Training and Transfer Effect of FluoroSim, an Augmented Reality Fluoroscopic Simulator for Dynamic Hip Screw Guidewire Insertion: A Single-Blinded Randomized Controlled Trial

BACKGROUND: FluoroSim, a novel fluoroscopic simulator, can be used to practice dynamic hip screw (DHS) guidewire insertion in a high-fidelity clinical scenario. Our aim was to demonstrate a training effect in undergraduate medical students who are not familiar with this operation and its simulation. METHODS: Forty-five undergraduate medical students were recruited and randomized to either training (n = 23) or control (n = 22) cohorts. The training cohort had more exposure to FluoroSim (5 attempts each week) over a 2-week period (with a 1-week washout period in between) compared with the control cohort (a single attempt 1 week apart) over a 2-week period. Five real-time objective performance metrics were recorded: (1) tip-apex distance (TAD) (mm), (2) predicted cut-out rate (%), (3) total procedural time (sec), (4) total number of radiographs (n), and (5) total number of guidewire retries (n). RESULTS: At baseline, there was no significant difference in the performance metrics, which confirmed the absence of a selection bias. The intragroup training effect demonstrated a significant improvement in all metrics for the training cohort only. A significant difference between groups was demonstrated as the training cohort significantly outperformed the control cohort in 3 metrics (procedural time [25%], number of radiographs [57%], and number of guidewire retries [100%]; p < 0.001). A learning curve showed an inversely proportional correlation between frequency of attempts and procedural time as well as the number of digital fluoroscopic radiographs that were made, indicating the development of psychomotor skills. There was also an improved baseline of the learning curve after the 1-week washout period, suggesting skill retention. CONCLUSIONS: Skill acquisition with the FluoroSim system was demonstrated with repeat exposure in a safe, radiation-free high-fidelity clinical simulation with actual operating room equipment. The task of DHS guidewire insertion requires cognitive and psychomotor skills that take a variable number of attempts to acquire, as demonstrated on the learning curve. Additional work is required to demonstrate that the skill tested by the FluoroSim is the same skill that is required for intraoperative DHS guidewire insertion. However, use of the FluoroSim provides improvement in skills with extra-clinical training opportunities for orthopaedic trainees. CLINICAL RELEVANCE: FluoroSim has demonstrated validity and training effect. It has the potential to be approved for possible use on patients in the operating room to help surgeons with the operation. Consequently, operating time, accuracy of TAD, and surgical outcomes may all be improved

Developing high-fidelity health care simulation scenarios : a guide for educators and professionals

“The final, definitive version of this article has been published in the Journal, Simulation & Gaming, 42 (1), 2011, copyright SAGE Publications Ltd on SAGE Journals Online: http://online.sagepub.com/ "The development of appropriate scenarios is critical in high-fidelity simulation training. They need to be developed to address specific learning objectives, while not preventing other learning points from emerging. Buying a patient simulator, finding a volunteertoact as the patient, or even obtaining ready-made scenarios from another simulation center are rarely insurmountable challenges. The issue often lies in how to use or adapt these for your own purpose: with your team, facilities, and resources but primarily for your learners. Published information is limited in the area of scenario preparation for health care education and continuing medical education or continuing professional development. This article is a guide for clinical tutors, standardized patient trainers, and patient simulator operators on how to script scenarios and proposes a new detailed and reusable template for writing scenarios. It contains practical sections such as how to decide on the learning objectives to be addressed, how to script and organize your scenarios, and how to pitch the suitable level of details to make the scenarios appropriately realistic.Peer reviewe

Employers skill survey : case study : health and social care

"This report examines the relationship between service delivery strategies and processes, and the deployment of skills, recruitment problems and skill gaps within selected sub-sectors of health and social care. The sub-sectors within health are physiotherapy and radiography. Within social care the focus is on care of the elderly (both residential and domiciliary care). Although subject to similar drivers and associated pressures, the two sub-sectors of health and social care display markedly different characteristics, particularly in terms of service delivery strategies, qualification frameworks and utilisation of skills. In simple terms, the health and social care subsectors considered within this report may be thought of as being situated at opposite poles of the ‘skills spectrum’: with radiography and physiotherapy characterised by high level skills, while care of the elderly is traditionally associated with low level skills. Hence, the two sub-sectors are discussed separately throughout this report. The greater complexity and range of skills required in the two health sub-sectors is reflected in the comparative length of the two sections of the report" - page 9

Applying hierarchical task analysis to medication administration errors

Medication use in hospitals is a complex process and is dependent on the successful interaction of health professionals functioning within different disciplines. Errors can occur at any one of the five main stages of prescribing, documenting, dispensing or preparation, administering and monitoring. The responsibility for the error is often placed on the nurse, as she or he is the last person in the drug administration chain whilst more pressing underlying causal factors remain unresolved. This paper demonstrates how hierarchical task analysis can be used to model drug administration and then uses the systematic human error reduction and prediction approach to predict which errors are likely to occur. The paper also puts forward design solutions to mitigate these errors

Echocardiography curriculum development for physician assistants using entrustable professional activities

BACKGROUND: With the projected increase of cardiovascular disease in the aging population, a higher demand for echocardiography use is predicted. However, there is a shortage in the supply of cardiologists, to the point that a 2009 American College of Cardiology survey report called it a "cardiology workforce crisis". The report also recommends a more aggressive use of PAs and NPs as one of the solutions to fill the shortage. Currently, echocardiography is not routinely included in the scope of practice for PAs in cardiology. While PAs attain strong basic science knowledge and clinical training experience in PA school, they typically do not receive additional formal postgraduate training. PAs have limited training opportunities to train in echocardiography and receive certification of recognition, but a formally standardized training program and certifying examination geared specifically for PAs are yet to be developed. This study seeks to develop a pilot curriculum in training echocardiography which can be standardized for utilization across various regions and medical subspecialties. The curriculum draws on the concept of Entrustable Professional Activities (EPA), which is being actively used in graduate medical education. HYPOTHESIS: After participating in the proposed pilot curriculum which involves online didactic learning and supervised hands-on clinical training, trained PAs will be able to reach proficiency in echocardiography operation and interpretation at level 4 supervision according to the EPA guidelines. METHODS: This study proposes a pilot curriculum with framework based on the EPA titled “performing and interpreting echocardiography” by PAs. The curriculum involves didactic and clinical training in echocardiography, with the goal to achieve mastery of level 4 supervision (minimal supervision). 2 subjects will be recruited from a teaching medical institution in the Greater Boston area with an IAC accredited echocardiography laboratory. After the 12-month training, participants will take ASCeXAM/ReASCE Online Practice Exam Simulation offered by the ASE. Upon 1) achievement of individualized EPAs as assessed by supervisor, and 2) simulation exam score of >80%, participants will earn a STAR in echocardiography. CONCLUSION: The study is the first step to establishing an effective training curriculum that will eventually be a basis for creating a certifying exam in echocardiography, designed specifically for PAs. As this study merely suggests a new curriculum, future studies should focus on identifying strengths and weaknesses of the curriculum after implementation and expansion to multiple sites, and gather data to use for continual improvement of the training curriculum

Tracking Report 2008 Nike, Thailand 070074906G

This document is part of a digital collection provided by the Martin P. Catherwood Library, ILR School, Cornell University, pertaining to the effects of globalization on the workplace worldwide. Special emphasis is placed on labor rights, working conditions, labor market changes, and union organizing.FLA_2008_Nike_TR_Thailand_070074906G.pdf: 30 downloads, before Oct. 1, 2020

Game Based Learning for Safety and Security Education

Safety and security education are important part of technology related education, because of recent number of increase in safety and security related incidents. Game based learning is an emerging and rapidly advancing forms of computer-assisted instruction. Game based learning for safety and security education enables students to learn concepts and skills without the risk of physical injury and security breach. In this paper, a pedestal grinder safety game and physical security game have been developed using industrial standard modeling and game development software. The average score of the knowledge test of grinder safety game was 82%, which is higher than traditional lecture only instruction method. In addition, the survey of physical security game shows 84% average satisfaction ratio from high school students who played the game during the summer camp. The results of these studies indicated that game based learning method can enhance students' learning without potential harm to the students

Alternative sweetener from curculigo fruits

This study gives an overview on the advantages of Curculigo Latifolia as an alternative sweetener and a health product. The purpose of this research is to provide another option to the people who suffer from diabetes. In this research, Curculigo Latifolia was chosen, due to its unique properties and widely known species in Malaysia. In order to obtain the sweet protein from the fruit, it must go through a couple of procedures. First we harvested the fruits from the Curculigo trees that grow wildly in the garden. Next, the Curculigo fruits were dried in the oven at 50 0C for 3 days. Finally, the dried fruits were blended in order to get a fine powder. Curculin is a sweet protein with a taste-modifying activity of converting sourness to sweetness. The curculin content from the sample shown are directly proportional to the mass of the Curculigo fine powder. While the FTIR result shows that the sample spectrum at peak 1634 cm–1 contains secondary amines. At peak 3307 cm–1 contains alkynes

Building Skills and Alliances to Meet Demand in New Jersey's Labor Market

This summary report examines the Ready for the Job initiatve, which profiled the skill and occupational requirements of 73 occupations in New Jersey. This report highlights four cross-industry demand skills: math and technology skills, problem solving and critical skills, communication and teamwork skills, and entrepreneurship and business skills