Updated: 22 Dec. 2006
Dyson D.H. Non-linear, visual-rich supplemental material designed for an introductory course in veterinary anesthesia. Journal of Veterinary Medical Education 2003;30(4):360-63. Department of Clinical Studies, Ontario Veterinary College, University of Guelph, ON, Canada. ddyson@uoguelph.ca
A possible reason for superficial learning in an introductory anesthesia course was considered to be a lack of visual reinforcement at the time of examination preparation. Students had limited access to live animal laboratories and clinical cases during the course, reducing their ability to depend on experiential learning. In an attempt to improve student learning, simple presentation software was used to develop a supplemental CD. The design involved multiple PowerPoint presentations that incorporated text, pictures, videos, and self-assessments. Non-linear exploration of the topics covered was made possible by extensive use of hyperlinks within and between presentations, moving the student to definitions, background material, videos, advanced details, and previously covered information. Comments received from students on a prototype were positive overall, and improvements were made related to their feedback. Other supplemental materials and lecture presentations can easily incorporate the techniques described here.
Gouvitsos F. Vallet B. Scherpereel P. [Anesthesia simulators: benefits and limits of experience gained at several European university hospitals]. [French] [Journal Article] Annales Francaises d Anesthesie et de Reanimation. 18(7):787-95, 1999 Aug.
Simulation has become essential in all situations where reality was too risky, too expensive, difficult to manage or inaccessible. In anaesthesia, the low rate of accidents and incidents, as well as the necessity to assure patient's safety, limit education and training in crisis management. The progress in data processing allowed the development of realistic anaesthesia simulators, associating the usual environment of an operating room, and made possible the simulation of a wide range of events. Most clinical incidents, mishaps, or manipulation errors can be simulated. A video recording allows the focus of attention on human factors. We assessed simulators in three European University hospitals. In Brussels as in Leiden, simulation was mainly used for training in crisis management. In Basel, the complete operating room staff participated in sessions, including also surgical simulation and improvement of communication within the team was one of the main goals. Simulation is valuable for residents' training, as well as continuing medical education, in crisis management and a better understanding of human factors. It remains without risk for the patient, with video possibilities improving the repetition of selected cases. However, its use for evaluation seems to be premature, due to the absence of studies demonstrating the validity and reproducibility of the results gained with simulation. Beyond technical limits which are amended continuously, the development of simulation is hindered by the very high cost of equipment and instructors.
Hall RE, Plant JR, Bands CJ, Wall AR, Kang J & Hall CA. Human
patient simulation is effective for teaching paramedic students endotracheal
intubation. Academic Emergency Medicine 2005;12(9):850-5.
OBJECTIVES: The primary purpose of this study was to determine whether the endotracheal intubation (ETI) success rate is different among paramedic students trained on a human patient simulator versus on human subjects in the operating room (OR). METHODS: Paramedic students (n = 36) with no prior ETI training received identical didactic and mannequin teaching. After randomization, students were trained for ten hours on a patient simulator (SIM) or with 15 intubations on human subjects in the OR. All students then underwent a formalized test of 15 intubations in the OR. The primary outcome was the rate of successful intubation. Secondary outcomes were the success rate at first attempt and the complication rate. The study was powered to detect a 10% difference for the overall success rate (alpha = 0.05, beta = 0.20). RESULTS: The overall intubation success rate was 87.8% in the SIM group and 84.8% in the OR group (difference of 3.0% [95% confidence interval {CI} = -4.2% to 10.1%; p = 0.42]). The success rate on the first attempt was 84.4% in the SIM group and 80.0% in the OR group (difference of 4.4% [95% CI = -3.4% to 12.3%; p = 0.27]). The complication rate was 6.3% in the SIM group and 4.4% in the OR group (difference of 1.9% [95% CI = -2.9% to 6.6%; p = 0.44]). CONCLUSIONS: When tested in the OR, paramedic students who were trained in ETI on a simulator are as effective as students who trained on human subjects. The results support using simulators to teach ETI.
Kunzel W & Dier H. Development of a realistic intubation simulator for teaching and training intratracheal intubation in dogs. [German] Wiener Tierarztliche Monatsschrift 2001;88(1):26-9.
Reynolds, W.
T. The anaesthetic machine, a computer tutorial program. [Journal article.
Conference paper] Journal of Veterinary Anaesthesia. 1991. Special
Supplement, 137. 1 ref.
Rowe R, Cohen RA. An evaluation of a virtual
reality airway simulator. Anesthesia and Analgesia 2002 Jul;95(1):62-66.
Departments of Anesthesiology and Diagnostic Imaging, Children's Hospital
Oakland, Oakland, CA 94609, USA. cho.dr.rwr@cho.org.
In this research, we sought to test the hypothesis that the AccuTouch Flexible
Bronchoscopy Simulator (Simulator) is an effective way to teach clinicians the
psychomotor skills necessary to use the fiberoptic bronchoscope as an instrument
for intubating the trachea of a pediatric patient. Pediatric residents with no
prior experience in fiberoptic bronchoscopy were studied. Residents performed
fiberoptic intubation on children undergoing general anesthesia. Tapes of these
intubations were analyzed for: time to visualization of the carina, and number
and time that the bronchoscope tip hit the mucosa. Residents were then trained
on the Simulator. Performance of fiberoptic intubation on a subsequent child was
compared. Training on the Simulator was the only instruction that the residents
received between the two cases. A control group of residents performed two
consecutive intubations without training on the Simulator between cases.
Residents studied an average of 17 cases, and spent 39 min on the Simulator.
Performance was markedly improved after the Simulator. Time to completion of
successful intubation with a bronchoscope was reduced from 5.15 to 0.88 min (P <
0.001). The number of times that the tip of the bronchoscope hit the mucosa was
reduced from 21.4 to 3.0 (P < 0.001). The amount of time that the resident spent
viewing the mucosa decreased from 2.24 to 0.19 min (P < 0.001). The percent of
time viewing the channel of the airway increased from 58.5% to 80.4% (P =
0.004). This bronchoscopy simulator was very effective in teaching residents the
psychomotor skills necessary for fiberoptic intubation. Significant improvement
was seen in time to completion of endotracheal intubation, as well as other
performance indicators. IMPLICATIONS: This research showed that the AccuTouch
Bronchoscopy Simulator is an effective way to teach the psychomotor skills
necessary to intubate the trachea of patients using a fiberoptic bronchoscope.
The residents that practiced on the Simulator dramatically improved their skills
compared with a control group of residents.
Swanson, C. R. Teaching clinical veterinary anesthesia with an interactive videodisc simulation: perceptual and academic results. [Journal article] Journal of Veterinary Medical Education. 1991. 18: 1, 17-20. 2 ref.
Syroid ND, Agutter J, Drews FA, Westenskow DR, Albert RW, Bermudez JC, Strayer DL, Prenzel H, Loeb RG, Weinger MB. Development and evaluation of a graphical anesthesia drug display. Anesthesiology 2002 Mar;96(3):565-575. Department of Anesthesiology, School of Medicine, University of Utah, Salt Lake City, Utah 84132-2304, USA. noahs@abl.med.utah.edu.
BACKGROUND: Usable real-time displays of intravenous anesthetic concentrations
and effects could significantly enhance intraoperative clinical decision-making.
Pharmacokinetic models are available to estimate past, present, and future drug
effect-site concentrations, and pharmacodynamic models are available to predict
the drug's associated physiologic effects. METHODS: An interdisciplinary
research team (bioengineering, architecture, anesthesiology, computer
engineering, and cognitive psychology) developed a graphic display that presents
the real-time effect-site concentrations, normalized to the drugs' EC(95), of
intravenous drugs. Graphical metaphors were created to show the drugs'
pharmacodynamics. To evaluate the effect of the display on the management of
total intravenous anesthesia, 15 anesthesiologists participated in a
computer-based simulation study. The participants cared for patients during two
experimental conditions: with and without the drug display. RESULTS: With the
drug display, clinicians administered more bolus doses of remifentanil during
anesthesia maintenance. There was a significantly lower variation in the
predicted effect-site concentrations for remifentanil and propofol, and
effect-site concentrations were maintained closer to the drugs' EC(95). There
was no significant difference in the simulated patient heart rate and blood
pressure with respect to experimental condition. The perceived performance for
the participants was increased with the drug display, whereas mental demand,
effort, and frustration level were reduced. In a post-simulation questionnaire,
participants rated the display to be a useful addition to anesthesia monitoring.
CONCLUSIONS: The drug display altered simulated clinical practice. These
results, which will inform the next iteration of designs and evaluations,
suggest promise for this approach to drug data visualization.
Wilson, D. V. Sneed, S. R. A technique for obtaining feedback from students using a computer program in a veterinary anesthesia course. [Journal article] Journal of Veterinary Medical Education. University of Toronto Press Inc.,Toronto, Canada: 2001. 28: 2, 78-81. 8 ref.
Introduction: the College of Veterinary Medicine at Michigan State University has been using computer-aided instructional programmes in our pre-clinical veterinary anaesthesia course. We describe an embedded feedback collection module (FCM) that facilitates the process of formative evaluation of the programme. Methods: the instructional programme was divided into discrete sections. The FCM was accessed easily from all sections of the programme. Instructions for use of the FCM were delivered orally to all users of the instructional programme and were included in the introduction section of the programme. Results: feedback was obtained from successive classes of veterinary students over four years, using our computer-aided instructional programme. Students in each class were required to use the programme either in class or for review and to leave at least one comment in the FCM. Of the 653 responses, 293 were positive and expressed appreciation for the programme, 209 contained specific comments or suggestions, and 151 were questions relating to the subject material contained within the programme. Written survey feedback was also obtained from some students in these classes. Conclusion: the FCM was effective and easy to implement. It proved an easy way to obtain user feedback, which was used in the ongoing process of programme design and content improvement.
