionnaire was given to the role-playing group to assess their satisfaction with the method.ResultsThe Mini-CEX scores showed that the role-playing group had superior clinical skills (p < 0.05), including communication, history taking, professionalism, organization, clinical skills, and physical examination, compared to the traditional teaching group. Furthermore, trainee satisfaction was high with the role-playing method,and the satisfaction were more than 95%.ConclusionThe role-playing method effectively improved the clinical skills of pediatric trainees, developed clinical communication skills, and enhanced the application of medical knowledge in a simulated medical environment.

An Escape Room to Orient Preclinical Medical Students to the Simulated Medical Environment.

IntroductionSimulation is increasingly being used in the preclinical years of US medical school curricula to provide experiential learning opportunities for students. However, preclinical medical students may not be able to access the full benefits of immersive simulation scenarios without an in-depth introduction to the simulation environment and manikin. An escape room may be an effective way to orient students in an interactive manner to overcome this barrier.MethodsWe designed and implemented a 90-minute escape room orientation activity to address student discomfort in the simulation environment by providing a team-based, hands-on exploration of identified critical features of the room and manikin in the guise of a routine clinic visit for a patient. We surveyed learners on their confidence immediately following the escape room and on their perceptions of the session effectiveness following their first simulation.ResultsA total of 148 preclinical medical students participated in the escape room activity in 30 groups of four to five persons. Of those students, 130 participated in a simulated patient case within 1 month of the escape room activity, and 89 filled out a follow-up survey. Of responding students, 80% reported that the escape room activity was highly effective or very effective in preparing them for participation in a simulated patient case.DiscussionImplementing an escape room orientation activity for preclinical medical students was effective in preparing students to participate in their first immersive simulation scenario.

Exploring the effect of virtual reality relaxation environment on white coat hypertension in blood pressure measurement

A phenomenon called White Coat Hypertension (WCH) often occurs when measuring blood pressure (BP) in a real medical environment. Utilizing virtual reality (VR) technology to present appropriate relaxation scenes can isolate the real medical environments and may provide a new method to avoid WCH and improve the accuracy of BP measurement. In this study, we designed four immersive VR relaxation scenes and conducted an experiment to explore the role of VR scenes in eliminating/detecting WCH in BP measurement. Results from the current sample showed that both systolic BP and diastolic BP measured in the simulated medical environment were significantly higher than the baseline level and the VR scene condition, while there were no significant differences between the BPs measured in VR scenes and the baseline level. It can be concluded that VR provides an effective approach to avoid WCH in BP measurement by visually and aurally isolating the real environment and assisting relaxation and provides a new approach to detect the occurrence of WCH by the comparison of BPs measured in the VR scene condition and real medical environments.

Preliminary design of an 7 DOF robotic manipulator positioning biopsy needle

Research in the field of medical robotics has advanced in last couple decades but it is still lacking in many areas such as radiology and diagnostics. In this research paper a robotic manipulator design for performing biopsy with the guidance of CT scan image is introduced. The prime objective here is to design a robotic manipulator that can manoeuvre on a CT machine without colliding with the machine or the human lying on the CT bed. Biopsy needle should be the only part of this manipulator intervening with the human body. The robotic model designed here has 7 degrees of freedom. DH parameters of the robotic model is devised and these parameters are validated by generating a kinematic model of the robotic manipulator with desired joint motions in Matlab software. Transformation matrix of the biopsy needle with respect to the base of the robotic model is formulated. 3D design of the robotic model is generated in Solidworks 2016 software. Simulation study of the motion of each joints is done in a simulated medical environment using a model of CT scan machine, bed and a human body placed on the bed. Collision detection feature of solidworks was activated while simulating to check whether the robotic manipulator model was colliding with the CT machine or the human body.

Application of standardized patients in intensive training of clinical skills for general practice trainees and its effectiveness

Objective To explore application of standardized patients (SPs) in intensive training of clinical competency for general practice trainees. Methods Fifty-three general practice trainees in Shanghai Zhongshan Hospital were enrolled in the study, randomly assigned to intervention and control groups. Control group proceeded in routine clinical rotation, while intervention group accepted intensive training course with SPs as trainers. Three months after intervention, clinical skills of the two groups were compared in a simulated medical environment. Results There was no statistically significant difference in their baseline characteristics between the two groups (P ＞0.05). Competency in history taking, physical examinations,communication with patients, comprehensive consultation, medical record writing as well as case-analysis,improved significantly in intervention group after intervention, as compared to those before it ( P ＜ 0. 01 ),with the highest score of communication skill of 82 ± 10. Although competency of history taking, physical examinations, comprehensive consultation, medical record writing also improved significantly three months later in control group as compared to their baselines (P ＜ 0. 01 ), while no statistically significant difference in their communication skills was found ( P ＞ 0. 05 ). Scores of skills in physician-patient communication,comprehensive consultation as well as medical record analysis were significantly higher in intervention group than those in control one after intervention ( P ＜ 0. 01 ), but no significant difference in physical examinations was found between the two groups ( P ＞ 0. 05 ). Conclusions Application of SP in intensive training course for clinical competency can remarkably improve their competency in interpersonal communication and comprehensive consultation for general practice trainees. Key words: Teaching ; Patient,simulation ; Clinical skills ;

High-stakes Assessment of Clinical skills in A simulated Environment.

BACKGROUND: Consistent with its mission to protect the public, the National Board of Osteopathic Medical Examiners (NBOME) implemented a clinical skills examination into its COMLEX-USA licensure examination series in 2004. The COMLEX-USA Level 2-Performance Evaluation (Level 2-PE) assesses the clinical skills of osteopathic candidates in a simulated clinical environment with standardized patients. These skills include physical examination, medical history-taking, palpatory diagnosis and osteopathic manipulative treatment (OMT), doctor-patient communication, professionalism, and written communication skills. Physician raters score the written notes and OMT. METHOD: Candidates completed a twelve station examination, where they are asked to evaluate and treat the standardized patient as appropriate. Candidates are allotted 23 minutes to complete the interview and patient evaluation and to document and synthesize their clinical findings, impressions, and plan in a written note. All testing was completed at NBOME’s National center for Clinical Skills Testing, a state-of-the-art simulation facility designed to ensure the necessary safety, security, and standardization required for high-stakes testing. RESULTS: From September, 2004 through June, 2006, NBOME tested 5748 candidates. First-time takers had a 95.7% pass rate. Generalizability coefficients for the data-gathering and doctor-patient communication components of the examination ranged from 0.78–0.84, respectively. There were modest correlations between scored Level 2-PE components (data-gathering-written note, r= .50). Correlation between clinical skills components and knowledge-based clinical science scores were moderate. CONCLUSIONS: The addition of Level 2-PE to the COMLEX-USA examination series allows for the valid and reliable measurement of clinical skills in a simulated medical environment. While standardized patients offer the opportunity to assess “hands-on” skills, many patient conditions are difficult, or impossible, to simulate. Other relevant competencies (e.g., technical procedures sure as phlebotomy and sensitive examinations such as digital rectal examinations) are difficult to test using standardized patients. Here, to improve the content validity of the assessment, the addition of other simulation modalities may be helpful.

Does a Head-Mounted Display Worsen Inattentional Blindness?

Head mounted displays (HMDs) can present visual information to operators at times when this would otherwise be difficult or impossible using standard visual displays. HMDs have been shown to benefit anesthetists in simulated medical environments. Operators, however, may have trouble extracting information from the HMD in dynamic environments. Operators may also fail to consciously perceive visual events that are important, meaningful, or bizarre if attending to other aspects of the visual scene. We investigated how attention manipulations (Focused, Divided, Just Watch) interact with display type (HMD, Standard Display) and found that participants were less likely to detect unexpected events using the HMD. We also found that unexpected event detection decreased from the Just Watch to Divided to Focused attention conditions. We suggest further testing be taken to ensure that HMDs to not result in failures to detect unexpected events in anesthesia monitoring.

Emergency and critical care pediatrics: use of medical simulation for training in acute pediatric emergencies

Recent data suggest that pediatric trainees receive insufficient training to manage acute pediatric emergencies. This review addresses the use of medical simulation as a way for medical learners to acquire and maintain skills needed to manage pediatric resuscitations. Recent work highlights the value of deliberate practice in the context of simulated medical environments to promote development of medical expertise. Several studies demonstrate the benefit of simulation-based training for improved skill acquisition in advanced life support, emergency airway management, and nontechnical skills. Work in other fields of medicine supports the integration of simulation into pediatric training programs. Medical simulation holds great promise to enhance existing pediatric training curricula by increasing skills and expertise in resuscitation. Future research is needed to identify best methods of pediatric simulation-based training.

Objective measures of situation awareness in a simulated medical environment.

One major limitation in the use of human patient simulators is a lack of objective, validated measures of human performance. Objective measures are necessary if simulators are to be used to evaluate the skills and training of medical practitioners and teams or to evaluate the impact of new processes or equipment design on overall system performance. Situation awareness (SA) refers to a person's perception and understanding of their dynamic environment. This awareness and comprehension is critical in making correct decisions that ultimately lead to correct actions in medical care settings. An objective measure of SA may be more sensitive and diagnostic than traditional performance measures. This paper reviews a theory of SA and discusses the methods required for developing an objective measure of SA within the context of a simulated medical environment. Analysis and interpretation of SA data for both individual and team performance in health care are also presented.

Evaluating the spoken English proficiency of graduates of foreign medical schools.

The purpose of this study was to gather additional evidence for the validity and reliability of spoken English proficiency ratings provided by trained standardized patients (SPs) in high-stakes clinical skills examination. Over 2500 candidates who took the Educational Commission for Foreign Medical Graduates' (ECFMG) Clinical Skills Assessment (CSA) were studied. The CSA consists of 10 or 11 timed clinical encounters. Standardized patients evaluate spoken English proficiency and interpersonal skills in every encounter. Generalizability theory was used to estimate the consistency of spoken English ratings. Validity coefficients were calculated by correlating summary English ratings with CSA scores and other external criterion measures. Mean spoken English ratings were also compared by various candidate background variables. The reliability of the spoken English ratings, based on 10 independent evaluations, was high. The magnitudes of the associated variance components indicated that the evaluation of a candidate's spoken English proficiency is unlikely to be affected by the choice of cases or SPs used in a given assessment. Proficiency in spoken English was related to native language (English versus other) and scores from the Test of English as a Foreign Language (TOEFL). The pattern of the relationships, both within assessment components and with external criterion measures, suggests that valid measures of spoken English proficiency are obtained. This result, combined with the high reproducibility of the ratings over encounters and SPs, supports the use of trained SPs to measure spoken English skills in a simulated medical environment.