Simplifying touch data from tri-axial sensors using a new data visualization tool.

Quantification and evaluation of palpation is a growing field of research in medicine and engineering. A newly developed tri-axial touch sensor has been designed to capture a multi-dimensional profile of touch-loaded forces. We have developed a data visualization tool as a first step in simplifying interpretation of touch for assessing hands-on clinical performance.

Clinical examination simulation: getting to real.

Verschuren and Hartog's six-stage methodology for design-oriented research is a process that is ideally suited to the development of artifacts that meet a desired outcome. We discuss the methodology and its relevance to simulation development for establishing a wide variety of realistic clinical breast examination models that can be used for assessment.

Expanding the use of simulators as assessment tools: the new pop quiz.

This study introduces a novel way to implement simulation in medical education. We investigated the feasibility of integrating a newly developed breast examination simulator into a breast exam technique lecture while also collecting detailed data on medical students' breast exam skills. Results indicate that it is feasible to integrate simulation technology into the classroom environment and collect detailed performance data that can be analyzed and used for skills assessment.

Are commercially available simulators durable enough for classroom use?

Our efforts show that commercially available simulators can be modified to affect realism and durability.

Use of sensor technology to explore the science of touch.

Two, world-renown researchers in the science of touch (Klatzky and Lederman) have shown that there are a set of reproducible and subconscious maneuvers that humans use to explore objects. Force measuring sensors may be used to electronically identify and quantify these maneuvers. Two sensored silicone breast models were configured to represent two different clinical presentations. One-hundred clinicians attending a local breast cancer meeting performed clinical breast examinations on the models, and their performance was captured using sensor-based data acquisition technology. We have found that Klatzy and Lederman's previously defined touch maneuvers are used during the clinical breast examination and can be identified and quantified for the first time using sensor technology.

Toward a simulation and assessment method for the practice of camera-guided rigid bronchoscopy.

We have developed a way to measure performance during a camera-guided rigid bronchoscopy using manikin-based simulation. In an effort to measure contact pressures within the airway during a rigid bronchoscopy, we instrumented pressure sensors in a commercially available bronchoscopy task trainer. Participants were divided into two groups based on self-reported levels of expertise: novice (none to minimal experience in rigid bronchoscopy) and experts (moderate to extensive experience). There was no significant difference between experts and novices in the time taken to complete the rigid bronchoscopy. However, novices touched a greater number of areas than experts, showing that novices induce a higher number of unnecessary soft-tissue contact compared to experts. Moreover, our results show that experts exert significantly less soft tissue pressure compared to novices.

A simulation-based assessment of clinical breast examination technique: do patient and clinician factors affect clinician approach?

BACKGROUND: Recent publications describing widely accepted clinical breast examination (CBE) techniques have sparked interest in setting standards for CBE. In support of CBE training and assessment, the purpose of our study was to quantify CBE palpation techniques using simulation technology and assess the affects of clinical presentation and clinician background on CBE techniques. METHODS: Three sensored silicone breast models were configured to represent 3 different clinical presentations. The models were examined by 102 clinicians at a local breast cancer meeting, and their performance was captured by using sensored based data acquisition technology. RESULTS: Clinicians had significantly longer examination times on the fatty breast with no masses compared with the breast with a dominant mass and the breast with fibrocystic changes (66.37 seconds, 40.50 seconds, and 42.28 seconds, P < .05). In addition, on average, female clinicians had significantly greater examination times (females = 56.66 seconds, males = 42.09 seconds, P < .05) and touched more sensors (females = 7.97, males = 6.30, P < .05) with greater pressures (females = 5.21, males = 4.82, P < .05) than their male counterparts. CONCLUSIONS: Clinical presentation and clinician background may affect CBE technique yet does not appear to negatively affect clinician accuracy. Additional research quantifying the range of CBE techniques used in medical practice may inform CBE standardization and competency testing.

Fear of missing a lesion: use of simulated breast models to decrease student anxiety when learning clinical breast examinations.

BACKGROUND: Medical students experience a considerable amount of discomfort during their training. The purpose of the current study was to identify sources of student anxiety when learning clinical breast examinations (CBEs) and to evaluate the effects of simulated breast models on student comfort. METHODS: Simulated breast models were introduced into the curriculum for 175 second-year medical students. Using surveys, students identified sources of anxiety and rated their comfort levels when learning CBE skills. RESULTS: "Fear of missing a lesion" and the "Intimate/personal nature of the exam" accounted for 73.8% of student anxiety when learning CBEs. In addition, there were significant improvements (P < .05) in student comfort levels when using simulated breast models to learn CBE skills. CONCLUSIONS: We have identified 2 of the top causes of anxiety for second-year medical students learning CBE. In addition, we found simulated breast models to be effective in increasing student comfort levels when learning CBEs.