ABSTRACT
Purpose: Historically, medical education relied on apprentice-based experiences requiring direct observation in patient cases. Simulation-based education has been shown to improve resident confidence but can be time intensive and difficult to coordinate. The COVID-19 pandemic demonstrated the need to develop distributed educational tools. Virtual reality (VR) platform has been shown to improve resident confidence and proficiencies. This pilot study compared educational and cost effectiveness of low-cost cardboard viewer VR (CVVR) and commercially available integrated headset VR (IHVR). Material(s) and Method(s): We created a VR video of an intracavitary brachytherapy case for treatment of cervical cancer. Radiation oncology residents from a single ACGME-accredited training program were recruited and randomized to IHVR or CVVR. Both groups were given unlimited access to their randomized technology. Each resident performed a timed intracavitary procedure on a simulator while 5 implant quality metrics were recorded. A pre- and post-simulation questionnaire assessed self-confidence, procedural knowledge, and perceived usefulness of VR technology. Result(s): There were 13 residents, including four post-graduate year (PGY)-2, three PGY-3, two PGY-4, and four PGY-5, in the study. Seven (53.8%) of residents had previously performed an intracavitary brachytherapy procedure, while six (46.2%) had no prior experience. There were six residents randomized to IHVR and seven residents randomized to CVVR. Both VR technologies improved self-perceived overall confidence, assembly skill, and comfort performing the procedure independently. There were also non-statistically significant improvements in the ability to correctly order the steps of the brachytherapy procedure on post-simulation survey compared to pre-simulation survey in both VR viewer groups. Average time required for implant (mean: CVVR - 200 seconds vs. IHVR - 235 seconds, p=0.38) and median objective proficiencies of implant quality (5/5 in both group, p=0.56) were similar. There was no difference between CVVR and IHVR as useful, enjoyable and engaging educational tool. Both groups would recommend the technology to another trainee. There were differences in the time between last usage of the VR technology with 50% of the residents in the IHVR group completing the last VR SBE more than 2 weeks before the procedure, while the majority of residents in the CVVR group (57%) completed the last VR SBE within 1 hour before the procedure. IHVR-based program would cost ~33x more than CVVR-based program based on an assessment of US-based programs. Conclusion(s): CVVR is a cost-effective alternative to a IHVR as a virtual education tool. Copyright © 2022
ABSTRACT
Purpose: Historically, medical education relied on apprentice-based experiences requiring direct observation in patient cases. Simulation-based education has been shown to improve resident confidence but can be time intensive and difficult to coordinate. The COVID-19 pandemic demonstrated the need to develop distributed educational tools. Virtual reality (VR) platform has been shown to improve resident confidence and proficiencies. This pilot study compared educational and cost effectiveness of low-cost cardboard viewer VR (CVVR) and commercially available integrated headset VR (IHVR). Material(s) and Method(s): We created a VR video of an intracavitary brachytherapy case for treatment of cervical cancer. Radiation oncology residents from a single ACGME-accredited training program were recruited and randomized to IHVR or CVVR. Both groups were given unlimited access to their randomized technology. Each resident performed a timed intracavitary procedure on a simulator while 5 implant quality metrics were recorded. A pre- and post-simulation questionnaire assessed self-confidence, procedural knowledge, and perceived usefulness of VR technology. Result(s): There were 13 residents, including four post-graduate year (PGY)-2, three PGY-3, two PGY-4, and four PGY-5, in the study. Seven (53.8%) of residents had previously performed an intracavitary brachytherapy procedure, while six (46.2%) had no prior experience. There were six residents randomized to IHVR and seven residents randomized to CVVR. Both VR technologies improved self-perceived overall confidence, assembly skill, and comfort performing the procedure independently. There were also non-statistically significant improvements in the ability to correctly order the steps of the brachytherapy procedure on post-simulation survey compared to pre-simulation survey in both VR viewer groups. Average time required for implant (mean: CVVR - 200 seconds vs. IHVR - 235 seconds, p=0.38) and median objective proficiencies of implant quality (5/5 in both group, p=0.56) were similar. There was no difference between CVVR and IHVR as useful, enjoyable and engaging educational tool. Both groups would recommend the technology to another trainee. There were differences in the time between last usage of the VR technology with 50% of the residents in the IHVR group completing the last VR SBE more than 2 weeks before the procedure, while the majority of residents in the CVVR group (57%) completed the last VR SBE within 1 hour before the procedure. IHVR-based program would cost ~33x more than CVVR-based program based on an assessment of US-based programs. Conclusion(s): CVVR is a cost-effective alternative to a IHVR as a virtual education tool. Copyright © 2022
ABSTRACT
Background: Historically, medical education relied on apprentice-based experiences requiring direct observation in patient cases. Simulation-based education has been shown to improve resident confidence but can be time intensive and difficult to coordinate. The COVID-19 pandemic demonstrated the need to develop distributed educational tools. Virtual reality (VR) platform has been shown to improve resident confidence and proficiencies. This pilot study compared educational and cost effectiveness of low-cost cardboard viewer VR (CVVR) and commercially available integrated headset VR (IHVR). Methods and Materials: We created a 2D, 360-degree VR video of an intracavitary brachytherapy case for treatment of cervical cancer. Radiation oncology residents from a single ACGME-accredited training program were recruited and randomized to IHVR or CVVR. Both groups were given unlimited access to their randomized technology. Each resident performed a timed intracavitary procedure on a simulator while five implant quality metrics were recorded. A pre- and post-simulation questionnaire assessed self-confidence, procedural knowledge, and perceived usefulness of VR technology. Results: There were 13 residents, including four post-graduate year (PGY)-2, three PGY-3, two PGY-4, and four PGY-5, in the study. Both VR technologies improved self-perceived overall confidence. Average time required for implant (mean: CVVR - 200 s vs IHVR - 235 s, p = 0.38) and median objective proficiencies of implant quality (5/5 in both group, p = 0.56) were similar. There was no difference between CVVR and IHVR as useful, enjoyable and engaging educational tool. Both groups would recommend the technology to another trainee. IHVR-based program would cost ∼33x more than CVVR-based program based on an assessment of US-based programs. Conclusion: CVVR is a cost-effective alternative to a IHVR as a virtual video-based education tool. Copyright © 2022 Shah, Taunk, Maxwell, Wang, Hubley, Anamalayil, Trotter and Li.
ABSTRACT
Purpose: Acuity circles (AC) allocation was implemented on 2/4/2020 with a goal of removing DSA and region from liver allocation and broadening the distribution of livers, particularly for highly medically urgent candidates. Method(s): OPTN waitlist and transplant data was analyzed 18 months pre- (8/6/2018- 2/3/2020) and post- (2/4/2020-8/3/2021) AC implementation. Result(s): Post-policy, there were 448 more adult (age 18+ at listing) and 83 less pediatric (<18 at listing) waitlist additions, 570 more adult (age 18+ at transplant) and 4 less pediatric (<18 at transplant) deceased donor liver-alone transplants, and 121 less adult and 12 less pediatric removals for death or too sick. Transplant rates significantly increased overall post-policy, notably in the most medically urgent groups (Figure 1). The national median transplant score for adults remained unchanged at 28 and decreased from 35 to 30 for pediatric transplant recipients, likely due to the increased number of adolescents (age 12-17) transplanted at MELD scores under 29. There was a noticeable shift in the distribution of distance between donor hospital and transplant program, particularly for the most medically urgent groups where larger proportions of livers are coming from 250-500 NMs (Figure 2). Despite this change, median cold ischemia time increased only 11 minutes for adult recipients and 33 minutes for pediatric recipients post-policy. One year post transplant patient survival decreased from 94% pre-policy to 93% post-policy (p=0.02). Conclusion(s): Broader allocation increased transplant rates and livers are traveling longer distances for candidates with greater medical urgency with little effect on cold ischemia time and post-transplant survival. Unfortunately, AC implementation was followed shortly by COVID-19 making it difficult to parse out COVID-19 from potential policy effects. Metrics will continue to be monitored as more data become available. (Figure Presented).
ABSTRACT
Background: Traditionally procedural training requires in-person and hands-on education. However, only about 50% of residents express confidence to develop a brachytherapy practice (Marcrom SR, et al. Int J Radiat Oncol Biol Phys 2019). The COVID-19 pandemic demonstrated the need to develop distributed educational tools for procedural experiences. Virtual reality (VR) platform has been shown to improves resident confidence and proficiencies (Taunk NK. et al. Brachytherapy 2021). Objective(s): We hypothesize that a low-cost cardboard viewer VR (CVVR) has similar educational effectiveness as commercially available integrated headset VR (IHVR). Method(s): We created a VR video of an intracavitary brachytherapy case. Radiation oncology residents from a single ACGME-accredited training program were recruited and randomized to IHVR or CVVR. Both groups were given unlimited access to their randomized technology. Each resident performed a timed intracavitary procedure on a simulator while 5 implant quality metrics were recorded. A pre- and post-simulation questionnaire assessed self-confidence, procedural knowledge, and perceived usefulness of VR technology. Result(s): There were 13 residents, including four post-graduate year (PGY)-2, three PGY-3, two PGY-4, and four PGY-5, in the study. Both VR technologies improved self-perceived overall confidence. Average time required for implant (mean: CVVR-200 seconds vs. IHVR-235 seconds, P=0.38) and median objective proficiencies of implant quality (5/5 in both group, P=0.56) were similar. There was no difference between CVVR and IHVR as useful, enjoyable and engaging educational tool. Both groups would recommend the technology to another trainee. IHVR-based program would cost ~33x more than CVVR-based program based on an assessment of US-based programs. Conclusion(s): CVVR is a cost-effective alternative to a IHVR as a virtual education tool (Figs. 1-3). (Table Presented).
ABSTRACT
BACKGROUND: The COVID-19 pandemic substantially impacted care of patients with schizophrenia treated with long-acting injectable antipsychotics (LAIs). This study examined how clinics adapted operations to maintain a standard of care for these patients after pandemic onset. METHODS: Online surveys were completed in October-November 2020 by one principal investigator (PI) or PI-appointed designee at 35 clinics participating in OASIS (NCT03919994). Items concerned pandemic impacts on clinic operations, particularly telepsychiatry, and on the care of patients with schizophrenia treated with LAIs. RESULTS: All 35 clinics reported using telepsychiatry;20 (57%) implemented telepsychiatry after pandemic onset. Telepsychiatry visits increased from 12%-15% to 45%-69% across outpatient visit types after pandemic onset;frequency of no-show and/or canceled telepsychiatry visits decreased by approximately one-third. Nearly half of clinics increased the frequency of telepsychiatry visits for patients with schizophrenia treated with LAIs. Approximately one-third of participants each reported switching patients treated with LAIs to longer injection interval LAIs or to oral antipsychotics. The most common system/clinic- and patient-related barrier for telepsychiatry visits was lower reimbursement rate and access to technology/reliable internet, respectively. Almost all participants (94%) were satisfied with telepsychiatry for maintaining care of patients with schizophrenia treated with LAIs;most predicted a hybrid of telepsychiatry and office visits post-pandemic. CONCLUSIONS: Changes made by clinics after pandemic onset were viewed by almost all participants as satisfactory for maintaining a standard of care for patients with schizophrenia treated with LAIs. Most participants predicted continuing telepsychiatry to support patient care post-pandemic;equitable access to telepsychiatry will be important in this regard. FUNDING: Alkermes, Inc.
ABSTRACT
Purpose: Acuity circles (AC) allocation was implemented on February 4, 2020. AC significantly changed the relative priority of candidates with allocation PELD/ MELD scores of 29 to 34. We therefore performed a difference-in-differences analysis for the effect of AC on adjusted deceased donor transplant and offer rates across PELD/MELD categories. Methods: The before-AC period was February 4, 2019 to February 3, 2020, and the after-AC period was February 4 to March 12, 2020, the day before the national declaration of emergency due to COVID-19. Deceased donor transplant rates used active candidate time on the waiting list during the study period. The deceased donor offer rate was the number of offers in the first 10 spots of match run a candidate received per person-year. Only offers before the final acceptance were included. Transplant and offer rates were adjusted for other candidate characteristics. Results: Candidates with PELD/MELD 29-32 and PELD/MELD 33-36 had larger differences in transplant rates before and after AC than candidates with PELD/MELD 15-28, while other PELD/MELD categories also had larger but non-significant dif Admin ferences compared to candidates with PELD/MELD 15-28 (Figure 1). In contrast, all candidates with PELD/MELD 29 and higher had dramatically larger offers rates before and after AC than candidates with PELD/MELD 15-28 (Figure 2). Conclusions: Taken together, the implementation of AC increased the relative access to deceased donor transplant for candidates with PELD/MELD of 29-36 without reducing access for candidates with higher allocation priority.
ABSTRACT
Purpose: Acuity circles (AC) allocation was implemented on February 4, 2020, followed shortly by the declaration of national emergency for COVID-19. The goal of this policy was to broaden distribution of livers, particularly for highly medically urgent candidates. Methods: OPTN liver waitlist, transplant, and donor data were used. Cohorts of deceased donor liver-alone transplants for the pre- (2/5 - 7/2/2019) and post-eras (2/4 - 6/30/2020), as well as cohorts of liver waitlist registrations added, liver-alone waitlist registrations removed due to death or too sick to transplant, and deceased liver donors during 2/5 - 8/6/2019 (pre-policy) and 2/4 - 8/4/2020 (post-policy) were assessed. Results: Similar volumes of deceased liver donors were recovered pre- and postpolicy (4545 vs. 4564). While 375 fewer new registrations were added to the liver waitlist post-policy largely due to COVID-19, similar numbers of registration removals occurred (1093 pre- vs. 1020 post-policy) (Figure 1). There were fewer transplants overall post-policy (2997 vs. 3140 pre), with similar proportions of recipients with MELD or PELD scores of 29 and higher (51.7% pre- vs. 51.2% post-policy). However, these most medically urgent recipients received livers from farther away post-policy (Figure 2). The variation in median allocation score at transplant, as a measure of disparity across areas, has also decreased by most geographic units (Figure 3). Conclusions: It can already be seen that livers are being more broadly distributed for those with greater medical urgency, and geographic disparities are decreasing. However, the confounding effects of COVID-19 cannot be parsed out from potential policy effects, and continued data accumulation and monitoring of the system by the OPTN Liver Committee will be needed to determine the true effects of this policy change. (Table Presented).