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Objectives: Social distancing practices brought on by the COVID-19 pandemic have limited the ability of residency training programs to deliver procedure training via traditional in-person methods. Financial strains brought on by the pandemic also mean that fewer resources may be available to develop novel teaching processes. We sought to investigate a protocol meant to address the rising need for inexpensive procedure training that can be performed remotely or in a socially distanced manner. Methods: We used a sausage model to train 11 family medicine residents in toenail procedures. The training was delivered via two-way video telecommunication as the residents were separated into small groups in separate rooms. Learners were given a cognitive skills evaluation and were asked to perform a self-assessment of their confidence with procedures using a scale of 1–10. These assessments were administered before and after the procedure and the results were compared using a paired t-test. Results: The cognitive score improved from a pretest average of 73.6% to a posttest average of 86.0% (P = 0.022). The improvements in trainee self-assessment were significant for all performance characteristics of the procedure. Conclusions: This evidence supports the use of synchronous video communication to train family medicine residents in toenail procedures using a sausage model.

Background: Rural rotations can be a valuable experience for emergency medicine (EM) residents. To date, there has not been a retrospective cohort study comparing procedures performed at urban versus rural emergency departments (EDs). Objectives: The purpose of this study was to compare procedures performed by EM residents in urban versus rural EDs, with the hypothesis that there will be no significant difference in the procedures performed. Methods: A retrospective cohort study was conducted comparing procedures performed by second- and third-year EM residents based on medical chart review. The procedures were counted at three locations in West Virginia, including a small rural ED, a large rural ED, and a tertiary care ED. Procedure notes were collected from September 2018 to September 2019. The final analysis included nine months, as three months did not have residents at all locations. Eight procedures were standardized based on the number of procedures performed per 100 hours worked by residents. A comparison of total procedures and complex versus simple procedures was performed. A Kruskal-Wallis H test was performed to compare resident hours for procedures between each of the three locations. To compare each of the hospitals to one another separately, Mann-Whitney U tests were performed. Results: The total resident hours worked included 1,800 at the small rural ED, 13,725.5 at the tertiary care ED, and 5,319 at the large rural ED. A p-value of 0.0311 for the Kruskal-Wallis H Test indicated a difference between at least two of the ED sites. A statistically significant difference exists (p-value = 0.0135) between the urban ED (95% CI: 0.15-0.62) and the large rural ED (95% CI: 0.54-1.53). There was no significant difference in complex versus simple procedures among the three locations (p-value = 0.4159). Conclusions: When compared with the tertiary care ED, residents performed more total procedures at the large rural ED and similar total procedure numbers at the small rural ED when standardized for hours worked. There was no significant difference when comparing complex and simple procedures among the three locations.

Introduction Transvenous pacemaker insertion is a critical life-saving procedure that is infrequently performed. Traditional mannequin-based training paradigms are resource intensive and sometimes inadequate due to time constraints. Rapid Cycle Deliberate Practice (RCDP) is an effective teaching modality for highly scripted procedures. We propose using a simulation-based technique of RCDP in virtual reality (VR) to teach this procedure. Methods Sixteen emergency medicine residents were recruited. A pre-survey was administered at the start of the session, followed by a baseline task trainer checklist-based assessment. This checklist was created based on expert consensus. Participants then underwent the RCDP VR intervention with a subsequent repeat checklist-based assessment as well as a post-survey. Results Post-test scores were found to be significantly higher than pre-test scores after residents completed VR deliberate practice simulation (19.5±3.5 vs 24.1±2.0; p

BACKGROUND: Ecological momentary assessment (EMA) methods can be used to remotely assess physical and mental health in daily life for hard-to-reach, marginalized, and geographically dispersed populations in the U.S., such as sexual minority women (e.g., lesbian, bisexual). However, EMA studies are often complex, and engaging participants from afar can be a challenge. This study experimentally examined whether adding videos to written recruitment materials would improve consent rates, reduce dropout rates, and improve survey completion rates for an online daily diary study. METHODS: As part of a 2-week study of same-sex female couples’ health, 376 women ages 18–35 were recruited from across the U.S. using a market research firm. Couples were randomized to an introductory information condition (written + video materials or written-only materials) prior to informed consent. RESULTS: Overall, 97.1% of eligible women reviewed introductory materials and of these 96.7% consented; consent rates did not differ by condition (written + video: 97.1%, written-only: 97.1%). Dropout rates were low (5.4%) and survey completion rates were high (90.4% of surveys completed); there were no group differences for study dropout (written + video: 3.6%, written-only: 7.0%) or survey completion (written + video: 92.5%, written-only: 88.4%). Data from women randomized to receive videos indicated more than half (53.3%) did not watch any of the five videos in full. However, among those who viewed the videos, time spent watching videos, watching more videos in full, and watching at least one video in full were each positive associated with survey completion rates. CONCLUSIONS: In summary, we had high consent rates, low dropout rates, and high survey completion rates regardless of video instructions. Although sexual minority women can be hard to reach, our potential participants appeared highly motivated to take part in research, and thus video recruitment materials were not necessary to improve participation. Future experimental research to maximize EMA study design and implementation could be important for populations less inclined to participate in EMA studies, or who are less familiar with research.

Background There is evidence to suggest that early exposure to clinical experiences could bolster a medical student's education and prepare them to tackle the problem-based learning encountered during clinical rotations. We hypothesized that incorporating common surgical procedures into the gross anatomy laboratory during preclinical years would enhance the anatomical learning experience for students. The incorporation of these procedures would not be disruptive to the normal conduct of the anatomy laboratory, nor result in exorbitant costs. Objectives The goal of a more integrated curriculum is to better enable medical students by providing them a unique learning experience, so that they may more readily recall the knowledge needed to deal with the complex problems of clinical work. Recognizing the importance of this concept, we have incorporated multiple common clinical procedures into our anatomy curriculum as a pilot program. Methods Seven common surgical procedures, including intraosseous needle insertion, venous cut-down, chest tube insertion, surgical cricothyroidotomy, core needle liver biopsy, appendectomy, and hysterectomy, were taught as a part of this study. Video instructions on each of the surgical procedures were provided before each corresponding laboratory. Surveys were distributed to study participants to measure their satisfaction with the procedures and whether or not it was disruptive to the allotted laboratory time. Results Both students and faculty who were sampled in the study reported that they were satisfied with the procedures (96.5% and 100%, respectively), that the procedures did not interfere with laboratory times (96% and 100%), and that the procedures facilitated clinical learning (98% and 100%). Conclusion This study demonstrated that providing a novel surgical teaching program to medical students was beneficial to their education and non-disruptive to the conventional anatomy curriculum. This exercise further facilitates osteopathic education by demonstrating how structure and function organize surgical practice. The integration of Edward Via College of Osteopathic Medicine, Auburn Campus's (VCOM-AC's) surgical procedures into other medical school anatomy courses can yield more prepared and confident students as they venture into their clinical rotations.

Background Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome. Methods An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as ‘early’, ‘developing’ and ‘mature’ time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time. Results Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The “early” phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in ‘elderly’ (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time. Conclusion The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.

Biomechanical modelling of human breast tissues has been widely studied for various medical applications such as surgical procedure training, pre-operative planning, diagnosis and clinical biopsy o...

Background Pediatric ACGME (Accreditation Council for Graduate Medical Education) requirements include demonstrated competence in umbilical line placement. Given a waning number of these procedures clinically available to residents, new methods of procedural teaching must be employed. We developed a simulation-based strategy, using adult-learning principles, to teach umbilical venous catheter (UVC) placement to pediatric residents. We also determined whether procedural teaching via simulation increased confidence and competence among pediatric residents in performing the procedure. Methods Out of 23 first-year pediatric residents, eight participated in the study. Participants completed a survey evaluating their self-perceived competence and confidence in umbilical line placement. Their simulated umbilical line placement was assessed using a standardized checklist. Residents were then trained on simulated line placement in small groups by neonatologists. Six months later, residents completed a post-training survey and were assessed while placing simulated lines. Statistical analysis was completed using a paired t-test for parametric data, Wilcoxon signed-rank sum test for non-parametric data, and McNemar’s chi-squared test for categorical data. Spearman’s correlation was used for ordinal variables and Pearson’s correlation was used for continuous variables. Results Nine PGY-1 (post-graduate year-1) residents completed the pre-training survey and simulation, while eight residents completed the post-training survey and simulation. There was an increase in resident confidence in placing umbilical lines six months after completion of the training session (p = 0.015) even though there was no difference in the number of umbilical lines that residents had placed in the intervening time. The residents performed a greater number of steps correctly after the training compared to their performance before the training (p=0.001). There was a statistically significant positive correlation between resident confidence and the number of steps performed correctly (rs(14)= 0.649, p = 0.006). There was no correlation between confidence and the number of umbilical lines placed on live subjects. Conclusion A teaching strategy that allows pediatric residents to struggle to perform UVC placement in a simulated setting, before receiving expert instruction, is effective at increasing their confidence and competence, even in the absence of exposure to human subjects.

Emergent thoracotomy is a rare but high-stakes procedure for trauma patients. Emergency medicine residents are expected to perform this procedure after graduation, but few get the opportunity to perform it, leading to suboptimal performance and patient morbidity and mortality. Previous low-cost thoracotomy trainers revolve around modifying an existing costly thoracotomy task trainer or bear limited resemblance to actual landmarks and anatomy. This study attempts to bridge this gap by creating a low-cost model with supplies found at most home improvement/craft stores that is more anatomically accurate. We constructed a low fidelity model, which residents ultimately found to be helpful in mastering this rare procedure, and after the training session, they reported a greater level of comfort and familiarization with the procedure.

Introduction Early formal instruction in procedural skills may increase the frequency with which residents perform procedures in the clinical setting. This workshop trained internal medicine residents in ultrasound skills and manual skills required to perform procedures common on medicine wards and required for board eligibility. Methods Since 2016, our internal medicine residency program has executed three annual half-day workshops for interns during orientation, before clinical duties began. Prior to the workshop, we directed interns to relevant educational resources in the form of online modules and videos. At the workshop, trainees rotated in small groups through facilitated stations to learn basics of procedural ultrasound and to practice manual tasks performed during paracentesis, thoracentesis, lumbar puncture, and peripheral intravenous catheter placement. We administered questionnaires before and immediately after the workshop and used Wilcoxon signed rank tests to compare self-assessed independence and confidence. Results Two hundred four interns with little prior procedural training participated in the workshop. Most participants (85%) indicated that orientation was the best timing for this training experience when compared to later options. Confidence and independence increased for ultrasound-marked thoracentesis, paracentesis, and peripheral intravenous catheters and for lumbar puncture without ultrasound. Discussion This internal medicine intern orientation workshop on procedures and procedural ultrasound was well received and increased participants’ confidence and sense of independence. This publication contains materials needed to reproduce the training experience.

Introduction Recognizing the need for interprofessional education for trainees, the University of Kansas Schools of Nursing (SON) and Medicine (SOM) created interprofessional procedure workshops to foster collaboration, communication, and learning with and from other disciplines. The first workshop focused on venipuncture and peripheral intravenous catheter (PIV) insertion. Methods An interprofessional work group including SON and SOM faculty developed a PIV procedure training workshop based on the “learn, see, practice, prove, do, maintain” framework. SON faculty and graduate nursing students provided support and mentoring during the training sessions. Nursing students acted as peer coaches for their medical student colleagues with the help of an evidence-based, standardized, deliberate practice guide. The document broke the procedure into phases—planning, preparation, insertion, and postinsertion care—and provided scaffolding for the beginner through assessment. Results On survey, most students felt the program was beneficial and met the learning objectives. After the sessions, medical students completed a PIV assessment, and nursing students completed a reflection on the experience. These postsession assignments for each group confirmed that the learning objectives had been met. Discussion The interprofessional PIV workshop was one module in a longitudinal interprofessional curriculum providing training for SON and SOM learners. One goal of this curriculum was to achieve higher graduate competencies in procedural skills and interprofessional practice. Additionally, in developing the workshop, a deliberate practice guide was created that provided an educationally sound and best-practice procedure to be standardized to all university learners on campus.

Objectives Many instructional materials for point-of-care ultrasound (US)-guided procedures exist; however, their quality is unknown. This study assessed widely available educational videos for point-of-care US-guided procedures relevant to internal medicine: central venous catheterization, thoracentesis, and paracentesis. Methods We searched Ovid MEDLINE, YouTube, and Google to identify videos for point-of-care US-guided paracentesis, thoracentesis, and central venous catheterization. Videos were evaluated with a 5-point scale assessing the global educational value and a checklist based on consensus guidelines for competencies in point-of-care US-guided procedures. Results For point-of-care US-guided central venous catheterization, 12 videos were found, with an average global educational value score ± SD of 4.5 ± 0.7. Indications to abort the procedure were discussed in only 3 videos. Five videos described the indications and contraindications for performing central venous catheterization. For point-of-care US-guided thoracentesis, 8 videos were identified, with an average global educational value score of 4.0 ± 0.9. Only one video discussed indications to abort the procedure, and 3 videos discussed sterile technique. For point-of-care US-guided paracentesis, 7 videos were included, with an average global educational value score of 4.1 ± 0.9. Only 1 video discussed indications to abort the procedure, and 2 described the location of the inferior epigastric artery. Conclusions The 27 videos reviewed contained good-quality general instruction. However, we noted a lack of safety-related information in most of the available videos. Further development of resources is required to teach internal medicine trainees skills that focus on the safety of point-of-care US guidance.

The constant evolution of virtual reality applications in areas of dentistry has been gaining proeminence and contributing in several areas of knowledge associated with the training of professionals to perform the dental procedures. In this work, we present the modeling of a virtual simulator prototype for training an obturation process, using the Phantom device a represent of the clinical instrument with interaction with the tooth represent by an OBJ file, allowing interaction of the professional in surgical procedure. In addition, the device simulates the generation of strength, tactile sensation, kinesthetic and proprioceptive sensation through its indicator when collision occurs with the object. The prototype is under development, preliminary testing will be supported by experts in the field, who will validate the visual and tactile feedback of the prototype.

Introduction NHS England announced a new nurse angiographer role with the purpose of reducing hospital waiting lists for elective angiography. Methods Development of a standardised operating procedure for training in Radial Arterial Access (RAA), guidance on how to minimise the risk and recognise complications and post procedural limb management. Obtaining approval at the new procedures committee. Training program 50 consultant supervised nurse led procedures for (RAA), establishing expertise in 100 further procedures, followed by roll out of the program to other nursing staff. Results During training (RAA) cannulation was successful on 1st attempt in 42 out of 50 (success rate allowing for two attempts 84%), with no complications recorded. Successful access by a more experienced operator N = 7, failed (RAA) N = 1. The following 100 were performed independently on unselected patients (success rate 81%; (1st pass 70)), with no complications, need for alternate access routes, N = 1. The following table details the success rate and patient comfort score recorded during 104 procedures performed by a nurse specialist and trainee registrars. Conclusion Nurse-led (RAA) is safe and feasible and has the potential to improve catheter laboratory efficiency, patient satisfaction, standardise procedure training and improve staff retention. Our next steps will be to train more nurses in radial access and progress to nurse led angiography. Conflict of Interest None

Precise simulators can replicate complete understanding of the models. In this survey, we focus on orthopedic simulators that are not only in replicating real-world models but also in educating with complete procedure: surgical, for instance. It covers 18 hip replacement, three-knee replacement, three facial surgeries, one spine surgery and six orthopedic psycho-motor skills training and assessment-based simulators. We also provide comparative studies and highlight current trends and possible challenges. We observed that orthopedic training methodologies have undergone a paradigm shift. This means that the simulators replace the use of sensitive hospital settings for training and skill acquisition. In brief, we address classified overview on existing orthopedic simulators: physical and Virtual Reality (VR)-based simulators. Key steps to develop computer-assisted, VR-based simulator are explored. Experts' opinion on the use of simulation technologies in the field of orthopedics is discussed.

Historically, the placement and maintenance of dialysis access has been an integral part of nephrology training. However, in recent years, a big debate has ensued regarding whether this should be limited to trainees' understanding and counseling the patients regarding indications, alternatives, risks and possible complications of these procedures or should it actually involve more of a hands-on experience for the trainees. Some of the barriers in making these procedures a requirement across the board are the lack of standardization of procedural training across various training programs and the absence of consensus on what achieving competency in these procedures looks like. However, in the era of declining interest in nephrology, giving up "ownership" of nephrology procedures and increasing reliance on other sub specialties might be a deterrent in attracting residents to this field; we have to make a concerted effort to increase the exposure and opportunities for the trainees to perform these procedures. Moreover, we need to emphasize the implementation of a curriculum for nephrology fellows to evaluate access properly in order to decrease the burden of access related complications. Lastly, we need to continue working towards a more structured curriculum for a dedicated interventional nephrology fellowship for trainees who want to focus on procedures for their long-term career goals.

Simulation training may improve proficiency at and reduce complications from central venous catheter (CVC) placement, but the scope of simulation's effect remains unclear. This randomized controlled trial evaluated the effects of a pragmatic CVC simulation program on procedural protocol adherence, technical skill, and patient outcomes.Internal medicine interns were randomized to standard training for CVC insertion or standard training plus simulation-based mastery training. Standard training involved a lecture, a video-based online module, and instruction by the supervising physician during actual CVC insertions. Intervention-group subjects additionally underwent supervised training on a venous access simulator until they demonstrated procedural competence. Raters evaluated interns' performance during internal jugular CVC placement on actual patients in the medical intensive care unit. Generalized estimating equations were used to account for outcome clustering within trainees.We observed 52 interns placing 87 CVCs. Simulation-trained interns exhibited better adherence to prescribed procedural technique than interns who received only standard training (P = 0.024). There were no significant differences detected in first-attempt or overall cannulation success rates, mean needle passes, global assessment scores, or complication rates.Simulation training added to standard training improved protocol adherence during CVC insertion by novice practitioners. This study may have been too small to detect meaningful differences in venous cannulation proficiency and other clinical outcomes, highlighting the difficulty of patient-centered simulation research in settings where poor outcomes are rare. For high-performing systems, where protocol deviations may provide an important proxy for rare procedural complications, simulation may improve CVC insertion quality and safety.

Background: The need for peripheral intravenous (IV) access in anatomically challenging patients is becoming a more commonly encountered clinical problem. The significant investment devoted to physician training for ultrasound-guided vascular access has not yet been matched by a similar commitment to nursing. Nurses, paramedics, and physicians are becoming more enthusiastic about peripheral IV access with ultrasound (PIVUS); however, institutional and clinician support has not yet been forthcoming. The learning curve for PIVUS has never been rigorously studied, and may be flatter than previously assumed. Methods: Registered nurses were selected to participate as trainees. Training involved 1:1 sessions consisting of formal orientation to portable ultrasound, mentoring, and practice sessions with a nurse practitioner who has expertise in ultrasound-guided peripheral vascular access; hands-on, supervised practice cannulating vessels on a nonhuman tissue simulator; and supervised attempts on live patients. Results: Seven of 8 trainees completed the training. The average number of patient encounters required to achieve 10 successful IV placements was 25 (range =18–32). The average time required for successful vessel cannulation was 19.57 minutes (range =5–62 minutes). An average of 25 attempts was required to achieve proficiency, and average of 50 cases was required to maintain consistency. Conclusions: In today's practice environment, PIVUS skills are increasingly important. The results of our study demonstrate that, with appropriate hands-on training and supervision, these skills can be effectively taught to registered nurses.

Objective The “National Standard Requirements for Helicopter Emergency Medicine Services Physicians” gives recommendations on medical requirements for flight physicians. This study describes the level of formal competence, experience, and guideline compliance of Norwegian helicopter emergency medical service (HEMS) physicians. Methods In May 2013, all HEMS physicians with full-time engagement at Norwegian HEMS bases were invited to participate in a cross-sectional survey using a structured, Web-based questionnaire. Results A total of 108 (79%) of 136 physicians replied to the survey, and all bases were represented. The majority (89%) had specialist training, and more than 60% had longer than 6 years of experience as a flight physician. Over 60% had attended trauma, pediatric, and incubator courses, and all physicians worked regularly in an anesthesia department. Most physicians were participating in simulation and procedure training. Conclusion Many of the basic requirements of the guidelines were met by HEMS physicians, but room exists for improvements. Norwegian HEMS physicians are experienced, but a need exists for a more structured curriculum in emergency medicine for HEMS physicians based on the broad spectrum of presented medical conditions to ensure optimal quality of care and safety for all patients in Norway.

Rationale and Objectives The Diagnostic Radiology Milestones Project provides a framework for measuring resident competence in radiologic procedures, but there are limited data available to assist in developing these guidelines. We performed a survey of current radiology residents and faculty at our institution as a first step toward obtaining data for this purpose. The survey addressed attitudes toward procedural standardization and procedures that trainees should be competent by the end of residency. Materials and Methods Current residents and faculty members were surveyed about whether or not there should be standardization of procedural training, in which procedures residents should achieve competency, and the number of times a procedure needs to be performed to achieve competency. Results Survey data were received from 60 study participants with an overall response rate of 32%. Sixty-five percent of respondents thought that procedural training should be standardized. Standardization of procedural training would include both the list of procedures that trainees should be competent in at the end of residency and the standard minimum number of procedures to achieve competency. Procedures that both residents and faculty agreed are important in which to achieve competency included central line/port procedures; CT-guided abdominal, thoracic, and musculoskeletal procedures; minor fluoroscopic-guided procedures; general fluoroscopy; peripheral line placements; and US-guided abdominal procedures. For most of these categories, most respondents believed that these procedures needed to be performed 6-20 times to achieve competency. Conclusion Both resident and faculty respondents agreed that procedural training should be standardized during residency, and competence in specific procedures should be achieved at the completion of residency. Although this study is limited to a single institution, our data may provide assistance in developing future guidelines for standardizing image-guided procedure training. Future studies could be expanded to create a national consensus regarding the implementation of the Diagnostic Radiology Milestones Project.

This project shows a procedure-training simulator targeted at the operation and maintenance of overland distribution power lines. This simulator is focused on workplace safety and risk assessment of common daily operations such as fuse replacement and power cut activities. The training system is implemented using VR goggles (Oculus Rift) and a mixture of a real scenario matched perfectly with its Virtual Reality counterpart. The real scenario is composed of a real "basket" and a stick - both of the equipment is the actual ones used in daily training. Both, equipment are tracked by high precision infrared cameras system (OptiTrack) providing a high degree of immersion and realism. In addition to tracking the scenario, the user is completely tracked: heads, shoulders, arms and hands are tracked. This tracking allows a perfect simulation of the participant's movements in the Virtual World. This allows precise evaluation of movements as well as ergonomics. The virtual scenario was carefully designed to accurately reproduce in a coherent way all relevant spatial, architectonic and natural features typical of the urban environment, reflecting the variety of challenges that real cities might impose on the activity. The system consists of two modules: the first module being Instructor Interface, which will help create and control different challenging scenarios and follow the student's reactions and behavior; and the second module is the simulator itself, which will be presented to the student through VR goggles. The training session can also be viewed on a projected screen by other students, enabling learning through observation of mistakes and successes of their peers, such as a martial arts dojo. The simulator features various risk scenarios such as: different climates - sun, rain and wind; different lighting conditions - day, night and artificial; different types of electrical structures; transformer fire and explosion; short-circuit and electric arc; defective equipment; many obstacles - trees, cars, windows, swarm of bees, etc.

Objectives: To find an animal model for modified Caldwell–Luc procedure training. The animal model should have (1) a proper cortical thickness in the lateral wall; (2) a similar morphology and resistance of the Schneiderian membrane in humans; and, finally, (3) an oral approach. Materials and methods: Twelve fresh heads (four Merino sheep, four Murciano–Granadina goats and four Large–White pigs). Two skulls from each of these species were also used. Several three-dimensional imagings from the skulls of each species were acquired using a C-arm. Two fresh heads of each species were used to perform the modified Caldwell–Luc procedure. Two fresh heads of each species were firstly frozen at � 301C for 48 h and then sawed in blocks containing only the target region of the maxillary sinus. Results: The average thickness was 2.03 mm in goat and sheep and 2.80 in pig. Releasing and elevation of the Schneiderian membrane from the sinus floor were easy in the three species. The approach of the maxillary sinus in sheep, goat and pig from the buccal vestibule required a previous surgical enlargement of the buccal vestibule. Conclusions: In conclusion, the cortical bone thickness and Schneider membrane characteristics in Merina sheep and Murciano–Granadina goat allow a perfect training for the modified Caldwell–Luc procedure. However, the approach from the oral cavity needs, in these species, a previous enlargement of the buccal vestibule. The excessive thickness of the cortical bone restricts the use of pigs for this technique.

Simulation technologies are gaining widespread acceptance across a variety of educational domains and applications. The current research examines whether basic nursing procedure training with high-fidelity versus low-fidelity mannequins results in differential skill acquisition and perceptions of simulator utility. Fifty-two first-year students were taught nasogastric tube and indwelling urinary catheter insertion in one of two ways. The first group learned nasogastric tube and urinary catheter insertion using high-fidelity and low-fidelity mannequins, respectively, and the second group learned nasogastric tube and urinary catheter insertion using low-fidelity and high-fidelity mannequins, respectively. The dependent measures included student performance on nasogastric tube and urinary catheter insertion testing, as measured by observer-based instruments, and self-report questionnaires probing student attitudes about the use of simulation in nursing education. Results demonstrated higher performance with high-fidelity than with low-fidelity mannequin training. In response to a self-report posttraining questionnaire, participants expressed a more positive attitude toward the high-fidelity mannequin, especially regarding its responsiveness and realism.

Objective: To compare the usefulness for training of a porcine model (larynx, trachea, and pig skin) and a manikin model using a Portex cricothyrotomy kit (PCK). Methods: In a prospective randomised crossover trial, participants in the airway workshop performed crico-thyrotomy using a PCK on the porcine and manikin models (Tracheostomy Trainer and Case). The porcine model was made with larynxes and trachea from freshly slaughtered pigs and covered with a piece of thinned pigskin stapled to a wooden board. Participants were asked to assess the following: reality of skin turgor; difficulty with skin penetration, landmark recognition and procedure; reality of the model; and preference for each model using a visual analogue scale (VAS) of 0–10 cm. The VAS scores for each model were compared. Results: 49 participants were included in the study. Mean (SD) VAS scores for the reality of skin turgor, degree of difficulty with skin penetration and landmark recognition were higher with the porcine model than with the manikin model (7.0 (2.1) vs 4.7 (2.0), 6.4 (2.4) vs 3.6 (2.2), 5.1 (2.2) vs 4.2 (2.5), respectively). There was no difference between the models in the difficulty of the procedure (5.0 (2.4) vs 4.7 (3.2)). The porcine model had a higher VAS score for overall reality and preference of the model (7.1 (2.0) vs 4.8 (2.3) and 7.1 (2.0) vs 4.8 (2.2), respectively). Conclusion: The porcine model is a more useful training tool than the manikin model for cricothyrotomy with PCK because of its reality and similarity to human anatomy.

The purpose of the study was to develop a training protocol for local anesthesia in dental students. The study involved 90 2d year dental school students divided into 3 groups according to procedure training method: on skeletal preparations; by «Typodont» simulator and by combination of methods. Manipulation effectiveness criteria in skeletal preparations was penetrating the mandibular foramina by isolation of the corresponding region by latex scarf. In «Typodont» the effective injection was determined by light and sound signals. The results showed the necessity for combined approach as it gives an opportunity to identify mandible foramina by projecting on soft tissue marks with further skills developing on the simulator. When using the combined approach only 4 students successfully completed their task by initial injection while at the second attempt only 4 were not successful.Цель настоящего исследования - разработка протокола обучения местному обезболиванию студентов стоматологических факультетов. В исследовании приняли участие 90 студентов II курса стоматологического факультета, которых разделили на 3 группы в зависимости от методики обучения манипуляции: на костных препаратах; на симуляторе Typodont и комбинация методов. Эффективность обучения на скелетированных препаратах оценивали по паданию в область отверстия нижней челюсти (НЧ) с заданной позиции при условии изоляции области ветви НЧ латексным платком. При работе на симуляторе Typodont критерием эффективности являлась активация светозвукового сигнала. Результаты исследования выявили оптимальность комбинированного обучения на костных препаратах и симуляторе, поскольку отмечалась зависимость между совершенствованием навыка при первой попытке и опытом при второй: при первичной инъекции полностью выполнили задание лишь 4 студента, в то время как при второй попытке только 4 испытуемых его не выполнили. Подобный подход дает возможность освоить индивидуальный поиск проекции отверстия нижней челюсти на костных структурах, которые проецируются на мягкие ткани при отработке навыка на симуляторе.Цель настоящего исследования — разработка протокола обучения местному обезболиванию студентов стоматологических факультетов. В исследовании приняли участие 90 студентов II курса стоматологического факультета, которых разделили на 3 группы в зависимости от методики обучения манипуляции: на костных препаратах; на симуляторе Typodont и комбинация методов. Эффективность обучения на скелетированных препаратах оценивали по паданию в область отверстия нижней челюсти (НЧ) с заданной позиции при условии изоляции области ветви НЧ латексным платком. При работе на симуляторе Typodont критерием эффективности являлась активация светозвукового сигнала. Результаты исследования выявили оптимальность комбинированного обучения на костных препаратах и симуляторе, поскольку отмечалась зависимость между совершенствованием навыка при первой попытке и опытом при второй: при первичной инъекции полностью выполнили задание лишь 4 студента, в то время как при второй попытке только 4 испытуемых его не выполнили. Подобный подход дает возможность освоить индивидуальный поиск проекции отверстия нижней челюсти на костных структурах, которые проецируются на мягкие ткани при отработке навыка на симуляторе.

Procedural competency is a substantial part of the emergency physician’s (EP) skill set. Emergency Medicine (EM) is unique in that the practicing EP must be comfortable with a wide array of procedures that have the following features: 1) They span the entire human body and cross many disciplines in medicine and surgery; 2) There are both invasive and non-invasive procedures; 3) They occur at unpredictable frequencies and never on a schedule; 4) They often need to performed under significant time-pressure; and 5) The patients they need to be performed on are often critically ill and unstable.

Training numbers for colonoscopy vary among specialties. Tracking colonoscopy quality indicators for program graduates may provide reliable outcome data to improve educational programs and establish training requirements. The purpose of this study was to measure specific colonoscopy quality indicators for a family medicine graduate to determine if outcome can be used to assess the quality of procedure training and contribute to more objective means of establishing training numbers.We present a case series of the first 800 colonoscopies performed by a newly credentialed family physician who had performed 101 procedures during residency training. Procedure reports and medical records were reviewed for all patients receiving a colonoscopy by this physician from September 2003 to September 2007. Selected quality indicators were compared to recommended colonoscopy standards.The overall reach-the-cecum rate was 98.6%. Adenomas were detected in 21.6% of females and 33.7% of males. All polyps measuring less than 2 cm were removed. Epinephrine was used for 3 patients with hemostasis after polypectomy. There were no perforations.Quality indicators for colonoscopy were met after 101 supervised procedures. Postgraduate tracking of nationally recognized colonoscopy quality indicators can provide valuable outcome data to improve residency training and assist in establishing uniform training requirements among specialties.

SURGEONS, LIKE MUSICIANS, CAN BE CONSIDERED PERformers. Traditionally, surgeons have learned their craft through a prolonged apprenticeship that allows trainees to gain a wide repertoire of skills by assisting at and performing numerous operations. Supervision was tailored to each surgeon’s level of experience and the demands of the procedure. Surgeons learned how to cope with a wide range of problems and complications by repeated practice located within the performance of actual operations. Dexterity was central to the process of learning a broad range of procedures. However, equally important were other skills that accrued with increasing experience: teamwork, leadership, communication, clinical judgment, and decision making. Unlike technical expertise, these qualities are most evident when coping with problems and dealing with the unexpected. The extended nature of surgical training, coupled with specific planning, ensured that trainees were exposed to a sufficient range of eventualities. The landscape of contemporary surgery is different. Demands for patient throughput are increasing, while reductions in work hours mean that trainees’ opportunities for hands-on interventional experience have been curtailed. Continual technological innovation applies relentless pressure to learn new techniques, and ethical imperatives support safer approaches to initial learning, such as simulation. Complex interventional procedures increasingly are being performed by physicians from many specialties, including surgery, cardiology, and radiology.

Rolls Royce and Associates Limited (RRA) have been a committed early user of virtual reality (VR) technology for resolving complex engineering problems, within their role as Design Authority for the Nuclear Steam Raising Plant, in support of the Naval Nuclear Propulsion Programme. Initial RRA research concluded that the main benefit of using VR would be in reducing the accumulated dose experienced by personnel operating in a nuclear environment. This would be accomplished through the techniques of high fidelity geography training, operating and maintenance procedure training, simulation and accurate dose prediction. RRA has adopted an application-led approach to providing VR solutions, based on through-the-glass and immersive systems. This paper discusses a number of issues associated with the development of three Superscape-based applications: maintenance procedure training aid; radiation dose management tool; and synthetic environment simulation. (2 pages)