Accuracy of instructor assessment of chest compression quality during simulated resuscitation.

OBJECTIVES: The 2010 American Heart Association Guidelines stress the importance of high quality cardiopulmonary resuscitation (CPR) as a predictor of survival from cardiac arrest. However, resuscitation training is often facilitated and evaluated by instructors without access to objective measures of CPR quality. This study aims to determine whether instructors experienced in the area of adult resuscitation (emergency department staff and senior residents) can accurately assess the quality of chest compressions as a component of their global assessment of a simulated resuscitation scenario. METHODS: This is a prospective observational study in which objective chest compression quality data (rate, depth, and fraction) were collected from the simulation manikin and compared to subjective instructor assessment. Data were collected during weekly simulation training sessions for residents, medical students, and nursing students. RESULTS: We included data from 24 simulated resuscitation scenarios assessed by 1 of 15 instructors. Subjective assessment of chest compression quality identified an adequate compression rate (100-120 compressions per minute) with a sensitivity of 0.17 (confidence interval [CI] 0.02-0.32) and specificity of 0.06 (CI -0.04-0.15), adequate depth (>50 mm) with a sensitivity of 0 and specificity of 0.38 (CI 0.18-0.57), and adequate fraction (>80%) with a sensitivity of 1 and a specificity of 0.25 (CI 0.08-0.42). CONCLUSION: Instructor assessment of chest compression rate, depth, and fraction demonstrates poor sensitivity and specificity when compared to the data from the simulation manikin. These results support the use of objective and technologically supported measures of chest compression quality for feedback during resuscitation education using simulators.

Feasibility of real-time workflow segmentation for tracked needle interventions.

Computer-assisted training systems promote both training efficacy and patient health. An important component for providing automatic feedback in computer-assisted training systems is workflow segmentation: the determination of what task in the workflow is being performed. Our objective was to develop a workflow segmentation algorithm for needle interventions using needle tracking data. Needle tracking data were collected from ultrasound-guided epidural injections and lumbar punctures, performed by medical personnel. The workflow segmentation algorithm was tested in a simulated real-time scenario: the algorithm was only allowed access to data recorded at, or prior to, the time being segmented. Segmentation output was compared to the ground-truth segmentations produced by independent blinded observers. Overall, the algorithm was 93% accurate. It automatically segmented the ultrasound-guided epidural procedures with 81% accuracy and the lumbar punctures with 82% accuracy. Given that the manual segmentation consistency was only 84%, the algorithm's accuracy was 93%. Using Cohen's d statistic, a medium effect size (0.5) was calculated. Because the algorithm segments needle-based procedures with such high accuracy, expert observers can be augmented by this algorithm without a large decrease in ability to follow trainees in a workflow. The proposed algorithm is feasible for use in a computer-assisted needle placement training system.

Perk Tutor: an open-source training platform for ultrasound-guided needle insertions.

Image-guided needle placement, including ultrasound (US)-guided techniques, have become commonplace in modern medical diagnosis and therapy. To ensure that the next generations of physicians are competent using this technology, efficient and effective educational programs need to be developed. This paper presents the Perk Tutor: a configurable, open-source training platform for US-guided needle insertions. The Perk Tutor was successfully tested in three different configurations to demonstrate its adaptability to different procedures and learning objectives. 1) The Targeting Tutor, designed to develop US-guided needle targeting skills, 2) the Lumbar Tutor, designed for practicing US-guided lumbar spinal procedures, and (3) the Prostate Biopsy Tutor, configured for US-guided prostate biopsies. The Perk Tutor provides the trainee with quantitative feedback on progress toward the specific learning objectives of each configuration. Configurations were implemented through simple rearrangement of hardware and software components, attesting to the modularity and ease of configuration. The Perk Tutor is provided as a free resource to enable research and development of educational programs for US-guided intervention.

The effect of augmented reality training on percutaneous needle placement in spinal facet joint injections.

The purpose of this study was to determine if augmented reality image overlay and laser guidance systems can assist medical trainees in learning the correct placement of a needle for percutaneous facet joint injection. The Perk Station training suite was used to conduct and record the needle insertion procedures. A total of 40 volunteers were randomized into two groups of 20. 1) The Overlay group received a training session that consisted of four insertions with image and laser guidance, followed by two insertions with laser overlay only. 2) The Control group received a training session of six classical freehand insertions. Both groups then conducted two freehand insertions. The movement of the needle was tracked during the series of insertions. The final insertion procedure was assessed to determine if there was a benefit to the overlay method compared to the freehand insertions. The Overlay group had a better success rate (83.3% versus 68.4%, p=0.002), and potential for less tissue damage as measured by the amount of needle movement inside the phantom (3077.6 mm(2) versus 5607.9 mm(2) , p =0.01). These results suggest that an augmented reality overlay guidance system can assist medical trainees in acquiring technical competence in a percutaneous needle insertion procedure.

Interprofessional resuscitation rounds: a teamwork approach to ACLS education.

PURPOSE: We developed and implemented a series of interprofessional resuscitation rounds targeting fourth year nursing and medical students, and junior residents from a variety of specialty programs. METHODS: Each two hour session was conducted in our patient simulation lab, and was held weekly during the academic year. Students were given specific instruction on the roles and responsibilities of resuscitation team members, and then teams of five worked through pre-defined Advanced Cardiac Life Support (ACLS) scenarios on a high fidelity patient simulator. At the end of each session students completed an anonymous evaluation of the program via a standardized questionnaire using Likert rating scales. RESULTS: A total of 222 evaluations (101 nursing students, 42 medical students, and 79 junior residents) were submitted from October 2005 to April 2006. Mean scores reflected a strong consensus that these rounds were valuable for their training, provided a vehicle for understanding team roles in resuscitation, and that these rounds should be mandatory for all medical and nursing trainees. Participants also expressed a desire for additional interprofessional training. CONCLUSION: Despite challenges inherent in teaching a diverse group of learners, these interprofessional resuscitation rounds were rated highly by nursing and medical trainees as valuable learning experiences.

Computer-assisted instruction of carpal bone radiograph interpretation.

This paper describes the development of a computer-assisted self-directed learning module to teach carpal bone radiograph interpretation to clinical clerks, and the evaluation of its efficacy as a teaching tool. The module was developed using commercially available authoring software and in collaboration with radiologists. Following an eight-month period where the module was a mandatory component of the clerkship rotation in emergency medicine, a convenience sample of 36 volunteers from various levels of medical training were recruited, and their ability to interpret carpal radiographs was tested in an objective structured clinical examination (OSCE). The scores of the clinical clerks who had completed the module were shown to be similar to the scores of emergency medicine residents with specific experience and training in this skill (mean: 5 vs. 6), and different from the scores of trainees who had not completed the module and had no specific training in this skill (mean: 5 vs. 2). This study suggests that our module may be an effective tool in teaching this skill to clinical clerks.