scholarly journals Outcomes of Using Heart Sound Simulator in Teaching Cardiac Auscultation

2010 ◽  
Vol 1 (1) ◽  
pp. e46-e50 ◽  
Author(s):  
Ralitsa Akins ◽  
Hoi Ho
Keyword(s):  
Curriculum Reform ◽  
Heart Sound ◽  
Medical Training ◽  
Clinical Skills ◽  
Training Session ◽  
Resident Training ◽  
Training System ◽  
Heart Sounds ◽  
Training Methods ◽  
Significant Difference

Background - Despite continued curriculum reform, the clinical skills competencies of medical graduates at all levels are steadily declining within a training system, where bedside opportunities become a luxury and the laboratory tests prevail over the clinical skills. While high-fidelity expensive simulators are being embraced by high-procedure volume specialties, low-fidelity and relatively inexpensive simulators, such as the heart sounds simulators remain under-utilized in medical training.  Methods - We used a commercially available heart sound synthesizer in 2-hour training sessions with students and residents. Pre-post testing was completed at the beginning of the training session and three weeks after the session; participant responses were recorded by audience interactive response system.  Results - Data analysis was accomplished with statistical software SPSS 17.0 utilizing paired t-test, and showed a statistically significant difference in learners’ knowledge and skills attainment 3 weeks after completion of the simulation training (p<0.0001).  Conclusions - Based on our findings and the review of literature, we recommend that heart sound simulation is introduced at medical student level as the standard for teaching cardiologic auscultation findings and as preparation for auscultation of live patients.  We also suggest that training with digitally simulated heart sounds is similarly beneficial in resident training.

scholarly journals Retention Of Cardiac Auscultation Skill Requires Paired Visual And Audio Information In New Learners

2008 ◽  
Vol 2 (2) ◽  
Author(s):  
Glenn Nordehn ◽  
Spencer Strunic ◽  
Tom Soldner ◽  
Nicholas Karlisch ◽  
Ian Kramer ◽  
...  
Keyword(s):  
Visual Information ◽  
Heart Sound ◽  
Heart Sounds ◽  
Sound Recognition ◽  
Cardiac Auscultation ◽  
Time Period ◽  
Significant Difference ◽  
Post Test ◽  
Short Time ◽  
Audio Information

Introduction: Cardiac auscultation accuracy is poor: 20% to 40%. Audio-only of 500 heart sounds cycles over a short time period significantly improved auscultation scores. Hypothesis: adding visual information to an audio-only format, significantly (p<.05) improves short and long term accuracy. Methods: Pre-test: Twenty-two 1st and 2nd year medical student participants took an audio-only pre-test. Seven students comprising our audio-only training cohort heard audio-only, of 500 heart sound repetitions. 15 students comprising our paired visual with audio cohort heard and simultaneously watched video spectrograms of the heart sounds. Immediately after trainings, both cohorts took audio-only post-tests; the visual with audio cohort also took a visual with audio post-test, a test providing audio with simultaneous video spectrograms. All tests were repeated in six months. Results: All tests given immediately after trainings showed significant improvement with no significant difference between the cohorts. Six months later neither cohorts maintained significant improvement on audio-only post-tests. Six months later the visual with audio cohort maintained significant improvement (p<.05) on the visual with audio post-test. Conclusions: Audio retention of heart sound recognition is not maintained if: trained using audio-only; or, trained using visual with audio. Providing visual with audio in training and testing allows retention of auscultation accuracy. Devices providing visual information during auscultation could prove beneficial.

scholarly journals Development of Simulation Methods in Biomedical Sciences - From Phantoms to Virtual Patients

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Rasa Mladenovic ◽  
Dragana Dakovic ◽  
Kristina Mladenovic
Keyword(s):  
Medical Training ◽  
Clinical Skills ◽  
Simulation Models ◽  
Training System ◽  
Medical Simulation ◽  
Biomedical Sciences ◽  
Entertainment Education ◽  
Digital World ◽  
Real Process ◽  
The Times

AbstractSimulation is an imitation of the operation of a real process or system over time that is applied for a variety of purposes, including entertainment, education, training, system evaluation, and research. Medical simulation is an artificial presentation of real clinical situations, which is applied in education. Medical simulation allows the acquisition of clinical skills without the risk of harming the patient. Medical simulations have been developed and refined over the years-simulation models, cadavers, actors and robots have found wide application in medical training. Of more sophisticated simulation technologies, Virtual and Augmented Realities are used. The presence of science in the digital world is necessary in order to market the proven knowledge acquired in an adequate manner. The traditional teaching process, despite serious and thorough research, seems non-inspirational, and it is important that educators and teachers keep up with the times and provide students with the latest teaching and work methods.

scholarly journals Neurology Training Program for the Education of Psychiatry Residents: Experiences Reported from Curitiba, Brazil

2020 ◽  
Vol 44 (4) ◽  
Author(s):  
Carlos Arteaga Rodriguez ◽  
Marcel Wilkins Pereira Souza ◽  
Nadhyne Somacal Remonti ◽  
Otto J. Hernandez-Fustes
Keyword(s):  
Psychiatry Residency ◽  
Medical Training ◽  
Clinical Skills ◽  
Resident Training ◽  
Theoretical Research ◽  
Psychiatric Residency ◽  
Medical Residency ◽  
Paradigm Change ◽  
Level Of Satisfaction ◽  
Service Training

Abstract: Introduction: There has been a greater demand for the psychiatry specialty, possibly associated with the paradigm change in asylum care for outpatients and communities; consequently, there is now a greater number of institutions for Medical Training in Psychiatric Residency. As such, we seek to elaborate upon the Neurology Program for Medical Residency in Psychiatry (NPMRP) and present the experience of its application. Methods: We present an observational and descriptive study of the NPMRP experience in Curitiba/Paraná/Brazil. To prepare the NPMRP, reflective theoretical research was carried out via data from the websites of the Brazilian Psychiatric Association, Brazilian Psychiatric Residencies, PubMed and SciELO. Thw keywords used included: program of psychiatry residency; neurology and psychiatry residency; neurology in psychiatry. Results: It is thought that the resident develops clinical skills through the neurology-psychiatry interface, via an in-service training of general neurology (1st year resident) and epilepsy and neurocognitive disorders (3rd year resident), which takes place once a week. Residents receive training in conducting interviews and brief neurological examinations, concerning the types of neurological diagnosis, request for additional tests and interpretation of the reports. The outpatient clinical sessions last 4-5 hours, resulting in one patient/hour per resident who, in turn, prepares the medical record. The cases are reviewed and discussed with the neurologist instructor, promoting patient/family participation in shared decision-making. At the end of the outpatient clinic session, an activity is carried out with the whole team to socialize the visits and review theoretical contents. Assessments are daily, quarterly and annual, covering both quantitative and qualitative aspects. Conclusion: The NPMRP has excellent results in improving resident training and patient care. There is an excellent opinion regarding learning by the residents and a good level of satisfaction of patients/family members. The neurologist instructor becomes part of the residency and the NPMRP integrates academic and assistance training. The authors propose the development of a national, standardized and reproducible NPMRP.

scholarly journals P031: Multidisciplinary healthcare and first aid provider training for in-flight medical emergencies: a crowdsourcing session followed by an airplane simulation

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S75-S75
Author(s):  
A. Seto ◽  
J. Kariath
Keyword(s):  
Cardiac Arrest ◽  
Clinical Skills ◽  
Healthcare Providers ◽  
Training Session ◽  
First Aid ◽  
Learning Objectives ◽  
Basic Knowledge ◽  
Self Confidence ◽  
Significant Difference ◽  
Medical Emergencies

Innovation Concept: Is there a healthcare provider on board? Healthcare providers may be less confident for in-flight medical emergencies (IFME), as these situations are not part of usual curriculum or practice contexts (e.g. hospitals). For example, the literature reveals that medical students and physicians lack IFME basic knowledge and preparedness. The goal is to pilot a training session for healthcare providers to improve their confidence in navigating IFME. Methods: This training innovation involved: i) a session to crowdsource insights from multidisciplinary healthcare and first aid providers, followed by reviewing considerations of a CMAJ 2018 article on airplane emergencies, and ii) 2 airplane simulations (syncope and cardiac arrest). During crowdsourcing, 7 IFME learning objectives were explored: i) challenges, ii) solutions, iii) equipment, iv) taking vitals, v) general approach, vi) cardiac arrest approach, and vii) human resources / role-delegation. Knowledge and approaches extracted were then applied in simulations. Participants provided scores out of 7.00 for: i) satisfaction of crowdsourcing session and simulation and ii) self-rated confidence on learning objectives at baseline, post-crowdsourcing session, and post-simulation. Results were analyzed with repeated measures ANOVA with post-hoc Tukey. Curriculum, Tool, or Material: The workshop curriculum was a crowdsourcing session and simulation to mentally rehearse and practice clinical skills in airplane settings to improve IFME preparedness. Conclusion: Participants rated the crowdsourcing activity (6.70/7.00, n = 11) and simulation (6.50/7.00, n = 11) positively. Confidence in the 7 topics improved from baseline (2.49/7.00) to post-crowdsourcing (5.23/7.00) to post-simulation (5.94/7.00). Significant differences (p < 0.01) between baseline and post-crowdsourcing, and between baseline and post-simulation were observed. There was no significant difference between post-crowdsourcing and post-simulation. One simulation limitation was not all could be rescuers; therefore, debriefing is important to meet learning objectives. Second, the simulation was not within an airplane; housing simulations inside an airplane with flight attendants is a potential next step. Overall, self-confidence in topics of IFME may improve after just one crowdsourcing session, facilitated through group discussions and mental rehearsal. Added simulations may maintain self-confidence on these topics, by promoting memory retention through active learning and repetition.

scholarly journals How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017748 ◽  
Author(s):  
Jolanta Świerszcz ◽  
Agata Stalmach-Przygoda ◽  
Marcin Kuźma ◽  
Konrad Jabłoński ◽  
Tomasz Cegielny ◽  
...  
Keyword(s):  
Physical Examination ◽  
Medical School ◽  
Curriculum Reform ◽  
Clinical Course ◽  
Clinical Skills ◽  
Laboratory Data ◽  
Significant Difference ◽  
Second Year ◽  
Laboratory Training ◽  
Preclinical Training

ObjectiveAs a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs.DesignAnalysis of routinely collected data.SettingOne Polish medical school.ParticipantsComplete OSCE records for 462 second-year students and 445 third-year students.Outcome measuresOSCE scores by matriculation year.ResultsIn comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG — tasks which had not been included in the second-year preclinical training.ConclusionOur results suggest the importance of preclinical training in a CS laboratory to improve students’ competence in physical examination at the completion of introductory clinical clerkships during the first clinical year.

Detection and localization of S1 and S2 heart sounds by 3rd order normalized average Shannon energy envelope algorithm

2021 ◽  
pp. 095441192199810
Author(s):  
Madhwendra Nath ◽  
Subodh Srivastava ◽  
Niharika Kulshrestha ◽  
Dilbag Singh
Keyword(s):  
Success Rate ◽  
Heart Sound ◽  
Heart Diseases ◽  
Heart Sounds ◽  
Sound Signal ◽  
Ecg Signal ◽  
Shannon Energy ◽  
Detection And Localization ◽  
Pcg Signals ◽  
Heart Sound Signal

Adults born after 1970s are more prone to cardiovascular diseases. Death rate percentage is quite high due to heart related diseases. Therefore, there is necessity to enquire the problem or detection of heart diseases earlier for their proper treatment. As, Valvular heart disease, that is, stenosis and regurgitation of heart valve, are also a major cause of heart failure; which can be diagnosed at early-stage by detection and analysis of heart sound signal, that is, HS signal. In this proposed work, an attempt has been made to detect and localize the major heart sounds, that is, S1 and S2. The work in this article consists of three parts. Firstly, self-acquisition of Phonocardiogram (PCG) and Electrocardiogram (ECG) signal through a self-assembled, data-acquisition set-up. The Phonocardiogram (PCG) signal is acquired from all the four auscultation areas, that is, Aortic, Pulmonic, Tricuspid and Mitral on human chest, using electronic stethoscope. Secondly, the major heart sounds, that is, S1 and S2are detected using 3rd Order Normalized Average Shannon energy Envelope (3rd Order NASE) Algorithm. Further, an auto-thresholding has been used to localize time gates of S1 and S2 and that of R-peaks of simultaneously recorded ECG signal. In third part; the successful detection rate of S1 and S2, from self-acquired PCG signals is computed and compared. A total of 280 samples from same subjects as well as from different subjects (of age group 15–30 years) have been taken in which 70 samples are taken from each auscultation area of human chest. Moreover, simultaneous recording of ECG has also been performed. It was analyzed and observed that detection and localization of S1 and S2 found 74% successful for the self-acquired heart sound signal, if the heart sound data is recorded from pulmonic position of Human chest. The success rate could be much higher, if standard data base of heart sound signal would be used for the same analysis method. The, remaining three auscultations areas, that is, Aortic, Tricuspid, and Mitral have smaller success rate of detection of S1 and S2 from self-acquired PCG signals. So, this work justifies that the Pulmonic position of heart is most suitable auscultation area for acquiring PCG signal for detection and localization of S1 and S2 much accurately and for analysis purpose.

scholarly journals Exploring Neurofeedback Training for BMI Power Augmentation of Upper Limbs: A Pilot Study

Entropy ◽  
2021 ◽  
Vol 23 (4) ◽  
pp. 443
Author(s):  
Hongbo Liang ◽  
Shota Maedono ◽  
Yingxin Yu ◽  
Chang Liu ◽  
Naoya Ueda ◽  
...  
Keyword(s):  
Training Session ◽  
Training System ◽  
Eeg Signals ◽  
Shoulder Joints ◽  
Power Spectral ◽  
Training Stage ◽  
Beta Power ◽  
Eeg Changes ◽  
Machine Interface ◽  
Flexion And Extension

Electroencephalography neurofeedback (EEG-NFB) training can induce changes in the power of targeted EEG bands. The objective of this study is to enhance and evaluate the specific changes of EEG power spectral density that the brain-machine interface (BMI) users can reliably generate for power augmentation through EEG-NFB training. First, we constructed an EEG-NFB training system for power augmentation. Then, three subjects were assigned to three NFB training stages, based on a 6-day consecutive training session as one stage. The subjects received real-time feedback from their EEG signals by a robotic arm while conducting flexion and extension movement with their elbow and shoulder joints, respectively. EEG signals were compared with each NFB training stage. The training results showed that EEG beta (12–40 Hz) power increased after the NFB training for both the elbow and the shoulder joints’ movements. EEG beta power showed sustained improvements during the 3-stage training, which revealed that even the short-term training could improve EEG signals significantly. Moreover, the training effect of the shoulder joints was more obvious than that of the elbow joints. These results suggest that NFB training can improve EEG signals and clarify the specific EEG changes during the movement. Our results may even provide insights into how the neural effects of NFB can be better applied to the BMI power augmentation system and improve the performance of healthy individuals.

scholarly journals Clinical Efficacy of a New Robot-assisted Gait Training System for Acute Stroke Patients

2021 ◽  
Author(s):  
Andy Chien ◽  
Fei-Chun Chang ◽  
Nai-Hsin Meng ◽  
Pei-Yu Yang ◽  
Ching Huang ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Acute Stroke ◽  
Quality Index ◽  
Pittsburgh Sleep Quality Index ◽  
Gait Training ◽  
Training System ◽  
Control Group ◽  
Stroke Patients ◽  
Robot Assisted ◽  
Significant Difference

Abstract Purpose Robot-assisted gait rehabilitation has been proposed as a plausible supplementary rehabilitation strategy in stroke rehabilitation in the last decade. However, its exact benefit over traditional rehabilitation remain sparse and unclear. It is therefore the purpose of the current study to comparatively investigate the clinical benefits of the additional robot-assisted training in acute stroke patients compared to standard hospital rehabilitation alone. Methods Ninety acute stroke patients (< 3 month) were recruited. All participants received the standard hospital neurorehabilitation comprises 45–60 min sessions daily for 3 weeks. Sixty patients also received an additional 30 min of robot-assisted gait training with the HIWIN MRG-P100 gait training system after each of the standard neurorehabilitation session. Outcome measures included: 1. Berg Balance Scale (BBS); 2. Brunnstrom Stage; 3. Pittsburgh Sleep Quality Index and 4. Taiwanese Depression Questionnaire (TDQ) which were assessed pre-treatment and then after every five training sessions. Results Both groups demonstrated significant improvement pre- and post-treatment for the BBS (robotic group p = 0.023; control group p = 0.033) but no significant difference (p > 0.1) between the groups were found. However, the robotic training group had more participants demonstrating larger BBS points of improvement as well as greater Brunnstrom stage of improvement, when compared to the control group. No significant within and between group statistical differences (p > 0.3) were found for Pittsburgh Sleep Quality Index and Taiwanese Depression Questionnaire. Conclusion The addition of robotic gait training on top of standard hospital neurorehabilitation for acute stroke patients appear to produce a slightly greater improvement in clinical functional outcomes, which is not transferred to psychological status.

Continuing Education: Improving Perceived Competence in School Nurses

2002 ◽  
Vol 18 (6) ◽  
pp. 360-363 ◽  
Author(s):  
Linda F. C. Bullock ◽  
M. Kay Libbus ◽  
Suzanne Lewis ◽  
Debra Gayer
Keyword(s):  
Continuing Education ◽  
Diabetes Management ◽  
Clinical Skills ◽  
Perceived Competence ◽  
School Nurses ◽  
School Age Children ◽  
Education Programs ◽  
Specific Content ◽  
Content Areas ◽  
Significant Difference

An investigator-designed survey was used to determine if attendance at specific continuing education programs increased the perceived competence of school nurses who enrolled and completed the programs. Respondents were queried about the general content of six courses offered by the Missouri Department of Health and Senior Services in conjunction with the University of Missouri—Columbia Sinclair School of Nursing. Specific content areas were mental health concerns, suicide prevention, diabetes management, asthma management, seizure disorders, and developing clinical skills as they pertained to school-age children. Comparing a sample of school nurses who had attended the programs with a group whom had not, a statistically significant difference was found in the participant group who reported higher self-perceived competence than the nonparticipant group in all content areas. Results of the study suggest that school nurses who attend specific continuing education programs feel more competent in practice than nurses who do not attend.

The Artisential® Articulated Laparoscopic Forceps: A Dry Lab Study to Examine Dexterity and Learning Effects in Operators with Different Levels of Laparoscopic Experience

2021 ◽  
Author(s):  
Ibrahim Darwich ◽  
Mohammad Abuassi ◽  
Christel Weiss ◽  
Dietmar Stephan ◽  
Frank Willeke
Keyword(s):  
Learning Effect ◽  
Training Session ◽  
Transfer Task ◽  
Learning Effects ◽  
Laparoscopic Instrument ◽  
Significant Difference ◽  
The Times ◽  
Time Required ◽  
Laparoscopic Experience ◽  
Different Levels

Purpose: The advent of robotic surgery has highlighted the advantages of articulation. This dry-lab study examined the dexterity and learning effect of a new articulated laparoscopic instrument: the ArtiSential® forceps (LIVSMED, Seongnam, Republic of Korea). Methods: A peg board task was designed. Three groups of volunteers with varying levels of laparoscopic expertise were organized to perform the task: expert, intermediate and novice. The participants performed the task using articulated and straight instruments, once before a 30-min training session and once afterwards. The times required to perform the task were recorded. The performances were analyzed and compared between the groups as well as between the straight and articulated instruments. Results: The experts were significantly faster than the novices with both instruments before the 30-min training session (p = 0.0317 for each instrument). No significant time difference was found among the three groups after the 30-min training session. The decrease in the time required to perform the peg-transfer task with the articulated instrument was significantly greater in the novice and intermediate groups (p = 0.0159 for each group). No significant difference in time reduction was observed between the groups with the straight instrument. Regardless of the user, the articulated device was associated with faster task performance than the straight device after 8 hours of training (p = 0.0039). Conclusion: The ArtiSential® articulated device can improve dexterity. A significantly greater learning effect was observed in the novice and intermediate groups in comparison with experts. A plateau in the learning curve was observed after a few hours of training.

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