Purpose A randomized controlled trial was carried out to determine whether Perk Tutor, a computerized training platform that displays an ultrasound image and real-time needle position in a three-dimensional (3D) anatomical model, would benefit residents learning ultrasound-guided lumbar puncture (LP) in simulation phantoms with abnormal spinal anatomy. Methods Twenty-four residents were randomly assigned to either the Perk Tutor (P) or the Control (C) group and asked to perform an LP with ultrasound guidance on parttask trainers with spinal pathology. Group P was trained with the 3D display along with conventional ultrasound imaging, while Group C used conventional ultrasound only. Both groups were then tested solely with conventional ultrasound guidance on an abnormal spinal model not previously seen. We measured potential tissue damage, needle path in tissue, total procedure time, and needle insertion time. Procedural success rate was a secondary outcome.
Objectives: Traditionally, technical skills proficiency has been assessed by direct observation. While direct observation and feedback are essential components in technical skills learning, they demand considerable investment of faculty time, and as an assessment tool, direct observation is inherently subjective and has been criticized as unreliable. The purpose of this study was to determine if quantitative electromagnetic motion tracking is feasible and can discriminate between experts and nonexperts during simulated ultrasound (US)-guided insertion of a central venous catheter (CVC) guidewire.Methods: Ten nonexperts (junior emergency medicine residents) and 10 experts (critical care fellows or attending physicians) were recruited. Electromagnetic sensor probes were used to capture hand motion during an US-guided internal jugular cannulation on a standardized manikin. Hand, US, and needle motion were analyzed for the following metrics: total path length, total time, translational movements, and rotational movements. Subjects were also videotaped and evaluated using a modified, validated global rating scale (GRS) by a blinded expert.Results: There was a significant difference in almost all examined motion parameters between experts and nonexperts. Experts took 66% less time (50.2 seconds vs. 148.7 seconds, p < 0.001) and had significantly less right-hand and US motion (total path length and translational and rotational movements). Left-hand total path length was the only parameter that was not significantly different between groups. Concurrent validity of motion parameters was established by strong correlations (r 2 > 0.74) to a previously published, modified GRS.Conclusions: Electromagnetic hand and instrument motion analysis is technically feasible for assessing competence in US-guided insertion of a CVC guidewire in a simulation setting. In showing that it discriminates between the performances of nonexperts and experts, this study has provided evidence for construct validity. It also shows excellent correlation with a modified version of a previously validated GRS, providing evidence of concurrent validity.ACADEMIC EMERGENCY MEDICINE 2015;22:212-218
Objective: To develop a simulation-based curriculum for residents to learn ultrasound-guided (USG) central venous catheter (CVC) insertion, and to study the volume and type of practice that leads to technical proficiency. Methods: Ten post-graduate year two residents from the Departments of Emergency Medicine and Anesthesiology completed four training sessions of two hours each, at two week intervals, where they engaged in a structured program of deliberate practice of the fundamental skills of USG CVC insertion on a simulator. Progress during training was monitored using regular hand motion analysis (HMA) and performance benchmarks were determined by HMA of local experts. Blinded assessment of video recordings was done at the end of training to assess technical competence using a global rating scale. Results: None of the residents met any of the expert benchmarks at baseline. Over the course of training, the HMA metrics of the residents revealed steady and significant improvement in technical proficiency. By the end of the fourth session six of 10 residents had faster procedure times than the mean expert benchmark, and nine of 10 residents had more efficient left and right hand motions than the mean expert benchmarks. Nine residents achieved mean GRS scores rating them competent to perform independently. Conclusion: We successfully developed a simulation-based curriculum for residents learning the skills of USG CVC insertion. Our results suggest that engaging residents in three to four distributed sessions of deliberate practice of the fundamental skills of USG CVC insertion leads to steady and marked improvement in technical proficiency with individuals approaching or exceeding expert level benchmarks. RÉSUMÉObjectifs: L'étude visait à élaborer un programme de formation axé sur la simulation et conçu à l'intention des résidents en vue de l'apprentissage de la mise en place échoguidée de cathéters veineux centraux (CVC), et à déterminer le nombre et le type d'exercices pratiques permettant d'en arriver à la compétence technique. Méthode: Dix résidents, en deuxième année d'études de cycles supérieurs, en médecine d'urgence et en anesthésie ont participé à quatre séances de formation de deux heures chacune, tenues à deux semaines d'intervalle, dans le cadre d'un programme structuré de pratique intentionnelle sur simulateur, en vue de l'acquisition des compétences de base dans la mise en place échoguidée de CVC. Les progrès réalisés durant la formation ont été suivis de près à l'aide d'un outil régulier de mesure, l'Hand Motion Analysis (HMA), et les valeurs de référence ont été déterminées par l'HMA des experts locaux. À la fin des séances de formation, les compétences techniques enregistrées sur bande vidéo ont fait l'objet d'une évaluation à l'insu par des experts, sur une échelle globale de notation (EGN). Résultats: Au départ, aucun des résidents n'atteignait l'une ou l'autre des valeurs de référence. Au fil de la formation, les mesures de l'HMA des résidents ont révélé une amélioration constante et i...
Objectives: A prospective cohort study was conducted using hand motion analysis (HMA) to assess the acquisition and retention of technical proficiency among first-year medical students learning the lumbar puncture (LP) skill in a simulated setting.Methods: Twenty-five subjects attended three or four simulation sessions at 6-week intervals. The initial session consisted of an introduction to the procedure and a baseline HMA assessment. This was followed by a session involving deliberate practice and evaluation using HMA. Subject HMA metrics were followed over time and compared to performance benchmarks to determine the volume of practice required to achieve and maintain technical proficiency in the simulated setting. Performance benchmarks were derived from the assessment of experts using HMA.Results: Subject baseline metrics were significantly different from expert (p < 0.01). At the outset of session 2, none of the subjects achieved the performance benchmarks. At the outset of sessions 3 and 4, 40 and 60% of subjects, respectively, demonstrated retention of technical proficiency. However, there was evidence of significant skill erosion between sessions (p < 0.01). The mean number of practice attempts required to achieve technical proficiency declined between sessions. Regression analysis indicated that there was a significant training effect for all students (overall negative slopes) over time. When examining the group as a whole, the speed at which students reached the expert benchmark was not significantly associated with number of practices in the first three sessions, although for some individuals these factors did appear associated. A total of 76% of subjects retained technical proficiency by session 4 and required a mean of 14 practices (range = 5 to 19). Conclusions:These results show that the majority of students require three to four sessions of deliberate practice to achieve a sustainable level of proficiency in the LP procedure. There is considerable variation in learning progression and retention of technical proficiency. These results have important implications for the design and resource requirements of a competency-based medical education program targeting LP training.ACADEMIC EMERGENCY MEDICINE 2015;22:1187-1195© 2015 by the Society for Academic Emergency Medicine T he current climate of medical education is one of continuous monitoring, improvement, and innovation. 1 Given the high-stakes nature of medical education, there is an obligation to develop validated training programs that will produce competent physicians. With rapidly evolving knowledge, technologies, and patient safety expectations, medical accreditation bodies and education stakeholders are transitioning to a competency-based medical education (CBME) model. 2,3 CBME focuses on identifying the abilities expected of
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.
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