ABSTRACTDuring 1986 five young adults left hospital to live in a bungalow in Exeter. This move has been described as a “second generation” project. In other words it was not one of the first such ventures in the area. It followed earlier, trail-blazing projects and had to compete for administrative and specialist support with a number of other projects being commissioned at the same time.No net change in staff/client ratio occurred and 70 per cent of the new staff team were staff who had previously worked with the young people whilst they were in hospital.A number of findings consistent with the view that the quality of life of the young people had been improved as a result of leaving hospital were recorded: they went out more, and to more varied places; they spent more time engaged in interaction with other people; less behaviour judged to be “inappropriate” was recorded; and staff considered the group as a whole to be “better off”.On the other hand little evidence of integration being achieved within the local community was recorded; and there was little or no evidence of individuals being supported in ways that increased their competence, particularly in relation to participating at a simple level in routine domestic tasks.The implications of these findings for others engaged in the large-scale commissioning of such housing projects are discussed.

Data were summarized from assessments of three computer-based problem solving decision aids for equipment maintenance. All three were shown to increase accuracy and reduce errors and time required to solve maintenance problems. Cost benefits were reported for one and suggested net savings of about $20 million per year in F-16 avionics maintenance. These assessments suggest that (1) a strong cost-effectiveness case can be made for these computer-based aids, (2) their development and implementation should consider the full range of options available for ensuring competent human performance, (3) both descriptive and prescriptive approaches should be employed in their design, (4) they will benefit from capabilities developed for intelligent tutoring systems, and (5) their absence from routine use despite their demonstrated promise suggests that more effort is needed to ensure that the state of practice advances along with the state of the art.

A needs assessment was performed to determine user information requirements for hand-held and mobile personal digital assistants within the clinical oncology community. Quantitative and qualitative data were collected through semi-structured interviews, a survey instrument and a focus group in order to triangulate the findings. The data were analyzed quantitatively for demographics, current practices and information-gathering preferences, and qualitatively for the development of future decision aids, clinical aids and practice management tools.

The temporal bone is one of seven bones that comprise the human skull, and has an intimate relationship with many vital structures. Anatomically, its three-dimensional relationships make it one of the most challenging areas for surgeons to understand and master. In addition, the temporal bone contains minute structures that are among the most sophisticated and delicate in the human body. These structures include the cochlea and vestibular organs, which are responsible for hearing and balance; the middle ear, including the ossicles, which conduct acoustic energy to the cochlea; and the facial nerve, which is responsible for controlling the muscles of facial expression, and contributes to the sensation of taste. Additionally, the temporal bone forms a major portion of the skull base, and has intimate relationships to vital structures including the carotid artery, jugular vein, cerebral cortex, brainstem, and cranial nerves. Surgical procedures performed on the temporal bone include: procedures to eradicate chronic and acute infections; procedures to remove malignant and benign tumors within the temporal bone, from the skull base, or from the posterior cranial fossa; procedures to restore the hearing mechanism; procedures to eliminate balance disorders; and procedures to correct congenital anomalies. For surgeons-in-training, and even surgeons-in-practice, mastery of the anatomy of the temporal bone and the many complex approaches necessary to treat patients takes years of focused endeavor. This is typically accomplished through the dissection of human cadaver temporal bones, which are scarce, and require a dedicated laboratory facility. Efforts are currently underway to develop a realistic simulator for temporal bone procedures. Users immersed in the simulator will interact with a three-dimensional temporal bone, derived from patient-specific data, using a haptic interface to simulate traditional surgical procedures. Feedback from experts in otologic surgery will be built into the system for additional instruction. This presentation will include an overview of the application being developed, a report of its current state of development, and plans for the future.

The use of virtual reality (VR) technology in training and education is an extension of 50 years of flight simulation research. As virtual reality becomes integrated into medical practices, the same questions that confronted the developers of flight simulation also apply to those in the medical domain. Does this technology work for training and education? If so, how well does it work? How much does it cost? Is it less expensive than the alternative training methods? In order to answer these questions the authors have taken a look at the same problems in the history of military simulation. The four techniques used to assess the value of military simulation have been, and still are, task analyses (a detailed, timed description of the actual tasks), standard experimental designs (i.e. the pre-test, post-test control group design), transfer-of-training experiments (where the evaluation metric is the actual task) and various combinations of the three. At present the only evaluation technique being used for VR in medical education is the task analysis.

Large-scale flight simulation was pioneered in the 1940s to help meet the training requirements and demand for pilots in World War II. Flight simulators have been effective for training, evaluating, and certifying military and commercial pilots. Accurate scenarios have been developed that allow pilots in training to gain experience without the risk and expense of learning while in flight. The research in aviation simulation suggests a transfer effectiveness ratio of 0.48. This means that 1 hour in the simulator saves a half hour in the air. Because of the successful use of flight simulation as a training technique, computer-based simulators are now used in a variety of domains.

The Institute for Defense Analyses (IDA) was contracted to perform a military standard task analysis of laparoscopic cholecystectomy, and to study the effectiveness of a virtual reality surgical skills simulator as a tool for surgical training and as a method for recording psychomotor behavior. This report describes the purpose of the study, its design, initial results, and implications for the field of medical education.