Validation of an effective, easy-to-make hemostasis simulator.

The purpose of this study is to describe the construction method of a cost-effective, easy-to-make hemostasis simulator and to compare its effectiveness as a training tool to cadaver training. The simulator is made of materials commonly found in hospitals and clinics. These include a column manometer, a 500-ml saline bag, two intravenous fluid lines, a three-way stopcock, and a 6-mm-diameter Penrose drain. The device was tested on 10 final-year veterinary students. All participants tied 40 knots on the simulator and 40 knots on equine jejunal arteries sourced from a local abattoir. They were then asked to fill out a questionnaire comparing both methods. Participants assigned an overall assessment median score of 8.5/10 to the simulator and of 6.2/10 to cadaver practice. The simulator provided reliable haptic feedback, giving trainees a lifelike feel very close to that experienced when actually closing a blood vessel. In addition, it was effective in objectively evaluating students' ability to place ligatures on vessels. After adequate training, students' skills had significantly improved, alongside their confidence in placing hemostatic sutures. This proves our model is also useful in teaching basic open-surgery skills. Finally, its low production cost makes it ideally suited for self-practice.

The awareness and attitudes of students of one indian dental school toward information technology and its use to improve patient care.

BACKGROUND: Many obstacles need to be overcome if digital and electronic technologies are to be fully integrated in the operation of dental clinics in some countries. These obstacles may be physical, technical, or psychosocial barriers in the form of perceptions and attitudes related to software incompatibilities, patient privacy, and interference with the patient-practitioner relationship. The objectives of the study are to assess the perceptions of Indian dental students of one school toward the usefulness of digital technologies in improving dental practice; their willingness to use digital and electronic technologies; the perceived obstacles to the use of digital and electronic technologies in dental care setups; and their attitudes toward Internet privacy issues. METHODS: The study population consisted of 186 final year undergraduate dental students from the A. B. Shetty Memorial institute of Dental Sciences, Rajiv Gandhi University of Health Sciences, Mangalore, India. Survey data were analyzed descriptively . RESULTS: Most students indicated that information technology enhances patient satisfaction, the quality of dental record, diagnosis, treatment planning, and doctor-doctor communication. Cost of equipment and need for technical training were regarded as major obstacles by substantial proportions of respondents. DISCUSSION: Most dental students at our school feel that the information technology will support their decision making in diagnoses and devising effective treatment plans, which in turn increase patient satisfaction and quality of care. Students also perceived that lack of technical knowledge and the high cost of implementation are major barriers to developing information technology in India.

How we develop and sustain innovation in medical education technology: Keys to success.

The use of information technology to support the educational mission of academic medical centers is nearly universal; however, the scope and methods employed vary greatly (Souza et al. 2008 ). This article reviews the methods, processes, and specific techniques needed to conceive, develop, implement, and assess technology-based educational programs across healthcare disciplines. We discuss the core concepts, structure, and techniques that enable growth, productivity, and sustainability within an academic setting. Herein are specific keys to success with examples including project selection, theory-based design, the technology development process, implementation, and evaluation that can lead to broad participation and positive learning outcomes. Most importantly, this article shares methods to involve students, faculty, and stakeholders in technology design and the development process that fosters a sustainable culture of educational innovation.

Learning in a virtual world: experience with using second life for medical education.

BACKGROUND: Virtual worlds are rapidly becoming part of the educational technology landscape. Second Life (SL) is one of the best known of these environments. Although the potential of SL has been noted for health professions education, a search of the world's literature and of the World Wide Web revealed a limited number of formal applications of SL for this purpose and minimal evaluation of educational outcomes. Similarly, the use of virtual worlds for continuing health professional development appears to be largely unreported. METHODS: We designed and delivered a pilot postgraduate medical education program in the virtual world, Second Life. Our objectives were to: (1) explore the potential of a virtual world for delivering continuing medical education (CME) designed for physicians; (2) determine possible instructional designs using SL for CME; (3) understand the limitations of SL for CME; (4) understand the barriers, solutions, and costs associated with using SL, including required training; and (5) measure participant learning outcomes and feedback. We trained and enrolled 14 primary care physicians in an hour-long, highly interactive event in SL on the topic of type 2 diabetes. Participants completed surveys to measure change in confidence and performance on test cases to assess learning. The post survey also assessed participants' attitudes toward the virtual learning environment. RESULTS: Of the 14 participant physicians, 12 rated the course experience, 10 completed the pre and post confidence surveys, and 10 completed both the pre and post case studies. On a seven-point Likert scale (1, strongly disagree to 7, strongly agree), participants' mean reported confidence increased from pre to post SL event with respect to: selecting insulin for patients with type 2 diabetes (pre = 4.9 to post = 6.5, P= .002); initiating insulin (pre = 5.0 to post = 6.2, P= .02); and adjusting insulin dosing (pre = 5.2 to post = 6.2, P= .02). On test cases, the percent of participants providing a correct insulin initiation plan increased from 60% (6 of 10) pre to 90% (9 of 10) post (P= .2), and the percent of participants providing correct initiation of mealtime insulin increased from 40% (4 of 10) pre to 80% (8 of 10) post (P= .09). All participants (12 of 12) agreed that this experience in SL was an effective method of medical education, that the virtual world approach to CME was superior to other methods of online CME, that they would enroll in another such event in SL, and that they would recommend that their colleagues participate in an SL CME course. Only 17% (2 of 12) disagreed with the statement that this potential Second Life method of CME is superior to face-to-face CME. CONCLUSIONS: The results of this pilot suggest that virtual worlds offer the potential of a new medical education pedagogy to enhance learning outcomes beyond that provided by more traditional online or face-to-face postgraduate professional development activities. Obvious potential exists for application of these methods at the medical school and residency levels as well.

Using technology in resource limited countries for competency based education and training.

Competency based education and training (CBET) helps to prepare graduates of medical laboratory science programs for the specific needs of the workforce. This is especially important in resource-limited countries where shortage of laboratory personnel creates a large demand for skilled graduates. Internet and other technology can be useful to teach specific tasks in CBET. Even in resource-limited countries, technology can be used in the implementation of competency based education and training curricula in medical laboratory programs.

Youth as content producers in a niche social network site.

Most U.S. teenagers participate in online social network sites, devoting hours to these networks, often at the expense of other leisure-time activities. This article describes young people's activities within one topic-focused niche network, outlining its unique features and the role of young people as content producers within and beyond the space. Links between youth's online contributions and their interest, self-expression, social connections, and civic involvement are discussed.

One laptop per child, local refurbishment or overseas donations? Sustainability assessment of computer supply scenarios for schools in Colombia.

With the intention of bridging the 'digital divide' many programmes have been launched to provide computers for educational institutions, ranging from refurbishing second hand computers to delivering low cost new computers. The fast and economical provision of large quantities of equipment is one of the many challenges faced by such programmes. If an increase is to be achieved in the sustainability of computer supplies for schools, not only must equipment be provided, but also suitable training and maintenance delivered. Furthermore, appropriate recycling has to be ensured, so that end-of-life equipment can be dealt with properly. This study has evaluated the suitability of three computer supply scenarios to schools in Colombia: (i) 'Colombian refurbishment', -refurbishment of computers donated in Colombia, (ii) 'Overseas refurbishment', -import of computers which were donated and refurbished abroad, and (iii) 'XO Laptop', -purchase of low cost computers manufactured in Korea. The methods applied were: Material Flow Assessment, -to assess the quantities-, Life Cycle Assessment, -to assess the environmental impacts, and the application of the Multiple Attribute Utility Theory, -to analyse, evaluate and compare different scenarios. The most sustainable solution proved to be the local refurbishment of second hand computers of Colombian origin to an appropriate technical standard. The environmental impacts of such practices need to be evaluated carefully, as second hand appliances have to be maintained, require spare parts and sometimes use more energy than newer equipment. Providing schools with second hand computers from overseas and through programmes such as 'One Laptop Per Child' has the disadvantage that the potential for social improvements - such as creation of jobs and local industry involvement - is very low.

Using technology to teach technology.

As staff development professionals, our goal is to provide cost-effective learning opportunities that meet the objectives of the learner, the program, and the organization. The decision to use instructional technology is based on cost, time, and outcomes. This article describes one organization's use of an inexpensive and versatile software application to develop Web-based tutorials to educate and train clinical staff on a new clinical information system.

An economic analysis of patient simulators clinical training in nursing education.

Patient simulators have become widely used in medical education including increasing use in nursing education. Research suggests their usefulness in developing nursing competence. Little research to date, however, has examined the financial feasibility of the use of patient simulators as an educational tool. The extent to which a simulation lab comprising six Laerdal SimMan high-fidelity patient simulators and a staff of nurse educators is a financially feasible alternative to classroom-based education is examined.

The Future of Clinical Education: Opportunities and Challenges from Allied Health Deans' Perspective.

ISSUE: There is limited information and consensus on the future of clinical education and the key factors impacting allied health (AH) clinical training. AH deans identified both opportunities and challenges impacting clinical education based on a proposed educational model. METHODS: From July 2013 to March 2014, 61 deans whose institutions were 2013 members of the Association of Schools of Allied Health Professions (ASAHP) participated in a three-round Delphi survey. Agreement on the relative importance of and the ability to impact the key factors was analyzed. Impact was evaluated for three groups: individual, collective, and both individual and collective deans. AH deans' responses were summarized and refined; individual items were accepted or rerated until agreement was achieved or study conclusion. RESULTS: Based on the deans' ratings of importance and impact, 159 key factors within 13 clinical education categories emerged as important for the future of clinical education. Agreement was achieved on 107 opportunities and 52 challenges. CONCLUSIONS: The Delphi technique generated new information where little existed specific to AH deans' perspectives on AH clinical education. This research supports the Key Factors Impacting Allied Health Clinical Education conceptual model proposed earlier and provides a foundation for AH deans to evaluate opportunities and challenges impacting AH clinical education and to design action plans based on this research.

High fidelity medical simulation in the difficult environment of a helicopter: feasibility, self-efficacy and cost.

BACKGROUND: This study assessed the feasibility, self-efficacy and cost of providing a high fidelity medical simulation experience in the difficult environment of an air ambulance helicopter. METHODS: Seven of 12 EM residents in their first postgraduate year participated in an EMS flight simulation as the flight physician. The simulation used the Laerdal SimMantrade mark to present a cardiac and a trauma case in an EMS helicopter while running at flight idle. Before and after the simulation, subjects completed visual analog scales and a semi-structured interview to measure their self-efficacy, i.e. comfort with their ability to treat patients in the helicopter, and recognition of obstacles to care in the helicopter environment. After all 12 residents had completed their first non-simulated flight as the flight physician; they were surveyed about self-assessed comfort and perceived value of the simulation. Continuous data were compared between pre- and post-simulation using a paired samples t-test, and between residents participating in the simulation and those who did not using an independent samples t-test. Categorical data were compared using Fisher's exact test. Cost data for the simulation experience were estimated by the investigators. RESULTS: The simulations functioned correctly 5 out of 7 times; suggesting some refinement is necessary. Cost data indicated a monetary cost of 440 dollars and a time cost of 22 hours of skilled instructor time. The simulation and non-simulation groups were similar in their demographics and pre-hospital experiences. The simulation did not improve residents' self-assessed comfort prior to their first flight (p > 0.234), but did improve understanding of the obstacles to patient care in the helicopter (p = 0.029). Every resident undertaking the simulation agreed it was educational and it should be included in their training. Qualitative data suggested residents would benefit from high fidelity simulation in other environments, including ground transport and for running codes in hospital. CONCLUSION: It is feasible to provide a high fidelity medical simulation experience in the difficult environment of the air ambulance helicopter, although further experience is necessary to eliminate practical problems. Simulation improves recognition of the challenges present and provides an important opportunity for training in challenging environments. However, use of simulation technology is expensive both in terms of monetary outlay and of personnel involvement. The benefits of this technology must be weighed against the cost for each institution.

Construct Validity for a Cost-effective Arthroscopic Surgery Simulator for Resident Education.

INTRODUCTION: Arthroscopy is one of the most challenging surgical skills to assess and teach. Although basic psychomotor arthroscopic skills, such as triangulation and object manipulation, are incorporated into many simulation exercises, they are not always individually taught or objectively evaluated. In addition, arthroscopic instruments, arthroscopy cameras, and the cadaver or joint models necessary for practice are costly. METHODS: A low-cost arthroscopic simulator was created to practice triangulation, probing, horizon changes, suture management, and object manipulation. The simulator materials were purchased exclusively from national hardware stores with a total cost averaging $79. The universal serial bus (USB) camera is included in the total cost. Three residency programs accredited by the Accreditation Council for Graduate Medical Education were tested on the simulator. Replica boards were created at each institution. Participants included medical students (20), residents (46), and attending physicians (9). RESULTS: Construct validity-the ability to differentiate between novice, intermediate, and senior level participants-was obtained. On all tasks, junior residents scored at a statistically significant lower rate than senior residents and attending physicians. CONCLUSIONS: This cost-effective arthroscopic surgical simulator objectively demonstrated that attending physicians and senior residents performed at a higher level than junior residents and novice medical students. The results of this study demonstrate that this simulator could be an important training tool for resident education.

U.S. Dental School Deans' Perceptions of the Rising Cost of Dental Education and Borrowing Pressures on Dental Students: Report of Survey Results.

This report presents findings from a survey of U.S. dental school deans designed to capture their perceptions regarding the rising cost of dental education and its impact on borrowing by dental students to finance their education. The survey included questions about factors influencing the cost of dental education, concerns about dental student borrowing, and financial awareness resources for students. The survey was distributed to the deans of all 63 U.S. dental schools in January 2013; 42 deans responded, for a 67% response rate. The results indicate that, according to the responding deans, new clinical technologies, technology costs, and central university taxes are the main factors that contribute to the increasing cost of dental education. Coupled with reduced state appropriations at public dental schools and declines in private giving at all dental schools, dental school deans face a perplexing set of financial management challenges. Tuition and fees are a primary source of revenue for all dental schools; however, many deans do not have total control over the cost of attending their schools since tuition and fees are often tied to mandates and policies from the parent university and the state legislature. The findings of this study indicate that U.S. dental school deans are aware of and concerned about the impact of increases in tuition and fees on dental student debt and that they are using a variety of strategies to address the growth in dental student borrowing.

From petting zoos to electronic classrooms: meeting the technology learning needs of family medicine teachers.

BACKGROUND AND OBJECTIVES: To meet the need for faculty development in the use of information technology for its membership, the Society of Teachers of Family Medicine (STFM) Program Committee implemented a pilot, fee-supported, electronic classroomformat at STFM's 2000 Annual Spring Conference. We assessed the characteristics of those who attended the sessions, the satisfaction of participants with the venue both from expressed satisfaction and enrollment, the financial viability of electronic classrooms, and whether participants used acquired skills 6 months after the conference. METHODS: An evaluation instrument was used to collect the demographic data on attendees and their satisfaction with the sessions they attended. This data was compiled and compared with the demographics of overall conference attendees. The enrollment and revenues for the electronic classrooms were totaled and compared with expenses. A 6-month post-conference phone survey was conducted to assess continued use of learned skills. RESULTS: Attendees were more likely to be physicians from community-based residencies. The program was filled to 80% capacity. Survey results indicated that the program was satisfying to attendees. Registration fees covered costs. Most participants were still using their new skills 6 months after the program. CONCLUSIONS: The electronic classroom pilot was successful and provides skills that participants use months after the program. This program can be used to meet the educational technology training needs of STFM members.

Dentocase - open-source education management system in dentistry.

Since 2001, an interdisciplinary project on multimedia education in medicine has been sponsored by the Federal Ministry of Education and Research at the Charité. One part of the project is on dentistry. In the light of the results of a survey of dental students, an Internet-based education management system was created using open-source back-end systems. It supports four didactic levels for editing documentation of patient treatments. Each level corresponds to the learning abilities of the students. The patient documentation is organized to simulate the working methods of a physician or dentist. The system was tested for the first time by students in the summer semester of 2003 and has been used since the winter semester of 2003 as part of the curriculum.

The triad of science foundations, instructional technology, and organizational structure.

Over the centuries and across all societies educational achievement does not improve. The attempt to improve the instructional process has concentrated on instructional technology. But these attempts have overlooked the importance of two other factors: the science that should underlie the instructional technologies and the organization that must operate those technologies. A considerable step forward in handling the problems of instructional effectiveness has been the derivation of instructional technologies based on Skinnerian science. But the instructional technologies based on Skinner's analysis of behavior are promoted as if they were to operate in an organizational vacuum. The division of labor, and its necessary coordination and control, is taken for granted. But in any large scale enterprise, the organization of the division of labor must fit the technology through which that enterprise achieves its mission. Educational technology must tie directly to a pertinent science and to a proper organizational structure. To teach effectively requires an overhaul along three lines: 1) a relevant science that reflects and encapsulates an accurate understanding of behavior; 2) a contingency-based technology of instruction that directly derives its practices upon proper scientific principles; and 3) a suitable organization based on teaching teams that operate the new instructional technology.

Introducing CAD/CAM into a predoctoral dental curriculum: a case study.

This article describes the decision making and implementation process used at Indiana University School of Dentistry to incorporate a CAD/CAM system into the predoctoral curriculum and presents data regarding the opinions of students and faculty members after one year. Using a non-validated survey instrument, D1 students rated their experience fabricating a CAD/CAM-generated crown. Eighty-eight of the 105 D1 students (84 percent response rate) responded to the four multiple-choice questions, and a varying number provided written responses. Eighty percent of the responding students rated the overall learning experience as good or excellent, and 43 percent judged that they were prepared to fabricate a crown independently. Students' comments about the experience were generally positive. The twelve supervising faculty members were also surveyed after the first year. When asked to evaluate the initial quality of the crowns at placement, they rated 89 to 98 percent of them good or excellent on the measures of marginal fit, axial contours, proximal contacts, and occlusal contacts. In their judgment, CAD/CAM-generated crowns were as good as or better than those received from commercial labs. After one year, the school's experience has been that the performance of these crowns is consistent with the literature and that they are a viable option. Also, the students are enthusiastic about this addition to the curriculum.

Information and communication technology use among Victorian and South Australian oral health professions students.

The objective of this study was to determine and analyze the use of information and communication technology (ICT) by oral health professions students in Victoria and South Australia. Data were collected during the 2009 and 2010 academic years via electronic survey. Out of 1,138 students studying in Adelaide and Victorian dental schools, 740 students participated, for an overall response rate of 65 percent. The majority were dental students (n=609) with 131 seeking a Bachelor of Oral Health (B.O.H.) degree. The majority were female (62.0 percent), had home Internet access (91.7 percent), and no barriers to accessing the Internet (87.2 percent). Among those who mentioned barriers, difficult access and cost were the most common. The Internet was accessed at least once a week by the majority for general purposes (93.5 percent) and for study purposes (84.2 percent). Nonetheless, thirty-nine students (5.3 percent) were non-frequent ICT users. The probability of an oral health professions student being in the non-ICT users group was explored utilizing a logistic regression analysis. The final model contained three predictors: location of school, ethnic background, and place of Internet use (χ(2) [3]=117.7; p<0.0001). After controlling for other variables in the model, those studying in South Australia were significantly more likely (OR=2.32; 95 percent CI 1.05 to 5.11) to be in the non-users groups. In the same manner, students from an Asian background were three times more likely to be non-users (OR=3.06; 95 percent CI 1.16 to 8.08). Those who had access to the Internet at home (OR=0.02; 95 percent CI 0.01 to 0.05) were less likely to be a non-user. These results represent a preliminary evaluation of ICT use among oral health professions students in Australia. It seems that a digital divide exists among these students. The information can be utilized in planning dental education programs and incorporating the use of ICT suitable for oral health professions students and in the design and implementation of employment recruitment and retention programs.

Teaching with technology: free Web resources for teaching and learning.

In this bimonthly series, the department editor examines how nurse educators can use Internet and Web-based computer technologies such as search, communication, collaborative writing tools; social networking, and social bookmarking sites; virtual worlds; and Web-based teaching and learning programs. In this article, the department editor and her coauthor describe free Web-based resources that can be used to support teaching and learning.