Learning rate for laparoscopic surgical skills on MIST VR, a virtual reality simulator: quality of human-computer interface.
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Acquiring laparoscopic surgical skills involves initial learning of cognitive and motor skills followed by refinement of those skills. The successful use of a virtual reality simulator depends on the quality of the interface for the human-computer interaction and this can be determined by the initial learning rate. MIST VR, a part-task virtual reality laparoscopic simulator, provides objective assessment of psychomotor skills and can generate an overall score for performance, based upon errors made and time taken for six different tasks. This study analysed the rate of early task/instrument/computer familiarization on consecutive scores achieved by surgically experienced and naive individuals. Eleven surgeons, 18 medical students and seven non-medical personnel were tested on the simulator up to ten consecutive times, within a 2-week period. Performance data from every task and repetition were analysed to obtain individual scores of task performance. The calculation of overall score penalized errors far more heavily than total time taken, with high scores indicating poor performance. The surgeon-computer interface generated a rapid and significant early familiarization curve up to the third session on the simulator, with significant reductions in both time taken and total contact errors made. These results suggest that MIST VR represents a high quality interface. Surgeons scored consistently and significantly better than other subjects on all tasks. For surgically naive individuals, it was possible to predict the level of laparoscopic skills performance that would be attained after overcoming initial simulator learning curve, by studying their initial score. Overall scores reflected surgical experience and suggest that the simulator is measuring surgically relevant parameters. MIST VR provides a validated and much needed method for objective assessment of laparoscopic skills, for a variety of surgical disciplines. (+info)
The diagnostic accuracy of Danish GPs in the diagnosis of pigmented skin lesions.
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BACKGROUND: The GP often has a primary function in assessing pigmented skin lesions in Denmark. No data are available on the diagnostic accuracy of this process. OBJECTIVE: We aimed to study the sensitivity, specificity and positive prognostic value of the diagnosis made by 27 trained or trainee GPs. METHOD: We tested the diagnostic accuracy of the viewing of colour slides of pigmented skin lesions under standardized conditions at a seminar on skin cancer. Diagnostic accuracy was determined only for the clinically relevant diagnosis of benign or malignant. RESULTS: The median diagnostic accuracy (sensitivity) for the group as a whole was 0.75 (95% CI 0.65-0.80), the specificity was 0.70 (95% CI 0.68-0.79) and the positive predictive value 0.70 (95% CI 0.62-0.77). CONCLUSION: These values are comparable with previously published figures for trainee dermatologists, and it is therefore concluded that ongoing interest rather than basic training is the major determinant for clinical acumen. (+info)
Remembrance of things past and concerns for the future.
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Stanley G. Schultz received the seventh annual Arthur C. Guyton Physiology Teacher of the Year Award. The following is a speech he delivered as he was presented the award at Experimental Biology '99 in Washington, DC, in April 1999. (+info)
Medicaid's role in financing graduate medical education.
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Medicaid is the second-largest explicit payer of graduate medical education (GME). All but five states pay for GME ($2.4 billion in 1998). As states rapidly move their Medicaid populations to managed care, Medicaid support for GME is subject to change. Just sixteen states and the District of Columbia carve out Medicaid GME payments from capitated rates to managed care plans and rechannel them to teaching programs. Concurrently, managed care has motivated several states to distribute Medicaid GME funds in ways more explicitly accountable to the public. Ten states require that GME payments be directly linked to state policy goals intended to vary the distribution of or limit the health care workforce. (+info)
Management confidence and decisions to refer to hospital of GP registrars and their trainers working out-of-hours.
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BACKGROUND: There is concern about the educational impact and possible stress on registrars of new out-of-hours co-operatives. AIM: To compare the confidence in managing out-of-hours problems of registrars in traditional on-call rotas and co-operatives with that of their trainers. To determine how frequently registrars discussed problems out-of-hours with their trainers, and to compare the referral pattern of registrars with their trainers out-of-hours. METHOD: Analysis of log diaries of out-of-hours experiences kept by registrars and trainers over two, two-month periods in winter and summer. RESULTS: Thirty registrars (out of a possible 51) and 34 (out of a possible 52) trainers took part in the winter, and 18 registrars and 29 trainers in the summer. Registrars were confident in their management, and their confidence increased over the year (59% versus 72% difference = 12%, 95% CI = 6% to 20% for very confident). Registrars varied in their discussion of problems with trainers. When 'a little worried' they discussed their management 30 out of 53 times (57%); if 'very confident', 36 out of 576 times (6%). Registrars during the summer segment of the study referred more frequently to hospital than trainers (20% versus 10% difference = 10%, 95% CI = 3% to 17%. Registrars in traditional rotas recorded a slightly higher but statistically insignificant level of confidence in their management of problems than those registrars in cooperatives. CONCLUSIONS: While many registrars are confident in their work and are using their trainer for information appropriately, some are not. Registrars may be referring to hospital at a much higher rate than their trainers. More research is required to confirm and further explore these findings. (+info)
The role of simulation in surgical training.
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Surgical training has undergone many changes in the last decade. One outcome of these changes is the interest that has been generated in the possibility of training surgical skills outside the operating theatre. Simulation of surgical procedures and human tissue, if perfect, would allow complete transfer of techniques learnt in a skills laboratory directly to the operating theatre. Several techniques of simulation are available including artificial tissues, animal models and virtual reality computer simulation. Each is discussed in this article and their advantages and disadvantages considered. (+info)
A regional survey of emergency surgery: the trainees' perspective.
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The reduction of junior doctors' hours and the 'Calmanisation' of higher surgical trainees have led to an inevitable decrease in clinical experience. The development of subspecialisation within general surgery limits the diversity of elective operative experience, while the resident surgical registrar continues to be faced by the same range of emergencies. Procedures such as tracheostomy, thoracotomy and emergency burr hole, although rare in an emergency setting, are seldom seen by surgical trainees outside ENT, cardiothoracic and neurosurgical departments, respectively. However, these life saving procedures continue to be within the remit of the general surgeon, and were considered as essential knowledge in the operative viva of the FRCS examination. (+info)