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Using Delphi methodology, we created measurement instruments for specific training tasks included in Marine Emergency Duties training. Six Marine and Offshore Safety and Survival instructors rated items important for immersion suit and self-contained breathing apparatus (SCBA) donning tasks. Consensus was reached, and an item was included on the final checklist when at least 80% of the experts rated the importance of the item as greater than or equal to four out of five. After one round of surveys, panelists reduced items from 12 to five for the immersion suit donning task and from 30 to 19 for the SCBA donning task. Delphi methodology allowed for the creation of checklists that can be used to assess trainee competence for two specific tasks. These checklists will aid researchers and educators in measuring performance within a course environment while producing as little interference with the instructional experience as possible.

While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various "willingness-to-pay" values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).

Directed self-guidance, whereby trainees independently practice a skill-set in a structured setting, may be an effective technique for novice training. Currently, however, most evaluation methods require an expert to be present during practice. The study aim was to determine if absolute symmetry error, a clinically important measure that can be assessed by the trainee, is a feasible assessment tool for self-guided learning of suturing skill. Forty-eight undergraduate medical trainees independently practiced suturing and knot tying skills using a benchtop model. Performance on a pretest, posttest, retention test and a transfer test was assessed using (1) the validated final product analysis (FPA), (2) the surgical efficiency score (SES), a combination of the FPA and hand motion analysis and (3) absolute symmetry error, a new measure that assesses the symmetry of the final product. Absolute symmetry error, along with the other objective assessment tools, detected improvements in performance from pretest to posttest (P less than 0.05). A battery of correlation analyses indicated that absolute symmetry error correlates moderately with the FPA and SES. The development of valid, reliable and feasible technical skill assessments is needed to ensure all training centers evaluate trainee performance in a standardized fashion. Measures that do not require the use of experts or computers have potential for widespread use. We suggest that absolute symmetry error is a useful approximation of novices' suturing and knot tying performance. Future research should evaluate whether absolute symmetry error can enhance learning when used as a source of feedback during self-guided practice.

Background: Most preoperative surgical training programs experience challenges with the availability of expert surgeons to teach trainees. Some research suggests that trainees may benefit from being allowed to actively shape their learning environments, which could alleviate some of the time and resource pressures in surgical training. The purpose of this study was to investigate the effects of self-directed or prescribed practice schedules (random or blocked) on learning suturing skills. Methods: Participants watched an instructional video for simple interrupted, vertical mattress and horizontal mattress suturing then completed a pretest to assess baseline skills. Participants were assigned to 1 of 4 practice groups: self-directed practice schedule, prescribed blocked practice schedule, prescribed random practice schedule or matched to the self-directed group (control). Practice of the skill was followed by a delayed (1 h) posttest. Improvement from pretest to posttest was determined based on differences in performance time and expert-based assessments. Results: Analyses revealed a significant effect of group for difference in performance time of the simple interrupted suture. Random practice did not show the expected advantage for skill learning, but there was an advantage of self-directed practice. Conclusion: Self-directed practice schedules may be desirable for optimal learning of simple technical skills, even when expert instruction is available. Instructors must also take into account the interaction between task difficulty and conditions of practice to develop ideal training environments. Contexte: La plupart des programmes de formation preoperatoire en chirurgie ont du mal a trouver des experts pour enseigner la chirurgie aux stagiaires. Selon certaines recherches, il pourrait etre utile de permettre aux stagiaires de structurer eux-memes leurs milieux d'apprentissage, ce qui pourrait se reveler avantageux compte tenu des contraintes de temps et de ressources. Le but de cette etude etait de mesurer les effets de differents horaires d'exercices, autodiriges ou prescrits (aleatoires ou fixes), sur l'apprentissage des techniques de sutures. Methodes: Les participants ont regarde une video de formation sur les sutures uniques interrompues de type matelassier verticales et horizontales, avant de subir un pretest pour evaluer leurs competences de base. Les participants ont ensuite ete assignes a 1 de 4 groupes de pratique : horaires d'exercices autodiriges, fixes prescrits, aleatoires prescrits ou assortis au groupe <> (temoin). La periode d'exercices etait suivie d'un post-test administre apres un delai d'une heure. L'amelioration des resultats entre le pretest et le post-test a ete determinee par les differences de temps d'execution et l'evaluation d'un expert. Resultats: Les analyses ont revele un effet significatif selon le groupe en ce qui a trait aux differences de temps d'execution pour la suture simple interrompue. Les horaires d'exercices aleatoires ne se sont pas accompagnes de l'avantage attendu pour ce qui est de l'apprentissage de la technique, mais on a note un avantage associe aux horaires d'exercices autodiriges. Conclusion: Les horaires d'exercices autodiriges pourraient etre souhaitables pour un apprentissage optimal des habiletes techniques simples, meme lorsqu'un enseignement par les experts est disponible. Les instructeurs doivent aussi tenir compte de l'interaction entre la difficulte de la tache et les conditions dans lesquelles se font les exercices pour ameliorer les milieux de formation., Surgical instructors often predetermine the details of training sessions, such as the order of practised tasks, the duration of practice, and timing and type of feedback, while the trainee remains [...]

Background: The purpose of our study was to investigate the impact of distracting noise on the performance on a simulated orthopedic bone drilling skill when that noise blocks routine auditory [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.apergo.2006.03.011 Byline: David Gonzalez (a), Heather Carnahan (a), Monate Praamsma (a), Adam Dubrowski (b) Keywords: Laparoscopy; Virtual reality design; Movement control Abstract: Computer-assisted analysis of wrist movement has recently emerged as an objective laparoscopic performance evaluation method. The first purpose of this study was to assess the differences in motion characteristics between the tip of the instrument and the wrist. The second purpose was to describe the control strategies used to move laparoscopic instruments. During a bead transfer task, motions of a laparoscopic needle driver's tip, heel, and the participants' wrist were monitored. Results showed that large amplitude movements were best described by movements of the wrist, and small amplitude movements were evidenced by motions of the instrument tip. Thus, for describing expertise, and for evaluation and feedback, motion of the tip of the laparoscopic instrument should be quantified, in addition to motion of the wrist. The motions of the instrument were controlled by utilizing the flexibility of the skin of the laparoscopic trainer in addition to using the fulcrum, and sliding through the trocar. In order to increase fidelity, virtual reality trainers should simulate the flexibility of the real structures around the insertion of the instrument. Author Affiliation: (a) Department of Kinesiology, University of Waterloo, Canada (b) Department of Surgery, University of Toronto, 200 Elizabeth St., Eaton South 1E 583, Toronto, Ontario, Canada M5G 2C5 Article History: Received 2 May 2005; Accepted 22 March 2006

ABSTRACT. Practice of complex tasks can be scheduled in several ways: as whole-task practice or as practice of the individual skills composing the task in either a blocked or a [...]