Medical Training

In healthcare, developing high procedural skill levels through training is a key factor for obtaining good clinical results on surgical procedures. Providing feedback to each student tailored to how the student has performed the procedure each time, improves the effectiveness of the training. Current state-of-the-art feedback relies on Checklists and Global Rating Scales to indicate whether all process steps have been performed and the quality of each execution step. However, there is a process perspective not successfully captured by those instruments, e.g., steps performed but in an undesired order, part of the process repeated an unnecessary number of times, or excessive transition time between steps. In this work, we propose a novel use of process mining techniques to effectively identify desired and undesired process patterns regarding rework, order, and performance, in order to complement the tailored feedback of surgical procedures using a process perspective. The approach has been effectively applied to analyze a real Central Venous Catheter installation training case. In the future, it is necessary to measure the actual impact of feedback on learning.

In 1994 and 1995, the Medical Council of Canada used an innovative approach to set the pass mark on its large scale, multi-center national OSCE which is designed to assess basic clinical and communication skills in physicians in Canada after 15 months of post-graduate medical training. The goal of this article is to describe the new approach and to present the experience with the method during its first two years of operation. The approach utilizes the global judgments of the physician examiners at each station to identify the candidates with borderline performances. The scores of the candidates whose performances are judged to be borderline are summed for each station, yielding an initial passing score for all stations and then the examination as a whole. The latter score is then adjusted upward one standard error of measurement for the final passing score and is used as one of the criteria to pass the examination. Based on the results to date, the new approach has worked well. The...

In this paper, a patient model is used in the core of a medical training simulator. A concrete case is developed and validated by an expert. The process followed in description, designing and evaluation of this case is described in detail. In addition, a windows based application is developed using visual C++ in order to assist during this designing process.

Making decisions about the care of individual patients is fundamental to health care. For each patient, many decisions have to be made. In the emergency room, for example, a doctor should decide which patient to see first, decide whether an x-ray should be made of an injured ankle, and decide how this specific ankle fracture of this specific patient should be treated. Medical training is focused on acquiring the knowledge and experience to make such decisions. Other factors that are essential for patient care, including empathy and technical abilities, also involve decision making. For example, in the outpatient clinic, a trade-off is needed when one patient needs more time and empathy, but the waiting room is packed and the physician is an hour behind schedule. In the operating room, a surgeon must decide whether to proceed with a complicated laparoscopic procedure to remove a gall bladder, to convert to an open procedure, or to ask a more experienced surgeon for help.

Object Nowadays, most of the surgical training programs follow a duration-based format that focuses on improving technical skills of trainees for a fixed amount of time before declaring their proficiency. More recently, different approaches have been proposed for the skills assessment; such as the objective structured clinical examination (OSCE). The OSCE consists of different stations in which trainees are required to perform practical exams while their performance is evaluated by examiners. However, their performance cannot be easily assessed by the simple observation of the task. As a result, no standard evaluation criteria can be conceived. Methods Thanks to the recent advances in Robot Technology (RT); more efficient training systems can be conceived. In particular, authors believe in the importance of developing automated training devices designed to provide training progress quantitative information of trainees. For this reason, at Waseda University, since 2004, we have proposed as a long-term research goal, the development of a Patient Robot which nearly reproduces the human body anatomy and physiology by embedding sensors and actuators into a human model. Due to the complexity of patient robot development, as a first approach, we have proposed the development of a Suture/Ligature Training System. In this paper, the details of Waseda-Kyotokagaku Suture No. 2 Refined II (WKS-2RII) are presented. The WKS-2RII has been designed to reproduce the task conditions of the suture and ligature as well as to provide quantitative information of artificial skin movement, and the physical properties of the suture. From such collected data, we have proposed an Evaluation Function that integrates all the proposed evaluation parameters. Results In order to verify the effectiveness of the WKS-2RII, a set of experiments were proposed to analyze the performance of subjects while performing the task with the WKS-2RII. The experiments were designed to determine if the proposed system may provide more detailed information of the task in a quantitative way. From the experimental results, we have confirmed that the WKS-2RII is capable of providing quantitative assessment of the task. In contrast to the conventional training methods (i.e., OSCE, etc.), the WKS-2RII can provide more detailed information of the task performance, so that the proposed system can detect the differences among different level of expertise (five surgeons, five medical students and five unskilled persons) as well as detect improvements of trainees by plotting the learning curve. Conclusions In this paper, we have presented the improvements on the WKS-2RII and a unique evaluation function has been proposed. Regarding the weighting coefficients, the discriminant analysis method was used to determine the optimal values of the weighting coefficients.

This article deals with the presence of physicians, surgeons and  apothecaries in the early modern Portuguese empire and the dissemination of medical knowledge there. In Portugal itself, the health care sector had been the target of considerable royal interference since the final years of the fifteenth century, during the construction of the early modern state. Regulatory frameworks were established to harmonise health care practice throughout the country and to control the organisation and distribution of the available health care
practitioners among local communities. As this was also the time when Portugal was investing heavily in its colonies, how were these policies reflected in the empire? Did health care feature in the Portuguese
government’s colonial strategies? How did the official policy to send medical personnel overseas work on the ground? Did it operate at a large enough scale to transform local practices?

This article contributes to knowledge on medical training and careers at a time of change driven by Enlightenment ideas, but also a time of conflict between age-old structures and new legal frameworks. By analyzing an individual trajectory in interaction with other individuals and institutions, the contradictions of the historical context that constrained the life of José Pinto de Azeredo are brought to light. The circumstances surrounding his professional activity are analyzed an aspect of this physician's trajectory that was until now unstudied. Some hypotheses are formulated to explain why he did not reach the objectives he set for himself.

This article reports a study comparing the problem-solving performance of housestaff with undergraduate medical training in either conventional or problem-based schools. After reading two clinical cases, residents were required to write differential diagnoses and pathophysiological explanations. Biomedical and clinical knowledge used and reasoning strategies were identified. The results suggest that housestaff performance is influenced by the nature of instruction. Housestaff trained in a conventional curriculum (CC) focused on patient information, separated biomedical from clinical knowledge, and used data-driven strategies. Housestaff from problem-based learning curricula (PBLC) organized their knowledge around generated inferences, integrated biomedical and clinical knowledge, and used hypothesis-driven strategies. Data-driven reasoning appears to be impeded in PBLC, suggesting that PBLC students have difficulties in acquiring problem schemata. Previous investigations also found ...

Summary. Concern is often expressed about the English language proficiency (ELP) of students engaged in professional training. This report assesses the ELP of the 1990 and 1991 intakes into medicine at the University of Sydney. A quick screening test and individual in-depth tests were used in a two-stage design. Admission to the course is highly competitive and most students are selected from the top 0.75% of Higher School Certificate results but 15% and 19% of the year cohorts were found to be below average in ELP. English proficiency was found to be consistently correlated with first- and second-year university results. Initiatives taken to support students with language disadvantages and to ensure that graduates will be able to communicate effectively with patients are outlined.