Use of the virtual ventilator, a screen-based computer simulation, to teach the principles of mechanical ventilation

Evaluation of the SIMULRESP: A simulation software of child and teenager cardiorespiratory physiology

BACKGROUND

Mathematical models based on the physiology when programmed as a software can be used to teach cardiorespiratory physiology and to forecast the effect of various ventilatory support strategies. We developed a cardiorespiratory simulator for children called "SimulResp." The purpose of this study was to evaluate the quality of SimulResp.

METHODS

SimulResp quality was evaluated on accuracy, robustness, repeatability, and reproducibility. Blood gas values (pH, PaCO2 , PaO2,  and SaO2 ) were simulated for several subjects with different characteristics and in different situations and compared to expected values available as reference. The correlation between reference and simulated data was evaluated by the coefficient of determination and Intraclass correlation coefficient. The agreement was evaluated with the Bland & Altman analysis.

RESULTS

SimulResp produced healthy child physiological values within normal range (pH 7.40 ± 0.5; PaCO2 40 ± 5 mmHg; PaO2 90 ± 10 mmHg; SaO2 97 ± 3%) starting from a weight of 25-35 kg, regardless of ventilator support. SimulResp failed to simulate accurate values for subjects under 25 kg and/or affected with pulmonary disease and mechanically ventilated. Based on the repeatability was considered as excellent and the reproducibility as mild to good. SimulResp's prediction remains stable within time.

CONCLUSIONS

The cardiorespiratory simulator SimulResp requires further development before future integration into a clinical decision support system.

Simulation Training for Residents Focused on Mechanical Ventilation: A Randomized Trial Using Mannequin-Based Versus Computer-Based Simulation

Supplemental digital content is available in the text.

Introduction

Advances in knowledge regarding mechanical ventilation (MV), in particular lung-protective ventilation strategies, have been shown to reduce mortality. However, the translation of these advances in knowledge into better therapeutic performance in real-life clinical settings continues to lag. High-fidelity simulation with a mannequin allows students to interact in lifelike situations; this may be a valuable addition to traditional didactic teaching. The purpose of this study is to compare computer-based and mannequin-based approaches for training residents on MV.

Methods

This prospective randomized single-blind trial involved 50 residents. All participants attended the same didactic lecture on respiratory pathophysiology and were subsequently randomized into two groups: the mannequin group (n = 25) and the computer screen–based simulator group (n = 25). One week later, each underwent a training assessment using five different scenarios of acute respiratory failure of different etiologies. Later, both groups underwent further testing of patient management, using in situ high-fidelity simulation of a patient with acute respiratory distress syndrome.

Results

Baseline knowledge was not significantly different between the two groups (P = 0.72). Regarding the training assessment, no significant differences were detected between the groups. In the final assessment, the scores of only the mannequin group significantly improved between the training and final session in terms of either global rating score [3.0 (2.5–4.0) vs. 2.0 (2.0–3.0), P = 0.005] or percentage of key score (82% vs. 71%, P = 0.001).

Conclusions

Mannequin-based simulation has the potential to improve skills in managing MV.

What Can Veterinary Educators Learn from PE Teachers?

Veterinary education requires the training of students in cognitive, affective, and psychomotor domains. However, the veterinary education literature tends to focus more on the cognitive domain, with less emphasis on the affective and psychomotor domains. Physical education (PE) teachers have been teaching psychomotor skills to students for decades using a variety of teaching models. Teaching models provide a framework encompassing theory, student and teacher interactions, instructional themes, research support, and valid assessments. This paper reviews some of the models used by PE teachers, including the Direct Instruction Model, the Cooperative Learning Model, the Personalized System for Instruction, and the Peer Teaching Model. We posit that these models might be particularly helpful for novice teachers in veterinary education settings, providing a structure for the teaching and assessment of psychomotor skills.

Instruction and Curriculum in Veterinary Medical Education: A 50-Year Perspective

Our knowledge of veterinary medicine has expanded greatly over the past 50 years. To keep pace with these changes and produce competent professionals ready to meet evolving societal needs, instruction within veterinary medical curricula has undergone a parallel evolution. The curriculum of 1966 has given way, shifting away from lecture-laboratory model with few visual aids to a program of active learning, significant increases in case- or problem-based activities, and applications of technology, including computers, that were unimaginable 50 years ago. Curricula in veterinary colleges no longer keep all students in lockstep or limit clinical experiences to the fourth year, and instead have moved towards core electives with clinical activities provided from year 1. Provided here are examples of change within veterinary medical education that, in the view of the authors, had positive impacts on the evolution of instruction and curriculum. These improvements in both how and what we teach are now being made at a more rapid pace than at any other time in history and are based on the work of many faculty and administrators over the past 50 years.

Simulations for mechanical ventilation in children: review and future prospects

Mechanical ventilation is a very effective therapy, but with many complications. Simulators are used in many fields, including medicine, to enhance safety issues. In the intensive care unit, they are used for teaching cardiorespiratory physiology and ventilation, for testing ventilator performance, for forecasting the effect of ventilatory support, and to determine optimal ventilatory management. They are also used in research and development of clinical decision support systems (CDSSs) and explicit computerized protocols in closed loop. For all those reasons, cardiorespiratory simulators are one of the tools that help to decrease mechanical ventilation duration and complications. This paper describes the different types of simulators described in the literature for physiologic simulation and modeling of the respiratory system, including a new simulator (SimulResp), and proposes a validation process for these simulators.

A new educational resource to improve veterinary students' animal welfare learning experience

A computer-aided learning (CAL) educational resource based on experiential learning principles has been developed. Its aim is to improve veterinary students' ability to critically review the effect on welfare of husbandry systems observed during their work placement on sheep farms. The CAL consisted of lectures, multiple-choice questions, video recordings of animals in various husbandry conditions, open questions, and concept maps. An intervention group of first-year veterinary students (N=31) was selected randomly to access the CAL before their sheep farm placement, and a control group (N=50) received CAL training after placement. Assessment criteria for the categories remember, understand, apply, analyze, evaluate, and create, based on Bloom's revised taxonomy, were used to evaluate farm reports submitted by all students after their 2-week placement. Students in the intervention group were more likely than their untrained colleagues (p<.05) to remember and understand animal-based measurements relating to the freedom from hunger and thirst; the freedom from discomfort; and the freedom from pain, injury, or disease. Intervention group students were also more likely to analyze the freedom from pain, injury, or disease and the freedom to exhibit normal behavior and to evaluate the freedom from fear and distress. Relatively few students in each group exhibited creativity in their reports. These findings indicate that use of CAL before farm placement improved students' ability to assess and report animal welfare as part of their extramural work experience.