Emergency Undocking Curriculum in Robotic Surgery

Introduction Traditional instruction for robotic surgery is typically devoid of training that addresses the delineation of interprofessional roles for operating room personnel. An emergency undocking scenario was developed for robotic surgeons with the objectives of improving time to access the patient, provider knowledge of and confidence in emergency undocking, completion of predetermined critical actions, and delineation of operating room personnel roles. Methods Over one month, participants joined in three sessions: Session 1 - formative, Session 2 - review, and Session 3 - summative. Embedded standardized participants (ESPs) represented members of the interprofessional team. Prior to entering the operating room for Sessions 1 and 3, trainees were asked to complete a confidence survey and multiple choice questionnaire (MCQ) for knowledge assessment. Participants were randomized to one of two cases and participated in the reciprocal case for the final session four weeks later. Following Session 1, participants underwent an educational intervention, including the proper technique for emergency undocking, emphasis on operating room personnel roles, and hands-on practice. Obstetrics and Gynecology (OBGYN) residents in post-graduate Years 2-4 and attending physicians with robotics privileges at Summa Health Akron Campus or Cleveland Clinic Akron General Medical Center were invited to participate. A total of 21 participants enrolled and finished the study. Results Among the 21 participants, there was a significant increase in the baseline level of knowledge (p-value=0.001) and in the confidence of surgeons when faced with an emergency undocking after the completion of our curriculum (p-value=0.003). Additionally, an improvement in the undocking times (p-value<0.001) and an increase in the critical actions performed (p-value=0.002) were observed. Conclusion The results of this study demonstrate that incorporating this curriculum into the training programs of robotic surgeons is an effective way to improve the surgical skill of emergency undocking

Iatrogenic Critical Care Procedure Complication Boot Camp: A Simulation‐Based Pilot Study

Background Traditional medical education strategies teach learners how to correctly perform procedures while neglecting to provide formal training on iatrogenic error management. Error management training (EMT) requires active exploration as well as explicit encouragement for learners to make and learn from errors during training. Simulation provides an excellent methodology to execute a curriculum on iatrogenic procedural complication management. We hypothesize that a standardized simulation‐based EMT curriculum will improve learner's confidence, cognitive knowledge, and performance in iatrogenic injury management. Methods This was a pilot, prospective, observational study performed in a simulation center using a curriculum developed to educate resident physicians on iatrogenic procedural complication management. Pre‐ and post‐intervention assessments included confidence surveys, cognitive questionnaires, and critical action checklists for six simulated procedure complications. Assessment data were analyzed using medians, interquartile ranges, and the paired change scores were tested for median equality to zero via Wilcoxon signed rank tests with p<0.05 considered statistically significant. Results Eighteen residents participated in the study curriculum. The median confidence increased significantly by a summed score of 12.5 (8.75 –17.25) (p<0.001). Similarly, the median knowledge significantly increased by 6 points (3 –8) from the pre‐ to post‐intervention assessment (p<0.001). For each of the simulation cases, the number of critical actions performed increased significantly (p<0.001 to p=0.002). Conclusion We demonstrated significant improvement in the confidence, clinical knowledge, and performance of critical actions after the completion of this curriculum. This pilot study provides evidence that a structured EMT curriculum is an effective method to teach management of iatrogenic injuries

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

An extensible toolkit for creating virtual sonic environments

Presented of the 6th International Conference on Auditory Display (ICAD), Atlanta, GA, April 2-5, 2000The Virtual Audio Server (VAS) is a toolkit designed for exploring problems in the creation of realistic Virtual Sonic Environments (VSE). The architecture of VAS p

Encoding urgency in legacy audio alerting systems

Presented at the 11th International Conference on Auditory Display (ICAD2005)Despite ongoing modernization efforts, the U.S. Navy expects that it will continue to make highly effective use of legacy systems for many years to come. This and a mandate to maintain fully mission capable platforms have made the service slow to place new audio alerting technologies in command and control environments, despite their demonstrated effectiveness in the laboratory and elsewhere. However, recent upgrade programs for decision support systems have brought with them opportunities to revise and improve standing audio alert techniques. In this paper, the authors describe how the legacy audio component of a Navy decision support workdesk was revised to encode appropriate levels of urgency for incoming action and information alerts. The preliminary design process and issues germane to it are discussed, and the results of an empirical design study are presented. In addition, the implemented solution and the results of a subsequent empirical evaluation are briefly described and discussed

The effect of auditory rendering on perceived movement: Loudspeaker density and HRTF

Presented at the 7th International Conference on Auditory Display (ICAD), Espoo, Finland, July 29-August 1, 2001.Until recently, multiple speaker systems for Virtual Environment (VE) applications were limited to a few front and rear speakers. Utilizing the Virtual Audio Server (VAS) with a Vector Base Amplitude Panning (VBAP) algorithm for multiple speaker control, an array of 24 speakers was constructed to test large speaker configurations. Localization of complex movement was superior with the 24-speaker system, compared to an 8-speaker configuration or HRTF spatialization

The effect of pitch shifts on the identification of environmental sounds: Design considerations for the modification of sounds in auditory displays

Presented at the 11th International Conference on Auditory Display (ICAD2005)To examine the plausibility of dynamically adjusting the sounds presented by an auditory display, a study addressing the effects of pitch shifting on the identifiability of a set of forty-one environmental sounds was carried out. The sounds were shifted both up and down in pitch and presented to listeners who were asked to identify them. Results show that pitch shifting is detrimental to the identification of environmental sounds, suggesting that benefits gained from dynamically manipulating sounds in an auditory display must be carefully weighed against perceptual effects on their identifiability. Results also indicated that the sounds in our study better retained their identity when shifted down in pitch than when shifted up. This result however is believed to arise from confounds in the study