Use of simulation to understand the effects of task complexity and time away on clinical confidence.

In prior studies, mannequin-based simulation training has been used to help decrease student anxiety toward intimate clinical examinations. Using time away as an independent variable, the aim of this study was to assess decay of clinical confidence for four procedural tasks that vary in procedural complexity. Clinical confidence with intimate examinations, after a standardized mannequin-based simulation curriculum, decays over time. This decay is noted after two months of time away. Longer periods of time away did not show increased differences.

Modification of commercially available simulators to elicit decision making behavior.

In recent years, simulation training has emerged as an innovative method for decreasing error and teaching complex procedures. Simulation has also been a valuable tool for evaluating investigatory and analytic thinking. By adding a specific, clinically oriented modification to a commercially available simulator, we were able to elicit first-year emergency medicine resident perceptions, actions, and decisions.

Introducing simulation technology to new faculty: do not let them play.

As part of our simulation-based curriculum design process, we require faculty instructors to formally examine and test the simulators prior to instructional use. This requirement is invaluable when using commercially available, mannequin-based simulations. Our study shows that, when teaching a clinical examination using simulation, the clinical presentation of a commercial simulator should be defined based on the consensus of experienced clinicians instead of the commercial label.

Clinical examination simulation: getting to real.

Verschuren and Hartog's six-stage methodology for design-oriented research is a process that is ideally suited to the development of artifacts that meet a desired outcome. We discuss the methodology and its relevance to simulation development for establishing a wide variety of realistic clinical breast examination models that can be used for assessment.

Are commercially available simulators durable enough for classroom use?

Our efforts show that commercially available simulators can be modified to affect realism and durability.

Toward a simulation and assessment method for the practice of camera-guided rigid bronchoscopy.

We have developed a way to measure performance during a camera-guided rigid bronchoscopy using manikin-based simulation. In an effort to measure contact pressures within the airway during a rigid bronchoscopy, we instrumented pressure sensors in a commercially available bronchoscopy task trainer. Participants were divided into two groups based on self-reported levels of expertise: novice (none to minimal experience in rigid bronchoscopy) and experts (moderate to extensive experience). There was no significant difference between experts and novices in the time taken to complete the rigid bronchoscopy. However, novices touched a greater number of areas than experts, showing that novices induce a higher number of unnecessary soft-tissue contact compared to experts. Moreover, our results show that experts exert significantly less soft tissue pressure compared to novices.