Development of a novel image-based program to teach narrow-band imaging.

OBJECTIVES: Narrow-band imaging (NBI) is a widely available endoscopic imaging technology; however, uptake of the technique could be improved. Teaching new imaging techniques and assessing trainees' performance can be a challenging exercise during a 1-day workshop. To support NBI training, we developed an online training tool (Medimq) to help experts train novices in NBI bronchoscopy that could assess trainees' performance and provide feedback before the close of the 1-day course. The present study determines whether trainees' capacity to identify relevant pathology increases with the proposed interactive testing method. METHODS: Two groups of 20 and 18 bronchoscopists have attended an NBI course where they did a pretest and post-test before and after the main lecture, and a follow-up test 4 weeks later to measure retention of knowledge. We measured their ability to mark normal and abnormal 'biopsy size' areas on bronchoscopic NBI images for biopsy. These markings were compared with areas marked by experts on the same images. RESULTS: The first group results were used to pilot the test. After modifications, the results of the improved test for group 2 showed trainees improved by 32% (total class average normalized gain) in detecting normal or abnormal areas. On follow-up testing, Group 2 improved by 23%. CONCLUSIONS: The overall class average normalized gain of 32% shows our test can be used to improve trainees' competency in analyzing NBI Images. The testing method (and tool) can be used to measure the follow up 4 weeks later. Better follow-up test results would be expected with more frequent practice by trainees after the course.

Outside Observer, an Enhanced Training Methodology: Bringing Back the Expert's Eye whilst Training Alone.

Traditional surgical teaching requires an expert trainer to be present during training. This training model allows an expert to observe a novice's performance and provide corrective feedback as errors are made. Virtual simulations offer a much needed alternative to learning through error and allow the trainee to hone skills without the presence of a skilled surgical trainer. However, current simulations limit the scope of training to tool directed learning, focusing training around instrumented simulated tool tips. This paper identifies a need for trainee centered virtual training to complement current approaches. The Outside Observer training methodology provides training feedback based on the observation of surgical tool tip manipulations in conjunction with the external movements a trainee performs during a procedure. It is thought that integrating movement and posture training with current tool tracking methods will provide more effective and accelerated learning.

Modification of commercial force feedback hardware for needle insertion simulation.

A SensAble Omni force feedback device has been modified to increase the face validity of a needle insertion simulation. The new end effector uses a real needle hub and shortened needle shaft in place of the Omni's pre-fitted pen shaped end effector. This modification facilitates correct procedural training through the simulation of co-located visual and haptic cues in an augmented reality approach to simulation. The development of the new end effector is described and a pictorial guide to its manufacture and the fitting process is provided. Initial results from face validation studies bode well for the fidelity of this low cost device.