Medical simulation has emerged as a transformative approach in toxicology education. By providing immersive, hands-on experience, simulation enhances learner engagement, critical thinking, and long-term knowledge retention while offering a safe environment to practice clinical decision-making without jeopardizing patient safety. Despite these advantages, the integration of simulation-based training remains limited in low- and middle-income countries (LMICs) due to resource constraints, lack of standardized curricula, and limited access to high-fidelity simulators. Additionally, little research has explored its optimal application in these settings. This review explores available evidence regarding the effectiveness of medical simulation in the diagnosis and treatment of toxicological emergencies in LMICs. Our findings suggest that while traditional lecture-based instruction may provide immediate knowledge gains, several studies suggest simulation-based training may enhance long-term retention and practical skills, particularly in resource-limited environments. This review highlights the need for further research to develop cost-effective, scalable simulation models tailored to LMICs and evaluate their impact on clinical outcomes in toxicology education.

BACKGROUND:There are limited opportunities to practice surgical skills and techniques in residency. Therefore, it is important to explore strategies which optimize surgical simulation experiences to enhance learning outcomes and skill retention. METHODS:Novice medical students (n = 29) were recruited to participate in a Fundamentals of Laparoscopic Surgery (FLS) peg transfer task training. Participants were randomly assigned to a control group, practicing the peg transfer task independently, or an experimental group, practicing with time pressure. Participant skill assessments were completed before the training, after the training, and 8-weeks after the training. Subjective and objective stress measurements were taken in the form of self-report surveys and heart rate variability data, respectively. RESULTS:For all the skill assessment measurements, there was no difference between groups in performance on the FLS task. Both groups showed improvement in performance after the training compared to before. The experimental group reported higher stress during and after the training period compared to the control group; however, there was no difference between groups on heart rate variability metrics. CONCLUSION:Time pressure while practicing an FLS task did not significantly impact learning acquisition or retention. However, the experimental group reported higher levels of stress. This preliminary study suggests time pressure does not confer an enhanced surgical skill learning experience for novices.

The impact of artificial intelligence (AI) will be felt not only in the arena of patient care and deliverable therapies but will also be uniquely disruptive in medical education and healthcare simulation (HCS), in particular. As HCS is intertwined with computer technology, it offers opportunities for rapid scalability with AI and, therefore, will be the most practical place to test new AI applications. This will ensure the acquisition of AI literacy for graduates from the country's various healthcare professional schools. Artificial intelligence has proven to be a useful adjunct in developing interprofessional education and team and leadership skills assessments. Outcome-driven medical simulation has been extensively used to train students in imagecentric disciplines such as radiology, ultrasound, echocardiography, and pathology. Allowing students and trainees in healthcare to first apply diagnostic decision support systems (DDSS) under simulated conditions leads to improved diagnostic accuracy, enhanced communication with patients, safer triage decisions, and improved outcomes from rapid response teams. However, the issue of bias, hallucinations, and the uncertainty of emergent properties may undermine the faith of healthcare professionals as they see AI systems deployed in the clinical setting and participating in diagnostic judgments. Also, the demands of ensuring AI literacy in our healthcare professional curricula will place burdens on simulation assets and faculty to adapt to a rapidly changing technological landscape. Nevertheless, the introduction of AI will place increased emphasis on virtual reality platforms, thereby improving the availability of self-directed learning and making it available 24/7, along with uniquely personalized evaluations and customized coaching. Yet, caution must be exercised concerning AI, especially as society's earlier, delayed, and muted responses to the inherent dangers of social media raise serious questions about whether the American government and its citizenry can anticipate the security and privacy guardrails that need to be in place to protect our healthcare practitioners, medical students, and patients.

Until recently, innovations in surgery were largely represented by extensions or augmentations of the surgeon's perception. This includes advancements such as the operating microscope, tumor fluorescence, intraoperative ultrasound, and minimally invasive surgical instrumentation. However, introducing artificial intelligence (AI) into the surgical disciplines represents a transformational event. Not only does AI contribute substantively to enhancing a surgeon's perception with such methodologies as three-dimensional anatomic overlays with augmented reality, AI-improved visualization for tumor resection, and AI-formatted endoscopic and robotic surgery guidance. What truly makes AI so different is that it also provides ways to augment the surgeon's cognition. By analyzing enormous databases, AI can offer new insights that can transform the operative environment in several ways. It can enable preoperative risk assessment and allow a better selection of candidates for procedures such as organ transplantation. AI can also increase the efficiency and throughput of operating rooms and staff and coordinate the utilization of critical resources such as intensive care unit beds and ventilators. Furthermore, AI is revolutionizing intraoperative guidance, improving the detection of cancers, permitting endovascular navigation, and ensuring the reduction in collateral damage to adjacent tissues during surgery (e.g., identification of parathyroid glands during thyroidectomy). AI is also transforming how we evaluate and assess surgical proficiency and trainees in postgraduate programs. It offers the potential for multiple, serial evaluations, using various scoring systems while remaining free from the biases that can plague human supervisors. The future of AI-driven surgery holds promising trends, including the globalization of surgical education, the miniaturization of instrumentation, and the increasing success of autonomous surgical robots. These advancements raise the prospect of deploying fully autonomous surgical robots in the near future into challenging environments such as the battlefield, disaster areas, and even extraplanetary exploration. In light of these transformative developments, it is clear that the future of surgery will belong to those who can most readily embrace and harness the power of AI.

Background Suturing requires repeated practice with guidance to prevent skill deterioration; however, guidance is often limited by expert availability. There is evidence that augmented reality (AR) may assist procedural skill acquisition among learners. This study examines the use of an AR suture guidance application to assist the independent practice of suturing. Methodology A novel suture guidance application was designed for the Microsoft HoloLens. The guidance system included a calibration system and holograms that projected over a suture pad in a stepwise manner. To assess the application, 30 medical students were recruited and randomly assigned to two groups. The control group (n = 16) was given 30 minutes of independent suture practice, while the experimental group (n = 14) utilized the suture guidance application. Both groups completed a pre- and post-test wound closure assessment. After the post-test, the control group trialed the suture guidance application. All participants completed a feedback survey on the application. Statistical analysis was completed using Stata (StataCorp., College Station, TX, USA) with paired Student's t-tests and Welch's t-tests with a significance of 95%. Results Both groups demonstrated a significant improvement in total time and time per stitch during the post-test. Additionally, comparing pre- and post-test assessments in the experimental group revealed a significant improvement in the total number of stitches (p = 0.007), the ratio of bisecting stitches (p = 0.02), and the symmetry of stitch bite (p = 0.03). The feedback survey supported the application for guiding suture placement and spacing. Participants identified limitations in the hologram stability and neck positioning. Conclusions This study suggests the potential to use AR to facilitate the independent practice of wound closure within simulation environments.

Standardized patients (SPs) are widely used in medical education to teach clinical skills and provide assessments. SPs allow students to practice history taking, physical exams, and communication in controlled settings. However, SPs have limitations such as fatigue, performance variability, and the inability to simulate certain conditions, which virtual patients (VPs) can address. VPs can address these limitations and offer consistency, scalability, and adaptability. Although VPs are being implemented in research settings, they have the potential to be powerful medical education tools. Advancements in immersive technologies such as virtual reality, haptic feedback, and artificial intelligence (AI) will allow the creation of hyper-realistic, interactive training environments that mimic the complexity of real patient encounters. Medical students will be able to engage with VPs in fully immersive settings, complete with haptic feedback and AI-driven dialogue, allowing for more lifelike diagnostic and procedural experiences. The wider availability of such technologies through web services has implications for global medical education and assessment.

Minimally invasive surgery (MIS) is limited in safety and efficiency by the hand-held nature and narrow fields of view of traditional laparoscopes. A multi-resolution foveated laparoscope (MRFL) was invented to address these concerns. The MRFL is a stationary dual-view imaging device with optical panning and zooming capabilities. It is designed to simultaneously capture and display a zoomed view and supplemental wide view of the surgical field. Optical zooming and panning capabilities facilitate repositioning of the zoomed view without physically moving the system. Additional MRFL features designed to improve safety and efficiency include its snub-nosed endoscope, tool-tip auto tracking, programmable focus profiles, unique selectable display modalities, foot pedal controls, and independently controlled surgeon and assistant displays. An MRFL prototype was constructed to demonstrate and test these features. Testing of the prototype validates its design architecture and confirms the functionality of its features. The current MRFL prototype functions adequately as a proof of concept, but the system features and performance require further improvement to be practical for clinical use.

Background We developed a multi-resolution foveated laparoscope (MRFL) to improve situational awareness in laparoscopic surgery. We assessed surgeon objective task performance and subjective attitudes with MRFL when used for box trainer tasks and porcine surgery. Methods The MRFL simultaneously obtains a wide-angle view and a magnified view. The 2 images are displayed simultaneously. 6 urologists and 2 general surgeons performed box trainer and porcine surgery tasks with the MRFL and a standard laparoscope. Task time, use of display options, and subjective assessments were obtained. Results Subjectively, surgeons rated situational awareness, depth perception, and instrument interference as comparable between the prototype MRFL and laparoscope for trainer tasks. For porcine surgery, the MRFL was rated as having less interference than the standard laparoscope. The image quality of the MRFL was rated interior to the standard laparoscope. Participants found the different viewing modes useful for different roles and reported that they would likely use the MRFL for conventional laparoscopic and robotic surgery. Objectively, box trainer task time was comparable for 2 of 3 tasks with the remaining task shorter for the standard laparoscope. Porcine nephrectomy and oophorectomy were feasible with the prototype MRFL, although nephrectomy task time was significantly longer than traditional laparoscopy. Conclusions The MRFL demonstrated feasibility for performing complex surgery. Surgeons had favorable attitudes toward its features and likelihood to use the device if available. Users utilized different view types for different tasks. Longer MRFL task times were attributed to poorer image quality of the prototype.

Background While effective treatments for posttraumatic stress disorder (PTSD) exist, many individuals, including military personnel and veterans fail to respond to them. Equine-assisted therapy (EAT), a novel PTSD treatment, may complement existing PTSD interventions. This study employs longitudinal neuro-imaging, including structural magnetic resonance imaging (sMRI), resting state-fMRI (rs-fMRI), and diffusion tensor imaging (DTI), to determine mechanisms and predictors of EAT outcomes for PTSD. Method Nineteen veterans with PTSD completed eight weekly group sessions of EAT undergoing multimodal MRI assessments before and after treatment. Clinical assessments were conducted at baseline, post-treatment and at 3-month follow-up. Results At post-treatment patients showed a significant increase in caudate functional connectivity (FC) and reduction in the gray matter density of the thalamus and the caudate. The increase of caudate FC was positively associated with clinical improvement seen immediately at post-treatment and at 3-month follow-up. In addition, higher baseline caudate FC was associated with greater PTSD symptom reduction post-treatment. Conclusions This exploratory study is the first to demonstrate that EAT can affect functional and structural changes in the brains of patients with PTSD. The findings suggest that EAT may target reward circuitry responsiveness and produce a caudate pruning effect from pre- to post-treatment.

Background. To overcome field of view and ergonomic limitations of standard laparoscopes, we are developing a multi-resolution foveated laparoscope (MRFL), which can simultaneously obtain both wide- and zoomed-in-view images. To facilitate the effectiveness of our MRFL, we have been investigating various ways of organizing and visualizing dual-view multi-resolution images acquired by the MRFL. In our prior study, we implemented and compared 6 display modes for the MRFL, assuming a typical clinical environment where a standard (but limited) resolution monitor is available. To take full advantage of our MRFL, displays having sufficient screen resolutions might be advantageous. The present study aims to further understand the effects of view configurations through displays with a standard high-definition (HD) resolution and a 4K resolution. In this study, we compare 3 display modes for limited-resolution displays against a new mode for sufficient-resolution displays. Methods. Twenty subjects performed 3 evaluation trials of a touching task with each display mode in an emulated MRFL environment. Various objective measurements including task completion time and the number of collisions, and subjective preference were recorded. Results. The new mode showed a better task completion time than the other modes, while it maintained a low number of collisions similar to the others. Moreover, the majority of participants selected the new mode as their most preferred one. Conclusions. With a sufficient display resolution, the co-registration between the unblocked and unwarped wide context view and the high-resolution zoomed-in view offered by the new mode was highly effective on both task performance and user preference.

Abstract Introduction Equine-assisted therapy (EAT) for post-traumatic stress disorder (PTSD) has attracted great interest despite lacking empirical support, a manual, and a standardized protocol. Our team of experts in EAT and PTSD developed an eight-session group EAT treatment protocol for PTSD (EAT-PTSD) and administered it to two pilot groups of military veterans to assess initial effects. Materials and Methods We describe the development of the treatment manual, which was used with two pilot groups of veterans. Protocol safety, feasibility, and acceptability were assessed by reported adverse events, treatment completion rates, and self-rated patient satisfaction. Preliminary data on PTSD, depressive, and anxiety symptoms and quality of life were collected pretreatment, midpoint, post-treatment, and at 3-month follow up. Results No adverse events were recorded. All patients completed treatment, reporting high satisfaction. Preliminary data showed decreases in clinician-assessed PTSD and depressive symptoms from pre to post-treatment and follow-up (medium to large effect sizes, d = .54–1.8), with similar trends across self-report measures (d = 0.72–1.6). In our pilot sample, treatment response and remission varied; all patients showed some benefit post-treatment, but gains did not persist at follow-up. Conclusions This article presents the first standardized EAT protocol. Highly preliminary results suggest our new manualized group EAT-PTSD appears safe, well-regarded, and well-attended, yielding short-term benefits in symptomatology and quality of life if unclear length of effect. Future research should test this alternative treatment for PTSD more rigorously.

Simulation-based training has been widely used in medical education. More specifically, various systems for minimally invasive surgery training have been proposed in the past two decades. The aim of this article is to review and summarize the existing simulation-based training systems for laparoscopic surgery in terms of their technical realizations. Forty-three training systems were found and analyzed. These training systems generally consist of training tasks, a visualization interface, and an instrument interface. Three different approaches—physical, virtual, and augmented reality—to implement visualization interfaces are discussed first. Then, haptic feedback, performance evaluation, and guidance methods are summarized. Portable devices to enable at-home training and instrument tracking technologies to support visualization, evaluation, and guidance are also presented. Based on survey of the relevant literature, we propose several recommendations to design the next-generation training systems in laparoscopic surgery. Novel guidance and assessment schemes with augmented reality visualization are recommended to design an intelligent surgical training simulator. This intelligent simulator enhances the training procedure and ultimately improves the patient safety.

You have accessJournal of UrologySurgical Technology & Simulation: Training & Skills Assessment II (MP47)1 Apr 2020MP47-11 DEVELOPMENT OF A LOW-COST, HIGH-FIDELITY SIMULATOR FOR ULTRASOUND-GUIDED PERCUTANEOUS NEPHROLITHOTOMY (PCNL) TRAINING Marissa K. Lovett*, Michael C. Phung, David E. Biffar, Allan J. Hamilton, Benjamin R. Lee, and David T. Tzou Marissa K. Lovett*Marissa K. Lovett* More articles by this author , Michael C. PhungMichael C. Phung More articles by this author , David E. BiffarDavid E. Biffar More articles by this author , Allan J. HamiltonAllan J. Hamilton More articles by this author , Benjamin R. LeeBenjamin R. Lee More articles by this author , and David T. TzouDavid T. Tzou More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000902.011AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ultrasound-guided percutaneous nephrolithotomy (US-PCNL) has emerged as an attractive alternative to traditional fluoroscopic PCNL. With only a limited number of training programs teaching US-PCNL, there remains a need for tools to assist with teaching this technique. Currently, most simulation PCNL models are expensive and focus on mimicking fluoroscopic guided access, with few models tailored to practicing the skills specific to US-PCNL. This study aimed to report the cost and fidelity of a novel US-PCNL simulator and assess its ability to change procedural confidence in urologic trainees. METHODS: The time, materials, and cost to creation of this model were recorded over 5 iterative versions. Using a 5-point visual analog scale (1 – Least Realistic; 5 – Most Realistic), model fidelity was assessed by: University of Arizona urology residents (n=9), and international attending urologists experienced in US-PCNL (n=8) at the AUA 2019 conference. Procedural confidence among the 9 residents was assessed before and after simulation training with the model – (5-point Likert scale; 1 – Not Comfortable, 5 – Very Comfortable). Confidence data was analyzed using a paired, two-tailed Student’s t-test. RESULTS: The model (Figure 1) costs ∼$50 USD and takes ∼1.5 hours to create. Mean overall model fidelity was 4.2 + 0.8, with high fidelity appreciated amongst specific model features including: visualization of needle (4.4 + 1.1) and fluid return (4.4 + 0.9); echogenicity of cortex (4.2 + 0.7), stones (4.2 + 0.8), and target calyces (4.1 + 0.8). After training with the model, urology resident procedural confidence increased significantly across all operational tasks, including: ultrasound probe positioning (p<0.01); identification of individual renal landmarks - capsule, cortex, stone, and target calyx (p<0.05); locating the needle on ultrasound (p<0.05); advancing the needle into the target calyx (p<0.01); and confirming fluid return (p<0.01). CONCLUSIONS: This low-cost simulator provides a high-fidelity, affordable solution for teaching urologists how to perform US-PCNL. Given the associated improvement in procedural confidence, this model can be a helpful addition to the training of urologists learning US-PCNL. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e688-e688 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Marissa K. Lovett* More articles by this author Michael C. Phung More articles by this author David E. Biffar More articles by this author Allan J. Hamilton More articles by this author Benjamin R. Lee More articles by this author David T. Tzou More articles by this author Expand All Advertisement PDF downloadLoading ...

This pilot study appraised traditional versus remote facilitation via telesimulation for an established interprofessional training at two geographically separate sites. Participant feedback was captured via 5- point Likert scale surveys. Results demonstrate learners supported the use of remote facilitation: to meet the interprofessional learning objectives, as an adequate replacement for live facilitation and to implement simulation education in low-resource or low-facilitator areas. Improvements were suggested for audio connectivity between participants. In conclusion, the program evaluation suggests that telesimulation, with remote and traditional facilitation, is an effective strategy to provide interprofessional simulation education. Improvements identified are to standardize the set-up of audio/visual technology and tailor participant orientation to encourage meaningful dialogue between sites.

Laparoscopic surgery relies on effective visualization of areas of interest and surrounding tissue. The limited field of view of traditional laparoscopes increases the risk of peripheral tissue injury. To address this limitation, a multiresolution foveated laparoscope (MRFL) was designed to enhance peripheral awareness while maintaining focus on the area of interest. Peripheral awareness and learner effect were evaluated with novices (n=13) and experts (n=8). These subjects completed a modified Fundamentals of Laparoscopy Surgery task using a traditional laparoscope, MRFL with autotracking (AT), and MRFL without autotracking (NoAT). Subjects using the traditional laparoscope performed better than MRFL AT and MRFL NoAT in task completion time and collision number. The learner effect was steeper with use of MRFL. In multiple tested parameters, MRFL NoAT performed as well as the traditional laparoscope while providing the added benefits of enhanced field of view and multiple viewing perspectives. These findings warrant further development of MRFL.

A Single Shot State Detection (SSSD) method is proposed to support a laparoscopic surgery skills training system - Computer-Assisted Surgical Trainer (CAST). CAST actively assists a trainee with visual, audio, or force guidance during different surgical practice tasks. In each task, the guidance is provided according to the target object state, which is one of the key components of CAST. We propose SSSD using deep neural networks to detect object states in a single image. We first model semantic objects to recognize objects' state given a training task and then apply a deep learning algorithm, single shot detector (SSD), to detect the semantic objects. The contribution of this research is to present a unified object state model collaborating with a deep learning object detector, which can be applied to the surgical training simulator, as well as other visual sensing and automation systems.

The changing landscape of healthcare education, delivery, and technology is placing new demands for significant inter-disciplinary and inter-professional training in medical simulation. New architectural concepts and building designs must ensure that large-scale healthcare simulation facilities offer customized training opportunities for nursing, medicine, public health, and pharmacy while allowing for maximal flexibility and adaptation across nearly fifty different user groups and stake holders. A novel concept of a larger, configurable "stage" design, more akin to a Hollywood production studio, with in-patient and outpatient suites seen as temporary or "standing" sets was created. The stage, called a "Sim Deck," can be easily dismantled while providing ample square footage for mass casualty scenarios. The facility required significant technological support to provide remote simulation training via existing and future telemedical technologies as well as remaining nimble enough to incorporate technologies in augmented and virtual reality, artificial intelligence, and large-scale learner management systems.