Joan W. Mayer

“Harvey,” the cardiology patient simulator: Pilot studies on teaching effectiveness

Abstract The final prototype of “Harvey,” a cardiology patient simulator, was completed in 1976. A review and critique of the simulators nonauscultatory and auscultatory physical findings by cardiologists indicated that the simulator was capable of faithfully reproducing the blood pressure, jugular venous pulsations, carotid and peripheral arterial pulsations, precordial impulses and auscultatory events of almost all cardiac diseases. Pilot studies using the simulator in a formal senior medical student elective program in cardiology showed an average gain in bedside examination skills of 32 percent ( p To assess the acceptability of the device, 770 undergraduate and graduate physicians, family practitioners, internists and cardiologists were exposed to the cardiology patient simulator. Their reaction was positive, 93 percent rating it excellent and 100 percent wishing to be taught with the device again in the future. Prolonged periods of use demonstrated the technical reliability of the simulator. Formal multicenter studies are now underway that will assess its effectiveness as a teaching and testing device. The long range goals of these efforts remain: (1) to produce better trained physicians in less time and at less cost; and (2) to provide an objective method to measure the clinical competency and skills of students and physicians in patient-oriented examinations, such as those for Board certification and recertification.

The electrocardiogram and vectorcardiogram in Wolff-Parkinson-White syndrome associated with bundle branch block

Abstract Five cases of WPW syndrome associated with bundle branch block were presented. In 3 cases the block affected the right and in 2 cases the left branch. Although tracings taken before and after pre-excitation were shown in several cases, they were not considered indispensable to the correct diagnosis, because it could be definitely ascertained by inspection of a single vectorcardiogram and electrocardiogram, provided that the premature ventricular depolarization occurred in the chamber with the intact bundle branch. Both methods of registering the electrical activity of the heart were accurate, although in one case, the changes in the vectorcardiogram were clearer than those in the scalar electrocardiogram.

Cardiology patient simulator and computer-assisted instruction technologies in bedside teaching

Summary. The design and uses of an innovative technology‐based approach which addresses critical problems with bedside teaching during ward rounds in the current health care situation are described. A cardiology patient simulator (HARVEY) and an accompanying computer‐based interactive laserdisk system provide medical students, house officers and other health professionals with the opportunity to encounter a wide variety of clinical problems for learning and assessment. A group of cardiologists and medical educators from a consortium of US medical schools has guided the development and formal assessment of the entire system over the past 10 years. The system and simulator can be configured and programmed to provide appropriate heart sounds, laboratory data, and test results upon request; hands‐on experience to practise examination skills is also available. The system, whole or in part, can be used in a variety of instructional modes from self‐instruction to demonstration teaching, and from self‐assessment to the final clinical examination. The systems effectiveness for teaching medical clerks is summarized, as is its use in providing continuing education for primary care doctors in rural practice.

The spatial vectorcardiogram in peri-infarction block

Abstract The spatial vectorcardiograms of 51 patients with myocardial infarction showing conduction disturbances other than right bundle branch block and left bundle branch block were analyzed. Invariably the initial vectors (due to the dead tissue per se) were in an opposite direction to the terminal slurrings. Consequently, bundle branch blocks could be ruled out with a high degree of certainty because the delays seen in these cases are of fixed location, not dependent on the site of infarction. In other words, left bundle branch block is characterized by a predominantly medial slowing with a loop placed in the left posterior quadrant, and right bundle branch block by a terminal delay (with occasional preterminal slurring), located in the right, and mainly anterior, quadrant. Even though the exact mechanisms responsible for peri-infarction block are not known, it is proposed, to avoid confusion, that this term be limited to the late vectorial abnormalities sometimes present after myocardial infarction. The initial QRS slurrings should be referred to as simply “early changes characteristic of infarction,” and included as part of Q wave changes, in spite of the fact that both disturbances in conduction might have a common genesis. A vectorcardiographic criterion for peri-infarction block was introduced taking into consideration the facts expressed above. With the use of oscilloscopic recordings, terminal slowings and slurrings were carefully studied and were estimated to be more important than total QRS duration. It is stressed that an unbiased comparison between electrocardiograms and vectorcardiograms cannot be made in the conduction abnormality considered as peri-infarction block unless the scalar recordings are obtained with a high fidelity machine.