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The Time Has Come: a Paradigm Shift in Diagnostic Radiology Education via Simulation Training.

ABSTRACT: Current radiology training for medical students and residents predominantly consists of reviewing teaching files, attending lectures, reading textbooks and online sources, as well as one-on-one teaching at the workstation. In the case of medical schools, radiology training is quite passive. In addition, the variety of important and high-yield cases that trainees are exposed to may be limited in scope. We utilized an open-source dcm4chee-based Picture Archiving and Communication System (PACS) named "Weasis" in order to simulate a radiologist's practice in the real world, using anonymized report-free complete cases that could easily be uploaded live during read-outs for training purposes. MySQL was used for database management and JBOSS as application server. In addition, we integrated Weasis into a web-based reporting system through Java programming language using the MyEclipse development environment. A freeware, platform-independent, image database was established to simulate a real-world PACS. The sever was implemented on a dedicated non-workstation PC connected to the hospital secure network. As the client access is through a webpage, the cases can be viewed from any computer connected to the hospital network. The reporting system allows for evaluation purposes and providing feedback to the trainees. Brief survey results are available. Implementation of such a low-cost, versatile, and customizable tool provides a new opportunity for training programs in offering medical students with an active and more realistic radiology experience, junior radiology residents with potentially better preparation for independent call, and senior resident and fellows with the ability to fine-tune high-level specialty-level knowledge.

SUBMITTER: Shu L

PROVIDER: S-EPMC7886946 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Introduction: Robot-assisted therapy for upper extremity (UE) impairments post-stroke has yielded modest gains in motor capacity and little evidence of improved UE performance during activities of daily living. A paradigm shift that embodies principles of motor learning and exercise dependent neuroplasticity may improve robot therapy outcomes by incorporating active problem solving, salience of trained tasks, and strategies to facilitate the transfer of acquired motor skills to use of the paretic arm and hand during everyday activities. Objective: To pilot and test the feasibility of a novel therapy protocol, the Active Learning Program for Stroke (ALPS), designed to complement repetitive, robot-assisted therapy for the paretic UE. Key ALPS ingredients included training in the use of cognitive strategies (e.g., STOP, THINK, DO, CHECK) and a goal-directed home action plan (HAP) to facilitate UE self-management and skill transfer. Methods: Ten participants with moderate impairments in UE function >6 months after stroke received eighteen 1-h treatment sessions 2-3/x week over 6-8 weeks. In addition to ALPS training, individuals were randomly assigned to either robot-assisted therapy (RT) or robot therapy and task-oriented training (RT-TOT) to trial whether the inclusion of TOT reinforced participants' understanding and implementation of ALPS strategies. Results: Statistically significant group differences were found for the upper limb subtest of the Fugl-Meyer Assessment (FMA-UE) at discharge and one-month follow-up favoring the RT group. Analyses to examine overall effects of the ALPS protocol in addition to RT and RT-TOT showed significant and moderate to large effects on the FMA-UE, Motor Activity Log, Wolf Motor Function Test, and hand portion of the Stroke Impact Scale. Conclusion: The ALPS protocol was the first to extend cognitive strategy training to robot-assisted therapy. The intervention in this development of concept pilot trial was feasible and well-tolerated, with good potential to optimize paretic UE performance following robot-assisted therapy.

Project description:Background:Minimally invasive spine surgery (MISS) and endoscopic spine surgery have continually evolving indications in the cervical, thoracic, and lumbar spine. Endoscopic spine surgery entails treatment of disc disease, stenosis, spondylolisthesis, radiculopathy, and deformity. MISS involves complex motor skills in regions of variable anatomy. Simulator use has been proposed to aid in training and skill retention, preoperative planning, and intraoperative use. Methods:A systematic review of five databases was performed for publications pertaining to the use of virtual (VR), augmented (AR), and mixed (MR) reality in MISS and spinal endoscopic surgery. Qualitative data analysis was undertaken with focus of study design, quality, and reported outcomes. Study quality was assessed using the Medical Education Research Quality Instrument (MERSQI) score and level of evidence (LoE) by a modified Oxford Centre for Evidence-Based Medicine (OCEBM) level for simulation in medicine. Results:Thirty-eight studies were retained for data collection. Studies were of intervention-control, clinical application, and pilot or cross-sectional design. Identified articles illustrated use of VR, AR, and MR in all study designs. Procedures included pedicle cannulation and screw insertion, vertebroplasty, kyphoplasty, percutaneous transforaminal endoscopic discectomy (PTED), lumbar puncture and facet injection, transvertebral anterior cervical foraminotomy (TVACF) and posterior cervical laminoforaminotomy. Overall MERSQI score was low-to-medium [M =9.71 (SD =2.60); range, 4.5-13.5], and LoE was predominantly low given the number of purely descriptive articles, or low-quality randomized studies. Conclusions:The current scope of VR, AR, and MR surgical simulators in MISS and spinal endoscopic surgery was described. Studies demonstrate improvement in technical skill and patient outcomes in short term follow-up. Despite this, overall study quality and levels of evidence remain low. Cohesive study design and reporting with focus on transfer validity in training scenarios, and patient derived outcome measures in clinical studies are required to further advance the field.

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The Time Has Come: a Paradigm Shift in Diagnostic Radiology Education via Simulation Training.

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