Automated Virtual Coach for Surgical Training

Surgical educators have recommended individualized coaching for acquisition, retention and improvement of expertise in technical skills. Such one-on-one coaching is limited to institutions that can afford surgical coaches and is certainly not feasible at national and global scales. We hypothesize that automated methods that model intraoperative video, surgeon's hand and instrument motion, and sensor data can provide effective and efficient individualized coaching. With the advent of instrumented operating rooms and training laboratories, access to such large scale intra-operative data has become feasible. Previous methods for automated skill assessment present an overall evaluation at the task/global level to the surgeons without any directed feedback and error analysis. Demonstration, if at all, is present in the form of fixed instructional videos, while deliberate practice is completely absent from automated training platforms. We believe that an effective coach should: demonstrate expert behavior (how do I do it correctly), evaluate trainee performance (how did I do) at task and segment-level, critique errors and deficits (where and why was I wrong), recommend deliberate practice (what do I do to improve), and monitor skill progress (when do I become proficient). In this thesis, we present new methods and solutions towards these coaching interventions in different training settings viz. virtual reality simulation, bench-top simulation and the operating room. First, we outline a summarizations-based approach for surgical phase modeling using various sources of intra-operative procedural data such as – system events (sensors) as well as crowdsourced surgical activity context. We validate a crowdsourced approach to obtain context summarizations of intra-operative surgical activity. Second, we develop a new scoring method to evaluate task segments using rankings derived from pairwise comparisons of performances obtained via crowdsourcing. We show that reliable and valid crowdsourced pairwise comparisons can be obtained across multiple training task settings. Additionally, we present preliminary results comparing inter-rater agreement in relative ratings and absolute ratings for crowdsourced assessments of an endoscopic sinus surgery training task data set. Third, we implement a real-time feedback and teaching framework using virtual reality simulation to present teaching cues and deficit metrics that are targeted at critical learning elements of a task. We compare the effectiveness of this real-time coach to independent self-driven learning on a needle passing task in a pilot randomized controlled trial. Finally, we present an integration of the above components of task progress detection, segment-level evaluation and real-time feedback towards the first end-to-end automated virtual coach for surgical training

Committed to Safety: Ten Case Studies on Reducing Harm to Patients

Presents case studies of healthcare organizations, clinical teams, and learning collaborations to illustrate successful innovations for improving patient safety nationwide. Includes actions taken, results achieved, lessons learned, and recommendations

The Effectiveness Of Virtual Humans Vs. Pre-recorded Humans In A Standardized Patient Performance Assessment

A Standardized Patient (SP) is a trained actor who portrays a particular illness to provide training to medical students and professionals. SPs primarily use written scripts and additional paper-based training for preparation of practical and board exams. Many institutions use various methods for training such as hiring preceptors for reenactment of scenarios, viewing archived videos, and computer based training. Currently, the training that is available can be enhanced to improve the level of quality of standardized patients. The following research is examining current processes in standardized patient training and investigating new methods for clinical skills education in SPs. The modality that is selected for training can possibly affect the performance of the actual SP case. This paper explains the results of a study that investigates if there is a difference in the results of an SP performance assessment. This difference can be seen when comparing a virtual human modality to that of a pre-recorded human modality for standardized patient training. The sample population navigates through an interactive computer based training module which provides informational content on what the roles of an SP are, training objectives, a practice session, and an interactive performance assessment with a simulated Virtual Human medical student. Half of the subjects interact with an animated virtual human medical student while the other half interacts with a pre-recorded human. The interactions from this assessment are audio-recorded, transcribed, and then graded to see how the two modalities compare. If the performance when using virtual humans for standardized patients is equal to or superior to pre-recorded humans, this can be utilized as a part task trainer that brings standardized patients to a higher level of effectiveness and standardization. In addition, if executed properly, this tool could potentially be used as a part task trainer which could provide savings in training time, resources, budget, and staff to military and civilian healthcare facilities

A Systematic Approach to Manage Clinical Deterioration on Inpatient Units in the Health Care System

The transformation of health care delivery in the United States is accelerating at unbelievable speed. The acceleration is a result of many variables including health care reform as well as the covariation occurring with adjustments in regulations related to resident work hours. The evolving care delivery model has exposed a vulnerability of the health system, specifically in academic medical centers of the United States. Academic medical centers have established a care delivery model grounded and predicated in resident presence and performance. With changes in resident work expectations and reduced time spent in hospitals, an urgent need exists to evaluate and recreate a model of care that produces quality outcomes in an efficient, service driven organization. One potential care model that would stabilize organizations is infusion of APNs with the expanded skills and knowledge to instill practice continuity in the critical care environment. A Medicare demonstration project is proposed for funding an APN expanded role and alteration in the care delivery model. Formative and summative evaluation and impact of such an expanded practice role is included in the proposed project. An evolved partnership between the advanced practice nurse and physician will serve to fill some of the gap currently existing in the delivery system of today. As the complexity and acuity of the patients in the hospital escalates, innovation is demanded to ensure a care model that will foster achievement of the quality outcomes expected and deserved

The role of virtual environment and virtual reality for knowledge transfer

Virtual Reality (VR) is a technology tool for workplace training that can lessen the total training time needed to learn complex cognitive tasks and aids a learner in converting abstract ideas into practical understanding. This review explores the use of VR training and its role in assisting a learner with knowledge transfer. A comprehensive literature search was conducted of peer-reviewed journal articles published between 2003-2018 and then 44 sources were selected for analysis. The reviewed research studies indicated that immersive VR training can provide a learner with a highly engaging virtual learning environment VE and stimulating experience that accommodates self-paced and self-directed learning. Trainers would benefit from potential immersive VR training outcomes such as bridging the gaps in understanding and promoting knowledge transfer and skill acquisition in a faster and more permanent manner when compared to traditional classroom training. It is recommended that future research should be conducted on the effects of VR cognitive load as it pertains to knowledge transfer

Global Assessment of Urological Endoscopic Skills (GAUES):development and validation of a novel assessment tool to evaluate endourological skills

Objective: To develop and evaluate an assessment tool for endourological skills during simulation including cystoscopy, ureteroscopy (URS) and transurethral resection (TUR) procedures. Methods: We designed a Global Assessment of Urological Endoscopic Skills (GAUES) tool, comprised of nine endourology task-specific and two global-rating skills items. The tool was developed through two rounds of the Delphi process. The GAUES tool was used to assess acquisition of URS and TUR skills of novices (Year 2 core surgical trainees, CT2) and intermediate level trainees (residents at the start of the UK higher surgical training programme in Urology, Speciality Trainee Year 3, ST3) at the Urology Simulation Boot Camp (USBC) between 2016 and 2018. Validity was evaluated by comparing scores between trainees with different levels of urological experience. Inter-rater reliability was also assessed. Results: We evaluated 130 residents, 52% of trainees were at an intermediate stage of training and 39% were novices. In all, 9% of the anonymous forms were missing demographics. The completion rate of the GAUES tool during the USBC for URS and TUR was 85% and 89%, respectively. Our analysis demonstrated a significant difference in all domains between intermediates and novices at assessment in URS, except for one domain more suited to clinical assessment (P\ua0=\ua00.226). There was excellent intraclass correlation (ICC) overall between the two experts’ judgements, ICC\ua0=\ua00.841 (95% confidence interval 0.767–0.893; P\ua

Undergraduate nursing student situation awareness during simulation

Graduate nurses encounter complex and rapidly changing patient care situations that require attentiveness, careful surveillance, and the recognition of subtle changes and patterns that will lead to appropriate decisions. Many researchers concur that new graduates are ill-equipped to meet these challenges, resulting in significant risk to patient safety. Situation Awareness (SA) is a skill that has been taught in the field of aviation to facilitate decision-making in complex, dynamic situations; however, there is little known about how nursing students develop SA. This mixed methods explorative study contrasted sophomore and senior nursing students’ (n=33) measured levels of SA during simulations of deteriorating patients, and gathered information from the students regarding how they came to be aware of changes. The results indicate students do not have complete SA (avg. score 69%). There is also evidence of significant differences between sophomore and senior nursing students’ scores on the comprehensive scale (F(1,31) = 10.394, p = .002) with senior scores significantly higher than sophomore scores. Students described how they became aware of the situation through developing expectations, determining salience and processing the information to create a meaningful whole. These themes support the proposed definition of situation awareness specific to nursing. This study found that nursing students develop Situation Awareness during the course of their nursing program indicating the necessity for deliberate development of this important skill. These study results can be also used to improve nursing education by teaching students specific skills including recognition of changes in respiratory rate and habits of frequent reassessment for patients whose condition is changing. Together these skills will help address the lack of SA which impairs clinical judgment and contributes to unsafe nursing care. Recommendations include further study and measurement of nursing student SA as well as teaching strategies aimed at developing SA