101 research outputs found
I saw, I conceived, I concluded: Progressive Concepts as Bottlenecks
Concept bottleneck models (CBMs) include a bottleneck of human-interpretable
concepts providing explainability and intervention during inference by
correcting the predicted, intermediate concepts. This makes CBMs attractive for
high-stakes decision-making. In this paper, we take the quality assessment of
fetal ultrasound scans as a real-life use case for CBM decision support in
healthcare. For this case, simple binary concepts are not sufficiently
reliable, as they are mapped directly from images of highly variable quality,
for which variable model calibration might lead to unstable binarized concepts.
Moreover, scalar concepts do not provide the intuitive spatial feedback
requested by users.
To address this, we design a hierarchical CBM imitating the sequential expert
decision-making process of "seeing", "conceiving" and "concluding". Our model
first passes through a layer of visual, segmentation-based concepts, and next a
second layer of property concepts directly associated with the decision-making
task. We note that experts can intervene on both the visual and property
concepts during inference. Additionally, we increase the bottleneck capacity by
considering task-relevant concept interaction.
Our application of ultrasound scan quality assessment is challenging, as it
relies on balancing the (often poor) image quality against an assessment of the
visibility and geometric properties of standardized image content. Our
validation shows that -- in contrast with previous CBM models -- our CBM models
actually outperform equivalent concept-free models in terms of predictive
performance. Moreover, we illustrate how interventions can further improve our
performance over the state-of-the-art
Cost of simulation-based mastery learning for abdominal ultrasound
BACKGROUND: Ultrasound is an essential diagnostic examination used in several medical specialties. However, the quality of ultrasound examinations is dependent on mastery of certain skills, which may be difficult and costly to attain in the clinical setting. This study aimed to explore mastery learning for trainees practicing general abdominal ultrasound using a virtual reality simulator and to evaluate the associated cost per student achieving the mastery learning level.METHODS: Trainees were instructed to train on a virtual reality ultrasound simulator until the attainment of a mastery learning level was established in a previous study. Automated simulator scores were used to track performances during each round of training, and these scores were recorded to determine learning curves. Finally, the costs of the training were evaluated using a micro-costing procedure.RESULTS: Twenty-one out of the 24 trainees managed to attain the predefined mastery level two times consecutively. The trainees completed their training with a median of 2h38min (range: 1h20min-4h30min) using a median of 7 attempts (range: 3-11 attempts) at the simulator test. The cost of training one trainee to the mastery level was estimated to be USD 638.CONCLUSION: Complete trainees can obtain mastery learning levels in general abdominal ultrasound examinations within 3 hours of training in the simulated setting and at an average cost of USD 638 per trainee. Future studies are needed to explore how the cost of simulation-based training is best balanced against the costs of clinical training.</p
What should be included in the assessment of laypersons' paediatric basic life support skills?:Results from a Delphi consensus study
Abstract Background Assessment of laypersonsâ Paediatric Basic Life Support (PBLS) skills is important to ensure acquisition of effective PBLS competencies. However limited evidence exists on which PBLS skills are essential for laypersons. The same challenges exist with respect to the assessment of foreign body airway obstruction management (FBAOM) skills. We aimed to establish international consensus on how to assess laypersonsâ PBLS and FBAOM skills. Methods A Delphi consensus survey was conducted. Out of a total of 84 invited experts, 28 agreed to participate. During the first Delphi round experts suggested items to assess laypersonsâ PBLS and FBAOM skills. In the second round, the suggested items received comments from and were rated by 26 experts (93%) on a 5-point scale (1â=ânot relevant to 5â=âessential). Revised items were anonymously presented in a third round for comments and 23 (82%) experts completed a re-rating. Items with a score above 3 by more than 80% of the experts in the third round were included in an assessment instrument. Results In the first round, 19 and 15 items were identified to assess PBLS and FBAOM skills, respectively. The ratings and comments from the last two rounds resulted in nine and eight essential assessment items for PBLS and FBAOM skills, respectively. The PBLS items included: âResponsivenessâ,â Call for helpâ, âOpen airwayâ,â Check breathingâ, âRescue breathsâ, âCompressionsâ, âVentilationsâ, âTime factorâ and âUse of AEDâ. The FBAOM items included: âIdentify different stages of foreign body airway obstructionâ, âIdentify consciousnessâ, âCall for helpâ, âBack blowsâ, âChest thrusts/abdominal thrusts according to ageâ, âIdentify loss of consciousness and change to CPRâ, âAssessment of breathingâ and âVentilationâ. Discussion For assessment of laypersons some PBLS and FBAOM skills described in guidelines are more important than others. Four out of nine of PBLS skills focus on airway and breathing skills, supporting the major importance of these skills for laypersonsâ resuscitation attempts. Conclusions International consensus on how to assess laypersonsâ paediatric basic life support and foreign body airway obstruction management skills was established. The assessment of these skills may help to determine when laypersons have acquired competencies. Trial registration Not relevant
Simulation-based assessment of upper abdominal ultrasound skills
Background: Ultrasound is a safe and effective diagnostic tool used within several specialties. However, the quality of ultrasound scans relies on sufficiently skilled clinician operators. The aim of this study was to explore the validity of automated assessments of upper abdominal ultrasound skills using an ultrasound simulator. Methods: Twenty five novices and five experts were recruited, all of whom completed an assessment program for the evaluation of upper abdominal ultrasound skills on a virtual reality simulator. The program included five modules that assessed different organ systems using automated simulator metrics. We used Messickâs framework to explore the validity evidence of these simulator metrics to determine the contents of a final simulator test. We used the contrasting groups method to establish a pass/fail level for the final simulator test. Results: Thirty seven out of 60 metrics were able to discriminate between novices and experts (p < 0.05). The median simulator score of the final simulator test including the metrics with validity evidence was 26.68% (range: 8.1â40.5%) for novices and 85.1% (range: 56.8â91.9%) for experts. The internal structure was assessed by Cronbach alpha (0.93) and intraclass correlation coefficient (0.89). The pass/fail level was determined to be 50.9%. This pass/fail criterion found no passing novices or failing experts. Conclusions: This study collected validity evidence for simulation-based assessment of upper abdominal ultrasound examinations, which is the first step toward competency-based training. Future studies may examine how competency-based training in the simulated setting translates into improvements in clinical performances.</p
Danish doctors' reactions to 'internationalization' in clinical training in a public university hospital
Supporting open, collaborative, evidence-based scholarship: considering the future of perspectives on medical education
Protocol for a randomised clinical trial of transoral ultrasound versus standard of care in the diagnosis of peritonsillar abscess
An Automatic Guidance and Quality Assessment System for Doppler Imaging of Umbilical Artery
Examination of the umbilical artery with Doppler ultrasonography is performed
to investigate blood supply to the fetus through the umbilical cord, which is
vital for the monitoring of fetal health. Such examination involves several
steps that must be performed correctly: identifying suitable sites on the
umbilical artery for the measurement, acquiring the blood flow curve in the
form of a Doppler spectrum, and ensuring compliance to a set of quality
standards. These steps rely heavily on the operator's skill, and the shortage
of experienced sonographers has thus created a demand for machine assistance.
In this work, we propose an automatic system to fill the gap. By using a
modified Faster R-CNN network, we obtain an algorithm that can suggest
locations suitable for Doppler measurement. Meanwhile, we have also developed a
method for assessment of the Doppler spectrum's quality. The proposed system is
validated on 657 images from a national ultrasound screening database, with
results demonstrating its potential as a guidance system.Comment: Fetal Ultrasound, Umbilical Artery, Doppler Ultrasoun
Simulation-based assessment of robotic cardiac surgery skills: An international multicenter, cross-specialty trial
Objective: This study aimed to investigate the validity of simulation-based assessment of robotic-assisted cardiac surgery skills using a wet lab model, focusing on the use of a time-based score (TBS) and modified Global Evaluative Assessment of Robotic Skills (mGEARS) score. Methods: We tested 3 wet lab tasks (atrial closure, mitral annular stitches, and internal thoracic artery [ITA] dissection) with both experienced robotic cardiac surgeons and novices from multiple European centers. The tasks were assessed using 2 tools: TBS and mGEARS score. Reliability, internal consistency, and the ability to discriminate between different levels of competence were evaluated. Results: The results demonstrated a high internal consistency for all 3 tasks using mGEARS assessment tool. The mGEARS score and TBS could reliably discriminate between different levels of competence for the atrial closure and mitral stitches tasks but not for the ITA harvesting task. A generalizability study also revealed that it was feasible to assess competency of the atrial closure and mitral stitches tasks using mGEARS but not the ITA dissection task. Pass/fail scores were established for each task using both TBS and mGEARS assessment tools. Conclusions: The study provides sufficient evidence for using TBS and mGEARS scores in evaluating robotic-assisted cardiac surgery skills in wet lab settings for intracardiac tasks. Combining both assessment tools enhances the evaluation of proficiency in robotic cardiac surgery, paving the way for standardized, evidence-based preclinical training and credentialing. Clinical trial registry number: NCT05043064.</p
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