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Wegner M, Dusse F, Beeser F, Leister N, Lefarth M, Finke SR, Böttiger BW, Dorweiler B, Stoll SE. Comparing Simulation Training of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy Using Conventional Versus 3D Printed Simulators (TRAC-Sim Study). J Intensive Care Med 2024; 39:820-828. [PMID: 38403970 DOI: 10.1177/08850666241232918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background: Individual implementation rate of bronchoscopy-guided percutaneous dilatational tracheostomy (PDT) varies among intensivists. Simulation training (ST) can increase the safety of medical procedures by reducing stress levels of the performing team. The aim of this study was to evaluate the benefit of ST in PDT regarding procedural time, quality of performance, and percepted feelings of safety of the proceduralist and to compare conventional simulators (CSIM) with simulators generated from 3D printers (3DSIM). Methods: We conducted a prospective, single-center, randomized, blinded cross-over study comparing the benefit of CSIM versus 3DSIM for ST of PDT. Participants underwent a standardized theoretical training and were randomized to ST with CSIM (group A) or 3DSIM (group B). After ST, participants' performance was assessed by two blinded examiners on a porcine trachea regarding time required for successful completion of PDT and correct performance (assessed by a performance score). Percepted feelings of safety were assessed before and after ST. This was followed by a second training and second assessment of the same aspects with crossed groups. Results: 44 participants were included: 24 initially trained with CSIM (group A) and 20 with 3DSIM (group B). Correctness of the PDT performance increased significantly in group B (p < .01) and not significantly in group A (p = .14). Mean procedural time required for performing a PDT after their second ST compared to the first assessment (p < .01) was lower with no difference between group A and group B and irrespective of the participants' previous experience regarding PDT, age, and sex. Moreover, percepted feelings of safety increased after the first ST in both groups (p < .001). Conclusions: ST can improve procedural skills, procedural time, and percepted feelings of safety of the proceduralist in simulated PDT.
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Affiliation(s)
- Moritz Wegner
- Department of Vascular and Endovascular Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Fabian Dusse
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Finnard Beeser
- Department of Vascular and Endovascular Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Nicolas Leister
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Marian Lefarth
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Simon-Richard Finke
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Bernd W Böttiger
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Bernhard Dorweiler
- Department of Vascular and Endovascular Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Sandra Emily Stoll
- Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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Gomez-Tames J, Yu W. Electro-localization method using a muscle conductive phantom for needle position detection towards medical training. Biomed Phys Eng Express 2023; 9:055030. [PMID: 37595567 DOI: 10.1088/2057-1976/acf1a6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/18/2023] [Indexed: 08/20/2023]
Abstract
Simulation in healthcare can help train, improve, and evaluate medical personnel's skills. In the case of needle insertion/manipulation inside the muscle during an nEMG examination, a training simulator Requires estimating the position of the needle to output the electrical muscle activity in real time according to the training plan. External cameras can be used to estimate the needle location; however, different error sources can make its implementation difficult and new medical sensing technologies are needed. This study introduces and demonstrates the feasibility of a conductive phantom that serves as the medium for needle insertion and senses the 3D needle position based on a technique named electro-localization for the first time. The proposed conductive phantom is designed so that different voltage distributions are generated in the phantom using electrodes placed on its borders. The needle is inserted in the phantom, and the recorded voltages are mapped to spatial coordinates using a finite element method (FEM)-based computational model of the conductive phantom to estimate the 3D needle tip position. Experimental and simulation results of phantom voltage distributions agreed. In 2D mapping (no depth consideration), the needle position error was 1.7 mm, which was marginally reduced if only the central area of the phantom was used (1.5 mm). In 3D mapping, the error was 4 mm. This study showed the feasibility of using a conductive muscle phantom as a new embedded sensor that estimates needle position for medical training of nEMG without relying on external sensors.
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Affiliation(s)
- Jose Gomez-Tames
- Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
| | - Wenwei Yu
- Graduate School of Science and Engineering, Chiba University, Chiba 263-8522, Japan
- Center for Frontier Medical Engineering, Chiba University, Chiba 263-8522, Japan
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Martínez JJ, Galvez-Yanjari V, de la Fuente R, Kychenthal C, Kattan E, Bravo S, Munoz-Gama J, Sepúlveda M. Process-oriented metrics to provide feedback and assess the performance of students who are learning surgical procedures: The percutaneous dilatational tracheostomy case. MEDICAL TEACHER 2022; 44:1244-1252. [PMID: 35544751 DOI: 10.1080/0142159x.2022.2073209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Assessing competency in surgical procedures is key for instructors to distinguish whether a resident is qualified to perform them on patients. Currently, assessment techniques do not always focus on providing feedback about the order in which the activities need to be performed. In this research, using a Process Mining approach, process-oriented metrics are proposed to assess the training of residents in a Percutaneous Dilatational Tracheostomy (PDT) simulator, identifying the critical points in the execution of the surgical process. MATERIALS AND METHODS A reference process model of the procedure was defined, and video recordings of student training sessions in the PDT simulator were collected and tagged to generate event logs. Three process-oriented metrics were proposed to assess the performance of the residents in training. RESULTS Although the students were proficient in classic metrics, they did not reach the optimum in process-oriented metrics. Only in 25% of the stages the optimum was achieved in the last session. In these stages, the four more challenging activities were also identified, which account for 32% of the process-oriented metrics errors. CONCLUSIONS Process-oriented metrics offer a new perspective on surgical procedures performance, providing a more granular perspective, which enables a more specific and actionable feedback for both students and instructors.
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Affiliation(s)
- Juan José Martínez
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Víctor Galvez-Yanjari
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rene de la Fuente
- Department of Anaesthesiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Catalina Kychenthal
- School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sebastián Bravo
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge Munoz-Gama
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Marcos Sepúlveda
- Department of Computer Science, School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile
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Abbott F, Ortega M, Bravo S, Basoalto R, Kattan E. Can we improve teaching and learning of percutaneous dilatational tracheostomy's bronchoscopic guidance? SAGE Open Med 2021; 9:20503121211002321. [PMID: 33796301 PMCID: PMC7983236 DOI: 10.1177/20503121211002321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 12/14/2022] Open
Abstract
Percutaneous dilatational tracheostomy has become the technique of choice in multiple intensive care units. Among innovations to improve procedural safety and success, bronchoscopic guidance of percutaneous dilatational tracheostomy has been advocated and successfully implemented by multiple groups. Most published literature focuses on the percutaneous dilatational tracheostomy operator, with scarce descriptions of the bronchoscopic particularities of the procedure. In this article, we provide 10 suggestions to enhance specific procedural aspects of bronchoscopic guidance of percutaneous dilatational tracheostomy, and strategies to optimize its teaching and learning, in order to promote learners' competence acquisition and increase patient safety.
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Affiliation(s)
- Francisco Abbott
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Marcos Ortega
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
- Departamento de Enfermedades
Respiratorias, Facultad de Medicina, Pontificia Universidad Católica de Chile,
Santiago, Chile
| | - Sebastian Bravo
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Roque Basoalto
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva,
Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago,
Chile
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Fuente R, Kattan E, Munoz‐Gama J, Puente I, Navarrete M, Kychenthal C, Fuentes R, Bravo S, Galvez V, Sepúlveda M. Development of a comprehensive Percutaneous Dilatational Tracheostomy process model for procedural training: A Delphi-based experts consensus. Acta Anaesthesiol Scand 2021; 65:244-256. [PMID: 32997799 DOI: 10.1111/aas.13716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/19/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Deconstructing a complex procedure improves skills learning, but no model has covered all relevant Percutaneous Dilatational Tracheostomy (PDT) procedural aspects. Moreover, the heterogeneity of techniques described may hinder trainees' competency acquisition. Our objective was to develop a PDT model for procedural training that includes a comprehensive step-by-step design. METHODS Procedural descriptions were retrieved after a structured search in medical databases. Activities were extracted and the adherence to McKinley's dimensions of procedural competence was analyzed. We developed a comprehensive PDT model, which was further validated through a Delphi-based consensus of Spanish-speaking international experts. RESULTS The 14 descriptions retrieved for analysis presented a median [interquartile range] of 18 [11-22] steps, covering 3 [2-4] of McKinley's dimensions. The Delphi panel's first model included all McKinley's dimensions, and was answered by 25 experts from nine countries, ending in the second round. The final model included 59 activities divided into six stages (51 from the initial model and eight proposed by experts) and performed by two operators (bronchoscopy and tracheostomy). CONCLUSIONS We have presented a PDT model that includes necessary competence dimensions to be considered complete. The model was validated by an experts' consensus, allowing to improve procedural training to promote safer patient care.
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Affiliation(s)
- Rene Fuente
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Jorge Munoz‐Gama
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Ignacio Puente
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Matías Navarrete
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Catalina Kychenthal
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Ricardo Fuentes
- División de Anestesiología Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Sebastian Bravo
- Departamento de Medicina Intensiva Facultad de Medicina Pontificia Universidad Católica de Chile Santiago Chile
| | - Victor Galvez
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
| | - Marcos Sepúlveda
- Department of Computer Science School of Engineering Pontificia Universidad Católica de Chile Santiago Chile
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Simulation-Based Mastery Learning of Bronchoscopy-Guided Percutaneous Dilatational Tracheostomy. Simul Healthc 2020; 16:157-162. [DOI: 10.1097/sih.0000000000000491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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