Leif Hedman

Target-focused medical emergency team training using a human patient simulator: effects on behaviour and attitude

Context  Full‐scale simulation training is an accepted learning method for gaining behavioural skills in team‐centred domains such as aviation, the nuclear power industry and, recently, medicine. In this study we evaluated the effects of a simulator team training method based on targets and known principles in cognitive psychology.

Visuospatial skills and computer game experience influence the performance of virtual endoscopy

Advanced medical simulators have been introduced to facilitate surgical and endoscopic training and thereby improve patient safety. Residents trained in the Procedicus Minimally Invasive Surgical Trainer-Virtual Reality (MIST-VR) laparoscopic simulator perform laparoscopic cholecystectomy safer and faster than a control group. Little has been reported regarding whether factors like gender, computer experience, and visuospatial tests can predict the performance with a medical simulator. Our aim was to investigate whether such factors influence the performance of simulated gastroscopy. Seventeen medical students were asked about computer gaming experiences. Before virtual endoscopy, they performed the visuospatial test PicCOr, which discriminates the ability of the tested person to create a three-dimensional image from a two-dimensional presentation. Each student performed one gastroscopy (level 1, case 1) in the GI Mentor II, Simbionix, and several variables related to performance were registered. Percentage of time spent with a clear view in the endoscope correlated well with the performance on the PicSOr test (r = 0.56, P < 0.001). Efficiency of screening also correlated with PicSOr (r = 0.23, P < 0.05). In students with computer gaming experience, the efficiency of screening increased (33.6% +- 3.1% versus 22.6% +- 2.8%, P < 0.05) and the duration of the examination decreased by 1.5 minutes (P < 0.05). A similar trend was seen in men compared with women. The visuospatial test PicSOr predicts the results with the endoscopic simulator GI Mentor II. Two-dimensional image experience, as in computer games, also seems to affect the outcome.

Exploring virtual worlds for scenario-based repeated team training of cardiopulmonary resuscitation in medical students.

Background Contemporary learning technologies, such as massively multiplayer virtual worlds (MMVW), create new means for teaching and training. However, knowledge about the effectiveness of such training is incomplete, and there are no data regarding how students experience it. Cardiopulmonary resuscitation (CPR) is a field within medicine in high demand for new and effective training modalities. Objective In addition to finding a feasible way to implement CPR training, our aim was to investigate how a serious game setting in a virtual world using avatars would influence medical students’ subjective experiences as well as their retention of knowledge. Methods An MMVW was refined and used in a study to train 12 medical students in CPR in 3-person teams in a repeated fashion 6 months apart. An exit questionnaire solicited reflections over their experiences. As the subjects trained in 4 CPR scenarios, measurements of self-efficacy, concentration, and mental strain were made in addition to measuring knowledge. Engagement modes and coping strategies were also studied. Parametric and nonparametric statistical analyses were carried out according to distribution of the data. Results The majority of the subjects reported that they had enjoyed the training, had found it to be suitable, and had learned something new, although several asked for more difficult and complex scenarios as well as a richer virtual environment. The mean values for knowledge dropped during the 6 months from 8.0/10 to 6.25/10 (P = .002). Self-efficacy increased from before to after each of the two training sessions, from 5.9/7 to 6.5/7 (P = .01) after the first and from 6.0/7 to 6.7/7 (P = .03) after the second. The mean perceived concentration value increased from 54.2/100 to 66.6/100 (P = .006), and in general the mental strain was found to be low to moderate (mean = 2.6/10). Conclusions Using scenario-based virtual world team training with avatars to train medical students in multi-person CPR was feasible and showed promising results. Although we found no evidence of stimulated recall of CPR procedures in our test-retest study, the subjects were enthusiastic and reported increased concentration during the training. We also found that subjects’ self-efficacy had increased after the training. Despite the need for further studies, these findings imply several possible uses of MMVW technology for future emergency medical training.

High-level visual-spatial ability for novices correlates with performance in a visual-spatial complex surgical simulator task

BackgroundThis study addresses how high-level visual-spatial ability of surgical novices is related to performance of two simulator tasks with (KSA) and without (MIST) anatomic graphics and haptic feedback, differing in visual-spatial complexity.MethodsVisual-spatial test scores assessed by Mental Rotation Test (MRT) and BasIQ and performance scores for Instrument Navigation (IN) in Key Surgical Activities (Procedicus KSA) and Manipulate and Diathermy (MD) in Minimally Invasive Surgical Trainer (Procedicus MIST) were correlated for 54 Swedish surgical novices.ResultsSignificant Pearson’s r correlations were obtained between visual-spatial scores measured by MRT-C and total score from the last trial for IN (r = 0.278, p < 0.05). Visual-spatial scores (measured by BasIQ) also correlated with total score from the first trial (r = 0.443, p < 0.05) and from the last trial (r = 0.489, p < 0.05).ConclusionHigh-level visual-spatial ability is important for surgical novices to possess in the early training phase of a visual-spatial complex task in KSA.

Using information technology: Engagement modes, flow experience, and personality orientations.

The engagement mode (EM) model describes how an IT user (subject) engages in an activity with an object in a certain mode. The model specifies five engagement modes (Enjoying/Acceptance, Ambition/C ...

Early use of Internet-based educational resources: effects on students' engagement modes and flow experience

This case study explores how educational training and clinical practice that uses personal computers (PCs) and Personal Digital Assistants (PDAs) to access Internet-based medical information, affects the engagement modes of students, flow experience components, and IT-competence. A questionnaire assessing these variables was administered before and after a training course. A follow-up interview investigated the contextual factors related to the use of PDAs. There were significant increases in IT-competence and in the positive and negative modes of engagement except for the Ambition/Curiosity mode. The overall flow experience did not change significantly over time. The PDA users showed an increase in negative modes across time larger than PC users due to technical, emotional, and motivational factors. This study concludes that a students interaction with PCs and, in particular, PDAs produces positive and negative engagement modes and flow experiences that can be better understood by using the Engagement Modes model (EM-model).

Training in tasks with different visual-spatial components does not improve virtual arthroscopy performance

Background: We earlier showed that training in the Procedicus KSA Simulator improves the performance of tasks done later in the same simulator. However, it is still unclear how performance in a specific visual-spatial simulator context may change after training in other simulators with different visual-spatial components. In particular, the aim of this study was to test whether performance in the Procedicus Virtual Arthroscopy (VA) Knee Simulator would remain unchanged after a training session in three other simulators with different visual-spatial components. Methods: Twenty-eight medical students participated in a quasi-transfer study. They were randomly allocated to an experimental group (n = 14) and a control group (n = 14). Results: Performance in the Procedicus VA Knee Simulator did not improve after training in other simulators with different visual-spatial components (t-test p = NS). No significant correlation was found between the Procedicus VA Knee and the Minimally Invasive Surgical Trainer (MIST) simulators. Conclusion: One hour of training in different visual-spatial contexts was not enough to improve the performance in virtual arthroscopy tasks. It cannot be excluded, however, that experienced trainees could improve their performance, because perceived similarity between different situations is influenced by many psychological factors, such as the knowledge or expertise of the person performing the transfer task.

Systematic simulation-based team training in a Swedish intensive care unit: a diverse response among critical care professions

Background Teamwork—that is, collaboration and communication—is an important factor for safe healthcare, but professions perceive the quality of teamwork differently. Objective To examine the relationship between simulation-based team training (SBTT) and different professions’ self-efficacy, experienced quality of collaboration and communication, perceptions of teamwork and safety, together with staff turnover. Methods All staff (n=151; physicians, nurses and nurse assistants) in an intensive care unit (ICU) at a university hospital were systematically trained over 2 years. Data on individual self-efficacy were measured using the self-efficacy questionnaire; the experienced quality of collaboration and communication, teamwork climate, safety climate and perception of working conditions were sampled using the ICU version of the safety attitudes questionnaire (SAQ). Staff turnover and sick leave was measured using the hospitals staff administration system for the intervention ICU and a control ICU in the same hospital. Results The perception of safety differed between professions before training. Nurses’ and physicians’ mean self-efficacy scores improved, and nurse assistants’ perceived quality of collaboration and communication with physician specialists improved after training. Nurse assistants’ perception of the SAQ factors teamwork climate, safety climate and working conditions were more positive after the project as well as nurses’ perception of safety climate. The number of nurses quitting their job and nurse assistants’ time on sick leave was reduced in comparison to the control ICU during the study period. Limitations Results for SAQ factors must be interpreted with caution given that Cronbachs α and inter-correlations for the SAQ factors showed lower values than benchmarking data. Conclusions All team members benefited from the SBTT in an authentic composed team, but this was expressed differently for the respective professions.

Effects of pre-training using serious game technology on CPR performance – an exploratory quasi-experimental transfer study

BackgroundMultiplayer virtual world (MVW) technology creates opportunities to practice medical procedures and team interactions using serious game software. This study aims to explore medical students’ retention of knowledge and skills as well as their proficiency gain after pre-training using a MVW with avatars for cardio-pulmonary resuscitation (CPR) team training.MethodsThree groups of pre-clinical medical students, n = 30, were assessed and further trained using a high fidelity full-scale medical simulator: Two groups were pre-trained 6 and 18 months before assessment. A reference control group consisting of matched peers had no MVW pre-training. The groups consisted of 8, 12 and 10 subjects, respectively. The session started and ended with assessment scenarios, with 3 training scenarios in between. All scenarios were video-recorded for analysis of CPR performance.ResultsThe 6 months group displayed greater CPR-related knowledge than the control group, 93 (±11)% compared to 65 (±28)% (p < 0.05), the 18 months group scored in between (73 (±23)%).At start the pre-trained groups adhered better to guidelines than the control group; mean violations 0.2 (±0.5), 1.5 (±1.0) and 4.5 (±1.0) for the 6 months, 18 months and control group respectively. Likewise, in the 6 months group no chest compression cycles were delivered at incorrect frequencies whereas 54 (±44)% in the control group (p < 0.05) and 44 (±49)% in 18 months group where incorrectly paced; differences that disappeared during training.ConclusionsThis study supports the beneficial effects of MVW-CPR team training with avatars as a method for pre-training, or repetitive training, on CPR-skills among medical students.

Short-Term Changes in Eyestrain of VDU Users as a Function of Age:

Operators at a Swedish Telecom Directory Enquiry Centre participated in tests of eyestrain including measures of accommodation and convergence near points, focusing accuracy, and dark focus. The optometric measurements were conducted before and after work at a visual display unit (VDU) and in two control conditions, with or without job rotation. Visual focus of accommodation was measured with a modified version of the field laser optometer method. The results showed no differential eyestrain effects, either in near points of accommodation and convergence or in focusing accuracy, between the three tasks. A small, age-dependent difference in dark focus was apparent after work in the job-rotation phase. It is concluded that the VDU work was not in itself conducive to eyestrain, and that, under the job conditions obtained in the present investigation, changes in the variables studied must be primarily attributed to other factors, such as age and workload on the day of testing.