Parvati Dev

Evaluation of an internet support group for women with primary breast cancer

Women with breast carcinoma commonly experience psychologic distress following their diagnosis. Women who participate in breast cancer support groups have reported significant reduction in their psychologic distress and pain and improvement in the quality of their lives. Web‐based breast cancer social support groups are widely used, but little is known of their effectiveness. Preliminary evidence suggests that women benefit from their participation in web‐based support groups.

Simulation for Team Training and Assessment: Case Studies of Online Training with Virtual Worlds

Individuals in clinical training programs concerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and frequently repetitive. The widely substituted alternative for real patients—high-fidelity, manikin-based simulators (human patient simulator)—are expensive and require trainees to be in the same place at the same time, whereas online computer-based simulations, or virtual worlds, allow simultaneous participation from different locations. Here we present three virtual world studies for team training and assessment in acute-care medicine: (1) training emergency department (ED) teams to manage individual trauma cases; (2) prehospital and in-hospital disaster preparedness training; (3) training ED and hospital staff to manage mass casualties after chemical, biological, radiological, nuclear, or explosive incidents. The research team created realistic virtual victims of trauma (6 cases), nerve toxin exposure (10 cases), and blast trauma (10 cases); the latter two groups were supported by rules-based, pathophysiologic models of asphyxia and hypovolemia. Evaluation of these virtual world simulation exercises shows that trainees find them to be adequately realistic to “suspend disbelief,” and they quickly learn to use Internet voice communication and user interface to navigate their online character/avatar to work effectively in a critical care team. Our findings demonstrate that these virtual ED environments fulfill their promise of providing repeated practice opportunities in dispersed locations with uncommon, life-threatening trauma cases in a safe, reproducible, flexible setting.

Design, Development, and Evaluation of an Online Virtual Emergency Department for Training Trauma Teams

Background: Training interdisciplinary trauma teams to work effectively together using simulation technology has led to a reduction in medical errors in emergency department, operating room, and delivery room contexts. High-fidelity patient simulators (PSs)—the predominant method for training healthcare teams—are expensive to develop and implement and require that trainees be present in the same place at the same time. In contrast, online computer-based simulators are more cost effective and allow simultaneous participation by students in different locations and time zones. In this pilot study, the researchers created an online virtual emergency department (Virtual ED) for team training in crisis management, and compared the effectiveness of the Virtual ED with the PS. We hypothesized that there would be no difference in learning outcomes for graduating medical students trained with each method. Methods: In this pilot study, we used a pretest-posttest control group, experimental design in which 30 subjects were randomly assigned to either the Virtual ED or the PS system. In the Virtual ED each subject logged into the online environment and took the role of a team member. Four-person teams worked together in the Virtual ED, communicating in real time with live voice over Internet protocol, to manage computer-controlled patients who exhibited signs and symptoms of physical trauma. Each subject had the opportunity to be the team leader. The subjects’ leadership behavior as demonstrated in both a pretest case and a posttest case was assessed by 3 raters, using a behaviorally anchored scale. In the PS environment, 4-person teams followed the same research protocol, using the same clinical scenarios in a Simulation Center. Guided by the Emergency Medicine Crisis Resource Management curriculum, both the Virtual ED and the PS groups applied the basic principles of team leadership and trauma management (Advanced Trauma Life Support) to manage 6 trauma cases—a pretest case, 4 training cases, and a posttest case. The subjects in each group were assessed individually with the same simulation method that they used for the training cases. Results: Subjects who used either the Virtual ED or the PS showed significant improvement in performance between pretest and posttest cases (P < 0.05). In addition, there was no significant difference in subjects’ performance between the 2 types of simulation, suggesting that the online Virtual ED may be as effective for learning team skills as the PS, the method widely used in Simulation Centers. Data on usability and attitudes toward both simulation methods as learning tools were equally positive. Discussion: This study shows the potential value of using virtual learning environments for developing medical students’ and resident physicians’ team leadership and crisis management skills.

Audience Response Made Easy: Using Personal Digital Assistants as a Classroom Polling Tool

Both teachers and students benefit from an interactive classroom. The teacher receives valuable input about effectiveness, student interest, and comprehension, whereas student participation, active learning, and enjoyment of the class are enhanced. Cost and deployment have limited the use of existing audience response systems, allowing anonymous linking of teachers and students in the classroom. These limitations can be circumvented, however, by use of personal digital assistants (PDAs), which are cheaper and widely used by students. In this study, the authors equipped a summer histology class of 12 students with PDAs and wireless Bluetooth cards to allow access to a central server. Teachers displayed questions in multiple-choice format as a Web page on the server and students responded with their PDAs, a process referred to as polling. Responses were immediately compiled, analyzed, and displayed. End-of-class survey results indicated that students were enthusiastic about the polling tool. The surveys also provided technical feedback that will be valuable in streamlining future trials.

Simulated Medical Learning Environments on the Internet

Learning anatomy and surgical procedures requires both a conceptual understanding of three-dimensional anatomy and a hands-on manipulation of tools and tissue. Such virtual resources are not available widely, are expensive, and may be culturally disallowed. Simulation technology, using high-performance computers and graphics, permits realistic real-time display of anatomy. Haptics technology supports the ability to probe and feel this virtual anatomy through the use of virtual tools. The Internet permits world-wide access to resources. We have brought together high-performance servers and high-bandwidth communication using the Next Generation Internet and complex bimanual haptics to simulate a tool-based learning environment for wide use. This article presents the technologic basis of this environment and some evaluation of its use in the gross anatomy course at Stanford University.

Three-dimensional imaging of bone from computerized tomography

An automatic computer technique was designed to produce three-dimensional (3D) images of bony anatomy on a cathode ray tube (CRT) from computerized tomography (CT) data. The authors transferred CT scan data of a cadaver and 11 patients to a computer system via magnetic tape. An automatic edge extraction algorithm generated an outline of bone specified by a range of CT numbers for each scan slice. These outlines were stacked in the computer and various graphics options used to represent the 3D anatomy of bone on a high-resolution CRT screen. The 3D image data were interfaced with a three-axis computer numerically controlled milling device to produce solid models of these bone images. Comparison of the dimensions of the solid models of the femur, hemipelvis, and femoral medullary canal to the actual cadaver specimen demonstrated that the models were accurate in size to within 1-3 mm. These 3D images and solid models will be helpful for preoperative diagnosis, surgical planning, and customized prosthesis manufacture in complex orthopaedic cases.

Interactive Simulated Patient: Experiences with Collaborative E-Learning in Medicine.

Interactive Simulated Patient (ISP) is a computer-based simulation tool designed to provide medical students with the opportunity to practice their clinical problem solving skills. The ISP system allows students to perform most clinical decision-making procedures in a simulated environment, including history taking in natural language, many hundreds of laboratory tests (e.g., images and endoscopy), and physical examination procedures. The system has been evaluated in a number of courses at three universities, Karolinska Institutet and Uppsala University in Sweden, and Stanford University in the United States. This article describes a study conducted in 2002, with an emphasis on results that pertain to collaboration between students. Results indicate that ISP is engaging and stimulates more active student involvement than traditional paper-based case presentation methods and that students seem to collaborate more easily when using ISP compared to traditional paper-based methods.

Imaging and visualization in medical education

Almost every imaging modality and type of visualization finds a place in the teaching of medicine. These include photographs of patients, dissected anatomy, and pathology tissue; videos of abnormal patient behavior; radiologic imagery such as computed-tomography scans; and images of isotope emissions in nuclear medicine. We also use synthetic or simulated images, such as animations of embryo development, graphs of simulation output, and 3D reconstructions of anatomy from cross-sectional imagery. Visualizations of simulated elastomechanical models allow us to see tissue undergoing natural processes, such as a heart beating, or intrusive processes, such as probing, cutting, or suturing. This tutorial reviews the many types of medical images available. Specific topics in medical education help demonstrate how imaging enhances their teaching.

Teleteaching endoscopy: the feasibility of real-time, uncompressed video transmission by using advanced-network technologies

BACKGROUND Teleteaching of endoscopy has been limited by the exorbitant cost and time inherent in high-quality digital endoscopy video transmission. The Digital Video Transport System (DVTS) transmitted over advanced networks, such as Internet2 and the Asia-Pacific Advanced Network (APAN), provides a unique infrastructure for sharing uncompressed digital videos of endoscopy. This may allow high-quality, real-time, international training of diagnostic and therapeutic endoscopy techniques at a low cost. OBJECTIVE To test the proof of concept of long-distance teaching through live, interactive, high-resolution video transmission by using advanced networks and the DVTS. We used teleteaching of image-enhanced endoscopy techniques as a model. DESIGN Prospective multicenter pilot study. SETTING AND PARTICIPANTS Trainees, faculty, and staff at 3 international endoscopy units. INTERVENTION An image-enhanced endoscopy video lecture with advanced-network technologies. MAIN OUTCOME MEASUREMENTS We compared image-based prelecture and postlecture test scores and secondarily assessed technical feasibility and quality. RESULTS The DVTS transmitted over advanced networks successfully transmitted uncompressed, high-resolution, digital lectures with endoscopic video (digital video format 720 x 480 pixels). Postsession scores improved. Participants highly rated the technical and informational quality. The majority reported a definite interest in participating in future sessions, with a mean rating (out of 5 [scale 1-5]) of 4.7 +/- 0.5. LIMITATIONS Pilot study with a limited number of participants and sessions. CONCLUSION The DVTS transmitted over advanced networks such as Internet2 and APAN can provide the infrastructure for transmission of high-resolution, uncompressed video endoscopy for the purpose of teleteaching endoscopy.

Three Dimensional Imaging of Bone From Analysis of Computed Tomography Data

A computer system was developed to reconstruct three dimensional images of bone from analysis of computed tomography data. Images of bone can be made within minutes and rotated for viewing from any direction. An editing process allows visualization of the articular surfaces of any joint. Solid models of the bone images can be produced with an accuracy of 1 mm to 3 mm by interfacing the image data with a computer numerically controlled milling machine. This technology will provide better information to the surgeon for preoperative diagnosis and planning and for the design of customized implants.