No abstract

OBJECTIVE To compare the effect of simulator functional fidelity (manikin vs a Dynamic Haptic Robotic Trainer [DHRT]) and personalized feedback on surgical resident self-efficacy and self-ratings of performance during ultrasound-guided internal jugular central venous catheterization (IJ CVC) training. In addition, we seek to explore how self-ratings of performance compare to objective performance scores generated by the DHRT system. DESIGN Participants were randomly assigned to either manikin or DHRT IJ CVC training over a 6-month period. Self-efficacy surveys were distributed before and following training. Training consisted of a pretest, 22 practice IJ CVC needle insertion attempts, 2 full-line practice attempts, and a posttest. Participants provided self-ratings of performance for each needle insertion and were presented with feedback from either an upper level resident (manikin) or a personalized learning system (DHRT). SETTING A study was conducted from July 2016 to February 2017 through a surgical skills training program at Hershey Medical Center in Hershey, Pennsylvania. PARTICIPANTS Twenty-six first-year surgical residents were recruited for the study. Individuals were informed that IJ CVC training procedures would be consistent regardless of participation in the study and that participation was optional. All recruited residents opted to participate in the study. RESULTS Residents in both groups significantly improved their self-efficacy scores from pretest to posttest (p < 0.01). Residents in the manikin group consistently provided higher self-ratings of performance (p < 0.001). Residents in the DHRT group recorded more feedback on errors (228 instances) than the manikin group (144 instances). Self-ratings of performance on the DHRT system were able to significantly predict the objective score of the DHRT system (R2 = 0.223, p < 0.001). CONCLUSION Simulation training with the DHRT system and the personalized learning feedback can improve resident self-efficacy with IJ CVC procedures and provide sufficient feedback to allow residents to accurately assess their own performance.

The realism in cutting force and ultrasound visualization was determined for a variety of phantom materials. Novel modified PVC polymer has great potential for use in ultrasound phantoms because of its realistic ultrasound imaging and modifiable stiffness. This customizability allows for easy creation of multilayer tissue phantoms.

Central venous catheterization (CVC) is a medical procedure where a surgeon attempts to place a catheter in the jugular, subclavian, or femoral vein. While useful, this procedure places patients at risk of a wide variety of adverse effects. Traditionally, training is performed on CVC mannequins, but these mannequins cannot vary patient anatomy. This work describes the development of a mobile training platform utilizing a haptic robotic arm and electromagnetic tracker to simulate a CVC needle insertion. A haptic robotic arm with custom syringe attachment used force feedback to provide the feeling of a needle insertion. A virtual ultrasound environment was created and made navigable by a mock ultrasound probe containing a magnetic tracking device. The effectiveness of the system as a training tool was tested on 12 medical students without CVC experience. An average increase in successful first insertion of 4.2% per practice scenario was seen in students who trained exclusively on the robotic training device. The robotic training device was able to successfully vary the difficulty of the virtual patient scenarios which in turn affected the success rates of the medical students. These results show that this system has the potential to successfully train medical residents for future CVC insertions.