ABSTRACT
Simulation-based training as an educational tool for healthcare professionals continues to grow in sophistication, scope, and usage. There have been a number of studies demonstrating the utility of the technique, and it is gaining traction as part of the training curricula for the next generation of cardiologists. In this review, we focus on the recent literature for the efficacy of simulation for practical procedures specific to cardiology, focusing on transesophageal echocardiography, cardiac catheterization, coronary angioplasty, and electrophysiology. A number of studies demonstrated improved performance by those trained using SBT when compared to other methods, although evidence of this leading to an improvement in patient outcomes remains scarce. We discuss this evidence, and the implications for practice for training in cardiology.
Subject(s)
Cardiologists/education , Cardiology/education , Education, Medical, Graduate/methods , Internship and Residency , Simulation Training/methods , Cardiac Catheterization , Cardiology/methods , Clinical Competence , Curriculum , Echocardiography, Transesophageal , Electrophysiologic Techniques, Cardiac , Humans , Learning Curve , Percutaneous Coronary Intervention/educationABSTRACT
BACKGROUND: Accurate interpretation of the electrocardiogram (ECG) remains an essential skill for medical students and junior doctors. While many techniques for teaching ECG interpretation are described, no single method has been shown to be superior. PURPOSE: This randomized control trial is the first to investigate whether teaching ECG interpretation using a computer simulator program or traditional teaching leads to improved scores in a test of ECG interpretation among medical students and postgraduate doctors immediately after and 3months following teaching. Participants' opinions of the program were assessed using a questionnaire. CONCLUSIONS: There were no differences in ECG interpretation test scores immediately after or 3months after teaching in the lecture or simulator groups. At present therefore, there is insufficient evidence to suggest that ECG simulator programs are superior to traditional teaching.
Subject(s)
Arrhythmias, Cardiac/diagnosis , Cardiology/education , Clinical Competence , Computer-Assisted Instruction/methods , Electrocardiography/methods , Simulation Training/methods , Education, Medical/methods , Educational Measurement , Humans , United StatesABSTRACT
Nickel-Titanium (NiTi) peripheral stents are commonly used for the treatment of diseased femoropopliteal arteries (FPA). However, cyclic deformations of the vessel, induced by limb movements affect device performance and fatigue failure may occur. Stent strut fracture has been described in the literature, and is implicated as a potential causative factor in vessel re-occlusion. In this paper, a numerical approach is proposed to predict the fatigue behaviour of peripheral NiTi stents within patient-specific arterial geometries, as additional information to aid clinician intervention planning. The procedure needs some patient-specific vessel features derived from routine clinical images but, when this information is not available, reference data from the literature may be used, obviously increasing the uncertainties of the results. In addition, specific stent material data are required and can be obtained from experimental tests. Several 3D finite element models resembling stented vessel segments are built and used for fatigue analyses. For each model, axial cyclic boundary conditions are obtained from a patient-specific lumped parameter model representing the entire artery as a series of suitable springs. This allows the simplification of stiffness changes along the vessel due to plaque and stent that affect local axial deformations. Imposed local cyclic bending values depend on the stent location along the FPA. The procedure is exemplified by its application to an actual clinical case that showed two strut fractures at 18 months follow-up. Interestingly, despite the lack of some of patient-specific information and the use of data from the literature to inform the model, the numerical approach was able to interpret the in vivo fractures.
Subject(s)
Computer Simulation , Equipment Failure Analysis , Models, Cardiovascular , Peripheral Arterial Disease , Popliteal Artery , Prosthesis Failure , Stress, Mechanical , Alloys , Humans , Male , Middle Aged , Nickel , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Peripheral Arterial Disease/surgery , Popliteal Artery/diagnostic imaging , Popliteal Artery/physiopathology , Popliteal Artery/surgery , TitaniumABSTRACT
BACKGROUND: Electrocardiogram (ECG) interpretation is poorly performed at undergraduate and post-graduate level. Incorrect ECG interpretation can lead to serious clinical error. Despite the incorporation of computerized ECG interpretation software into modern ECG machines, the sensitivity and specificity of current technology remain poor, emphasizing the on-going need for doctors to perform ECG interpretation accurately. PURPOSE: This is the first review in this important area and aims to critically evaluate the current literature in relation to the optimal format and method of teaching ECG interpretation at undergraduate and postgraduate level. CONCLUSIONS: No single method or format of teaching is most effective in delivering ECG interpretation skills; however, self-directed learning appears to be associated with poorer interpretation competence. Summative in preference to formative assessment is associated with improved interpretation competence. Web-based learning offers a promising modern approach to learning ECG interpretation, though caution must be exercised in accessing user-uploaded content to supplement learning.
