Improving Academic Performance in Medical Students Using Immersive Virtual Patient Simulation: A Randomized Controlled Trial.

OBJECTIVES: To determine whether immersive virtual patient simulation (IVPS) on the MedicActiv platform is influential in improving student academic performance in module validation tests. DESIGN: In this prospective randomized controlled study a comparison was made between IVPS training combined with regular faculty courses versus courses alone. The primary endpoint was module validation grades. Secondary endpoints were satisfaction scores (overall interest, ergonomics, realism, immersion, and training efficiency). SETTING: Angers School of Medicine, France. PARTICIPANTS: 2018 to 2019 class of fourth-year students, included on a voluntary basis. In the first semester 51 students were included, of whom 13 were excluded for lack of compliance (6 and 7 from the IVPS and control groups, respectively). In the second semester we included 57 students, of whom 10 were excluded for lack of compliance (2 and 8 from the IVPS and control groups, respectively). RESULTS: Mean age was 21 years (±0.8). There were 85 female and 23 male students. In the first semester mean grades were 13.4 ± 1.6 versus 11/.9 ± 2.4 in the IVPS and control groups, respectively (p = 0.038). In the second semester mean grades were 15.3 ± 2.5 versus 11.9 ± 3.6 in the IVPS and control groups, respectively p < 0.001. The entire study population was pooled (n = 85): mean grades were 14.5 ± 2.4 versus 11.9 ± 3 in the IVPS group and the control group, respectively, p < 0.001. The satisfaction questionnaire response rate was 54% (46/85). Score percentages ≥4 regarding overall interest, ergonomics, realism, immersion and training efficiency were 89%, 85%, 100%, 93%, and 93% respectively. CONCLUSIONS: Complementing conventional university education with simulation of virtual consultation cases on the MedicActiv platform improved student academic performance as compared with students studying regular courses. Students reported high levels of satisfaction with overall interest, ergonomics, realism, immersion and training efficiency on the MedicActiv platform.

Learning Laparoscopic Skills: Observation or Practice?

OBJECTIVE: The aim of this study was to assess the respective roles of observation and direct practice in the retention of laparoscopic skills. MATERIALS AND METHODS: Eighteen fifth-year medical students were included in a two-session laparoscopic learning course. During the first session, each participant was given four tasks to complete from the "Basic skills" and "Essential tasks" modules of the Simbionix LAP Mentor™, and another four tasks for observation only. During the second session, each participant completed all eight tasks. Performance evaluation was assessed using the objective structured assessment of technical skills (OSATS) global rating scale and LAP Mentor metrics. RESULTS: The mean OSATS score during the first session (S1) was 16.7 ± 3.2. This increased by 34% during the second session (S2), reaching 21.8 ± 2.6 in the group of former observer students (S2O, P < .0001), and by 56% (25.1 ± 1.9) in the group of former practicing students (S2A, P < .0001). The analysis of LAP Mentor metrics showed that 14 of 28 parameters (50%) improved in the S2A group compared to S1, whereas only 25% of the parameters improved in the S2O group, the difference being significant (P = .048). In both groups, the more complex the task, the more the number of improved parameters decreased. CONCLUSIONS: Although simple observation of laparoscopic skills improved further performance, direct practice on the virtual reality trainer ensured more effective training. This work therefore advocates incorporating personal training on simulators into residents' surgical curricula.

[Simulation in health care, an overview and framework for development]. / La simulation en santé, état des lieux et cadre de développement.

Following the example of Anglo-Saxon countries, which have been using it for some thirty years, simulation in health care is growing rapidly in France. The development of this challenging pedagogical method is guided by several documents published by the French National Health Authority.

Medical consultation simulations and the question of the actors - simulated or standardized patients.

The simulated or standardized patients play an increasingly role in the training of health professionals by simulation. Either professional or amateurs performers, and sometimes " real " patients, called expert patients, are acting. Actor training and preparation to achieve the simulation sessions should be rigorous. With afew exceptions, improvisation is not appropriate. The actors have rights (image, psychological support, compensation ....) but also duties (training, commitment, evaluation ....). Their participation in debriefings can be particularly useful for learners, under the control of trainers. The realism they contribute to the training simulation is an indisputable teaching tool.

[Simulation, an emerging learning tool]. / La simulation, un outil d'apprentissage en devenir.

Simulation in healthcare is part of an innovative pedagogical approach. Confronted with concrete work situations, "learners" are faced with dummies in typical working conditions. They are thereby able to practise technical procedures without any risk. Multi-professional and multi-disciplinary groups are favoured and emphasis is placed on the understanding of the job and discussion around nursing practices.

Planning safe anesthesia: the role of collective resources management.

OBJECTIVE: Anticipation and planning are essential steps of risk management but the mechanisms of planning behavior are incompletely understood, especially the factors including collective work. The aim of this research is to understand how anesthetists plan safe solution to perform anesthesia. METHODS: A study based on interviews was conducted in two French hospitals. Data processing focused on the main decisions made by 20 anesthetists during two simulated pre-anesthetic consultation. The main decisions made have been identified and the decision criteria have been analyzed. RESULTS: To ensure patient safety, all anesthetists do not plan the same solution. The rejection or the selection of solutions by each physician rests on two types of criteria: the assessment of risks for the patient and the assessment of resources available to handle the situation. For the latter, the knowledge on the individual skills of each and the adoption of "local benchmark practices" play an essential role. CONCLUSION: Ultra safe performance in highly variable systems cannot be achieved only through standardization but also through the possibility and ability of the subjects to adapt their practices to their own skills and to that of their colleagues. The conditions for the development of this "adaptative safety" are discussed.

Short-term neurological outcome of children after surgery for brain tumors: incidence and characteristics in a pediatric intensive care unit.

PURPOSE: The main treatment for majority of pediatric brain tumors relies on surgery. In postoperative period, patients require monitoring in a pediatric intensive care unit (PICU). In this study, we analyzed the incidence of postoperative neurological complications and the outcome of neurological impairment in individual patients. PATIENTS AND METHODS: Our retrospective single-center study concerned all patients who were admitted to the PICU of the University Hospital of Angers between 2002 and 2008, after brain tumor resection. Population, perioperative data, and outcome through the stay in PICU have been analyzed. RESULTS: We reported 117 neurosurgical procedures. Majority of children (85.3%) were affected by neurological deficit before surgery: cranial nerve palsy and cerebellar syndrome were the most frequent impairment. In the first 2 days, neurological symptoms improved for 27 patients (23.7%), especially in children with preoperative cerebellar syndrome, convulsions, or endocrine disorders. Mean length of stay in PICU was correlated with the severity of neurological impairment (p = 0.006). Five children presented a transient mutism after surgery for infratentorial tumors (n = 5/54, 9.2%). Eight spontaneous cerebral spinal fluid leaks occurred precociously after surgery, and neurological infections complicated half of them. Neurological infections occurred in 12 patients (ten meningitis, one ventriculitis, and one brain abscess). One patient died after surgery. CONCLUSIONS: All these complications and their risk factors have to be systematically searched for in order to decrease postoperative morbidity of brain tumors in children. They justify neurosurgeons and anesthesiologists specialized in these pathologies.

[Botulism, a clinical diagnosis]. / Botulisme, un diagnostic clinique.

Foodborne botulism results from the effect of a neurotoxin produced by a sporulated anaerobic bacillus called Clostridium botulinum. The mode of contamination occurs through the consumption of foodstuff, already contaminated by the neurotoxin. Following an incubation period that varies from 2 hours to 8 days, the symptoms start with intestinal problems. Then paralysis of the cranial nerve pairs sets in, classically manifested by diplopia, dysphagia, dysphonia, areactive mydriasis and ptosis. The onset of motor disorders occurs in descending order with possible involvement of the respiratory muscles, hence requiring reanimation measures and sometimes mechanical ventilation. The diagnosis of botulism is clinical. Identification of the botulinum toxin in the blood or faeces of the patients or in the contaminating food stuff confirms the diagnosis.

[Foodborne botulism, epidemiologic aspects]. / Botulisme alimentaire, aspects epidémiologiques.

With a mean of 30 cases reported per year, following Italy, France ranks second in the European countries in terms of incidence of botulism. Food stuff of commercial origin, of artisanal or industrial manufacture fabrication, is increasingly implicated in the genesis of outbreaks of botulism. Moreover, the modern methods of conserving food (vacuum packed food, frozen food...) allow the development of Clostridium bacteria. The diversification of the risks related to the type of products incriminated and to the new conservation methods, associated with the extension of commercial exchanges, result in the risk of widespread internationally outbreaks of botulism.

[Foodborne botulism, prevent and treatment]. / Botulisme alimentaire, prévention et traitement.

The United States and Europe agree that the treatment of botulism is based on symptomatical measures and, notably, on mechanical ventilation when the respiratory function is impaired. Opinions diverge regarding the specific treatment represented by anti-botulinum serum: used systematically in the United States and frequently in many European countries, France never uses it other than in a few cases. Identification of the contaminating foodstuff is a fundamental element in limiting extension of the disease. Reducing the delay in declaration and the identification and correction of bad cooking practices would help to reduce the number of cases of botulism.

[Key points.] / Botulisme, un diagnostic clinique.

BOTULISM, A CLINICAL DIAGNOSIS:

[Key points.] / Botulisme alimentaire, prévention et traitement.

FOODBORNE BOTULISM, PREVENT AND TREATMENT:

Simulation of human gentamicin pharmacokinetics in an experimental Enterococcus faecalis endocarditis model.

Significant differences between animal and human pharmacokinetics may be responsible for the conflicting results of experimental studies. This study determined the impact of human pharmacokinetic simulation (HPS) on gentamicin activity in an Enterococcus faecalis endocarditis model. The decrease in bacterial counts was greater with HPS than with a dose-equivalent regimen without HPS.

The therapeutic use of magnesium in anesthesiology, intensive care and emergency medicine: a review.

PURPOSE: To review current knowledge concerning the use of magnesium in anesthesiology, intensive care and emergency medicine. METHODS: References were obtained from Medline(R) (1995 to 2002). All categories of articles (clinical trials, reviews, or meta-analyses) on this topic were selected. The key words used were magnesium, anesthesia, analgesia, emergency medicine, intensive care, surgery, physiology, pharmacology, eclampsia, pheochromocytoma, asthma, and acute myocardial infarction. PRINCIPLE FINDINGS: Hypomagnesemia is frequent postoperatively and in the intensive care and needs to be detected and corrected to prevent increased morbidity and mortality. Magnesium reduces catecholamine release and thus allows better control of adrenergic response during intubation or pheochromocytoma surgery. It also decreases the frequency of postoperative rhythm disorders in cardiac surgery as well as convulsive seizures in preeclampsia and their recurrence in eclampsia. The use of adjuvant magnesium during perioperative analgesia may be beneficial for its antagonist effects on N-methyl-D-aspartate receptors. The precise role of magnesium in the treatment of asthmatic attacks and myocardial infarction in emergency conditions needs to be determined. CONCLUSIONS: Magnesium has many known indications in anesthesiology and intensive care, and others have been suggested by recent publications. Because of its interactions with drugs used in anesthesia, anesthesiologists and intensive care specialists need to have a clear understanding of the role of this important cation.