No abstract

No abstract

Developing high levels of competence in the execution of surgical procedures through training is a key factor for obtaining good clinical results in healthcare. To improve the effectiveness of the training, it is advisable to provide feedback to each student tailored to how the student has performed the procedure on each occasion. Current state-of-the-art feedback is based on Checklists and Global Rating Scales, which indicate whether all process steps have been carried out and the quality of each execution step. However, there is a process perspective that is not captured successfully by these instruments, e.g., steps performed, but in an undesired order, group of activities that are repeated an unnecessary number of times, or an excessive transition time between two consecutive steps. In this research, we propose a novel use of process mining techniques to effectively identify desired and undesired process patterns regarding rework, the order in which activities are performed, and time performance, in order to complement the tailored feedback for surgical procedures using a process perspective. The proposed approach was applied to analyze a real case of ultrasound-guided Central Venous Catheter placement training. It was quantitatively and qualitatively validated that the students who participated in the training program perceived the process-oriented feedback they received as favorable for their learning.

A similar EC50 but more respiratory depression, sedation and PONV were found with fentanyl TCI than with remifentanil TCI.

Introduction Bronchoscopy-guided percutaneous dilatational tracheostomy (BG-PDT) is an invasive procedure regularly performed in the intensive care unit. Risk of serious complications have been estimated in up to 5%, focused during the learning phase. We have not found any published formal training protocols, and commercial simulators are costly and not widely available in some countries. The objective of this study was to present the design and simulator performance of a low-cost BG-PDT simulator. Methods A simulator was designed with materials available in a hardware store, synthetic skin pads, ex vivo bovine tracheas, and a pipe inspection camera. The simulator was tested in 8 experts and 9 novices. Sessions were video recorded, and participants were equipped with the Imperial College Surgical Device, a hand motion–tracking device. Performance was evaluated with a multimodal approach, including first attempt success rate, global success rate, total procedural time, Imperial College Surgical Device–derived proficiency parameters, and global rating scale applied blindly by 2 expert observers. A satisfaction survey was applied after the procedure. Results A simulator was successfully constructed, allowing multiple iterations per assembly, with a fixed cost of US $30 and $4 per use. Experts had greater global and first attempt success rate, performed the procedure faster, and with greater proficiency. It presented high user satisfaction and fidelity. Conclusions A low-cost BG-PDT simulator was successfully constructed, with the ability to discriminate between experts and novices, and with high fidelity. Considering its ease of construction and cost, it can be replicated in almost any intensive care unit.