Simulator-based Education Research Articles

Factors impacting curricula in maritime simulator-based education

AbstractThe International Convention on Standards of Training, Certification, and Watchkeeping for Seafarers (STCW) provides a foundational framework for maritime education and training (MET). However, variations in its interpretation across different nations and institutions lead to diverse teaching practices and strategies. This diversity stems from differences in national regulations, resources, cultures, and the perspectives of institutions and instructors. This study introduces a concept map to scaffold the key concepts influencing maritime simulator-based education. By examining both the education system and student factors, the concept map offers insights into these various factors through observations from simulator-based teaching sessions and discussions with maritime educators and students. This tool can help identify differences and highlight good practices. It is a valuable resource for stakeholders, promoting a novel approach to developing an effective, comprehensive, coherent maritime simulator-based education.

Formative assessment in maritime simulator-based higher education

Assessment in maritime simulator-based education has traditionally been informal and subjective based on instructor experience. Recent research suggests that a more objective and formal approach could be beneficial. Formative assessment has attracted significant attention from higher education institutions. Thus, this study aimed to examine the current practice of formative assessment in maritime simulator-based education, with a special emphasis on simulator instructors’ teaching methods. A qualitative approach with observations and interviews was used in the study since it could provide deep insights into educators’ motivations and understandings of how to meet the educational needs of their students. The findings inform the formative assessment strategies may explicitly enhance maritime education.

Benefits and pitfalls of learning anatomy using the dissection module in an indian medical school: A millennial Learner's perspective

BackgroundFor generations, the use of cadavers has been the chief pillar for learning anatomy. However, the limited availability of cadavers and the advent of modern technologies in learning have led to the use of substitutes such as prosection, anatomical models, and audio-visual (AV) aids. The current study was therefore undertaken to seek students' opinions regarding the usefulness of the traditional dissection module in the modern era of teaching-learning. MethodologyThe questionnaire-based study involved 145 medical undergraduate students exposed to dissection in anatomy during their first year (2018–19). Three themes were identified based on the students’ responses. They were advantages of learning anatomy by dissection, disadvantages of learning anatomy by dissection, and dissection classes versus other educational resources used in learning anatomy. The students' opinions related to the themes were considered. ResultsThe majority of the students stated that the act of dissection deepens one's understanding (91.8%) and provides a three-dimensional perspective of structures (92.4%). A group of students felt that the dissection is time-consuming (57%) and prosection (64.6%) helped them gain information quicker. However, when asked whether dissection should be eliminated from the curriculum, the majority (86%) of the students disagreed. However, the students agreed that dissection should be supported by educational tools (74%). ConclusionThe study strengthens the belief of using dissection for better anatomy learning and adds that dissection hall teaching is the best approach for anatomy teaching-learning. Millennial learners prefer the act of dissection to learn practical anatomy and consider the recent advances such as simulator-based education, video demonstrations, virtual and augmented reality only as supplements.

Analysis of the Effect of Electronic Chart Display and Information System Simulation Technologies in Maritime Education

AbstractAn accident that may occur during maritime transport has substantially tangible, intangible, and environmental consequences. Approximately 85% of accidents at sea depend on human and communication factors. Therefore, it is expected to prevent adverse events in advance and to determine the procedures to be followed with simulator trainings before navigation at sea. National and international agreements set a standard for seafarers' education programs. The use of the simulator is recommended according to the Standards of Training, Certification and Watchkeeping for Seafarers (STCW) for maritime training, which is in accordance with international standards. These training programs should be designed to improve seafarers' ability in order to make accurate decisions, think quickly, and find solutions. Developments in the field of technology have enabled a wide range of simulation applications in electronic devices. The studies have shown that the professional knowledge of students has been increased with simulator-based education in many professions. This article presents a comparison that was made between simulation training and theoretical education. Two hundred surveys were conducted for 100 maritime students who received Electronic Chart Display and Information System (ECDIS) simulation training. It is aimed to measure the effect of ECDIS computer simulators on educational efficiency and suggest the use of simulators for the training of maritime students.

Adapting a Haptic Motor-Skill Simulator to Include 3D Histology and Supporting Information Architecture (IA)

In response to an ever-increasing demand for more efficient medical and dental training, simulator-based education has seen a marked increase in development and adoption. But technological advances do not necessarily add up to better learning outcomes. This pursuit has even generated criticism that the means often lose sight of the end. We are presented with an increasingly relevant challenge to adapt simulator technology in alignment with systems advancements and research in adult learning.To address this question, an existing haptic-based, periodontal-probing simulator was revised with expanded learning goals in mind. The former technology was used, but furnished with new 3D models and a multimodal approach to the curriculum intended to foster contextual learning.The 3D model was detailed with clinically-relevant histology intended to build a holistic conceptual understanding of the oral tissue and disease etiology of gingivitis and periodontitis in context with the procedure. Yet providing visual detail without direction is inadequate for ensuring learning objectives are met. Furthermore, simplified models are needed in a haptic system to maintain uninterrupted simulator performance; this means a loss of visual detail and material realism. To meet these challenges, the information architecture (IA) was designed to include tiered activities including dynamic exploration with a high-fidelity model, performance evaluation for self-assessment, and knowledge check for learning reinforcement.The 3D models and proposed methodology in this research are intended to exhibit how, with proper integration, these attributes can convert a single-objective, motor skill exercise into a complete learning experience.

Generating real-time objects for a bridge ship-handling simulator based on automatic identification system data

Most accidents at sea are caused due to decision errors made by crew members. Hence, nautical education plays an important role. A common approach for training crew members is the usage of ship handling simulators. Our paper aims at increasing the closeness to real-world scenarios of simulator-based education for nautical personnel by integrating real objects into the simulation process. This integration aims at improving the learning experience leading to higher safety on sea. Since the introduction of the Automatic Identification System (AIS), which has to be installed on professional operating vessels, vessel movements can be tracked. Thus, we are using AIS data for the data integration process. Within this context several practical problems are addressed which arise in the design of a software architecture which uses live AIS data. This includes the availability of specific AIS data attributes, the AIS reporting intervals, and the mapping of AIS data to the Distributed Interactive Simulation (DIS) interface. Presented results have been successfully implemented in a software architecture which integrates a live AIS data stream into the simulation process of a full mission bridge simulator.

Simulators in bridge operations training and assessment: a systematic review and qualitative synthesis

This article presents a systematic review and qualitative synthesis of the use of simulators in maritime education and training (MET), with a focus on bridge operations during navigation training and assessment. The review found 34 articles published in a wide range of academic journals, displaying a global field of research consisting of three main disciplines: Maritime professionals (n = 15), Human factors (n = 13) and Education (n = 6). An important conclusion made after synthesising the results of the studies is that while the potential of using simulators in training and assessment are clear, little is known about which instructional practices would ensure valid and reliable results of simulator-based education. Since MET institutions train their students for one of the most safety-critical industries in the world, there is a need for empirical studies that explore the use of simulator-based training and assessment further to lay the foundation for an evidence-based educational practice.

Combined EUS and EBUS are complementary methods in lung cancer staging: Do not forget the esophagus.

Endoscopic ultrasound (endobronchial ultrasound-guided transbronchial needle aspiration [EBUS-TBNA] and transesophageal ultrasoundguided fine needle aspiration [EUS-FNA]) can be performed in an outpatient setting under local anesthesia with mild sedation. The procedures are well established for diagnosis and staging of a variety of diseases, such as lung cancer [1–3]. Accurate staging of non-small cell lung cancer (NSCLC) is crucial for allocation to surgical treatment. By using endoscopic ultrasound, surgical staging procedures can be avoided in a considerable proportion of patients with NSCLC. In short, EUS is excellent for the left and lower paraesophageal structures plus structures under the diaphragm, whereas EBUS provides access to structures close to the large airways on both sides. Thus the two procedures are complementary (● Fig.1) [4]. Currently no single endoscope offers the benefits of both endobronchial and transbronchial access. Compared to EBUS, EUS has many advantages. EUS is better tolerated (no cough), the ultrasonic window angle is larger (150–180 versus 50–60 degrees with EBUS), the ultrasonic image is better due to higher resolution, it allows better visualization of small structures, the operator can orientate independent of an endoscopic view with secretions, and the transducer is in close contact with the target, owing to endoscopic suction with deflation of the esophageal lumen. With EUS, there are also no hard cartilage rings interposed between the needle and the target and needle maneuverability is better with improved targeting due to an “elevator.”All of these benefits are outweighed by a single disadvantage: the psychological barrier to use of EUS that exists among many—but not all—thoracic physicians. The way to overcome this barrier is to let a thoracic physician perform EUS with the smallest EBUS endoscope, that is, to perform a so-called EUS-B procedure [5, 6] even if the equipment is not designed for the purpose and therefore, in many respects, inferior compared to EUS-FNA. In their current paper, Meena and Bartter performed a retrospective comparison of EUS-B and EBUS in a total of 155 procedures and found that EUS-B was faster, patients needed less sedation and oxygen, and the time to discharge was shorter, whereas the diagnostic yield was the same. The authors conclude that EUS is the procedure of choice when applicable, meaning that, for example, EUS-B should be preferable to EBUS in a patient with a suspicious lymph node station 7 or 4L. It must be remembered, however, that in the majority of cases, choosing one method over the other is not the issue because EBUS and EUS are complementary and can be performed in a single session [4]. It should be mentioned that, for obvious reasons, several of the advantages of EUS listed above are not achievable with EUS–B. One example is superior ultrasonic visualization. It must also be noted, that in the current study, regions under the diaphragm relevant for staging of NSCLC (● Fig.1) could not be reached with the relatively short EUS–B technique, meaning that EUS does not get its full credit as a comparator in the study. Further, patient preference also have been explored by asking whether an individual preferred a foreign body in the airway or in the esophagus, although the answer seems predetermined. If thoracic physicians are not to be left behind in terms of advancements in endoscopic ultrasound, it is mandatory that necessary education and training be established for EUS as well as EBUS, including theoretical courses, simulator-based education, and clinical training plus valid assessment of all three elements [7–10]. But do not forget the esophagus!

Simulation-based Assessment and Retraining for the Anesthesiologist Seeking Reentry to Clinical Practice

Established models for assessment and maintenance of competency in anesthesiology may not be adequate for anesthesiologists wishing to reenter practice. The authors describe a program developed in their institution incorporating simulator-based education, to help determine competency in licensed and previously licensed anesthesiologists before return to practice. The authors have used simulation for assessment and retraining at their institution since 2002. Physicians evaluated by the authors' center undergo an adaptable 2-day simulation-based assessment conducted by two board-certified anesthesiologists. A minimum of three cases are presented on each day, with specific core competencies assessed, and participants complete a standard Clinical Anesthesia Year 3 level anesthesia knowledge test. Participants are debriefed extensively and retraining regimens are designed, where indicated, consisting of a combination of simulation and operating-room observership. Twenty anesthesiologists were referred to the authors' institution between 2002 and 2012. Fourteen participants (70%) were in active clinical practice 1 yr after participation in the authors' program, five (25%) were in supervised positions, and nine (45%) had resumed independent clinical practice. The reasons of participants not in practice were personal (1 participant) and medico-legal (3 participants); two participants were lost to follow-up. Two of 14 physicians, who were formally assessed in the authors' program, were deemed likely unfit for safe return to practice, irrespective of further training. These physicians were unavailable for contact 1 yr after assessment. Anesthesiologists seeking to return to active clinical status are a heterogeneous group. The simulated environment provides an effective means by which to assess baseline competency and also a way to retrain physicians.

Risk Presentation Aimed at Improving Older Drivers' Understanding of Their Problems via Simulator-Based Education Programs

This study examined simulator-based methods of illustrating risks to elderly drivers in order to improve their ability to anticipate hazards. Experiments were performed using hypothesized driving p...

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) on the use of endoscopy simulators for training and assessing skill

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) on the use of endoscopy simulators for training and assessing skill

In-simulator training of driving abilities in a person with a traumatic brain injury

Aim: This study reports the case of a 23-year-old woman (MC) who sustained a severe traumatic brain injury in 2004. After her accident, her driving license was revoked. Despite recovering normal neuropsychological functions in the following years, MC was unable to renew her license, failing four on-road evaluations assessing her fitness to drive.Method: In hope of an eventual license renewal, MC went through an in-simulator training programme in the laboratory in 2009. The training programme aimed at improving features of MC's driving behaviour that were identified as being problematic in prior on-road evaluations. To do so, proper driving behaviour was reinforced via driving-specific feedback provided during the training sessions.Results: After 25 sessions in the simulator (over a period of 4 months), MC significantly improved various components of her driving. Notably, compared to early sessions, later ones were associated with a reduced cognitive load, less jerky speed profiles when stopping at intersections and better vehicle control and positioning. A 1-year retention test showed most of these improvements were consistent.Conclusions: The learning principles underlying well conducted simulator-based education programmes have a strong scientific basis. A simulator training programme like this one represents a promising avenue for driving rehabilitation. It allows individuals without a driving license to practice and improve their skills in a safe and realistic environment.

A systematic review of training that use an integrated patient simulator.

The purpose of this article is to systematically review the literature that describes training and assessment that use an integrated patient simulator (IPS). We also tried to determine how to train learners with simulators, plan, and perform research on simulator-based education. Literature searches were conducted to identify articles from PubMed, EMBASE, and KMbase that were related to training and assessment that use an IPS, published from January 1999 to September 2008. Forty articles met the criteria and were analyzed. The results were as follows: Studies on IPS are the most common in graduate medical education (GME). The impact of IPS-based education is relatively greater in GME versus undergraduate medical education (UME) or continuing medical education (CME). IPS research in GME is characterized by addressing the effectiveness of clinical application, the training of procedures, and algorithms, rather than knowledge or simple skills. And research design is more elaborate in GME than UME or CME. IPS training in CME focuses mostly on specific clinical skills. Most training sessions in UME are offered to groups, but assessment is performed for a single student. Also, inter-rater reliability is checked unsatisfactorily in UME. IPS research in UME is characterized by limitations in design due to connections to the regular curriculum. According to findings above, we propose that: more detailed research design should be performed to overcome the limitations of UME research. For GME, increasing simulator-based training opportunities is desired, because its effectiveness and adaptability are relatively high.

The use of multimodality simulation in the evaluation of physicians with suspected lapsed competence

A simulator-based educational program has been incorporated into many anesthesia residency training programs. The effectiveness of this method of teaching has been validated by several studies and is generally accepted as an effective method of resident education. Evaluation of performance and positive critical feedback through debriefing has been attributed to the effectiveness of simulator-based education. Perhaps, this process can be used to evaluate the competence of practicing physicians. We report our experience using multimodality simulator technology to assess physicians who may have allowed their competence to lapse. We discuss our simulator-based assessment process and the strengths and limitations of our program. We also discuss the legal ramifications of participating in such assessments. Because of confidentiality agreements signed by all parties involved with this process, cases are discussed in general terms to assure anonymity.

Role of simulators, educational programs, and nontechnical skills in anesthesia resident selection, education, and competency assessment

Theoretical knowledge for anesthesia residents requires learning from a variety of sources. Technical skills are important and simulators are being used in many centers. Anesthesia nontechnical skills, those are, cognitive, interpersonal, and decision making, may not be uniformly acquired during clinical training and may need to be specifically taught and evaluated. Clinical competency committees usually evaluate the performance of every resident on a 6-month basis; however, a more objective test should be used. Training is evolving and higher standards in this field should create safer anesthesiologists. Simulator-based education and testing and assessment of nontechnical skills should be a priority in anesthesia residency programs.

Unique Medical Education Programs at Nippon Medical School

In an attempt to improve the content of the educational programs offered by Nippon Medical School and to better prepare our students to work in the rapidly changing world of medicine, the school has recently revamped its teaching methodology. Particular emphasis has been placed on 1) simulator-based education involving the evaluation of students and residents in a new clinical simulation laboratory; 2) improving communication skills with the extensive help of simulated patients; 3) improving medical English education; 4) providing early clinical exposure with a one-week clinical nursing program for the first year students to increase student motivation at an early stage in their studies; 5) a new program called Novel Medical Science, which aims to introduce first-year students to the schools fundamental educational philosophy and thereby increase their motivation to become ideal physicians. The programs have been designed in line with 2006 guidelines issued by the Ministry of Education, Culture, Sports, Science and Technology to allow flexibility for students to take part in education outside their own departments and year groups as part of the Ministry's program to encourage distinctive education at Japanese universities.

Absolute and Relative Value of Patient Simulator Features as Perceived by Medical Undergraduates

Patient simulators incorporate a range of technical features. An understanding of which features are most valuable and which may be less so is important for simulator design and utilization. In this study, we attempted to answer the question of whether or not certain simulator features are perceived by learners as more useful than others in achieving specified educational objectives. The subjects were third and fourth year medical students participating in an Emergency Medicine Simulation Workshop (n = 97). Following the Workshop, subjects rated each of 13 simulator features on a 5-point scale from distracting to extremely useful in achieving specified educational objectives; and then identified the most and least useful features. There were significant differences between the scores of the most highly rated features (vital sign display, interactive voice, chest rise, and palpable pulse), and those of the features with the lowest ratings (abnormal breath sounds, prerecorded voice, IV arm, and heart tones) (4.75 vs. 3.93, P < 0.0001). Three features (heart tones, abnormal breath sounds, and prerecorded voice) were rated by more than one third of the students as distracting, not useful, or uncertain if useful. On the ranking scale, highly rated features tended to be identified as most useful, and those with the lowest ratings were more often ranked as least useful. There was a statistically significant (P < 0.0001) correlation between rating and rankings. There are significant differences in the perceived usefulness of patient simulator features. This has implications both for simulator design and for simulator-based education.

Percutaneous Renal Access Simulators

Percutaneous renal access is an integral step in percutaneous renal drainage and percutaneous nephrolithotomy. Urologists are increasingly obtaining access themselves, as this eliminates reliance on a second "surgeon" and increases flexibility with respect to procedure timing and the location of the access tract. Surprisingly few models have been developed to train urologists in percutaneous renal access. Harvested porcine kidney/ureter units mounted so they can be viewed radiographically and accessed by needle puncture through material simulating the human flank have been incorporated into two models. The PERC Mentor (Simbionix; Lod, Israel) is a virtual-reality simulator developed specifically for training in percutaneous renal puncture. Hands-on intraoperative training continues to be the primary method for learning percutaneous renal access. However, bench model and simulator-based education offer a useful adjunct.