Implementing virtual worlds for systematic training of prehospital CPR in medical school.

We report on a study that investigates the relationship between repeated training of teams managing medical emergencies in the Virtual World and affective learning outcomes in a group of 12 medical students. The focus of the training was on individual actions, but also on interaction and behaviour in the team. Current CPR training seems to lack important team training aspects which this type of training is addressing. We found an increase in flow experience and in self efficacy. This type of training could probably be expanded to other groups for a similar purpose because of its easiness to use, adaptability and interactivity.

Evaluation of a surgical simulator for learning clinical anatomy.

BACKGROUND: New techniques in imaging and surgery have made 3-dimensional anatomical knowledge an increasingly important goal of medical education. This study compared the efficacy of 2 supplemental, self-study methods for learning shoulder joint anatomy to determine which method provides for greater transfer of learning to the clinical setting. METHODS: Two groups of medical students studied shoulder joint anatomy using either a second-generation virtual reality surgical simulator or images from a textbook. They were then asked to identify anatomical structures of the shoulder joint as they appeared in a videotape of a live arthroscopic procedure. RESULTS: The mean identification scores, out of a possible score of 7, were 3.1 +/- 1.3 for the simulator group and 2.9 +/- 1.5 for the textbook group (P = 0.70). Student ratings of the 2 methods on a 5-point Likert scale were significantly different. The simulator group rated the simulator more highly as an effective learning tool than the textbook group rated the textbook (means of 3.2 +/- 0.7 and 2.6 +/- 0.5, respectively, P = 0.02). Furthermore, the simulator group indicated that they were more likely to use the simulator as a learning tool if it were available to them than the textbook group was willing to use the textbook (means of 4.0 +/- 1.2 and 3.0 +/- 0.9, respectively, P = 0.02). CONCLUSION: Our results show that this surgical simulator is at least as effective as textbook images for learning anatomy and could enhance student learning through increased motivation. These findings provide insight into simulator development and strategies for learning anatomy. Possible explanations and future research directions are discussed.

Simulated learning environments in anatomy and surgery delivered via the next generation internet.

The Next Generation Internet (NGI) will provide high bandwidth, guaranteed Quality of Service, collaboration and security, features that are not available in today's Internet. Applications that take advantage of these features will need to build them into their pedagogic requirements. We present the Anatomy Workbench and the Surgery Workbench, two applications that require most of these features of the NGI. We used pedagogic need and NGI features to define a set of applications that would be difficult to operate on the current Internet, and that would require the features of the NGI. These applications require rich graphics and visualization, and extensive haptic interaction with biomechanical models that represent bony and soft tissue. We are in the process of implementing these applications, and some examples are presented here. An additional feature that we required was that the applications be scalable such that they could run on either on a low-end desktop device with minimal manipulation tools or on a fully outfitted high-end graphic computer with a realistic set of surgical tools. The Anatomy and Surgery Workbenches will be used to test the features of the NGI, and to show the importance of these new features for innovative educational applications.

Becoming a GP facilitator. A training approach.

The UNSW School of Medical Education has devised a training program for general practitioners to develop skills as GP facilitators involved with small groups in Continuing Medical Education programs and was offered in 1994. This program was well received by the participants and further developments are under way. Prior research on the most effective CME strategies for general practitioners confirms the value of this approach.

Prevalence and predictors of adolescent dating violence.

This study of 561 rural North Carolina adolescents examined relationships among race, parental educational level, family structure, parental discipline, family violence exposure, and dating violence experiences. The sample was predominantly female (77%), with 40% black and 58% white. The subjects ranged in age from 15 to 20 years; 80% of the adolescents were 16-18. Dating violence experiences were assessed by a researcher-constructed instrument measuring warning signs of potential violence and actual violent experiences. The results suggested that recognition of abusive relationships is difficult, with many adolescents denying such a relationship but actually reporting numerous abusive events. Sixty percent had experienced violent acts during dating relationships; 24% reported extreme violence (episodes of rape, use of weapons). More than 20% of the adolescents reported family violence and 2.2% reported family sexual abuse. The study suggests new avenues for research in adolescent date violence, and for interventions with high risk groups.

Implementation and evaluation of a new approach to clinical instruction.

An approach to clinical instruction based on the Learning Vector model was introduced in a hospital laboratory during the 1985-86 academic year. Fifteen clinical instructors and nine medical technology students participated in the study. Clinical instructors attended an initial workshop on the model and met monthly during the academic year with the project directors to discuss their progress. The implementation of the model and the reactions of students and instructors to the model were evaluated using attitudinal questionnaires, interviews, and observations. Instructors were most successful using the model during the learning activities component of clinical instruction and were less consistent in implementing the model in the expectation-setting and evaluation components of instruction. According to instructors and students, advantages of this approach included improved communication, guidance and organization of instruction, and an increased emphasis on feedback and evaluation. The major constraint to implementation was a limited amount of time spent with students, due to scheduling or workload.

Renal autoregulatory efficiency during angiotensin-converting enzyme inhibition in dogs on a low sodium diet.

Autoregulatory efficiency of renal blood flow (RBF) and glomerular filtration rate (GFR) was evaluated in 12 anesthetized dogs that had been maintained on low-sodium diet during control conditions and following infusion of an angiotensin-converting enzyme inhibitor (captopril). Converting enzyme inhibition (CEI) decreased systemic blood pressure by 15.5 +/- 3.5%, increased RBF by 36.3 +/- 6.5%, and increased GFR by 25.9 +/- 10.7%. In response to reductions in renal arterial pressure, RBF was efficiently autoregulated and did not change significantly until the 89- to 75-mm Hg range during the control period and the 74- to 54-mm Hg range during CEI. Overall GFR autoregulatory efficiency was generally well maintained during CEI; however, evaluation of the coupled autoregulatory efficiency of RBF and GFR indicated that during angiotensin blockade, there was a greater incidence of a dissociation between RBF and GFR autoregulatory efficiency. Six of the 12 dogs showed reduced GFR autoregulatory efficiency at renal arterial pressures where RBF was still well maintained. Thus, while the data indicate that blockade of the renin-angiotensin system does not abolish the basic capability of the kidney to autoregulate either RBF or GFR efficiently, more subtle influences on the coupling of RBF and GFR autoregulatory efficiency were observed at the lower level of the autoregulatory range.

Radiographic clues to fractures of the unossified medial humeral condyle in young children.

A fracture involving the trochlear ossification center as well as the medial epicondyle is a more serious injury than simple avulsion of the medial epicondyle. This diagnosis may be difficult in young children before the secondary centers are ossified. Radiographic clues to this injury in a young child are localized soft tissue swelling over the medial aspect of the elbow accompanied by a metaphyseal flake and/or a positive fat pad sign. In the older child, separation of the ossified medial epicondyle with a positive fat pad sign suggests a more complex injury.

Enteric duplication cyst.

We have described a case of cystic duplication of the small bowel in a newborn with a palpable abdominal mass. Roentgenographic studies of this patient failed to show any intrinsic abnormalities of the gastrointestinal or genitourinary tracts. At surgery, a sausage-shaped enteric duplication of the ileum was removed.