Validation studies of virtual reality simulation performance metrics for mechanical thrombectomy in ischemic stroke.

INTRODUCTION: Mechanical thrombectomy (MT) has transformed the treatment of ischemic stroke. However, patient access to MT may be limited due to a shortage of doctors specifically trained to perform MT. The studies reported here were done to (1) develop, operationally define, and seek consensus from procedure experts on the metrics which best characterize a reference procedure for the performance of an MT for ischemic stroke and (2) evaluate their construct validity when implemented in a virtual reality (VR) simulation. METHODS: In study 1, the metrics for a reference approach to an MT procedure for ischemic stroke of 10 phases, 46 steps, and 56 errors and critical errors, were presented to an international Delphi panel of 21 consultant level interventional neuroradiologists (INRs). In study 2, the metrics were used to assess 8 expert and 10 novice INRs performing a VR simulated routine MT procedure. RESULTS: In study 1, the Delphi panel reached consensus on the appropriateness of the procedure metrics for a reference approach to MT in ischemic stroke. Group differences in median scores in study 2 demonstrated that experienced INRs performed the case 19% faster (P=0.029), completed 40% more procedure phases (P=0.009), 20% more steps (P=0.012), and made 42% fewer errors (P=0.016) than the novice group. CONCLUSIONS: The international Delphi panel agreed metrics implemented in a VR simulation of MT distinguished between the computer scored procedure performance of INR experts and novices. The studies reported here support the demonstration of face, content, and construct validity of the MT metrics.

A computer-human interaction model to improve the diagnostic accuracy and clinical decision-making during 12-lead electrocardiogram interpretation.

INTRODUCTION: The 12-lead Electrocardiogram (ECG) presents a plethora of information and demands extensive knowledge and a high cognitive workload to interpret. Whilst the ECG is an important clinical tool, it is frequently incorrectly interpreted. Even expert clinicians are known to impulsively provide a diagnosis based on their first impression and often miss co-abnormalities. Given it is widely reported that there is a lack of competency in ECG interpretation, it is imperative to optimise the interpretation process. Predominantly the ECG interpretation process remains a paper based approach and whilst computer algorithms are used to assist interpreters by providing printed computerised diagnoses, there are a lack of interactive human-computer interfaces to guide and assist the interpreter. METHODS: An interactive computing system was developed to guide the decision making process of a clinician when interpreting the ECG. The system decomposes the interpretation process into a series of interactive sub-tasks and encourages the clinician to systematically interpret the ECG. We have named this model 'Interactive Progressive based Interpretation' (IPI) as the user cannot 'progress' unless they complete each sub-task. Using this model, the ECG is segmented into five parts and presented over five user interfaces (1: Rhythm interpretation, 2: Interpretation of the P-wave morphology, 3: Limb lead interpretation, 4: QRS morphology interpretation with chest lead and rhythm strip presentation and 5: Final review of 12-lead ECG). The IPI model was implemented using emerging web technologies (i.e. HTML5, CSS3, AJAX, PHP and MySQL). It was hypothesised that this system would reduce the number of interpretation errors and increase diagnostic accuracy in ECG interpreters. To test this, we compared the diagnostic accuracy of clinicians when they used the standard approach (control cohort) with clinicians who interpreted the same ECGs using the IPI approach (IPI cohort). RESULTS: For the control cohort, the (mean; standard deviation; confidence interval) of the ECG interpretation accuracy was (45.45%; SD=18.1%; CI=42.07, 48.83). The mean ECG interpretation accuracy rate for the IPI cohort was 58.85% (SD=42.4%; CI=49.12, 68.58), which indicates a positive mean difference of 13.4%. (CI=4.45, 22.35) An N-1 Chi-square test of independence indicated a 92% chance that the IPI cohort will have a higher accuracy rate. Interpreter self-rated confidence also increased between cohorts from a mean of 4.9/10 in the control cohort to 6.8/10 in the IPI cohort (p=0.06). Whilst the IPI cohort had greater diagnostic accuracy, the duration of ECG interpretation was six times longer when compared to the control cohort. CONCLUSIONS: We have developed a system that segments and presents the ECG across five graphical user interfaces. Results indicate that this approach improves diagnostic accuracy but with the expense of time, which is a valuable resource in medical practice.

Implementing peer tutoring in a graduate medical education programme.

BACKGROUND: In modern times, peer tutoring methods have been explored in health care education for over 30 years. In this paper, we report our experience of implementing a peer-tutoring approach to Clinical Skills Laboratory (CSL) training in the Graduate Entry in Medicine Programme (GEM) at University College Cork. METHODS: Eighteen fourth-year medical students were recruited as peer tutors for CSL sessions on physical examination. In order to standardise the process, we developed a training course for peer tutors that comprised two stages. They then ran the practical sessions with junior students, under the watchful eye of medical educators. At the end of the last CSL session, the students were given 10 minutes to reflect individually on the experience, and were asked to complete a feedback form. RESULTS: Twenty-four of the 42 GEM students and six of the seven Senior Tutors (STs) completed and returned their feedback forms. With the caveats of small sample sizes and low response rates, both groups reported that they had both positive and negative experiences of peer tutoring, but that the positive experiences predominated. CONCLUSION: The overall experience was positive. In terms of the primary thesis of this study, the STs thought that they were well prepared by the teaching staff to take part in these teaching sessions.