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PubMed1978

The use of instructor-patients to teach physical examination techniques.

The increasing difficulty in obtaining appropriate hospitalized patients to give enlarging classes of medical students their first exposure to abnormal physical findings has led to the development of an instructor-patient program. Sixteen community residents with relatively stable respiratory, cardiovascular, musculoskeletal, or neurological findings were recruited and trained as instructor-patients to teach the technical elements of the examination of the affected organ system. Evaluation of the technical skills of 46 second-year students trained by instructor-patients and those of 41 randomly selected students trained in these skills by physician instructors demonstrated that the two have comparable technical skills five to eight weeks after the training sessions. Faculty recruitment, instructor-patient recruitment and training, and evaluation are discussed.

Education, Medical, Undergraduate↗

PubMed2002

An essay on the Houston Conference policy statement: static yet incomplete or a work in progress?

Ardila (Neuropsychol. Rev. 12: 3, 2002) criticizes the Policy Statement from the Houston Conference on Specialty Education and Training in Clinical Neuropsychology (Hannay et al., Arch. Clin. Neuropsychol. 13: 157-250, 1998) as possessing deficiencies in the training of clinical neuropsychologists in three fundamental knowledge areas: the history of the discipline, neuropsychological syndromes, and neuropsychological theory. These problems are seen here as a result of a more pervasive problem associated with the Houston Conference training model's emphasis on technical skill over science and the attempt to micromanage the training of the clinical neuropsychologist at the administrative level.

Humans↗

PubMedDate not supplied

[Scientific evidence in medicine: the only alternative?].

The present article aims to reflect on the current situation of medical sciences by incorporating a critical discussion of knowledge atomization, which can be a consequence of the pragmatism of scientific evidence. The article proposes to integrate the contributions of quantitative and qualitative methodologies in health sciences, paying attention to qualitative and quantitative designs that take into account the complexity of human beings and their axiological, social, and cultural referents.The authors defend and argue for the need for health research to contemplate five useful dimensions for decision-making, approaching the object of the study and without eliminating the subject and his/her polyhedral and complex circumstances. Medicine must unavoidably consider technological and technical knowledge, but this training must not elude the necessary relational and communicative competences. Scientific and medical updating implies a constant close association between technical rigor and improved links among the individuals involved (health professionals and the public), with a careful and respectful attitude. Community activity and the gradual establishment of complicities are put forward as the basis for an integrative health model, with biopsychosocial roots, both at a theoretical and a practical level.

Attitude of Health Personnel↗

PubMedDate not supplied

[Laparoscopic cholecystectomy].

Laparoscopic digestive surgery is right now like a revolution. The author, after a short historic hommage to Raoul Palmer who in 1940 realized the first laparoscopy and also to Philippe Mouret and François Dubois who performed the first laparoscopic cholecystectomy in the world in 1987, is doing some comments. The comments are based in the experience of the author who performed in his surgical department about 400 cholecystectomies and another study realized with B. Delaitre on 6512 cases showing a decrease of morbidity however a dramatic increase of biliary complications from 1/1000 to 1% this leads the author to two types of reflexions. One based on technical problem especially in high frequency surgery, the other in training of this new surgical technic and also on rapid extension, sometime anarchistic, of the indications of this new digestive laparoscopic surgery. In conclusion, we have to performed clinical research before doing next applications of laparoscopic surgery and keep in mind the necessity for a new technic to be better for patients.

Absenteeism↗

PubMed1993

[Celioscopic cholecystectomy].

Laparoscopic digestive surgery is right now like a revolution. The author after a short historic homage to Raoul Palmer who in 1940 realized the first laparoscopy and also to Philippe Mouret and François Dubois who performed the first laparoscopic cholecystectomy in the world in 1987, is doing some comments. The comments are based in the experience of the author who performed in his surgical department about 400 cholecystectomies and another study realized with B. Delaitre on 6512 cases showing a decrease of morbidity however a dramatic increase of biliary complications from 1.0/00 to 1% this leads the author to two type of reflexions. One based on technical problem especially in high frequency surgery the other in training of this new surgical technic and also on rapid extension, sometime anarchistic of the indications of this new digestive laparoscopic surgery. In conclusion, we have to performed clinical research before doing next applications of laparoscopic surgery and keep in mind the necessity for a new technic to be better for patients.

Cholecystectomy, Laparoscopic↗

PubMed1999

Evaluation of laparoscopic skills: a 2-year follow-up during residency training.

OBJECTIVE: To evaluate laparoscopic technical skill in surgical residents over a 2-year period. DESIGN: The laparoscopic technical skills of general surgical residents were evaluated using the MISTELS program. This provides an objective evaluation of laparoscopic skill, taking into account precision and speed. SETTING: Inanimate laparoscopic skills centre. PARTICIPANTS: Ten general surgical residents (5 PGY1, 3 PGY2 and 2 PGY3 residents) who were required to complete 3 structured laparoscopic tasks. OUTCOME MEASURES: A composite score incorporating precision and timing was assigned to each task. The paired t-test was used to compare performance of each resident at the 2 levels of their residency training for each task. Linear regression analysis was used to correlated level of training and total score (sum of all tasks). RESULTS: Linear regression analysis demonstrated a highly significant correlation between level of training and total score (r = 0.82, p < 0.01). There was a significant increase in scores in the cutting and suturing task over the 2-year period (p < 0.01). Transferring skills did not improve significantly (p = 0.11). CONCLUSIONS: Performance in the simulator improved over residency training and was correlated highly with postgraduate year. This simulator model is a valuable teaching tool for training and evaluation of basic laparoscopic tasks in laparoscopic surgery.

Canada↗

PubMed2004

Competency-based training of basic trainees using human cadavers.

BACKGROUND: Increasing constraints on operative training in the clinical setting provide impetus for the development of alternative training models. Anatomy dissection courses utilizing human cadavers have been useful in imparting knowledge of human anatomy for surgical trainees. The present study evaluates the impact of competency-based technical skills instruction as an adjunct to cadaveric dissection courses on the procedural skills of basic surgical trainees (BST). METHODS: A single cohort of BST was prospectively evaluated regarding their self-reported confidence and competency in performing saphenous vein cutdowns immediately before and after an anatomy dissection course. RESULTS: Nine BST were evaluated (66% were male). One subject withdrew from the study, leaving eight BST for final analysis. Mean number of years since graduation from medical school was 2.5 years (range: 2-4 years). Seven BST were in their first year of training. All subjects had completed an early management of severe trauma (EMST) course. Total prior experience of saphenous vein cutdowns for all subjects was a single attempt on a sheep cadaver at the EMST course. The percentage of BST expressing little or no confidence in performing cutdowns decreased after the dissection course (50% vs 0, P < 0.05). Mean time taken for completion of cutdown decreased after the dissection course. (5 min 52 s vs 3 min 52 s, P < 0.05). Mean size of incision used to perform cutdown decreased after the course. (4.5 cm vs 3.4 cm, P < 0.05). The percentage of subjects experiencing complications during cutdown decreased after the course (38% vs 0, P < 0.05). CONCLUSIONS: Anatomy dissection courses using human cadavers may contribute to improving the confidence and competency of BST in performing saphenous vein cutdowns. Technical training components should be considered as an adjunct to future anatomy dissection courses involving surgical trainees.

Anatomy↗

PubMedDate not supplied

Expanding acute care nurse practitioner and clinical nurse specialist education: invasive procedure training and human simulation in critical care.

Programs educating advanced practice nurses (APNs), including acute care nurse practitioners (ACNPs) and clinical nurse specialists (CNSs) may struggle with the degree to which technical and cognitive skills necessary and unique to the care of critically ill patients should be incorporated within training programs, and the best ways these skills can be synthesized and retained for clinical practice. This article describes the critical care technical skills training mechanisms and use of a High-Fidelity Human Simulation (HFHS) Laboratory in the ACNP and CNS programs at the University of Pittsburgh School of Nursing. The mechanisms for teaching invasive procedures are reviewed including an abbreviated course syllabus and documentation tools. The use of HFHS is discussed as a measure to provide students with technical and cognitive preparation to manage critical incidents. The HFHS Laboratory, scenario development and implementation, and the debriefing process are discussed. Critical care technical skills training and the use of simulation in the curriculum have had a favorable response from students and preceptors at the University of Pittsburgh School of Nursing, and have enhanced faculty's ability to prepare APNs.

Acute Disease↗

PubMed2006

Development and evaluation of home-based speed-of-processing training for older adults.

OBJECTIVES: To develop technical parameters for a videotape-based speed-of-processing training protocol, to evaluate the feasibility of self-administration (experiment 1), and to evaluate the protocol's effectiveness (experiment 2). DESIGN: A feasibility study (experiment 1) and a pre-post, 4-arm, nonrandomized controlled trial (experiment 2). SETTING: University research center. PARTICIPANTS: A population-based sample (37 men, 47 women; age range, 65-94y) (experiment 1). A population-based sample (age > or =65y) with no prior exposure to the Useful Field of View assessment or speed-of-processing training, no dementia or life-limiting illness, a Mini-Mental State Examination score of greater than 24, corrected far visual acuity of greater than or equal to 20/40, contrast sensitivity of greater than or equal to 1.50 log(10), and deficient processing speed (experiment 2). For experiment 2, 8 of 189 eligible people declined to participate. The final sample for this experiment included 100 men and 81 women (age range, 65-91y). INTERVENTIONS: Eight to ten 1-hour cognitive training sessions. MAIN OUTCOME MEASURE: Posttraining gains in processing speed. RESULTS: Self-administration was feasible. Subjects who underwent home-based training improved their processing speed significantly more than either control group (F(3,146)=16.16, P<.001). Their gains were 74% as great as the gains of those who underwent trainer-facilitated speed-of-processing training. CONCLUSIONS: People can improve their processing speed at home using readily available technology. Future research should explore the relation of these improvements to driving performance.

Activities of Daily Living↗

PubMed2000

[Methods for quality assurance of medical examination in epidemiological field studies: the "Study of Health in Pomerania" (SHIP)].

The aims of the population-based, cross-sectional survey "Study of Health in Pomerania" (SHIP) are to describe prevalences and distributions of a broad range of diseases, as well as environmental and behavioural risk factors in the region of Pomerania (North-eastern Germany). The examinations are performed in two study units by different physicians, technicians and interviewers and laboratory analyses in two separate laboratories. In addition, the study will take at least 3 years and approximately 7000 persons will be examined. Because of the design of the study a special concept of quality assurance is indispensable. In the present paper methods are presented for quality assurance and control in anthropometry, ECG, echocardiography, abdominal sonography, carotid ultrasound, sonography of the thyroid gland, blood pressure measurements as well as clinical laboratory analyses. The technical control protocols, the training programmes of the observers and methods to establish observer and method variabilities are presented by means of typical examples. The logistic, personal and technical measures for quality assurance and control require appropriate attention. The methods and procedures presented here are expected to provide an effective instrument to continually monitor the quality of medical examinations in the SHIP study.

Adult↗

PubMed1989

Coping skill training in groups.

Though similar to traditional group psychotherapy in many respects, a coping skill training approach differs principally in several areas and technically in many more. Coping skill training group therapy tends to employ many concrete intervention strategies to enhance various aspects of process, drawing on ongoing data to evaluate group interaction and individual responses. The approach draws more heavily on cognitive, modeling, reinforcement, and problem-solving procedures to achieve specifically determined goals, and it depends less on interpretive and confrontative methods. The author discusses a wide range of techniques to show the benefits of this approach.

Adaptation, Psychological↗

PubMed2001

Training psychotherapists in attributes of "mind" from Zen and psychoanalytic perspectives, Part I: Core principles, emptiness, impermanence, and paradox.

This paper outlines the principles of a conceptual foundation for an innovative approach to the training of the modern psychotherapist, using certain technical and philosophical percepts found in the practice of Zen, divorced from its usual role as a form of Buddhism and/or a religious belief. A set of core principles derived from Zen and embedded in psychoanalytic theory are listed. Specific values are embodied in the day to day practice of the psychotherapist. The first of these values is the understanding of the true nature of emptiness in relation to the self and the non-Cartesian universe. Then the concept of impermanence and the centrality of paradox to the practice of Zen and psychotherapy is described. The basis of this approach to the education of the psychotherapist is grounded in the assumption that the usual training format with its focus on training in technical skills, with personal treatment being an additional requirement for many psychodynamic therapists, is insufficient for a complete educational experience. The training of the mind itself is an often forgotten and yet essential component of the training process.

Buddhism↗

PubMedDate not supplied

Experimental study of visual training effects in shooting initiation.

INTRODUCTION: The present study was conducted to investigate the influence of specific visual training in shooting initiation performance. METHODS: Seventy-one first-year university students were divided randomly into two groups. The experimental group followed a nine-session shooting training program that included technical, physical and psychological components, along with specific visual exercises. The control group followed the same program with one difference: this group received theoretical lectures on psychological training techniques instead of doing visual exercises. Pre- and post-test results were obtained for shooting, concentration, saccades and visual acuity. RESULTS: Statistical analysis indicated significant gains in the four mentioned variables for the experimental group. The control group also showed significant differences in the three first variables but no significant improvement in visual acuity. No significant differences in shooting performance were observed between groups. CONCLUSIONS: The effect of vision training on sports initiation performance is still not clear. It cannot be assumed that the improvement is transferable to the performance of precision shooting at the stage of sports initiation.

Journal Article↗

PubMed1998

Worker health and safety training: assessing impact among responders.

A mail survey was conducted among emergency responders who received training at the New Jersey/New York Hazardous Materials Worker Training Center. Responses indicate that technical topics are extremely important (i.e., decontamination, personal protection); that the vast preponderance of trainees felt confident in their ability to recall specific critical concepts in a crisis; and that 42% of respondents (75) had experienced an incident that would have resulted in injury or death without training. Phone surveys for details of specific incidents reported by 43 of the 75 mail survey respondents revealed that anecdotal data provide powerful evidence of the value of training; that extensive and uniform training is needed across jurisdictions; that training should emphasize the technical aspects of health and safety, and should include demonstration and hands-on techniques; and that integrated organizational support for implementation of health and safety practices is critical.

Decontamination↗

PubMed2000

[The characteristics of the mechanical activity of the respiratory muscles during the diaphragmatic respiration technic].

UNLABELLED: Noteworthy among breathing training techniques is so-called diaphragmatic breathing. In spite of the technique's name, however, little is known of the functional characteristics of this ventilatory method. OBJECTIVE: To asses the mechanics of respiratory muscles, particularly diaphragm muscles, during diaphragmatic breathing in patients with severe chronic obstructive pulmonary disease (COPD). METHODS: Ventilatory pattern and respiratory pressures (abdominal [Pga], intrathoracic [Pes] and transdiaphragmatic [Pdi]) were studied in 10 patients with severe COPD in stable phase (age 69 +/- 6 years, FEV1 33 +/- 12% ref) at baseline and during deep breathing with spontaneous muscle recruitment (SMR) and during breathing training. Measurements were taken with the patient seated and in supine decubitus position. RESULTS: In seated position ventilatory pattern was similar with SMR and during breathing training. Mean Pdi during airflow, however, was greater during breathing training than with SMR (34.8 +/- 8.0 and 29.3 +/- 9.3 cmH2O, respectively, p < 0.05) for similar levels of Pes. Mechanical effectiveness of the diaphragm expressed as Vt/Pdi) was less during breathing training, however (36.1 +/- 10.4 and 49.5 +/- 15.8 cc/cmH2O, p < 0.05), with no changes in overall efficacy of respiratory muscles (Vt/Pes). In supine decubitus position, ventilatory patterns of SMR and breathing training were similar, although Vt and T1 were slightly higher in the latter (1,065 +/- 305 vs. 1,211 +/- 314 cc, p < 0.01; and 2.76 +/- 1.32 vs. 3.07 +/- 1.23 sec, p < 0.05). Pdi was also higher during breathing training (29.7 +/- 10.2 and 38.0 +/- 10.5 cmH2O, p < 0.05), although accompanied in this case by a higher Pes (21.2 +/- 7.5 to 26.4 +/- 8.4 cmH2O, p < 0.005). In supine decubitus position, the effectiveness of both diaphragm muscles and respiratory muscles overall was similar for both ventilatory modes. CONCLUSIONS: Breathing training truly involves greater use of the diaphragm, both in seated and supine decubitus positions. Breathing training does not provide greater ventilatory efficacy than SMR, however, in COPD patients.

Aged↗

PubMed1990

[Perceived effort: correlation with the anaerobic threshold and usefulness in a training program].

Following the extensive technical progress in monitoring of sports performance, putting certain physiological principles out of reach for the everyday sportsman, we wondered if perceived effort (PE) as described by Borg is a parameter that is of use, or complementary, to the determination of the anaerobic threshold (AT) during an incremental test on a treadmill on one hand and to prescribing exercise adapted to the type of metabolic load on the other. 46 sportsmen (various soccer players, regional runners) were asked to complete a Conconi Test on a treadmill and at the same time were asked to evaluate their PE (as defined by Borg) at each performance level. We then plotted PE as a function of running speed, thus finding a point of inflexion (ascending) for PE. The speed corresponding to this point shows an excellent correlation with the AT as determined from cardiac frequency. The absolute value of PE at the AT varied little within our group, but seemed to vary according to the type of sport and the subjects' sports practice. Taking the limitations of this method in consideration, PE may be used as an additional indicator in the determination of the AT in an incremental AT-test and can be useful in the prescription of an exercise program.

Adolescent↗

PubMed1995

[Heart patient and sports].

Patients with heart disease may benefit from scheduled exercising in different ways. Exercise tolerance is increased, risk factors are controlled, and even progression and regression of coronary artery disease can be influenced by training and diet. Psychological effects include lessened depression and reduced anxiety. Overall, regular physical activity is important for maintenance of health and may lead to a better quality of life. In order to minimize the risk of training, the patients should be provided with guidelines for exercising by the physician. Activities should include dynamic endurance exercises and properly selected calisthenics (without a need for high technical skills). Circuit weight training of moderate intensity is helpful for promoting muscle strength. Training has to be followed not less than 2 to 3 hours per week in at least three sessions at an intensity corresponding to 60 to 85% of the maximum heart rate achieved in a symptom-limited maximum exercise-test. Cardiac patients at high risk (decreased left ventricular function, persisting ischaemia, low exercise capacity, severe symptoms, older age) should exercise at lower intensities.

Anxiety↗

PubMed2005

Virtual reality simulation for the operating room: proficiency-based training as a paradigm shift in surgical skills training.

SUMMARY BACKGROUND DATA: To inform surgeons about the practical issues to be considered for successful integration of virtual reality simulation into a surgical training program. The learning and practice of minimally invasive surgery (MIS) makes unique demands on surgical training programs. A decade ago Satava proposed virtual reality (VR) surgical simulation as a solution for this problem. Only recently have robust scientific studies supported that vision METHODS: A review of the surgical education, human-factor, and psychology literature to identify important factors which will impinge on the successful integration of VR training into a surgical training program. RESULTS: VR is more likely to be successful if it is systematically integrated into a well-thought-out education and training program which objectively assesses technical skills improvement proximate to the learning experience. Validated performance metrics should be relevant to the surgical task being trained but in general will require trainees to reach an objectively determined proficiency criterion, based on tightly defined metrics and perform at this level consistently. VR training is more likely to be successful if the training schedule takes place on an interval basis rather than massed into a short period of extensive practice. High-fidelity VR simulations will confer the greatest skills transfer to the in vivo surgical situation, but less expensive VR trainers will also lead to considerably improved skills generalizations. CONCLUSIONS: VR for improved performance of MIS is now a reality. However, VR is only a training tool that must be thoughtfully introduced into a surgical training curriculum for it to successfully improve surgical technical skills.

Attention↗