Simulation Training Group Research Articles

Randomized Controlled Trial Comparing Training of Transseptal Puncture With or Without Intracardiac Echocardiography.

Intracardiac echocardiography (ICE) has been widely used in the catheter ablation of atrial fibrillation (AF). However, the value of ICE in the training of transseptal puncture (TSP) is unclear. ICE-Training Study was a single-center, parallel-group, unmasked, randomized controlled trial registered in ChineseClinicalTrials.gov. Participants were randomly assigned (1:1) to different groups (1) the ICE simulator training group (ICE-ST), in which TSP was trained and performed under the guidance of both ICE and x-ray; and (2) the conventional simulator training group (Con-ST), in which TSP was trained and performed only under the guidance of x-ray. The trainees need to undergo the training stage and the evaluation stage. From October 2022 to December 2022, 18 consecutive fellows (age 32.4±4.4years, 12 males) without experience of TSP were included. The training period (16.9±6.6 vs. 29.6±8.7 times, p=0.003) and the fluoroscopy time (120.3±25.3 vs. 189.3±40.2s, p<0.001) of the ICE-ST group was significantly shorter than that of the Con-ST group. No significant difference was found in the comprehensive performance of TSP in the ICE-ST group (composite score 96.7±5.7) and the Con-ST group (composite score 95.9±6.3, p=0.62), but the selection of TSP sites in the ICE-ST group was commonly better than that in the Con-ST group. ICE could improve the efficiency of TSP training and optimize the site of TSP to facilitate catheter manipulation in the ablation. ChineseClinicalTrials.gov identifier: ChiCTR2200058377.

Effectiveness of hybrid simulation training on medical student performance in whole-task consultation of cardiac patients: The ASSIMILATE EXCELLENCE randomized waitlist-controlled trial

BackgroundAssessment of comprehensive consultations in medicine, i.e. a complete history, physical examination, and differential diagnosis, is regarded as authentic tests of clinical competence; however, they have been shown to have low reliability and validity due to variability in the real patients used and subjective examiner grading. In the ASSIMILATE EXCELLENCE study, our aim was to assess the effect(s) of expert tuition with hybrid simulation using a simulated patient wearing a novel auscultation vest, i.e. a hybrid simulated patient, and repeated peer grading using scoring checklists on student learning, performance, and acumen in comprehensive consultations of patients with valvular heart disease.MethodsASSIMILATE EXCELLENCE was a randomized waitlist-controlled trial with blinded outcome assessment undertaken between February 2021 and November 2021. Students at the Royal College of Surgeons in Ireland in either the second or third year of the four-year graduate-entry medical degree programme were randomized to a hybrid simulation training or waitlist control group and undertook three consultation assessments of three different clinical presentations of valvular heart disease (cases: C1–C3) using hybrid simulation. Our primary outcome was the difference in total score between and within groups across time; a secondary outcome was any change in inter-rater reliability across time. Students self-reported their proficiency and confidence in comprehensive consultations using a pre- and post-study survey.ResultsIncluded were 68 students (age 27.6 ± 0.1 years; 74% women). Overall, total score was 39.6% (35.6, 44.9) in C1 and increased to 63.6% (56.7, 66.7) in C3 (P < .001). On intergroup analysis, a significant difference was observed between groups in C2 only (54.2 ± 7.1% vs. 45.6 ± 9.2%; P < .001), a finding that was mainly driven by a difference in physical examination score. On intragroup analysis, significant improvement in total score across time between cases was also observed. Intraclass correlation coefficients for each pair of assessors were excellent (0.885–0.996 [0.806, 0.998]) in all cases. Following participation, students’ confidence in comprehensive consultation assessments improved, and they felt more prepared for their future careers.ConclusionsHybrid simulation-based training improves competence and confidence in medical students undertaking comprehensive consultation assessment of cardiac patients. In addition, weighted scoring checklists improve grading consistency, learning through peer assessment, and feedback.Trial registrationClinicalTrials.gov Identifier: NCT05895799

A novel 3D-printed educational model for the training of laparoscopic bile duct Exploration:a pilot study for beginning trainees

BackgroundLaparoscopic common bile duct exploration (LCBDE) is a minimally invasive procedure for the removal of bile duct stones that is often performed by experienced hepatobiliary surgeons; beginners do not easily master this approach. AimTo investigate the effectiveness and practicality of a three-dimensional printed (3DP) anatomical model based on radiographic images in the training of LCBDE techniques and formulate standardized educational workflows. MethodsColored LCBDE training models were produced using 3DP technology. Twenty standardized training trainees were randomly divided into two groups: a 3DP model training group and a traditional laparoscopic simulation training group. Both groups received the same number of teaching hours. After a 4-weeks training course, the trainees’ subjective and objective progress in basic knowledge and manipulations were evaluated and compared. ResultsCompared with traditional laparoscopic simulation, 3DP model simulation training is of great significance in improving trainers' understanding of surgical procedures and cooperation during the operation. Trainees with 3DP models training demonstrated a significant improvement in their understanding of the key points of surgery (χ2 = 6.139, p = 0.013) and skills scores, especially in core procedural steps operation. More importantly, the trainees showed higher levels of satisfaction and self-confidence while assisting in the surgery. ConclusionWith the development of 3DP models, improvements in the learning effect for theoretical understanding and practical skills were significant. The present study is the initial educational experience with 3DP models to facilitate the operational capabilities of the trainees for LCBDE.

Evaluating the learning performances for CNC machine practice in mechanical engineering degree courses based on students’ mental workload

This study evaluates the performance of learning CNC machining in mechanical engineering degree programs by assessing students’ mental workload (MWL). Both subjective (NASA-Task Load Index) and objective (increasing ratio of heart rate, IRH) evaluation methods were employed to assess the MWL of 46 students randomly assigned to two groups: a traditional training group and a combined simulation training group. The results demonstrate the significant impact of the training method on students’ MWL. Specifically, the MWL and IHR values of the combined simulation training group were 54.3 and 9.2, respectively, while those of the traditional training group were 58.3 and 13.2. Additionally, the correlation analysis showed a significant correlation between the IHR value and the MWL score of NASA-TLX. These findings suggest that implementing simulated software and the combined simulation training method effectively reduces students’ MWL, thereby promoting active knowledge acquisition. Consequently, students’ MWL can be utilized to evaluate the effectiveness of technical education with the aim of enhancing training efficiency and quality.

Laparoscopic training on virtual-reality simulators or live pigs-a randomized controlled trial.

Thirty-six novice surgical residents without independent laparoscopic experience were randomly paired with a peer and randomized into three groups: VR simulator group (dyad training on LapSim VR simulators), pig surgery group (training on live, anesthetized pigs) and control group (training by a lecture on laparoscopic surgery, surgical videos and textbooks). After 6h of training, all participants performed a simulated cholecystectomy procedure using a pig liver with adherent gallbladder working in pairs. All procedures were video-recorded and the recordings were saved on USB-sticks in a blinded fashion identifiable only by the unique participant number. All video-recordings were scored blindly and independently by two expert raters using the Global Operative Assessment of Laparoscopic Skills (GOALS) assessment instrument. The performances in the three groups were significantly different, P less than 0.001. Both the VR simulation training group and the live pigs training group performed significantly better than the control group, both P values less than 0.001. However, there was no significant difference in the performance of the two simulation-based training groups, P=0.66. Novice surgical trainees can benefit from both VR simulator training and pig surgery simulation compared with traditional studying and there was no significant difference between the two modalities. The authors recommend that VR simulators should be used for basic training of laparoscopic skills and surgery on live animals should be reserved for higher-level surgical training.

Effectiveness of the miWe Simulator Training on Powered Wheelchair-driving Skills: A Randomized Controlled Trial

ObjectivesTo evaluate the effectiveness of a home-based simulator training, in comparison with a videogame-based training, in terms of powered wheelchair driving skills, skills use in a real-world setting, and driving confidence. DesignSingle-blinded randomized controlled trial. SettingCommunity. ParticipantsNew powered wheelchair users (N=47) randomly allocated to simulator group (n=24, 2 drop-out) and control group (n=23, 3 drop-out). InterventionsThe miWe wheelchair simulator (simulator group) or a kart driving videogame (control group) was setted-up at participants’ homes (computer + joystick). They were instructed to use it at least 20 minutes every 2 days, during a period of 2 weeks. Primary Outcome Measure(s)Assessments were done at baseline (T1) and post-training (T2) using the Wheelchair Skills Test Questionnaire (WST-Q, version 4.1), Wheelchair Confidence Scale (WheelCon), Assistive Technology Outcomes Profile for Mobility, and Life-Space Assessment (LSA). The time necessary to complete 6 WST tasks was measured with a stopwatch. ResultsParticipants of the simulator group significantly increased their WST-Q capacity score at T2 by 7.5% (P<.05), whereas the control group remained at the same score (P=.218). Participants of both groups rolled backward and went through a door significantly faster at T2 (P=.007; P=.016), but their speed did not change for the other skills. The WheelCon score significantly increased after training (+4% for the control group and +3.5% for the simulator group, P=.001). There was no T1-T2 difference between groups for the WST-Q performance scores (P=.119), the ATOP-Activity (P=.686), the ATOP-Participation scores (P=.814), and the LSA score (P=.335). No adverse events or side effects were reported during data collection or training. ConclusionsParticipants of both groups improved some skills and their wheelchair driving confidence. The simulator training group also demonstrated a modest post-training gain in their WST-Q capacity, but more studies would be needed to explore the long-term effects of the McGill immersive wheelchair simulator (miWe) simulator on driving skills.

A randomized controlled trial of simulation training in teaching coronary angiographic views

IntroductionSimulation technology has an established role in teaching technical skills to cardiology fellows, but its impact on teaching trainees to interpret coronary angiographic (CA) images has not been systematically studied. The aim of this randomized controlled study was to test whether structured simulation training, in addition to traditional methods would improve CA image interpretation skills in a heterogeneous group of medical trainees.MethodsWe prospectively randomized a convenience sample of 105 subjects comprising of medical students (N = 20), residents (N = 68) and fellows (N = 17) from the University of Arizona. Subjects were randomized in a stratified fashion into a simulation training group which received simulation training in addition to didactic teaching (n = 53) and a control training group which received didactic teaching alone (n = 52). The change in pre and post-test score (delta score) was analyzed by a two-way ANOVA for education status and training arm.ResultsSubjects improved in their post-test scores with a mean change of 4.6 ± 4.0 points. Subjects in the simulation training arm had a higher delta score compared to control (5.4 ± 4.2 versus 3.8 ± 3.7, p = 0.04), with greatest impact for residents (6.6 ± 4.0 versus 3.5 ± 3.4) with a p = 0.02 for interaction of training arm and education status.ConclusionsSimulation training complements traditional methods to improve CA interpretation skill, with greatest impact on residents. This highlights the importance of incorporating high-fidelity simulation training early in cardiovascular fellowship curricula.

Effect of surgical simulation training on the complication rate of resident-performed phacoemulsification

ObjectiveTo study the effect of additional training with ophthalmic surgical simulation on the intraoperative complication rates of phacoemulsification performed by residents.Methods and materialsThis was a retrospective study of phacoemulsification surgeries...

Impact of COVID-19 specific simulation training in improving intubators’ level of comfort during intubations of COVID-19 patients - Results from a USA national survey

BackgroundTracheal intubation is a hazardous aerosolizing procedure with a potential risk of spreading SAR-CoV-2 between patients and physicians. AimThe purpose of this study was to explore the impact of COVID-19 specific simulation training in improving provider level of comfort during the intubation of COVID-19 patients. MethodsIn this cross-sectional national study, an electronic survey was disseminated using a snowball sample approach to intubators from 55 hospitals across the United States. The survey assessed providers’ comfort of intubating and fear of contracting the virus during COVID-19 intubations. ResultsA total of 329 surveys from 55 hospitals were analyzed. Of 329 providers, 111 providers (33.7%) reported participating in simulation training. Of those, 86 (77.5%) reported that the simulation training helped reduce their fear of intubating COVID-19 patients. Providers in the simulation training group also reported a higher level of comfort level with intubating both general patients (median [range] no-simulation training group 9 [3–10], simulation training group 9 [6–10]; p = 0.015) and COVID-19 patients (no-ST 8 [1–10], ST group 9 [4–10]; p < 0.0005) than providers in the no-simulation training group. ConclusionsOur study suggests that COVID-19 specific intubation simulation training promotes provider comfort. Simulation training may be implemented as part of airway management training during the current and novel pandemic situations.

Increase Intensive Care Staff Comfort and Proficiency With Emergent Re-sternotomy in the Post-Open-Heart Patient by Using SynDaver® Simulation.

Simulation training has been used in many avenues such as aeronautics, law enforcement, and healthcare to assist in training personnel to learn a new task and perform highly technical procedures. Simulation training has demonstrated beneficial for providing low-use, high-risk jobs such as landing a plane with a complete engine failure, performing reconstructive surgery, and even emergent lifesaving procedures. Our simulation training group chose to develop our custom hands-on training to perform emergent re-sternotomy on the post-open-heart patient based upon this belief. The goal of this project was to assist the bedside intensive care nurse in their self-perception of being comfortable and proficient in helping the physician with the procedure of an emergent re-sternotomy on the post-surgical open-heart patient. Measurement of self-perception of comfort and proficient was measured with a pre/post-questionnaire. The pre/post-questionnaire results showed improvement ranging from an increase in self-scoring from 1.2 to 1.7, with statistical significance demonstrated with a p <0.05.

Comparison of Simulation-Only vs. Simulation + Live Training in Paracentesis

Background Several studies have examined the effects of simulation and live training experiences on abdominal paracentesis skills, but no study has examined the durability of such training or compared skills retention between the simulation-only and hybrid training approaches. Methods A subset of internal medicine residents who participated in simulation-based training in abdominal paracentesis were assigned to an additional, live training experience. Procedural knowledge and skill were assessed following initial training and at six months, and compared between groups. Results Complete data was available for 29 out of 37 residents who received simulation-only training and 18 out of 23 who received simulation plus live training. There were no statistical differences in procedural skills scores at either point in time. The simulation plus live training group achieved a higher mean score on the knowledge test at six months (p=0.006). Conclusions Simulation-based training is sufficient for achieving initial mastery in abdominal paracentesis, but not for maintaining paracentesis skills at six months in the absence of structured, maintenance training. The addition of a live training experience to complement the simulation training was not sufficient to prevent skills decline.

Comparison of Four Methods of Paramedic Continuing Education in the Management of Pediatric Emergencies

Introduction: Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. Objective: To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. Methods: A validated, performance-based, simulated clinical assessment module was used to provide a baseline measurement of paramedics’ resuscitation skills during three simulated pediatric emergencies. Educational modules were developed that targeted deficiencies identified by the baseline assessment, including advanced pediatric life support skills, airway management, use of the Broselow-Luten Tape®, pediatric drug dose calculations and drug delivery, seizure management, and trauma assessment. Paramedics from five EMS agencies in Michigan were randomized to four education intervention groups. The control group used an existing, online, continuing education course. Three experimental groups were exposed to the same content during five, one-hour sessions conducted over 2.5 years. Instruction was delivered using high-fidelity, simulated case-based training, low-fidelity simulation training, or lecture with procedural skills lab, based on group assignment. After the training, all groups were tested within 4–6 months using methods identical to baseline testing. Results: One hundred forty-seven subjects completed the study. There were no differences in baseline skill levels among the four groups. Only the low fidelity simulation training group demonstrated improvement of combined scenario scores (p = 0.0008). Scores for targeted skills improved in one scenario in the high-fidelity group, two in the low-fidelity group, one in the lecture/lab group, and none in the control group. Conclusions: Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments.

Functional brain connectivity related to surgical skill dexterity in physical and virtual simulation environments.

.Significance: Surgical simulators, both virtual and physical, are increasingly used as training tools for teaching and assessing surgical technical skills. However, the metrics used for assessment in these simulation environments are often subjective and inconsistent.Aim: We propose functional activation metrics, derived from brain imaging measurements, to objectively assess the correspondence between brain activation with surgical motor skills for subjects with varying degrees of surgical skill.Approach: Cortical activation based on changes in the oxygenated hemoglobin (HbO) of 36 subjects was measured using functional near-infrared spectroscopy at the prefrontal cortex (PFC), primary motor cortex, and supplementary motor area (SMA) due to their association with motor skill learning. Inter-regional functional connectivity metrics, namely, wavelet coherence (WCO) and wavelet phase coherence were derived from HbO changes to correlate brain activity to surgical motor skill levels objectively.Results: One-way multivariate analysis of variance found a statistically significant difference in the inter-regional WCO metrics for physical simulator based on Wilk’s Λ for expert versus novice, , . Partial eta squared effect size for the inter-regional WCO metrics was found to be highest between the central prefrontal cortex (CPFC) and SMA, CPFC-SMA (). Two-tailed Mann–Whitney U tests with a 95% confidence interval showed baseline equivalence and a statistically significant () difference in the CPFC-SMA WPCO metrics for the physical simulator training group () versus the untrained control group () following training for 10 consecutive days in addition to the pretest and posttest days.Conclusion: We show that brain functional connectivity WCO metric corresponds to surgical motor skills in the laparoscopic physical simulators. Functional connectivity between the CPFC and the SMA is lower for subjects that exhibit expert surgical motor skills than untrained subjects in laparoscopic physical simulators.

Effects of situational simulation and online first-aid training programs for nurses in general medical wards: A prospective study

BackgroundTo maintain patient safety, effective first-aid skills are necessary during emergencies. It is important to develop in-service education programs to equip clinical nurses with first-aid skills. ObjectivesThis study explored the effects of first-aid skills and knowledge between situational simulation training and online teaching. It also examined the different effects of two training programs associated with nurses' baseline first-aid ability. DesignThis was a randomized, single-blind controlled study. SettingThe study was conducted from December 15, 2016 to May 28, 2018, in the nursing department of a medical center in Taiwan. ParticipantsParticipants were 92 general ward nurses. MethodsParticipants were randomly assigned to either a situational simulation training or an online teaching group. We used a first-aid knowledge test (FAKT) and a first-aid skills test (FAST) to measure the participants' learning outcomes after intervention and we did cost comparisons between groups. ResultsThere were no significant differences in the changes in FAKT and FAST scores after intervention between situational simulation training and online teaching groups (p = 0.76, p = 0.45). All the participants in both training programs showed improvements via increased scores on FAST (M ± SD = 35.27 ± 12.08 for online teaching, M ± SD = 36.08 ± 10.78 for situational simulation training) and FAKT (M ± SD = 21.09 ± 18.59 for online teaching, M ± SD = 23.39 ± 15.36 for situational simulation training). However, for the subgroup of participants who scored <75% on the FAST pretest, better improvements only occurred in the situational simulation training, but the situational simulation training program had higher costs than the online teaching program. ConclusionsThe improvement was greater in the situational simulation training group among nurses who could not exceed scores of 75% for first-aid skills. First-aid skill scores below 75% are likely a sign of nurses who need more assistance, discussion, and debriefing from situational simulation training.

Effect of vascular simulation training on practice performance in residents: a retrospective cohort study

ObjectiveThis study aims to investigate the teaching effect of vascular simulation training (ST) in rotating vascular residents.DesignRetrospective cohort study.Setting and participantsA total of 95 vascular residents were included from 2015 to 2018 in a university affiliated centre western China, and divided into an ST group and a conventional training (CT) group. The ST group received ST and CT, and the CT group only received CT.Primary outcome measuresTheoretical scores were assessed, and the technique parameters, complications and radiation damage of the procedures were analysed.ResultsThe mean scores (8.74±1.09 vs 8.13±1.31) and the rate of willingness for retraining (93.62% vs 79.17%) in residents were higher in the ST group than in the conventional training (CT) group (p<0.05). The success rate of arterial puncture was significantly higher in the ST group (78.72% vs 58.33%, p=0.03); however, the incidence of complications was similar between the two groups (p>0.05). The time of the puncture procedure was significantly lower (9.56±5.24 vs 12.15±6.87 min), and the comfort score of the patient (5.49±1.72 vs 4.71±1.57) was higher in the ST group than in the CT group (p<0.05). At the end of the assessment, the learning time for angiography (3.65±0.64 vs 4.07±0.77 months) and the complete procedure time (33.81±10.11 vs 41.32±12.56 min) were lower in the ST group than in the CT group (p<0.01). The fluo time for angiography (489.33±237.13 vs 631.47±243.65 s) and the cumulative air kerma (401.30±149.06 vs 461.16±134.14 mGy) were significantly decreased in ST group (p<0.05).ConclusionThe application of a vascular simulation system can significantly improve the clinical performance of residents and reduce the radiation damage from a single intervention procedure in patients.

Effect of a Spay Simulator on Student Competence and Anxiety

Spay simulation has gained attention at colleges of veterinary medicine that seek to utilize low-cost models in lieu of more cost-prohibitive high-fidelity devices or cadaveric specimens. A spay simulator was developed to provide veterinary students at the University of Florida College of Veterinary Medicine a reusable, inexpensive, and error-enabled device for self-practice in anticipation of a live canine ovariohysterectomy. Seventy-four students were recruited, half of whom participated in spay simulation training. A survey was designed to capture students' state and trait anxiety, as well as their self-assessed perceived levels of competence, confidence, and knowledge of anatomy, before and after their live animal surgery. During the live surgical laboratories, surgical competencies were assessed using the Objective Structured Assessment of Technical Skills (OSATS) for operative performance. We hypothesized that the spay simulation training group would have higher reported levels of competence, confidence, and knowledge of anatomy. Additionally, students enrolled in spay simulation training were expected to exhibit a lower level of post-operative anxiety and higher OSATS scores compared with the control group. Results demonstrated a significant increase in perceived anatomical knowledge and improvement in perceived competence level following spay simulation training as compared with the control group. Areas of no difference included perceived confidence, OSATS scores, and overall level of anxiety. The results of this study demonstrate that this low-fidelity spay simulator has a unique place in student surgical training, producing novice surgeons with increased perceived competence and knowledge of anatomy following spay simulation training and live animal surgery.

Contribution of Haptic Simulation to Analogic Training Environment in Restorative Dentistry.

The aim of this study was to evaluate the contribution of virtual reality to the conventional analogic training environment and show the complementarity of conventional techniques and virtual reality in the learning of dental students. All 88 first-year dental students at a dental school in France in early 2019 were randomly assigned to one of two groups: group 1 (n = 45) was assigned to cavity preparations on a haptic simulator (Virteasy) and group 2 (n = 43) was assigned to conventional practical work on plastic analogue teeth (Kavo). Following three training sessions, the students in group 1 took a final exam on the same plastic analogue teeth exercise. The results showed improvement in the drilling skill of both groups. The simulator-trained group (group 1) had similar results to the plastic analogue-trained group (group 2) in the final test on a plastic analogue tooth. In this study, virtual reality allowed an assessment based on objective criteria and reduced the subjectivity of evaluations conducted on plastic analogue teeth. Considering the saving of supervision and teaching time as well as the material gain offered by virtual reality, the learning methods of haptic simulators are educational options that should be considered by dental educators.

The Effect of Triangulation Simulator Training on Arthroscopy Skills: A Prospective Randomized Controlled Trial

PurposeTo prospectively evaluate the transferability of skills acquired on a low-cost, at-home, nonanatomic triangulation simulation system to cadaveric models.MethodsWe randomized 28 medical students into either a simulator-training group (n = 14) or group with no training (control, n = 14). All subjects were pretested using a standardized checklist of arthroscopic skills on cadaveric knees and shoulders. Training-group subjects practiced on the triangulation simulator for 90 minutes per week for 4 consecutive weeks. Control subjects received no training. All subjects completed a post-test checklist of arthroscopic skills on cadaveric knees and shoulders, as well as 4 training tasks on the simulator. A blinded orthopaedic surgeon evaluated the arthroscopic videos using the Arthroscopic Surgical Skill Evaluation Tool (ASSET) score.ResultsTraining-group knee and shoulder ASSET scores increased from 12.2 ± 1.85 to 14.6 ± 2.76 (P = .02) and from 14.6 ± 3.5 to 17.9 ± 4.5 (P = .29), respectively. In the control group, knee and shoulder ASSET scores increased from 14.3 ± 3.12 to 14.25 ± 4.67 (P = .99) and from 14.2 ± 2.7 to 17.07 ± 6.7 (P = .58), respectively. There were no significant differences in the mean post-test ASSET scores between the training group and control group for either knee or shoulder arthroscopy. The post-test ASSET safety subscore during knee arthroscopy was significantly higher in the training group (P = .03). The training group was able to complete significantly more simulator tasks compared with controls (P = .003) at post-testing. A significant positive correlation was found between knee arthroscopy performance and the number of tasks completed during simulation post-testing (P = .043). There was no significant correlation between shoulder arthroscopy performance and simulation performance (P = .532).ConclusionsBasic triangulation skills may be acquired by training on a low-cost, at-home, nonanatomic triangulation simulation system, although the degree of transferability and universal joint applicability, as well as the existence of an early ceiling effect in skill development, could not be shown.Level of EvidenceLevel II, randomized controlled trial.

Evaluation of simulation based learning in the management of cardiovascular emergencies among Moroccan medical students

The importance of medical simulation as a modern teaching tool becomes obvious. Despite, its significant expansion these last years, particularly in specialties like anesthesia, emergency medicine and obstetrics, it's not widely used in specialties like cardiology. The purpose of our study was to assess the effectiveness of simulation-based medical education in the management of cardiovascular emergencies among Moroccan graduate students. Materials Our study was a prospective, observational, multi-centre study including the students of Casablanca, Rabat, and Fes universities from the 5 th to the 7 th year of medicine who underwent 6 phases: First a pre-test, then a theoretical and practical training on cardiovascular emergencies after which the students were separated in two groups, one undergoing the medical simulation training (group 1) and one who didn’t (group 2), followed by a theoretical then a practical post-test. At last, the students were asked to answer a satisfaction survey. The statistical analysis was bivariate with a significant P value < 0.05. A totalf of 57 students were enrolled in the study and divided into 2 groups (Group 1, n = 25 and Group 2, n = 27). Both groups were comparables in terms of year of study, faculty and their previous internships as well as a former participation in medical simulation. The pre-test results were comparable between the two groups (6.05 ± 2.68 for group 1 versus 5.88 ± 2.52 for group 2). However, both theoretical post-test results (18.83 ± 1.27 versus 17.13 ± 2.01 for group 2, P < 0.001) and practical evaluation results (16.15 ± 1.72 versus 10.92 ± 1.35, P < 0.001), were in favor of group 1. This preliminary study showed the significant benefit of simulation-based medical teaching and learning as an innovating teaching tool in the cardiovascular emergencies in the medical students’ basic training and suggests its generalization to the cardiology and intensive care interns’ continuous training.

Evaluation of avirtual reality simulator for learning direct ophthalmoscopy in student teaching

The use of direct ophthalmoscopy in non-ophthalmological specialties seems to be decreasing in the clinical routine. This could be due to alack of training and thus an uncertain assessment. The aim of this study was to evaluate the effectiveness and acceptance of learning direct ophthalmoscopy on asimulator in comparison to the classical teaching method among students. Within the framework of the student block internship for ophthalmology, atotal of 34students took part in the project. The first group received classical training, the second group received simulator training. The learning success was assessed by an objective structured clinical examination (OSCE). The simulator training group showed asignificantly higher points score in individual disciplines. The subjects in the classical group achieved alearning success in the OSCE of 78%. In the simulator-based group ahigher score of 91% was achieved with alower scatter in all subdisciplines. The patient and instructor-independent availability of the teaching materials, areduction of light exposure for patients and test subjects, as well as astandardized and controlled mediation of physiological and pathological findings can be emphasized as advantages of the tested simulator. The simulator-based training for learning direct funduscopy is effective. The virtual reality simulator evaluated in this project can improve the training of students and residents.