Simulation-Based Education in Acute and Chronic Pain Training.

PURPOSE OF REVIEW: The use of simulation-based education (SBE) in medical training has expanded greatly and has grown to include high fidelity and task simulation along with hybrid models using patient actors to enhance education and training of critical events as well as technical skills. RECENT FINDINGS: In the field of anesthesiology, SBE has been particularly useful for crisis resource management and rare critical scenarios and new research into the use of SBE using task simulation for procedural skill development has been done highlighting the benefits to subspecialty procedural training. Medical simulation has become a common practice in medical training and research. SBE has demonstrated positive outcomes in improving technical skills, knowledge, comfort, and clinical performance. The widespread implementation of SBE in regional anesthesia and chronic pain training varies, with cost and availability being factors. Nonetheless, SBE has shown great potential in enhancing education and preparing physicians in subspecialties of anesthesia.

Comparing the Effectiveness of Four Different Design Media in Communicating Desired Performance Outcomes With Clinical End Users.

OBJECTIVE: The purpose of this study was to compare the effectiveness of four different design communication media in helping clinical end users understand spatial and functional information and in supporting their ability to provide design feedback. BACKGROUND: It is critical to involve clinical end users early in the design process to test design solutions and ensure the design of a new healthcare facility supports their ability to deliver high-quality care. Traditional architectural design communication media such as floor plans and perspectives can be challenging for clinical design team members to understand. Physical and virtual mock-ups are becoming more popular as design communication media. However, nominal evidence exists comparing the effectiveness of different design media in supporting clinical end-user engagement and contribution during the design process. METHOD: An exploratory, qualitative study was conducted with clinical end users to evaluate the effectiveness of four different media commonly used in design communication. RESULTS: Traditional architectural representations convey limited useful information to clinical end users, impacting the amount and type of feedback they can provide. More immersive media, such as physical and virtual mock-ups, support an increasingly holistic understanding of proposed design solutions, inciting more design solutions that range from the inclusion and exclusion of design features to location, position, and functionality of those features. CONCLUSIONS: When used in combination, each media can contribute to eliciting clinical end-user feedback at varying scales. The overall preference and higher effectiveness in eliciting design feedback from clinical end users highlights the importance of physical mock-up in communicating healthcare design solutions.

Physiological and Subjective Responses Associated to Physical and Mental Load in a Simulated Task / Respuestas fisiológicas y subjetivas asociadas a la carga física y mental en una tarea simulada / Respostas fisiológicas e subjetivas associadas à carga física e mental em uma tarefa simulada

Abstract Objective: To develop a quasi-experimental study to know the changes in physiological responses and perceived efforts of a group of fifteen healthy students that performed a simulated task related with the operation of a CNC lathe in a lab environment. Materials and Methods: The participants were asked to randomly complete a total of eight sessions including single and combined test of physical and mental load. Low/High Physical Load and Low/ High Mental Load were established as independent variables. Heart rate, physical performance, mental performance, and effort perception were established as dependent variables. Conclusions: High load levels have a significant effect on the heart rate increasing, but not in the perception of effort. High levels of mental load have a significant effect on physical and mental performance.

Resumen Objetivo: Desarrollar un estudio quasi-experimental para conocer los cambios en las respuestas fisiológicas y esfuerzos percibidos en un grupo de quince estudiantes sanos que realizaron una tarea simulada relacionada con la operación de un torno CNC en ambiente de laboratorio. Materiales y métodos: Los participantes completaron un total de ocho sesiones que incluyeron pruebas individuales y combinadas de esfuerzo físico y mental. La Carga Mental Baja/Alta y Carga Física Baja/Alta fueron establecidas como variables independientes. Frecuencia cardiaca, desempeño físico, desempeño mental y la percepción de esfuerzo fueron establecidas como variables dependientes. Conclusiones: Los niveles altos de carga física tienen un efecto significativo en el incremento de la frecuencia cardiaca, pero no en la percepción de esfuerzo. Los niveles altos de carga mental tienen un efecto significativo en el desempeño físico y mental.

Resumo Objetivo: Desenvolver um estudo quase-experimental para conhecer as mudanças nas respostas fisiológicas e esforços percebidos em um grupo de 15 estudantes saudáveis que realizaram uma tarefa simulada relacionada com a operação de um torno CNC em ambientes de laboratório. Materiais e métodos: Os participantes completaram um total de 8 sessões que incluíram provas individuais e combinadas de esforço físico e mental. A Carga Mental Baixa/Alta e a Carga Física Baixa/Alta foram estabelecidas como variáveis independentes. Frequência cardíaca, desempenho físico, desempenho mental e a percepção de esforço foram estabelecidas como variáveis dependentes. Conclusões: Os níveis altos de carga física têm um efeito significativo no incremento da frequência cardíaca, mas não na percepção de esforço. Os níveis altos de carga mental têm um efeito significativo no desempenho físico e mental.

The influence of internal and external tibial rotation offsets on knee joint and ligament biomechanics during simulated athletic tasks.

BACKGROUND: Following anterior cruciate ligament injury and subsequent reconstruction transverse plane tibiofemoral rotation becomes underconstrained and overconstrained, respectively. Conflicting reports exist on how rotations influence loading at the knee. This investigation aimed to determine the mechanical effects of internal and external tibial rotation offsets on knee kinematics and ligament strains during in vitro simulations of in vivo recorded kinematics. METHOD: A 6-degree-of-freedom robotic manipulator arm was used to articulate 11 cadaveric tibiofemoral joint specimens through simulations of four athletic tasks produced from in vivo recorded kinematics. These simulations were then repeated with 4° tibial rotation offsets applied to the baseline joint orientation. FINDINGS: Rotational offsets had a significant effect on peak posterior force for female motion simulations (P < 0.01), peak lateral force for most simulated tasks (P < 0.01), and peak anterior force, internal torque, and flexion torque for sidestep cutting tasks (P ≤ 0.01). Rotational offsets did not exhibit statistically significant effects on peak anterior cruciate ligament strain (P > 0.05) or medial collateral ligament strain (P > 0.05) for any task. INTERPRETATION: Transverse plane rotational offsets comparable to those observed in anterior cruciate ligament deficient and reconstructed patients alter knee kinetics without significantly altering anterior cruciate ligament strain. As knee degeneration is attributed to abnormal knee loading profiles, altered transverse plane kinematics may contribute to this. However, altered transverse plane rotations likely play a limited role in anterior cruciate ligament injury risk as physiologic offsets failed to significantly influence anterior cruciate ligament strain during athletic tasks.

Developing integrated clinical reasoning competencies in dental students using scaffolded case-based learning - empirical evidence.

INTRODUCTION: This study provides empirical evidence of the development of integrated clinical reasoning in the discipline-based School of Dentistry, University of Pretoria, South Africa. Students were exposed to case-based learning in comprehensive patient care (CPC) in the preclinical year of study, scaffolded by means of the four-component instructional design model for complex learning. METHODS: Progress test scores of third- to fifth-year dental students, who received case-based teaching and learning in the third year (2009-2011), were compared to the scores of preceding fourth- and fifth-year cohorts. These fourth- and fifth-year cohorts received content-based teaching concurrently with their clinical training in CPC. The progress test consisted of a complex case study and 32 MCQs on tracer conditions. Students had to gather the necessary information and had to make diagnostic and treatment-planning decisions. RESULTS: Preclinical students who participated in the case-based teaching and learning achieved similar scores compared to final-year students who received lecture-based teaching and learning. Final-year students who participated in the case-based learning made three more correct clinical decisions per student, compared to those who received content-based teaching. Students struggled more with treatment-planning than with diagnostic decisions. CONCLUSION: The scaffolded case-based learning appears to contribute to accurate clinical decisions when compared to lecture-based teaching. It is suggested that the development of integrated reasoning competencies starts as early as possible in a dental curriculum, perhaps even in the preclinical year of study. Treatment-planning should receive particular attention.

Establishment of performance standards and a cut-score for the Canadian Forces firefighter physical fitness maintenance evaluation (FF PFME).

The bookmark method for setting cut-scores was used to re-set the cut-score for the Canadian Forces Firefighter Physical Fitness Maintenance Evaluation (FF PFME). The time required to complete 10 tasks that together simulate a first-response firefighting emergency was accepted as a measure of work capacity. A panel of 25 Canadian Forces firefighter supervisors set cut-scores in three rounds. Each round involved independent evaluation of nine video work samples, where the times systematically increased from 400 seconds to 560 seconds. Results for Round 1 were discussed before moving to Round 2 and results for Round 2 were discussed before moving to Round 3. Accounting for the variability among panel members at the end of Round 3, a cut-score of 481 seconds (mean Round 3 plus 2 SEM) was recommended. Firefighters who complete the FF PFME in 481 seconds or less have the physical capacity to complete first-response firefighting work.

Novel Peritonsillar Abscess Task Simulator.

The management of peritonsillar abscesses is a skill developed early in residency training. Although drainage is not technically complicated, the procedure is intimidating to the neophyte. Task simulators have become increasingly common to provide training opportunities in a controlled environment. The authors designed a peritonsillar abscess simulator using a latex moulage of the oral cavity and other common materials. Twelve medical professionals of various levels of experience were instructed to expose, anesthetize, aspirate, and drain the simulated abscess. After completion, a questionnaire was completed by each volunteer. Initial impressions were positive that the model adequately replicated the tasks requisite for abscess drainage and was suitable as an instructional device. The initial construct cost was approximately 10 dollars, with disposables costing roughly 25 cents. Further research is under way to formally assess the simulator for face, content, and construct validity.